Self-Assessment Questions

This section provides a review. Mark each statement on the Answer Sheet according to the factual materials contained in this issue and the opinions of the authors.

Article One (pp. 3-12)

1. Which member of the concussion management team determines if the athlete can return to play or physical activity following a concussion?

   • Speech-language pathologist (SLP).

   • Athletic trainer.

   • Team physician.

   • Coach.

2. Which member of the concussion management team completes all neurocognitive baseline and postinjury testing?

   • Speech-language pathologist.

   • Athletic trainer.

   • Team physician.

   • Physical therapist.

3. Which member of the concussion management team interacts daily with the athlete and has a strong knowledge of the individual's past injuries, performance levels, personality, and internal drive?

   • Speech-language pathologist.

   • Athletic trainer.

   • Team physician.

   • Physical therapist.

4. Athletes typically return to baseline neurocognitive and symptom-rating levels within how many days following concussion?

   • 1 to 3 days.

   • 5 to 7 days.

   • 15 to 20 days.

   • 30 to 35 days.

5. According to best practice, which of the following areas should be assessed following a suspected concussion?

   • Neurocognitive performance.

   • Somatic and emotional symptoms.

   • Balance and vestibular function.

   • Eye coordination.

   • All of the above.

   Article Two (pp. 13-26)

6. What term denotes the expression of emotion through linguistic or extra-linguistic cues?

   • Affect.

   • Pragmatics.

   • Lability.

   • Perseveration.

7. Individuals with traumatic brain injury (TBI) demonstrate deficits in:

   • Recognizing emotion in faces.

   • Identifying emotion from prosody.

   • Interpreting sarcastic remarks.

   • Understanding humor in jokes.

   • All of the above.

8. In conversing with an individual with difficulty in processing emotions:

   • Do not use facial expressions to display emotions.

   • Be sure the words and facial features of the emotion agree.

   • Avoid talking about emotions.

   • Use short sentences.

   • Reduce the variability in your intonation pattern because it is confusing.

9. Which of the following statements is false?

   • Emotional content facilitates recall in healthy individuals at the word and paragraph levels.

   • Emotional content does not facilitate recall at either the word or paragraph levels for individuals with TBI.

   • Emotional content facilitates recall at the word level but not the paragraph level for individuals

     with TBI.

   • Individuals with TBI have shown deficits in recognizing and expressing emotional cues through facial expressions.

   • Individuals with TBI have shown deficits in recognizing and expressing emotional cues through vocal prosody.

   Article Three (pp. 27-35)

10. What is the cognitive exertion effect?

    • Improvement of physical ability with the increase of cognitive effort.

    • Worsening of general symptoms with increased cognitive effort.

    • Worsening of physical ability with the increase of cognitive effort.

    • Improvement of general symptoms with increased cognitive effort.

    • Improvement of cognitive function with increased cognitive effort.

11. Dr. Gerard Gioia and his team found that...

    • More individuals suffered longer lasting symptoms after a concussion with increased cognitive activity.

    • More individuals suffered increased symptoms after a concussion with increased physical activity.

    • More individuals suffered longer lasting symptoms after a concussion with decreased physical activity.

    • More individuals suffered increased symptoms after a concussion with increased cognitive activity.

    • More individuals suffered longer lasting symptoms after a concussion with increased cognitive activity.

12. What is the underlying reason for suggesting rest as a means of combating concussion?

    • It is designed to help restore physical energy after concussion.

    • Rest is designed to prevent further injury after concussion.

    • Rest is meant to preserve the body's nutrients for repairing brain injury.

    • The primary function of rest is a palliative measure to help injured individuals cope with pain.

    • Rest recommendations are a means of decreasing the duration of concussion symptoms.

13. Post stroke and other brain injury victims often report...

    • Increased symptoms, including depression, with the avoidance of physical activity.

    • Decreased symptoms, including depression, with the avoidance of activity.

    • Increased symptoms, including depression, with the avoidance of activity.

    • Resolution of symptoms with the avoidance of activity.

    • No change in symptoms including depression with the avoidance of activity.

14. Current rest guidelines state that...

    • 6 days minimum of cognitive rest is required before a graded return to normal cognitive activity.

    • 3 to 5 days maximum of cognitive rest is required before a graded return to normal cognitive activity.

    • 1 to 3 days minimum of cognitive rest is required before a graded return to normal cognitive activity.

    • 3 days maximum of physical and cognitive rest is required before a graded return to normal activity.

    • 1 to 3 days maximum of physical and cognitive rest is required before a graded return to normal activity.

    Article Four (pp. 36-47)

15. Dizziness or imbalance is attributed to the cervical spine when:

    • The patient has impaired vestibular ocular reflex.

    • Benign paroxysmal positional vertigo is ruled out.

    • The dizziness or imbalance occurs when the neck is stabilized, but painful.

    • The patient reports a sense that objects are moving in the environment.

    • The dizziness or imbalance occurs when the patient reports pain while moving the neck.

16. Benign paroxysmal positional vertigo is a condition of the semicircular canals of the inner ear. It occurs when:

    • Endolymph fails to move within the inner ear.

    • Otoconia migrates to the utricle.

    • Otoconia migrates into one or more of the semicircular canals.

    • Utricle migrates into the semicircular canals.

    • There is a rupture of the cupula.

17. An intervention which targets impaired vestibular ocular reflex includes:

    • Maintaining gaze on one point while the head moves.

    • Having the patient stand while the environment moves around him.

    • Dix Hallpike maneuver.

    • Canalith repositioning procedure.

