Standardized Concussion Assessment Tool - 3 (SCAT3)

>13 years, Endorsed by Concussion in Sport Group, Maddock’s questions, self report symptoms, memory & attention via the SAC

The leading causes of TBI are what?

MVA, Struck by or against an object, Falls, Assault

An example of a primary brain injuries are focal brain injuries, what falls under focal brain injuries?

Coup-contrecoup injury, Polar brain injury, Lacerations

Blast overpressure on the organs

What falls under Secondary brain injuries?

Subdural hematoma, Herniation, Intracerebral hematoma, Epidural hematomas

Concussions can occur at any age, from…

Violence (abuse, or explosions/ blasts), Playground/sports injury, Falls (work accidents, older adults), MVAs (head impact, or whiplash)

An example of a secondary brain injury is Hypoxic-Ischemic Injury, what falls under Hypoxic-Ischemic Injuries?

Arterial hypotension, Arterial hypoxemia, Cerebral vasospasm, Increased ICP

CONCUSSION: More than a functional injury?

Blood based biomarkers (Tau), Histology biomarkers (tau and beta-amyloid deposits), Imaging based: (EEG), (TMS), (PET), functional MRI, etc, Genetic based biomarkers

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Neuromuscular Unit 3

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Questions 90

Answers

1
Acts inconsistent & non-purposeful manner ; Pt. may groan if pinch arm or press nail bed ; NOT specific to stimulus!
Automatic - appropriate
Generalized response
Purposeful - appropriate
Localized response
2
Using Glasgow Coma scale, what is a 13-15 score?
Minor brain injury
Moderate brain injury
Severe brain injury
3
Is not an acute sign and symptom of a concussion ?
Decreased attention
Dizziness
Slurred or impaired speech
Incoordination (stumbles, dysmetria, slowness)
4
Standardized Concussion Assessment Tool - 3 (SCAT3)
>13 years
Endorsed by Concussion in Sport Group
Maddock’s questions, self report symptoms, memory & attention via the SAC
Notes LOC, amnesia, strength, sensation, coordination
5
Metabolic Energy Crisis; Cerebral glucose demand increase while cerebral blood flow decrease
Blast-Related Concussion
Blunt Force Concussion
6
The leading causes of TBI are what?
MVA
Struck by or against an object
Falls
Assault
7
Types of herniation?
Uncal
Central
Tonsillar
Focal
8
Occurs within minutes to hours after injury, from a cascade of events
Primary brain injury
Open head injury
Secondary brain injury
Closed head injury
9
Tertiary Injury- Blunt trauma from striking solid surface
Blast-Related Concussion
Blunt Force Concussion
10
Normal ICP is ?
4-15 mmHg
15-20 mmHg
30-40 mmHg
20-30 mmHg
11
Skull fx is in a linear or a depressed fashion → frequently assoc. w/ intracranial hemorrhages.
Open head injury
Closed head injury
Primary brain injury
Secondary brain injury
12
May perform motor activities, brief but w/o real purpose ; Purposeful attempts to remove restraints & get out of bed
Confused - inappropriate
Confused - appropriate
Confused - agitated
13
Systemic injury like obstruction of airway, leads to reduction of O2, common after TBI
Increased ICP
Arterial hypotension
Arterial hypoxemia
Cerebral vasospasm
14
1.7 million individuals sustain a TBI each year in the USA
False
True
15
WHICH IMPAIRMENT IS NOT COMMONLY ASSOCIATED W/ TBI ?
Cognitive Impairments
Neurobehavioral impairments
Musculoskeletal impairments
Neuromuscular impairments
16
Under medical management, restoration of vital fxs and prevention of secondary brain damage is top priority?
False
True
17
Physiologic axonal stretching -Microscopic axonal dysfunction
Blast-Related Concussion
Blunt Force Concussion
18
Generally not oriented, can participate in therapy but need breaks ; Alert, not agitated but may wander randomly
Confused - appropriate
Confused - inappropriate
Confused - agitated
19
Paresis, abnormal tone, motor function, postural control
Cognitive Impairments
Neuromuscular impairments
Neurobehavioral impairments
Musculoskeletal impairments
20
An example of a primary brain injuries are focal brain injuries, what falls under focal brain injuries?
Coup-contrecoup injury
Blast injury
Polar brain injury
Lacerations
21
(primary)?
Patient running towards object
Blast overpressure on the organs
Shrapnel hitting the pt.
Patient being pushed or flung backwards and hitting object
22
What falls under Secondary brain injuries?
Subdural hematoma
Herniation
Intracerebral hematoma
Epidural hematomas
23
Concussions can occur at any age, from…
Violence (abuse, or explosions/ blasts)
Playground/sports injury
Falls (work accidents, older adults)
MVAs (head impact, or whiplash)
24
ICP is monitored via catheter into the brain; 40 mmHg will impair blood flow to the brain causing secondary injury
False
True
25
(Secondary)?
Shrapnel hitting the pt.
Blast overpressure on the organs
