Concussion is a common injury with about __% of all student athletes in contact sports suffering a concussion during their season.

• 2%

• 6%

• 10%

• 20%

Answer:  10%

It is recommended that student athletes have a baseline test of neurocognitive functioning because:

• The test will tell the parents which sports the child should play

• The test provides a baseline so that if a concussion occurs, there is something to compare brain function after the injury.

• The test will look for abnormalities that may interfere with the child’s ability to play sports.

Answer:The test provides a baseline so that if a concussion occurs, there is something to compare brain function after the injury.

True or False: Amnesia is a rare side effect of a concussion.

True

False

Answer:False

If you compared it to a food, your brain has the consistency of:

• Hamburger

• Cooking oil

• Gelatin

Answer:Gelatin

True or False: A concussion can only be caused by a blow to the head.

True

False

Answer:False

True or False: Children who have suffered a concussion should rest mentally as well as physically.

True

False

Answer:True

If the symptoms of a concussion last for weeks, this is called:

• Post-concussion syndrome

• Concussive edema

• Concussion complication disorder

• Reflexive concussion

Answer:Post-concussion syndrome

Which of the following is not a significant risk factor for the problem outlined in question 7

• Being older

• Being female

• Having a sports-related concussion

Answer: Having a sports-related concussion

Which of the following is not a symptom of a concussion?

nausea or vomiting

slurred speech

feeling anxious or irritable

feeling happy

“seeing stars”

Answer:feeling happy

Which of the following is not a common reason that high school sports injuries occur?

improper training

drinking too much water during the game

wearing the wrong type of shoes

lack of safety equipment

Answer:drinking too much water during the game

Which is a good way to heal from a concussion?

Physical and mental rest

Exercise and problem-solving video games

Brain transplant

Answer:Physical and mental rest

True or false: If you don’t lose consciousness, you don’t have a concussion.

True

False

Answer: False

When it comes to a head injury in sports, the best thing to remember is:

“No pain, no gain!”

“When in doubt, sit out!”

Answer: “When in doubt, sit out!”

incidences of concussions

Answer: -30% of all concussions in individuals between 5 to 19 are sports related -highest sports : football, wrestling, girls/boys soccer and girls basketball -game concussion are higher than practice

definition of concussion

Answer: -a complex pathophysiological process affecting the brain induced by traumatic biomechanical forces -concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury

external forces may include any of the following events:

Answer: -the head being struck by an object -the head striking an object, the brain undergoing an acceleration/deceleration movement without direct external trauma to the head -a foreign body penetrating the brain, forces generated from events such as a blast or explosion, or other force yet to be defined

concussions occur when

Answer: linear and/or rotational forces are transmitted to the brain causing the “neurometabolic cascade”

neurometabolic cascade

Answer: -release of excitatory neurotransmitters -increase in amounts of ATP -increase in glucose metabolism -decrease in cerebral blood flow -decrease in oxygen metabolism -spike in potassium causes the dulling effect and that takes time to regulate

diffuse axonal injury

Answer: most frequent head injury -occurs from shearing, stretching or traction on small nerves leading to poor axonal transport, focal swelling and possible axonal disconnection

head injuries

Answer: -diffuse axonal injury (most common) -contusion -subdural hemorrhage

second impact syndrome

Answer: -rare condition -onset of second concussion before completely healing from the initial -rapid swelling of brain tissue -signs/symptoms: dilated pupils, loss of eye movement, 

respiratory failure, death

age recovery rates change

Answer: prof athlete = 1 day college = 7 days high school = 10-26 days youth = 30 days `

post concussion protocol

Answer: there is none, individualized approach

PA law with concussion

Answer: must be removed from play, cleared by medical professional, and educated prior to return to play

risk factors – migraine Hx & current complaints

Answer: -no association has been shown between pre existing migraine and prolonged course -however, post “migraine symptom complex” had a longer recovery

risk factors – prior concussions

Answer: 2-5.8 times higher risk of sustaining another concussion, conflicting evidence on recovery course

risk factors – number, severity, and recovery length

Answer: increases in any of these are predictors for a prolonged recovery -*dizziness sideline is a predictor of recovery greater than 21 days

risk factors – mood disorders

Answer: pre-exisiting or result will complicate diagnosis and management -17 to 46% oh high school and college athletes have symptoms of anxiety, depression, or irritability – no evidence that pre existing mood disorders predispose athletes to concussion -anxiety, depression, and other psychological impairments may affect NP testing

risk factors – learning ability

Answer: -preinjury ADD/ADHD may be associated with increased cognitive dysfunction and prolonged recovery -baseline score are lower in this population

risk factors – age

Answer: developing brains with less cognitive reserve, recovery times are longer

concussion symptoms

Answer: -headache (most common) -feeling slow -difficulty concentrating -dizziness (2nd most common) -fogginess -fatigue -visual blurring -light sensitivity -memory issues -balance problems

pre-participation exam

Answer: -concussion related questions (number, frequency, severity, and recovery) -presence of mood, learning, attention, or migraine disorders -baseline testing – impact remains unclear

impact testing

Answer: immediate post concussion -assessment and cognitive testing

SCAT2

Answer: sports concussion assessment tool 2 -sideline test included 22 item

king devick test

Answer: -can look at eye movement, attention, and language skills -PTs are using this for baseline measurement during initial eval

on field management of a collapsed athlete

Answer: -check airway, breathing and heart function -physical exam including c/s and brain injury –immobilize spine if c spine can not be cleared and transfer to E –brain injury – mental status, unequal pupil reaction and worsening symptoms

sideline assessment of concussion

Answer: -immediate stop from play and assessment from a healthcare provider -standardized assessment tool -a player should be continually monitored if kept sideline for deteriorating mental status -if a concussion is thought to have not occurred, the player may not return to the game with serial evaluation

most common symptoms to use medications for

Answer: sleeping, depression, and headache

current medical management

Answer: physical and cognitive rest until symptoms improve or resolve followed by graded program of actvity

differences between concussion managment and vestibular

Answer: -altered cognitive fxn, HA -observe C/spine and vision

impairments with concussion

Answer: -postural control (c spine) -dizziness, peripher vs. central -visual/ocular motor

balance error scoring system

Answer: -3 positions with firm/foam surface eyes closed -double leg stance, SLS, tandem – pt is timed for 20 seconds and the number – errors include: hands off iliac crest, opening eyes, step/fall, moving hips >30 degrees abduction, lifting forefoot or heel

impaired postural control

Answer: -perform sensory integration exercises -SLS eyes open and closed -squats with Bosu

oculomotor training

Answer: -monitor for Sx the entire time -convergence training -saccade training and visual pursuit -perform task, rest let Sx decrease, then repeat

dual tasking training

Answer: incorporating high level cognitive task with static and dynamic balance activities

vestibular therapy

Answer: dizziness, balance, headaches

manual therapy

Answer: headaches, neck pain, and nay impaired strength

progressive aerobic activity

Answer: deconditioning

return to play stages

Answer: -no activity -light aerobic exercise <70% max HR -sport-specific exercise -non contact drills -full contact drills -return to play