Pathophysiology & Clinical Manifestations
What is a concussion?
A concussion is a type of traumatic brain injury caused by bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth in the skull, also known as a whiplash.The brain floats freely in CSF, when there is a blunt force to the head, it accelerates the brain within the skull and then the brain decelerates abruptly on hitting the inner skull surfaces.
(Mullally, 2017)
A history of ________ increases the risk of concussion?
a. Head injury
b. Neurocognitive impairment
c. Concussion
d. Slower recovery of neurologic functions
Concussion. History of concussion or multiple head injury can not only cause short and long term complications but it also makes the individuals more vulnerable to repeat injury which thus makes the person more likely to experience a concussion. (Dessy et al., 2017)
What symptoms need emergency attention? Select all that apply.
a. A headache that gets worse or does not go away.
b. Weakness, numbness, or decreased coordination.
c. Sensitive to light and noise.
d. Repeated vomiting or nausea.
e. Slurred speech.
Answers: A headache that gets worse or does not go away, Weakness, numbness, or decreased coordination, repeated vomiting or nausea, slurred speech.
A, B, D, E (Concussions, 2019).
What causes longer rest periods for patients with concussions?
Hx of Concussions → It has also been seen that athletes who have and a prior concussion have a longer time recovery in subsequent concussions. If there has been a concussion in the past year, there was nearly 3 times the median duration of symptoms when compared with athletes that had a concussion more than a year ago or had never had one. (Kosoy, & Feinstein, 2018)
What are the clinical manifestations of concussion?
Headache/ “pressure” in head
Loss of consciousness
N&V
Balance problems
Bothered by light and noise
Feeling sluggish, foggy, groggy
Memory problems
Mood changes
(Mullally, 2017)
Which is NOT a sport-related assessment tool used to assess for concussion?
a. The Standardized Concussion Assessment Tool
b. Immediate Post-Concussion Assessment and Cognitive Testing
c. King-Devick Oculomotor Test
d. Post-Concussion Symptom Scale
e. All of the above
f. None of the above
none of the above. All of the assessments tools are used to diagnose concussion. According to an article, there are many various sports related assessment tools that can be used to assess for concussion such as The Standardized Concussion Assessment Tool (SCAT3)
Glascow Coma scale (GCS)
Maddocks score
symptom evaluation
cognitive evaluation using paper-pencil test that assesses the person’s orientation, immediate recall, concentration and delayed recall.
neck examination
balance examination
coordination examination
Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) - (usually used in sports and compares results to baseline)
Test for verbal memory, reaction time, visual-motor speed, and visual motor composites.
King-Devick (KD) Oculomotor Test
Tests eye movement and brain stem functions.
Post-Concussion Symptom Scale (PCSS) (subjective)
Subjective self-reported questionnaire of concussion related symptoms such as headache, nausea, vomiting.
(Dessy et al., 2017)
What are the patient teachings for concussion?
Observation for worsening symptoms and advise patient/family member on importance of cognitive and physical rest after concussion Duignan & O’Connor, 2016).
List the interprofessional team members involved in treatment of a pediatric concussion.
1) family team (student, parents, teammates)
2) medical team (emergency department physician, pediatrician, consussion specailst, psychologist, school physican.
3) school academic team (teacher, school counselor, social worker, school administrator)
4) School physical activity team
(Kosoy, & Feinstein, 2018)
What is post-concussion syndrome?
Post-concussion syndrome (PCS) is the persistence of concussion symptoms beyond the normal course of recovery. Patients experiencing PCS can experience concussion-like symptoms at rest or in response to too much physical or cognitive activity affecting their usual physical, professional and social lives. (Mullally, 2017)
How can concussion be assessed Objectively vs. Subjectively?
Subjective assessment can be done by assessing their self reported concussion symptoms such as the presence of headaches, nausea, vomiting, dizziness etc.
Objective assessment can be done by performing clinical exam, Postural assessment, Neurocognitive testing, CT scan and MRI, Assess memory and orientation impairments.
(Dessy et al., 2017)
What is Rowan’s Law?
A new legislation to protect young athletes (Rushowy, 2018).
Why might long periods of rest not be beneficial for Concussion Recovery?
“While it was once the practice to have long periods of rest prior to returning to activity, newer studies have shown that this might not help recovery. Long periods of rest may lead to fatigue, depression, anxiety, and physiological deconditioning, most instances of a large increase in mental activity were not followed by a symptom spike in concussions.” (Kosoy, & Feinstein, 2018)
What are the complications of concussion?
PCS
Epidural or subdural hematoma
Parenchymal hemorrhage
Increased ICP
(Mullally, 2017)
Which of the following proteins are present in the the blood 12 hours after a head injury? (Select all that apply)
a. ubiquitin carboxyl terminal hydrolase L1
b. Nebulin
c. Serum amyloid P component
d. glial fibrillary acidic protein
There is a new blood test called Banyan brain trauma indicator and the first blood test that evaluates mild brain traumatic injury or concussion in adults. This is done by measuring the levels of two protein biomarkers known as ubiquitin carboxyl terminal hydrolase L1 and glial fibrillary acidic protein. These proteins are released from the brain and into the blood within 12 hrs of head injury. Measuring the levels of these proteins after a mild traumatic brain injury can help predict which patients may have intracranial lesions visible by a CT scan and which wont.
(New blood test aids in concussion evaluation, 2018)
What are the six stages of Return-to-Play?
No activity
Light aerobic exercise
Sport-specific exercise
Noncontact training drills
Full-contact practice
Return to play
(Lynch, 2016)
What are the pharmacological interventions used for the treatment of Concussions?
Trick Questions… no pharmacologic treatment has been shown to speed recovery from traumatic brain injury. However, there are pharmacological treatments to help manage the symptoms associated with concussions. Such as: Acetaminophen for relief of pain from headaches. Avoid NSAIDs for risk of bleeding. Antiemetics may also be used for relief of N&V (Meehan, 2011)