Patient running towards object
Patient being pushed or flung backwards and hitting object
26
RANCHO LOS AMIGOS LEVELS OF COGNITIVE FXN (LOCF) - measure patients with disordered consciousness?
False
True
27
A concussion is complex pathophysiological process affecting the brain, induced by biomechanical forces ?
False
True
28
Cognitive impairments include altered levels of consciousness, coma, vegetative state & Minimally conscious state (MCS)
True
False
29
Females are about 1.5 times more likely than males to sustain a TBI?
False
True
30
An example of a secondary brain injury is Hypoxic-Ischemic Injury, what falls under Hypoxic-Ischemic Injuries?
Arterial hypotension
Arterial hypoxemia
Cerebral vasospasm
Increased ICP
31
In vegetative state, sleep/wake cycles are present and have reflexive responses (like opening eyes, but no responses)?
True
False
32
Sustains injury, skull remains intact, the pressure on the brain is on the inside.
Secondary brain injury
Open head injury
Closed head injury
Primary brain injury
33
DAI is evident in CT or MRI, mostly found in neurological exams?
True
False
34
Always invert individuals w/ elevated ICP to reduce the levels?
False
True
35
The most common cause of TBI in those under 5 and over 65 is due to falls
True
False
36
A cascade of events;Ion channel dysfunction;Potassium rush out of the neurons & destructive calcium/sodium ions rush in
Blast-Related Concussion
Blunt Force Concussion
37
Constriction of the cerebral blood vessels in response to trauma and reducing blood perfusion to the brain
Arterial hypotension
Cerebral vasospasm
Arterial hypoxemia
Increased ICP
38
Advanced MRI techniques may reveal micro blood products in concussion ?
False
True
39
Disassociation b/w wakefulness and awareness; higher cortical regions not in sync with your brain stem
Coma
Vegetative state
Minimally conscious state
40
CONCUSSION: More than a functional injury?
Blood based biomarkers (Tau)
Histology biomarkers (tau and beta-amyloid deposits)
Imaging based: (EEG), (TMS), (PET), functional MRI, etc
Genetic based biomarkers
41
Blow to the head is hard enough the brain will bounce & make contact with the skull opp. the site of local brain damage
Coup-contrecoup injury
Lacerations
Polar brain injury
Blast injury
42
After a TBI 15-20 mmHg is expected?
True
False
43
A concussion is a structural disturbance, NOT a functional injury
False
True
44
Blink from strong light,follow moving objects,respond to discomfort&commands; Responses are directly related to stimulus
Automatic - appropriate
Localized response
Generalized response
Purposeful - appropriate
45
Fast movmnt of brain lead to stretching/tearing of neuronal axons w/in myelin sheath (subcortical white matter shearing)
Epidural hematomas
Herniation
Subdural hematoma
DAI (Diffuse axonal injury)
46
Secondary Injury -Fragments cause penetrating injury
Blunt Force Concussion
Blast-Related Concussion
47
Intra-cerebral hematoma is usually the most deadly type of hematoma because of the location ?
False
True
48
Neg. test findings do NOT rule out concussion
True
False
49
Intracranial hematomas - skull is rigid, ICP pressure goes up → blood accumulates → brain damage
Primary brain injury
Secondary brain injury
Open head injury
Closed head injury
50
50% of athletes report symptoms of concussion?
True
False
51
The body and head stop w/ impact but the brain continues to accelerate forward until it hits the skull.
Coup-contrecoup injury
Polar brain injury
Blast injury
Lacerations
52
Consistently orientated, can complete tasks for up to an hour even in distracting environments; Require no assistance
Generalized response
Purposeful - appropriate
Localized response
Automatic - appropriate
53
Brain pushes through foramen magnum
Herniation
Epidural hematomas
DAI (Diffuse axonal injury)
Subdural hematoma
54
Shift of brain, cuts off circulation→ reduced perfusion to brain
Increased ICP
Cerebral vasospasm
Arterial hypoxemia
Arterial hypotension
55
Children 0-4 years of age & adolescents 15-19 years of age are at the highest risk for TBI ?
True
False
56
Using Glasgow Coma scale, what is a 1-8 score?
Minor brain injury
Moderate brain injury
Severe brain injury
57
Agitation/aggression, disinhibition, apathy, emotional lability, mental inflexibility, impulsivity, irritability?
Neurobehavioral impairments
Musculoskeletal impairments
Neuromuscular impairments
Cognitive Impairments
58
Systemic blood loss due to bodily injuries that lead to low BP & as a result the brain doesnt receive enough blood flow
Arterial hypoxemia
Cerebral vasospasm
Arterial hypotension
Increased ICP
59
Where blood accumulates at the top of the dura, assoc. w/ medial meningeal artery damage
Subdural hematoma
DAI (Diffuse axonal injury)
Herniation
Epidural hematomas
60
