Concussion

Having Concussion (mTBI) Symptoms that don’t Go Away Is Scary and Stressful

Concussion
Concussion

Concussion, a form of mild traumatic brain injury (TBI), is a leading public health problem, with an estimated 1.6 to 3.8 million sport-related concussions each year in the United States. The majority of patients with sport-related concussion recover within a 7- to 10-day period. Persistence of symptoms beyond the generally accepted time frame for recovery may represent a prolonged concussion or may herald the development of post-concussion syndrome (PCS).

If you have been having symptoms for more than a few weeks, it is smart to be proactive.  Research recommends initial cognitive rest, but you need to actively treat the problem at this point.  It is a stressful time and you need answers.  This is when you need to be working with someone who specializes in concussion rehabilitation.

We Do Not Treat Acute Emergency Situations of Head Injury

Those should only be managed by the hospital emergency room. Many times these injuries require a CT scan. Once a more serious situation is ruled out, the best approach in the first 30 days after a concussion is physical and mental rest until symptom resolution as well as proper nutrition to reduce brain inflammation. We recommend a strict 7-day total rest period immediately following the injury. This means, no school, work, TV, homework, exercise or video games. We are expertly trained in the best nutritional approach to take after a person suffers a concussion and can provide specific nutritional recommendations that can aid in decreasing brain inflammation in the acute period following the concussion.

If a concussion sufferer is still having symptoms after the initial rest period, they have post-concussion syndrome (PCS) and are best cared for using specific functional neurological care. Many times these patients DO NOT improve with more time; they need an intensive rehabilitative approach.

We See Post-Concussion Syndrome Patients

As Functional Neurologists we see post-concussion syndrome patients who do not achieve full neurological recovery both objectively and symptomatically through rest within the initial 30 days post injury. It is important to understand the majority of concussion sufferers that do feel better with rest may not really be recovered neurologically. It’s essential that they have the proper testing done to evaluate all the potential areas of their brain that may be affected by the concussion. These areas are not limited to the cognitive areas of the brain tested by a neurocognitive test such as IMPACT, but also the areas that affect balance, equilibrium, blood flow to the brain itself and other vital functions. Very often a concussion sufferer will pass a neurocognitive test such as IMPACT, meaning the cognitive areas of the brain are functioning well, but they may still have serious deficits in other areas causing their symptoms. If a player goes back to play with these deficits and functioning at less than 100% there is a greater chance that they will get hurt again.

We Do Not Treat With Medication

Medications affect the brain as a whole and are not specific or able to bias certain neurological areas. It is not possible for a chemical to only affect the specific areas of the brain injured by the concussion and not the non-injured areas. For example, if only the left side of a person’s brain stem is affected causing dizziness and poor balance, how could the chemical action of the medication only affect one side and not the other? It is for that reason we do not use medication and instead use specific brain stimulation to train and repair the specific areas affected by the concussion. The most current research is supporting this approach.

In order to better understand this methodology it’s important to understand how a Functional Neurologist differs from conventional medical neurology. The key difference between a Functional Neurologist and a conventional medical neurologist lies primarily in their approaches to treatment.

A conventional medical neurologist is typically focused on the diagnosis of structural pathology and utilizes only pharmaceutical and surgical interventions to treat disease.

A Functional Neurologist views the nervous system as a moldable, changeable entity that can be affected in its function through many types of environmental stimulation and specific therapies. This concept of the brain being able to change its function throughout life via environmental stimulation is termed neuroplasticity and is at the very core of a Functional Neurologist’s clinical methodology.

We Look at Overall Brain Function

We look at each specific brain region affected by the concussion in addition to the individual’s specific functional capabilities and the neurochemical effects of the concussion as well. This is different than just passing a computerized test or vague, generalized batteries of tests that do not look at various things from a functional model.

We Combine the Latest Research-Backed Neurological Examinations and Advanced Neurological Testing

The advanced neurological testing procedures listed below allow us to pinpoint brain impairments that may be responsible for your post concussive symptoms as well as limiting function and cognition.

Video Nystagmography – VNG

VNG is a computerized system used in the assessment of the oculomotor system (nervous system control of moving your eyes) and the function of those areas of your brain controlling these movements.

The Video Nystagmography (VNG) test is comfortably performed in our office. We simply place special goggles with an infrared camera on your head to record and measure your eye movements in both light and dark conditions.