    • Standing with feet together and maintaining gaze without moving the head.

18. Physiologic dysfunction in mild traumatic brain injury/postconcussive syndrome (mTBI/PCS) is not characterized by which of the following:

    • Decreased cerebral blood flow.

    • Exercise intolerance and increased symptoms.

    • Increased cerebral blood flow.

    • Abnormal heart rate response during exercise/exertion.

    • Deconditioning from physical activity limitation due to headache and dizziness.

19. Individuals with mTBI and PCS may have balance impairment due to:

    • Deficits coordinating vestibular information.

    • Deficits coordinating vestibular, visual, and somatosensory information.

    • Dizziness in busy visual environments.

    • Difficulty integrating visual input and generating conjugate eye movements.

    • Disequilibrium weight bearing on uneven surfaces.

    Article Five (pp. 48-56)

20. What sensory domain(s) is/are potentially relevant for measuring balance in concussion?

    • Vision.

    • Somatosensation.

    • Vestibular.

    • All of the above.

21. The neurometabolic cascade affects general function of the neurons by.

    • Altering neurotransmission.

    • Altering axonal structure.

    • Altering neuron bioenergetics.

    • Altering the number of neurons.

22. Which test is currently the most widely used in concussion management?

    • BESS.

    • Center of pressure through a force plate.

    • Sensory organization test.

    • Gait.

23. Given the information provided in the chapter, which test may be the most effective for assessing concussion injury?

    • BESS.

    • Dynamic tests of balance.

    • Gait.

    • Dual task (dynamic balance task plus cognitive task).

24. What is an additional consideration for the interpretation of balance performance in athletes?

    • Complexity of task.

    • Postural control requirements of the athlete's sport.

    • Challenge of the task.

    • Foot position.

25. Oculomotor assessment postconcussion is a valuable tool to add to assessment of balance because.

    • It evaluates an additional component of the visual system.

    • It is easy to implement and has been validated.

    • It evaluates similar motor control circuitry as postural control and is sensitive to injury.

    • It adds complexity to postural control tasks.

    Article Six (pp. 57-64)

26. Which acceleration force causes less damaging in a severe trauma?

    • Angular acceleration.

    • Linear acceleration.

    • Diagonal acceleration.

    • Redirectional acceleration.

27. Sport-related subconcussive impacts in all ages as cranial impacts typically are described:

    • Traumatic brain injury (TBI).

    • Neurological dysfunction is seen on X-rays or CT scans.

    • Cranial impacts that do not result in known or diagnosed concussion on clinical grounds.

    • More severe than a concussion and every impact results in a concussion.

28. SLPs should be aware of repetitive head impacts in pediatrics that are associated with future degenerative functions in the following scale:

    • High to severe: 90-110 G.

    • Low to moderate: 13-60 G.

    • Moderate: 40-50 G.

    • Low to mild: 10-15 G.

29. To monitor subconcussive impacts, which of the following field instrument can be used by an interdisciplinary team?

    • PLS-5.

    • Accelerometer or impact monitor.

    • PPVT-IV.

    • Sensory organization test.

30. Which of the following symptom has contributed to the immediate identification on the effect of mild subconcussive injury?

    • Confusion.

    • Sensitivity to light.

    • Dizziness.

    • Headache.

31. Which of the following assessments is directly validated for subconcus-sive impacts?

    • Smart impact monitor.

    • ImPACT Pediatric.

    • Perform attention task.

    • No assessment.

32. What is the main cognitive process that should be included in neurocognitive testing?

    • Rapid processing.

    • Visual and word memory.

    • Attention, memory, and executive functions.

    • None of the above.

33. The interdisciplinary team is a must and in order to establish direct clinical implication (physical, cognitive, and performance), an SLP should work “hand to hand” with:

    • Coaches, parents, and teachers.

    • Physical therapist and psychologist.

    • Exercise physiologist.

    • All of the above.

    Article Seven (pp. 65-78)

34. The diagnostic term “cognitive-communication disorder” implies that:

    • An individual has developmental cognitive delays that impact overall communication.

    • Both thinking and communication are equally impacted.

    • A neuropsychological evaluation is required prior to SLP intervention.

    • Acquired changes in cognition, as occur in TBI, also impact communication skills.

    • Only cognitive skills should be considered when evaluating an individual.

35. Which of the following is not a common occurrence after mTBI?

    • Changes in social communication.

    • Changes in expressive language.

    • Changes in auditory functioning.

    • Decreases in quality of life.

    • Spastic dysarthria.

36. Neurobiopsychosocial modeling in mTBI implies that:

    • Researchers remain unsure as to key factors in mTBI.

    • Likelihood of sustaining and recovery from mTBI is highly multifactorial.

    • Neurologic function is the most important factor in mTBI.

    • Individuals cannot recover unless evaluated by providers from numerous disciplines.

    • Emotional health and physical factors are equally important in mTBI.

37. Which of the following is not a factor impacting SLP clinical assessment in

    mTBI?

    • There are no broad published guidelines for best practices in SLP evaluation.

    • There is not a clear characterization of communication changes in mTBI.

    • SLPs have mixed presence on mTBI rehabilitation teams.

    • Patients with mTBI can get fatigue easily, impacting assessment choices.

    • There are limited strong options available for SLPs to assess in mTBI.

38. Integrated practice units rely on which of the following?

    • Providers being co-located in a single facility.

    • Providers being able to communicate with each other routinely.

    • Shared measures to help gauge clinical care outcomes.

    • Respect of all providers' judgments and opinions in clinical decision making.

    • All of the above are important in integrated practice units.