Ontario Neurotrauma Foundation

Guideline For Concussion/Mild Traumatic Brain Injury & Persistent Symptoms

3rd Edition, for Adults over 18 years of age

Ontario Neurotrauma Foundation

Tools and Resources

Diagnosis/Assessment of Concussion/mTBI

Appendix 1.1

Acute Concussion Evaluation (ACE): Physician/Clinician Office Version

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Appendix 1.2

Abbreviated Westmead Post Traumatic Amnesia Scale (A-WPTAS)

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Appendix 1.3

Brain Injury Advice Card - Long Version

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Appendix 1.4

Brain Injury Advice Cards - Short Versions: Example # 1

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Brain Injury Advice Cards - Short Versions: Example # 2

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Appendix 1.5

The Rivermead Post Concussion Symptoms Questionnaire

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Appendix 1.6

Post Concussion Symptom Scale

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Appendix F

Other Links/Resources

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Table 1.1

Risk Factors Influencing Recovery Post mTBI

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Table 1.2

Key Features of mTBI Assessment in an Emergency Department or Doctor’s Office

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Figure 1.1

Canadian CT Head Rule

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Algorithm 1.1

Initial Diagnosis/Assessment of Adult mTBI

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Initial Management of Concussion/mTBI

Appendix 1.3

Brain Injury Advice Card (Long Version)

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Appendix 1.4

Brain Injury Advice Card (Short Version)

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Appendix 2.1

Specialized Concussion Clinics/ Centres in Ontario

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Post Concussion Care Pathway

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Referral Indicators

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Concussion Symptom Management

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Appendix 2.2

Parkwood Pacing Graphs

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Algorithm 2.1

Algorithm: Initial Management of Symptoms Following mTBI

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Table 1.1

Risk Factors Influencing Recovery Post mTBI

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Sport-Related Concussion/mTBI

Appendix 3.1

Sport Concussion Assessment Tool (SCAT5)

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Appendix 3.2

Concussion Recognition Tool 5

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Appendix 3.3

Buffalo Concussion Treadmill Testing

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Appendix 3.4

Important Components of a Neurological Exam

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Appendix F

Other Links/Resources to Consider

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Figure 1.1

Canadian CT Head Rule

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Table A

Common Symptoms of mTBI

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Table 3.1

Concussion Modifiers

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Table 3.2

Graduated Return-to-Sport Strategy

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Table 12.2

Stepwise Approach to Return-to-Work Planning for Patients with Concussion/mTBI

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General Recommendations Regarding Diagnosis/Assessment of Persistent Symptoms

Appendix 1.5

Rivermead Post Concussion Symptoms Questionnaire

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Appendix 1.6

Post Concussion Symptom Scale

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Appendix 4.1

ICD-10 Definitions for Differential Diagnosis Related to mTBI

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Table 4.1

Differential Diagnoses Related to mTBI

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Table 1.1

Risk Factors Influencing Recovery Post mTBI

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General Recommendations Regarding Management of Persistent Symptoms

Appendix 1.3

Brain Injury Advice Card (Long Version)

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Appendix 1.4

Brain Injury Advice Cards (Short Versions)

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Appendix 2.5

Specialized Concussion Clinics/Centres in Ontario

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Algorithm 5.1

Management of Persistent Symptoms following mTBI

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Table 1.1

Risk Factors Influencing Recovery Post mTBI

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Post-Traumatic Headache

Appendix 6.1

International Classification of Headache Disorders (ICHD-III) Beta:

Acute Headache Attributed to Mild Traumatic Injury to the Head

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Appendix 6.2

International Classification of Headache Disorders (ICHD-III) Beta:

Persistent Headache Attributed to Mild Traumatic Injury to the Head

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Appendix 6.3

Diagnostic Criteria for Selected Primary Headache Types from the International Classification of Headache Disorders (ICHD-III) Beta

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Appendix 6.4

Headache Diary

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Appendix 6.5

International Classification of Headache Disorders (ICHD-III) Beta: Medication-Overuse Headache

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Appendix 3.4

Important Components to Include in the Neurological and Musculoskeletal Exam

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Appendix 6.6

Self-Regulated Intervention and Lifestyle Strategies to Minimize Headache Occurrence