Specific areas and pathways of the brain are activated during different types of eye movements. During the test computer software is recording and graphing your precise eye movements as you follow the visual target with your eyes. By measuring your recorded eye movements and displaying them on the computer screen you can see your own eye movements and how they compare to normal measurements.

The following eye movements are measured by VNG:

Gaze Stability: It is essential that the brain stabilizes the gaze of the eyes for proper equilibrium and balance. One of the most common ocular motor deficiencies seen in concussion cases is poor gaze stability. This can be seen on the VNG tracing.

Pursuits: Pursuits are slow and steady eye movements that allow you to track a moving object. Good smooth pursuits are essential to everyday functions but are particularly important to athletes. The pursuit mechanism is commonly altered in concussion.

Saccades: Saccades are fast eye movement used to shift a person’s gaze from one object to another. Saccades need to be fast and accurate. A concussion can alter the speed and accuracy of a person’s saccades causing multiple symptoms.

Optokinetics (OPK): This is an essential eye movement that allows for visual function as the surrounding visual environment passes by. When these are dysfunctional it can indicate poor brain function.

 Vestibular Ocular Reflex: When you move your head your eyes should move equally in the opposite direction if this reflex is functioning properly. When this reflex is disrupted by concussion it also can create many symptoms especially dizziness and poor gait.
The VNG eye movement tracings provide invaluable neurologic information concerning specific areas of your brain affected by concussion. We are experts at analyzing these specific eye movements and determining if they have been disrupted in their proper function. We correlate the VNG findings with our other testing and examination procedures to develop a specific therapeutic program for each individual

Balance Testing

People with concussion or mTBI commonly report problems with balance. Between 30% and 65% of people with these injuries suffer from dizziness and disequilibrium (lack of balance while sitting or standing) at some point in their recovery. Dizziness includes symptoms such as lightheadedness, vertigo (the sensation that you or your surroundings are moving), and imbalance.

We use high tech equipment to evaluate the patient’s balance in a very advanced way. This assessment can help us pinpoint where in the patient’s brain the dysfunction/injury is and also clues us into how to perform specific rehabilitation to aid in recovery.

Testing includes:

Eyes Open,
Firm Surface
Provides a baseline. Information available by all three sensory inputs: Somatosensory, visual and vestibular
Eyes Closed,
Firm Surface
Visual not available; somatosensory and vestibular are available. If the athlete performs poorly, the vestibular or somatosensory may be compromised, with an increase in visual dependency.
Eyes Open,
Unstable Surface
Somatosensory compromised; visual and vestibular are available. If the athlete performed poorly, visual or vestibular may be compromised, with an increase in somatosensory dependency.
Eyes Closed,
Unstable Surface
Visual not available; somatosensory compromised, only vestibular available. Concussed athletes are
most likely to present problems in this condition. If performance is reduced beyond normal or baseline readings, the vestibular system may be disrupted.

We offer a Complete Concussion Baseline

Concussion baseline testing is for athletes who play contact sports. Our base line is more complete than the typical baseline that only includes some form of neurocognitive testing. Our baseline includes:

VNG & Balance Testing

We Use Breakthrough Neurological Therapies to Improve Brain Function

The neurological therapies or brain stimulations we use are specific and unique for each individual. These therapies are determined by the neurological consultation, the neurological examination and advanced neurological computerized testing. These therapies help restore impaired function by using the concepts of neuroplasticity and the brain’s inherent ability to repair itself. The therapies target affected areas with specific activities to rebuild neural pathways. These stimulations are aimed at reactivating the nervous system where abilities have been compromised.

Therapy regimens may include:

  • Specific eye exercises based on the testing
  • RPSS: Repetitive Peripheral Somatosensory Stimulus
  • Vibration Therapy
  • Proprioceptive stimulation
  • Vestibular stimulation
  • Balance Therapy
  • Advanced muscle retraining
  • Interactive Metronome
  • EYELIGHTS
  • Optokinetics
  • Oxygen Therapy
  • Peripheral Stimulation of Cranial Nerves

We Do Specific Biomechanical Spinal Care

Head injuries that result in concussion often are associated with injury to the neck and spine. Joint dysfunction may further impair brain function, when the nerves in the neck that fire back to the brain are not working well. If necessary spinal therapies may include: Biomechanical Chiropractic care and Core Stability Exercises designed to correct a poorly aligned spine and to strengthen the muscles that support the structure of the spine.

We Provide Metabolic Care Using The Latest In Functional Medicine To Support Healthy Brain Function And Reduce Inflammation

From a metabolic perspective, there are several things that happen following a concussion.

