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Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

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Nội dung chi tiết: Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

CHARTER 6Outpatient care of the concussed athlete: Gauging recovery to tailor rehabilitative needsWith Elizabeth M. Pieroth, Psy.D.IntroductionThe com

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2mplex pathophysiology of injury and recovery of the nervous system emulates the diverse presentation, symptomatology, and challenges to diagnosis of c

oncussion. As science continues to unfold the nature of the critical window period of recovery following injury, it is imjierative that accurate tools Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

to evaluate the injured athlete during this period arc developed and researched. Only through projxtr assessment, including monitoring of the patient

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

's subjective symjMoms and use of validated objective measures, can clinicians attempt to determine when the brain is recovered from injury without co

CHARTER 6Outpatient care of the concussed athlete: Gauging recovery to tailor rehabilitative needsWith Elizabeth M. Pieroth, Psy.D.IntroductionThe com

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2mptom checklists, neurocognilive assessment, balancc/coordination ocular testing), observation and quantification of recovery employs a similar approa

ch.1 This multimodal approach is comprised of continual clinical history and exams, ncurocognitive testing (in the form of sideline assessment tools), Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

symptom checklists (as discussed in Chapter 3), psychiatric evaluation (as discussed in chapter 5), and most importantly, neuropsychological testing

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

and other complimentary modalities like (xulomotor, vestibular, gait/ balance, and electrophysiological evaluations.- A survey, completed by 610 NCAA

CHARTER 6Outpatient care of the concussed athlete: Gauging recovery to tailor rehabilitative needsWith Elizabeth M. Pieroth, Psy.D.IntroductionThe com

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2 baseline neurological status, acutely assess postconcussion, and to determine appropriate return to play.’ The likelihood of receiving multimodal tec

hniquesfor assessment is highly influenced by the available resources al that institution. Therefore, these techniques may differ versus those used at Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

a high school setting a Division 1 university.Though this multimodal approach is laborious, it is necessary due to the heterogeneous clinical picture

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

post injury for each athlete com posed of various symptoms on deficits, and also their recovery pattern. Athletes may present with profound symptoms

CHARTER 6Outpatient care of the concussed athlete: Gauging recovery to tailor rehabilitative needsWith Elizabeth M. Pieroth, Psy.D.IntroductionThe com

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2pted to characterize this process demonstrating that posture, balance, and veslibular/ocular deficits usually present early with improvement by 3 5 da

ys post injury, while subjective symptoms tend to last longer, resolving by 3—14 days jxxsl injury. Neurcx:ognitive deficits, on the other hand, have Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

been shown Io persist longer with recovery from 1 to 4 weeks after injury.*-13 These lime frames are not set rules but do give an appreciation Io the

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

varying recovery period exposed by the specific assessment tool that is used.14 Also, depending on the nature or severity of the injury, athletes may

CHARTER 6Outpatient care of the concussed athlete: Gauging recovery to tailor rehabilitative needsWith Elizabeth M. Pieroth, Psy.D.IntroductionThe com

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2l testing.’"' This undoubtedly highlights the importance for a multimodal approach with many clinical Ux>ls, and emphasizes the need to repeatedly ass

ess the athlete following injury in order to correctly identify those that have recovered from their brain injury, versus those that require a prolong Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

ed gradation of return to activity.Due to the varying neurological deficits following a concussive injury and the many1322&je> 7ji$ethnolimitations to

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

each modality, the repeated use of a multimodal testing protocol will improve the sensitivity in formulating a broader picture of neurological recove

CHARTER 6Outpatient care of the concussed athlete: Gauging recovery to tailor rehabilitative needsWith Elizabeth M. Pieroth, Psy.D.IntroductionThe com

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2player rehabilitation. This multimodal approach has been adopted and applied to clinics geared towards the management of the concussed athlete. For in

stance, a model proposed by the University of Pittsburgh Medical Center Sports Concussion Program incorjx>rales the clinical interview, symptom and ne Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

urocognitive testing, and vestibular ocular screening in order to obtain a holistic neurological assessment of the con cussed athlete.161 This informa

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

tion is then used to develop an individualized treatment regimen with rehabilitative services based on the needs of the patient (vestibular, cognitive