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Appendix 6.7

Prophylactic Therapy

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Appendix F

Other Links/Resources to consider

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Table 6.1

Important Components to Include in the Focused Headache History

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Algorithm 6.1

Assessment and Management of Post-Traumatic Headache following mTBI

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Sleep-Wake Disturbances

Appendix 7.1

Brief Definitions of Sleep Disorders Most Frequently Reported Following TBI

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Appendix 7.2

Short Clinical Interview for Sleep after Head Injury

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Appendix 7.3

Sleep and Concussion Questionnaire

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Appendix 7.4

Sleep Hygiene Program

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Appendix 7.5

Behavioural Recommendations for Optimal Sleep

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Appendix 7.6

Sleep Diary

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Appendix 7.7

Limiting Time Spent in Bed

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Appendix 7.8

Recreating a Time and Place for Sleep

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Appendix F

Other Useful Links/References for Resources to Consider

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Table 7.1

Important Components to Include in the Sleep-Wake Disturbances Screen

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Algorithm 7.1

Assessment and Management of Persistent Sleep-Wake Disturbances Following mTBI

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Mental Health Disorders

Appendix 8.1

Patient Health Questionnaire 9-Item Scale (PHQ-9) for Depression

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Appendix 8.2

Generalized Anxiety Disorder 7-Item Scale (GAD-7)

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Appendix 8.3

Primary Care PTSD Screen (PC-PTSD)

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Appendix 8.4

PTSD Checklist (PCL-5)

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Appendix 8.5

CAGE and CAGE-AID Questionnaire

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Appendix F

Other Links/ Resources to consider

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Table 8.1

General Considerations Regarding Pharmacotherapy after mTBI

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Algorithm 8.1

Assessment and Management of Persistent Mental Health Disorders Following mTBI

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Cognitive Difficulties

Appendix 1.5

Rivermead Post Concussion Symptoms Questionnaire

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Appendix 1.6

Post Concussion Symptom Scale

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Appendix 3.1

SCAT5

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Appendix F

Other Useful Links/References for Resources to Consider

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Vestibular (Balance/ Dizziness) & Vision Dysfunction

Appendix 10.1

Dizziness Handicap Inventory

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Appendix 10.2

Dix-Hallpike Manoeuvre and Particle Repositioning Manoeuvre (PRM)

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Appendix 10.3

The Epley Manoeuvre

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Appendix 10.4

Screening Techniques for Vision Dysfunction

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Appendix F

Other Links/ Resources to consider

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Fatigue

Appendix 1.5

Rivermead Post Concussion Symptoms Questionnaire

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Appendix 11.1

Barrow Neurological Institute (BNI) Fatigue Scale

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Appendix 11.2

List of Medications Associated with Fatigue, Asthenia, Somnolence, and Lethargy from the Multiple Sclerosis Council (MSC) Guideline

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Appendix 11.3

Patient Advice Sheet on Coping Strategies for Fatigue

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Appendix 11.4

Increasing Physical Activity to Better Manage Fatigue

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Appendix 2.6

Parkwood Pacing Graphs

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Appendix F

Other Useful Links/References for Resources to Consider

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Table 11.1

Fatigue: Assessment and Management Factors for Consideration

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Return-to-Activity / Work / School Considerations

Appendix 12.1

Components of the Vocational Evaluation following mTBI

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Appendix 12.2

Example Concussion/mTBI Accessibility Intake Package for Student Services/Special Needs Department

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Appendix 12.3

Greater Accommodations for Students with Persistent Symptoms following mTBI

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Appendix 12.4

Managing Your Return to Post-Secondary Activities: Package Template and Activity Log

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Appendix 12.5

Acute Concussion Evaluation (ACE) Care Plan - Work Version

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Appendix 12.6

Acute Concussion Evaluation (ACE) Care Plan - School Version

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Table 12.1

Factors Associated with Poor Functional Outcomes

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Table 12.2

Stepwise Approach to Return-to-Work Planning for Patients with Concusison/mTBI

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Algorithm 12.1

Return-to-Work Considerations

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Algorithm 12.2

Return-to-School (Post-Secondary) Considerations

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