  • Increased glutamate levels
  • Altered glucose utilization
  • Mitochondrial dysfunction
  • Reduced available Magnesium
  • Brain Inflammation

In the injured brain there is a slow build-up of free radicals, prostaglandins, lipid peroxidation products, inflammatory cytokines and excite-toxins that damage the connections between brain cells, the synapses, axons and dendrites. This inflammatory process is mediated by cells called microglia. Once the microglial cells are activated, they tend to persist in this state and can actually create even greater neural inflammation over time

There are specific dietary recommendations and nutritional compounds that can reduce this brain inflammation and make a better environment for brain recovery following a concussion. We combine these evidence-based drug-free dietary recommendations and nutritional supplements with our specific brain therapies to achieve maximal benefit for the post-concussion patient.

We base a patient’s specific nutritional needs on their preliminary lab results. The following are some of the lab tests we may run to determine the best nutritional approach each individual concussion patient will need:

  • Preliminary Lab Testing
  • The effects of a concussion can be compounded by the person’s metabolic health prior to the injury.
  • A Complete Metabolic Panel (CMP)
  • A Lipid and Thyroid Panel
  • A CBC (Complete Blood Chemistry)
  • Vitamin and Mineral Testing (Vit D, B12, magnesium, calcium, phosphorus etc)
  • Inflammation Testing: Homocysteine levels and C – reactive protein (CRP).
  • Iron and Ferritin Testing For Anemia

Some patients suffering post-concussion syndrome are also suffering from a pre-inflammatory processes that compounded the effect of the concussion.

We can assess your thyroid, adrenal, immune, blood and gut function. All can be affecting your brain health. By addressing any problems with your thyroid, adrenal glands, immune system, blood chemistry or gut function, we can help your nervous system to function more properly. The complete metabolic panel allows us to check your blood glucose levels since glucose and oxygen are needed by the brain to function properly.

Special Lab Panels and Testing

Your preliminary blood testing will let us know if any of the special testing listed below will be necessary in helping you recover from your concussion.

Many concussion patients have a microscopic breakdown of their intestinal wall known as intestinal permeability that may be a result of poor brain function from the concussion or a poor diet prior to the injury. This breakdown called leaky gut will cause the small intestines and colon to become inflamed as well as allow the brain to maintain its inflamed state. An inflamed gut will cause an inflamed brain.

The Gut-Brain Connection:

The gastrointestinal system is known as the “Second Brain” and has just as many neurons as the brain itself. Our 2 brains- the one in our head and the one in our bowel- must cooperate. When they do not, then there is chaos in the gut and misery in the head-everything from “butterflies’ to cramps, from diarrhea to constipation.       – Michael D. Gershon, MD author of “The Second Brain”

Stool Microbial Ecology testing for intestinal bacteria, yeast, parasites and dysbiosis. Eliminating intestinal inflammation will help to reduce overall body and brain inflammation

Adrenal Stress Index (ASI)

We can further test your adrenal glands with a test called an Adrenal Stress Index. Your adrenal glands are your “stress” organs, meaning that they react to stress. If you have been or are currently under stress, this test is a must! When your body’s cortisol levels are abnormal, it is a sign that your body’s sympathetic nervous system is over-firing. A concussion may cause an over-firing sympathetic nervous system. Abnormal cortisol levels can be corrected via specific neurologic and nutritional protocols.

Specific Nutritional Protocols

These specific nutritional protocols are based on your neurological testing, your blood work findings and your special lab panels. Our goal is to provide the brain with the best metabolic environment to support and obtain the best results from our neurological care. The effects of a concussion can be compounded by the person’s metabolic health prior to the injury. These protocols are designed specifically for you and may include any of the following:

  • Anti-inflammatory diet
  • Specific diet and supplement protocols for leaky gut correction
  • Liver detoxification
  • Specific diet and supplement protocols to decrease brain and gut inflammation and decrease chronic pain
  • Non-drug protocols for high blood sugars, diabetes, hypoglycemia and high cholesterol
  • Natural protocols for hypothyroidism
  • Nutritional protocols for abnormal adrenal (stress gland) function
  • Specific diet and supplement protocols for autoimmunity
  • Food sensitivity diet recommendations
  • Migraine trigger elimination diets

For information about our Post-Concussion Recovery Evaluation including our neurological exam, advanced diagnostic testing and Report of Findings, call our office at 631-673-1001 to schedule a consultation!