Concussion Assessment

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					       Concussion Assessment
• Chapter 18, p. 610
           Clinical Anatomy--
                         p. 611


• Decreasing Risk of
  Brain Injury
  – Anatomical
     • Skull
     • Skin
  – Equipment
     • Mouthpieces
     • NOCSAE approved
     • Safety checks
           Clinical Anatomy--
                         p.613


• Blood Circulation in
  the Brain--
   – Brain demands 20% of
     body’s O2 uptake at
     rest
   – O2 need increases 7%
     with each degree (C)
     increase in body core
     temp
   – Very vascular
       Head Injury Assessment
                           p.614


• Signs/symptoms               • Level of Consciousness
   – may be obvious or         • Primary Survey
     hidden                      (ABC’s)
   – monitor for days/weeks    • Secondary Survey
     after injury
                               • Position?
• Document all treatment
                               • Planning?
• Always suspect neck
  injury until proven
  otherwise
       Head Injury Assessment:
               History
                          p. 616
• Assess mechanism &
  scope of injury
• Location of symptoms
   – C-spine?
   – Head?
• Mechanism of injury
   – coup
   – contrecoup
   – repeated subconcussive
     forces (boxing)
 Mechanism of c-spine injuries--
                            p. 617


• Excessive ROM
   – usually hyperflexion
   – +/- spinal rotation
   – Axial loading
• Fig. 18-8, p. 617
• Fig. 18-9, p. 618
      Head Injury Assessment--
           Observation--
                         p.617
• Helmet removal?
• Position of the head
• C-spine alignment
   – spinous processes
• Battle’s sign
            Observation--Eyes
                          p.617


• General appearance
  – dazed/distant?
• Nystagmus
• Anisocoria
  – (fig.18-10, p. 618)
• ―Raccoon eyes‖
• PEARL?
     Observation--Nose & Ears
                            p. 618


• Drainage/Bleeding
• Halo Test (p. 619)
• Sign of greater scope
  of injury
   – greater brain trauma
   – skull fx
   – nasal fx
      Head Injury Assessment--
             Palpation
                             p. 618
• Cervical Spine
   – spinous processes (C7
     and proximal)
• Skull/Face
   – inion->zygoma
• Soft tissue spasm (?)
   – trap & SCM
               Functional Tests--
                              p. 619

• Memory
   – retrograde amnesia
   – anterograde amnesia
   – fig. 18-12, p. 619
• Questioning
       • routine
       • repeated
       • RAM vs. ROM injury
   – Box 18-2, 3—p. 620
• Neuropsychological
  Testing
   – Table 18-3, p. 621
             Functional Tests--
                           p. 623


• Behavior                     • Balance & Coordination
   – mood swings                    – Romberg’s test
   – attitude changes                  • Box 18-4, p. 622
   – abnormal/inappropriate         – Heel-toe walk
     activities                       (Tandem Walking)
• Analytical/processing             – Box 18-6 (BESS)
  skills                       • Vital Signs
   – know your athletes!            – pulse
   – Math, plays, etc               – Bp
   – Simple directions              – respirations
           Neurological Tests--
                         p. 625


• Glasgow Coma Scale         • 90% less than or equal to 8
                               are in coma
   – 8 or less= severe
                             • Greater than or equal to 9 not
   – 9-11: moderate
                               in coma
   – 12+
                             •    8 is the critical score
• Table 18-8, p. 631         • Less than or equal to 8 at 6
                               hours - 50% die
                             • 9-11 = moderate severity
                             •    Greater than or equal to 12 =
                                  minor injury
          Glasgow Coma Scale
• Glasgow Coma Scale
  –   8 or less= severe
  –   9-11: moderate
  –   12+ :mild/no injury
  –   Recheck scores often
          Neurological Tests--
                      p. 626


• Cranial Nerve
  Function
• fig. 18-4, p. 626
             Pathologies--
• Concussion
• Postconcussion
  Syndrome
• Second Impact
  Syndrome
• Intracranial
  Hematoma
                   Concussion
• Table 18-7, p. 629       • Observation:
• Definitions                 – attitude/emotions
• Grading Systems             – nystagmus, anisocoria
   – Table 18-9, p. 631       – ear/nose drainage

• History:                 • Functional tests:
   – acute impact             – Romberg test
   – c/o dizziness,           – Balance/coordination
     headache, tinnitus,   • Neurological tests
     diplopia, etc
        Intracranial Hematoma
                       p. 633


• Following concussion     • Symptoms:
• Gradual worsening             –   severe HA
• Severe symptoms               –   vomiting
  (amplified)                   –   one-sided weakness
                                –   altered consciousness
• Increasing neuro signs
                                –   decreasing Glasgow
• 50% mortality rate                score
                           • Refer Immediately!
     Postconcussion Syndrome
                         p. 632


• Continued symptoms         • Possible Symptoms;
  after the initial or            – Headache
  return of symptoms              – Dizziness
• rest or exertion                – Confusion
• Do not return to                – Concentration
                                    problems
  participation until
                                  – Photophobia
  ALL symptoms are
  resolved                        – etc.
      Second Impact Syndrome
                           p. 632


• Catastrophic injury
• Initial concussion not
  resolved
• Symptoms = mild
  concussion initially
  and rapidly
  deteriorates (minutes)
• 50% mortality rate
      Concussion Management
• Always suspect neck     • Return to Play
  injury initially          Criteria:
• Remain calm                – Table 18-10, p. 632
• Adhere to your chosen      – No participation until
                               all symptoms resolve
  grading scale                completely
• Protect the athlete
  from further injury
• Re-evaluate often