Explosive device that may detonate and a transient shock wave is produced, damaging the brain.
Blast injury
Polar brain injury
Coup-contrecoup injury
Lacerations
61
Arousal state not functioning, not usually permanent
Minimally conscious state
Vegetative state
Coma
62
After skull fracture, sometimes catheter inserted leading to infection
Post traumatic epilepsy/seizures
Intracranial infections
63
ACUTE SYMPTOMOLOGY OF A CONCUSSION INCLUDE..
Physical signs (like LOC, amnesia)
Cognitive impairment (like slowed reaction times)
Behavioral changes (like irritability)
Symptoms (like headache, fogginess, emotional liability)
64
Is not an acute sign and symptom of a concussion ?
Disorientation
Delayed verbal expression
Emotional lability
Vacant stare
65
When bony or irregularities of the skull actually cut surface of the brain; almost always with hematomas..
Polar brain injury
Coup-contrecoup injury
Lacerations
Blast injury
66
Affecting arousal level, attention, concentration, memory, learning, executive fxn ?
Neuromuscular impairments
Cognitive Impairments
Neurobehavioral impairments
Musculoskeletal impairments
67
Can occur after brain injury or years after. Patients should avoid bright lights, spinning as well as being inverted
Post traumatic epilepsy/seizures
Intracranial infections
68
WHICH FALLS UNDER PT EXAMINATION - ACTIVE REHABILITATION ?
Can patient follow 1, 2, 3 step commands?
Is the patient oriented to person, place, and/ or time?
Does the patient recognize family members?
Does the patient demonstrate any insight into what happened?
69
If the scalp is cut its considered a compound skull fx & they are assoc. w/dural tears which will increase risk of ICP?
True
False
70
Primary Injury- Shock waves from blast disrupts brain tissue, similar to diffuse axonal injury, more widespread
Blunt Force Concussion
Blast-Related Concussion
71
Due to acc/dec and rotational forces and occur w/ focal/polar brain injuries
Herniation
Subdural hematoma
Epidural hematomas
DAI (Diffuse axonal injury)
72
Tips/poles of brain (temporal & frontal lobes) are most susceptible to injury when touching bony alignment of skull?
False
True
73
Military Acute Concussion Evaluation (MACE)
Ideally performed w/in 24 hours of injury
History or injury, symptoms, neuro screen & short cognitive test
15 mins
Endorsed by Concussion in Sport Group
74
More consistently following directions, but still a safety risk & generally unaware of impairments
Confused - inappropriate
Confused - appropriate
Confused - agitated
75
For the same sport, females have higher incidences of concussions than males?
True
False
76
Can attend to activities, but supervision required for new learning ; Don’t understand consequences for actions
Purposeful - appropriate
Automatic - appropriate
Localized response
Generalized response
77
The most common cause of TBI in those between 5 & 65 years of age is due to motor vehicle accidents
False
True
78
ACUTE “SIDELINE” DIAGNOSTIC FOR CONCUSSION
Notes LOC, amnesia, strength, sensation, coordination
Happens on sideline and takes 5 min. to complete
Scores orientation, immediate memory, concentration, delayed recall
Endorsed by Concussion in Sport Group
79
Headache is the most commonly reported symptom for a concussion?
False
True
80
DAI is not localized and will typically spread over a large area and stretch
False
True
81
Intra-cerebral hematoma is intrinsic cerebral arterial blood that accumulates within the brain?
False
True
82
(Tertiary)?
Blast overpressure on the organs
Patient running towards object
Shrapnel hitting the pt.
Patient being pushed or flung backwards and hitting object
83
Increased dizziness, vertigo, hearing loss, cognitive deficits, HA & disequilibrium
Blast-Related Concussion
Blunt Force Concussion
84
Sleep disturbances (like insomnia) can be caused by a concussion?
True
False
85
Venous blood accumulates beneath dura; Mostly elderly w/ shrinking brain, can occur during fall or MVA?
Herniation
DAI (Diffuse axonal injury)
Epidural hematomas
Subdural hematoma
86
Patient inhibits minimal evidence of themselves or their environment
Coma
Vegetative state
Minimally conscious state
87
A concussion..
Results in set of clinical symptoms, usually does NOT involve LOC
Caused by direct blow to head, neck, face or body
Resolution of symptoms typically occurs but may be prolonged in some cases
Can result in the patient falling into a coma
88
The damage occurs at the moment of impact
Secondary brain injury
Closed head injury
Open head injury
Primary brain injury
89
In vegetative state= persistent state (no meaningful behavior, no awareness for >1 yr or >3 mo w/ anoxic brain injury)
True
False
90
Under medical management, Glasgow Coma Scale (GCS) is used to determine severity of injury (assess LOC & arousal)
False
True

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