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Concussion Management for Healthcare Professionals: Summary
Buffalo Treadmill Test/Bike Test This testing is done on a treadmill or bike to see how the brain reacts while increasing the heart rate in a controlled environment. A completed test lasts 20 minutes. Research suggests that if individuals complete the 20-minute protocol, broken into fine 4-minute protocols, they will be able to fully heal and return to play within the shortest amount of time. Increase in symptoms mean the test is positive for a concussion. No increase in symptoms means it is safe to start the RTP concussion protocol. Research suggests that this is a safe test to perform 7 days after a diagnosed concussion. No definitive research suggests the test is okay within 7 days. ASSESSING FOR A SEVERE BRAIN INJURY Cranial Nerve (CN) Testing • Olfactory Nerve (CN I) : This is your sense of smell. The easiest way to test this is to see if an individual can notice a new smell • Optic Nerve (CN II) : The optic nerve can be tested by viewing something far away and close by (i.e., What's the time on the clock? Can you read this sentence on this document?). Pupil constriction and dilation can be checked by covering one eye and shining a pen light in the other to look asymmetries bilaterally with the pupil • Oculomotor (CN III), Trochlear (CN IV), Abducens (CN VI) : These are all tested by having a patient follow your finger or a pen while you move in an H-pattern, testing the individual’s ability to hold a gaze and track vertically and laterally with their eyes without moving their head. Any eye deviations, abnormal head posture, or nystagmus should be documented • Trigeminal Nerve (CN V) : Can be tested by asking if the individual can feel you touching their skin. Do they have sensation in their limbs? • Facial Nerve (CN VII) : This nerve can be tested by asking someone to smile, frown, and blink to see if they have any issues performing these tasks • Vestibulocochlear Nerve (CN VIII) : This is your ability to hear. Snapping fingers and clapping hands are ways to test hearing bilaterally to see if they can hear properly in each ear • Glossopharyngeal Nerve (CN IX), Vagus Nerve (CN X) : These 2 tests can be done simultaneously as you ask a person to open their mouth wide and then close their mouth and try to swallow • Spinal accessory Nerve (CN XI) : This test can be done by having a person shrug their shoulders while you provide resistance as well as providing resistance as a person rotates their head to the right and left • Hypoglossal Nerve (CN XII) : This nerve can be tested by asking the patient to stick out their tongue and view it for abnormalities
Ruling out Neck Fractures • Make sure to do Spurling's compression test – a test where you put pressure on the top of the head compressing the cervical spine. You can put direct force on the spine while the neck is straight as well as laterally flexed with the neck in extension • Look at AROM of the neck and spine; be worried if there is decreased AROM • Palpate along the cervical spinous processes to note pain or deformities • Sensation needs to be present throughout the body; if not, think of a neck fracture Brain Bleeding Warning Signs • Vomiting uncontrollably • Remaining unconscious for longer than 30 seconds • Eye movement, Nystagmus, etc. – problems with tracking • Unequal pupil sizes bilaterally • Nonreactive to changes in light by the pupil • Increasing headache • Repeating the same question multiple times DIAGNOSTIC TOOLS MRI Certain brain tissue characteristics in gray matter are linked to a person's overall history of concussions. However, when it comes to white matter, the association with prior concussions seems to depend on the severity of the concussions. CT Scan Can help to see brain bleeds, can check for inflammation of the brain pushing up against the skull. X-ray Help to determine if a skull fracture is present, if there is swelling present, or an y other bony abnormalities. TREATMENT VR Training This is the ability to use virtual reality to help in the recovery process of a concussion. Games can be played that can simulate activities within virtual reality, which could be a safe way to challenge the brain and body while recovering from a concussion. It allows to simulate activities without performing the physical aspects of those activities. It can be performed in the comfort of your own home or based in a clinic. The games can help with direct feedback and get objective balance measures. Eye Tracking Training the eyes can help strengthen the muscles in the eye similar to rehabilitation of muscles in other parts of the body. Re-training the eyes on where to look and focus can help the recovery process. Using dual task activities is a way to get the mind and body connections working appropriately.
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