CHARTER 6Outpatient care of the concussed athlete: Gauging recovery to tailor rehabilitative needsWith Elizabeth M. Pieroth, Psy.D.IntroductionThe com

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2approach allows a more detailed treatment with specific cognitive and physical restrictions and rehabilitation schedule for the athlete based on their

particular deficits.The intricate nature of concussive injury, presentation. and recovery, requires a comprehensivemethod in the outpatient setting t Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

o gauge recovery and improve return to activity recommendations. The continued assessment following injury should entail a combination of clinical his

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

tory/ exam, sideline or other ncurocognitivc testing, symptom checklists, neuropsychological testing (if accessible), and other modalities like oculom

CHARTER 6Outpatient care of the concussed athlete: Gauging recovery to tailor rehabilitative needsWith Elizabeth M. Pieroth, Psy.D.IntroductionThe com

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2at arc used in the concussed athlete to measure their neurological deficit ami monitor their recovery. Through proper identification of these deficits

, specific rehabilitative recommendations can be made to individually tailor the athlete’s road to recovery.Neuropsychological testing"The application Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

ol neuropsychological testing in concussion has been shown to be of clinical value and contributes significant information in concussion evaluation.

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

.Although in most cases cognitive recovery largely overlaps with the time course of symptom recovery, it has been dem onslraled that cognitive recover

CHARTER 6Outpatient care of the concussed athlete: Gauging recovery to tailor rehabilitative needsWith Elizabeth M. Pieroth, Psy.D.IntroductionThe com

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2 Pittsburgh Medical Center Sports Concussion Program. Primary referral t$ through emergency departments, primary care physicians, and athletic trainer

s. A comprehensive evaluation ts performed by a neuropsychologist to determine rehabilitative needs and need for referrals to other medical profession Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

als. (From Reynolds E et aL. Establishing a Clinical Service for the Management of Sports-Related Concussions. Neurosurgery v75. 2014. Wolters Kluwer

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

Health. Inc. With permission.)symptom resolution...it must lx* emphasized, however, that neuropsychological assessment should not be the sole basis of

CHARTER 6Outpatient care of the concussed athlete: Gauging recovery to tailor rehabilitative needsWith Elizabeth M. Pieroth, Psy.D.IntroductionThe com

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2ent clinical domains and investigational results... At present, there is insufficient evidence to recommend the widespread routine use of baseline NP

testing".10 Reflective of this encompassing stance of neuropsychological testing (NPT) taken by the 2013 Zurich Guidelines, we will further introduce Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

NPT, along with the benefits, limitations, and recommendations for the use of M*T. We hope that this will relay to the reader why NPT has been so acti

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

vely adopted for use in return to activity decisions, specifically in athletes experiencing a chai longing postinjury course, in cither high school, c

CHARTER 6Outpatient care of the concussed athlete: Gauging recovery to tailor rehabilitative needsWith Elizabeth M. Pieroth, Psy.D.IntroductionThe com

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2 written or computerized tests that measure cognitive abilities like attention concentration, memory acquisition, verbal and visual memory, executive

functioning, psychomotor reaction time, and global cognitive abilities.’7-75 A clinician can then compare postin jury NPT scores Io either age-matched Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

normative values and/or preinjury Iraseline scores Io objectively measure the postinjury neurological, cognitive deficit and make suggestions for the

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

players recovery/rehabililative process.-6 Many have advocated for this “return to baseline" approach for the decision process of return to activity.

CHARTER 6Outpatient care of the concussed athlete: Gauging recovery to tailor rehabilitative needsWith Elizabeth M. Pieroth, Psy.D.IntroductionThe com

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2wing concus sive injury.119 W 75There are numerous written (paper-pencil) cognitive tests that can be used in concussion assessment. The choice of tes

ts is made by the examiner, as there is no specific battery of paperpencil tests for concussion assessment. One of the disadvantages of paper-pencil c Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

ognitive tests is the lack of alternative forms available for repeat testing. The test-retest reliability of many commonly used paper-pencil tests may

Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

lx poor and there are concerns about practice effects withrepeated exposure to a test.28,29 That is. the athlete's improved score on repeat tests may

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