5 - concussion

Question 1

what is recommended initially after a concussion?

Answer 1

relative rest for the first 1-2 days

Question 2

after 2 days, a ___ program should be started

Answer 2

subthreshold program

Question 3

subthreshold program parameters

Answer 3

• 80% BCTT threshold
• goal is 30-45 min (but up to their tolerance)
• avoid > 45 min early on so brain can heal

Question 4

is resistance training encouraged in the acute phase of concussion recovery?

Answer 4

NO

if they insist, keep it < 30% 1 RM
avoid anaerobic training (no O2 to brain)

Question 5

when should exercise be stopped?

Answer 5

• an increase in 3 symptoms (dizziness, HA, nausea, light headedness, fogginess)
• OR 1 symptom increases by 3 points

rule of three

Question 6

athletes can increase to ___% of symptom-limited HR on BCTT

Answer 6

90%

note that average person is only 80%

Question 7

it is recommended that symptoms stay ___ increase from baseline and resolve back to baseline within ___

Answer 7

• stay < 2/10 increase from baseline
• resolve w/in an hour

Question 8

interval training

Answer 8

• 30-60 sec cardio, followed by 2+ min of controlled breathing (rest)
• highly recommended for “faster” recovery
• can be done in acute phase

Question 9

interval training parameters

Answer 9

• at 50-80% HR max
• controlled breathing → inhale 4 sec, hold 1 sec, exhale 8 sec
• follow up w/ 5-30 min of cognitive ex’s

Question 10

high intensity interval training (HIIT)

Answer 10

• high intensity for 20 sec, followed by 10 sec rest
• NOT what you want early

Question 11

high intensity interval training parameters

Answer 11

• up to 80% HR max (50-80%)
• perform for 2-4 min per body region (UE, LE, core)
• should wait until close to return to sport/activity

Question 12

concussion symptom categories

Answer 12

• ocular
• vestibular
• cognitive
• cervical

Question 13

ocular symptoms treatment

Answer 13

• focus on repeated stress (exposure to visual stimulus) + recoveries
• avoid dark rooms for rest

Question 14

vestibular symptoms treatment

Answer 14

• PT vestibuar treatment
• help settle sx’s

Question 15

cognitive symptoms treatment

Answer 15

• memory tasks, dual-tasking
• cognitive breaks

where pts will likely struggle the most

Question 16

cervical symptoms treatment

Answer 16

• manual therapy
• DNF activation
• mobility, breathing

Question 17

VOMS screen consists of …

Answer 17

• smooth pursuit
• saccades (horizontal, vertical)
• convergence
• VOR (horizontal, vertical)
• visual motion sensitivity (VMS, VORc)

Question 18

ocular treatment dosage

Answer 18

• failed test becomes treatment (use appropriate speed)
• progress as tolerated by incorporating other tx categories … balance, ocular, cognition

Question 19

T/F: we should push patients past their symptoms during treatment

Answer 19

F … allow sx’s to increase 2 levels from baseline

stop if ≥ 3 increase
allow rest in b/w to allow sx’s to return to baseline

Question 20

what should you see with a brock string and/or 3/4 dot card?

Answer 20

• closest bead/dot → V
• middle bead/dot → X
• furthest bead/dot → A

tests convergence

Question 21

types of ocular treament

Answer 21

• HART chart, brock string, 3/4 dot card
• VOR x 1, VOR x 2
• active eye movements b/w 2 targets
• imaginary targets
• marsden ball

Question 22

what does a marsden ball work on?

Answer 22

• vision + ocular movements
• improve peripheral awareness

Question 23

adult prognosis

Answer 23

2-3 days

adults heal faster

Question 24

college athlete prognosis

Answer 24

7-10 days

Question 25

high school athlete prognosis

Answer 25

14-21 days

Question 26

middle school athlete prognosis

Answer 26

28-35 days

Question 27

improve gaze stability by increasing gain of VOR

Answer 27

adaptation (vestibular tx)

Question 28

reduce sensitivity through repeated exposure

Answer 28

habituation (vestibular tx)

Question 29

use of other strategies to replace lost or compromised function

Answer 29

substitution (vestibular tx)

Question 30

types of vestibular treatment

Answer 30

- adaptation - habituation - substitution - balance + gait - optokinetic stimulation (busy background) - repositioning maneuvers (for BPPV)

Question 31

benefits of cognitive treatment

Answer 31

- ↑ cognitive performance (memory, attention, processing speed, executive function) - enhanced neuroplasticity - faster recovery time - ↓ post-concussion sx's - ↑ QOL

Question 32

what comes together to form joint position sense?

Answer 32

- afferent input about cervical muscle length changes from muscle spindles - vestibular nuclei w/ info from visual + vestibular systems

Question 33

pts suffering from concussion or neck pain may have disturbances to ___ input leading to abnormalities w/ ___ of neck + head

Answer 33

- disturbances to cervical afferent input - abnormalities w/ sensorimotor control

Question 34

return to learn protocol (6 stages)

Answer 34

1. physical + cognitive rest 2. light cognitive activity, introduce school work as tolerated 3. back to school part-time → school work only at school 4. part-time school → school work, HW, ↓ accommodations 5. full-time school → full days, minimal accommodations 6. full-time school → full academic load

Question 35

when can a person progress through the return to learn stages?

Answer 35

- begin stage 2 when sx-free for 24 hrs - begin stage 3 if tolerating 60 min school work in 30 min intervals - begin stage 4 if tolerating 120 min cognitive activity in 30-45 min intervals - begin stage 5 if tolerating 240 min cognitive activity in 45-60 min intervals - begin stage 6 if tolerating school full-time w/ no learning accommodations

Question 36

which should be completed first ... return to learn or return to play?

Answer 36

return to learn

Question 37

return to play/sport protocol (6 stages)

Answer 37

1. no sporting activity 2. light aerobic ex 3. sport-specific ex 4. non-contact drills 5. full-contact practice 6. back in the game, normal game play

Question 38

when can a person progress through the return to play/sport stages?

Answer 38

- once symptom free for 24 hrs in that stage - need medical clearance before moving to stage 5 (full-contact practice)