Concussion
When would the Buffalo Treadmill test need to be stopped?
Patient reaches maxHR (220-age)
Symptom exacerbation gets worse by 3 or more on VAS
Patient exhaustion >17 RPE without significant symptom exacerbation
Patient requests to stop
Rapid progression of symptoms
Patient looks faint/stopped communicating
What is included in the symptomatic rest period after a concussion?
NO EXERCISE for 24-48 hrs!!
Decreased school activity
DON'T rest in a dark room
If a patient has LOC for 45 minutes, alteration of consciousness for more than 1 day, post traumatic amnesia for 3 days and has a GCS score of 9 what level of TBI is this considered?
Moderate TBI
What RLA level can we expect carry over of re-learned tasks?
starting at RLA 6: confused appropriate
What are the signs of Dysautonomia?
Increased HR, RR, BP
Diaphoresis
Hypothermia
Paroxysmal sympathetic hyperactivity
What are the guidelines to making an exercise program for a post concussion general patient and athlete?
General: exercise at 80% of their symptomatic HR for 20 mins/day after 5 min warm up
Athlete: exercise at 90%of their symptomatic HR for 20 mins/day, if tolerated well move to 2x/day
What are some examples of primary brain damage?
Diffuse axonal injury, focal injury, locked in syndrome, acquired brain injuries, concussion
What are poor prognostic factors for TBI?
Low initial GCS score=poor recovery
Coma > 2 weeks= moderate to severe disability
PTA > 12 weeks: moderate to severe disability
What RLA level can we expect to see carry over of new tasks?
RLA 7: automatic appropriate
If a patient had a lesion in the spinocerebellar region of the cerebellum what would their signs and symptoms look like?
Hypotonia, impaired adaptive motor trunk-limb coordination (dysmetria, intention tremor, rebound effect)
What are some of the requirements an athlete has to meet in conjunction with vestibular ocular dysfunction (VOD) to return to play?
NPC< 6 cm
VOW 160 bpm with no symptoms
Tolerance of fast smooth pursuits with no symptoms
What are some examples of secondary brain damage?
Hypoxic, ischemic injury (cardiovascular and respiratory)
Swelling, edema
Increased ICP
If a patient is able to open their eyes, CAN'T respond consciously, may experience periods of wakefulness what RLA level are they at?
RLA level 2: generalized response
What RLA level might the patient over or underestimate their abilities?
RLA 8: purposeful appropriate
What would a patient's symptoms look like if they had a cerebrocerebellar lesion?
Abnormal timing of movement, decomposition of movement, impaired hand-eye, eye-foot coordination
What is the earliest we see a patient after their concussion?
10-14 days post concussion
What is a diffuse axonal injury?
disruption of axons and small blood vessels from shearing which causes neuronal death and hemorrhage
What treatments would be appropriate for this patient?
RLA 4: Confused Agitated
Treatment: functional tasks (saliency), start in closed environment
What does it mean if a person is in a vegetative state? What about a persistent vegetative state?
Sleep wake cycles but remains UNCONSCIOUS, may have periods of arousal and spontaneous eye opening without tracking
Persistent vegetative state: vegetative state for a year or longer
What would a patient's symptoms look like if they had a Vestibulocerebellar lesion?
How long does it take for patients to recover from a concussion?
about 4 weeks
What are the signs of increased ICP? What does increased ICP cause in the brain? What is the normal ICP?
Increased BP and decreased HR
Compresses brain tissue, decreases perfusion and may cause possible herniation
Normal: 5-10 mmHg
The patient is starring in the direction of a nurse speaking in their room and can pull away from uncomfortable stimuli but their behaviors are not intentional, what RLA level are they at?
RLA 3: localized response
How would a patient present if they were in a minimally conscious state?
Severely altered consciousness with at least 1 behavioral sign of consciousness
ex. turning toward a loud noise
What is feedforward control? What about feedback?
Feedforward: using programmed responses to influence motor to avoid errors during an activity
Feedback: using sensory input from vestibular, visual and proprioceptive to compare intended to actual movements to create a plan for movement