Welcome Guest!    Login | Signup

Motor vehicle accident and Sport induced Concussions. What you need to know

An auto/bike or sport-related concussion is an individualized injury that presents with a myriad of cognitive ( ability to think and process information ), physical, emotional, somatic ( muscle), and sleep-related symptoms and impairments ( tasks that you cannot perform as well post injury ), that should require a multifaceted approach to assessment and management.

24486261 - woman with headache, migraine, stress, insomnia, hangover in casual dress with blank space

Concussion is also known as TBI ( traumatic brain injury ), and is often referred to after the injury as a Post Concussive Syndrome ( PCS ). You do not need a loss of consciousness, or a blow to the head, exclusively, to get a concussion. Concussions can occur with rapid changes in head velocity ( i.e. Whiplash ) and with sonic stress ( large repetative, or singular, explosive sounds).

Recently, researchers have reported that vestibular ( see below) impairments are common after a concussion and may delay recovery from this injuryDizziness, which may represent an underlying impairment of the vestibular and/or ocular ( eye ) motor systems, is reported by 50% of concussed athletes, and, is associated with a 6.4-times greater risk, relative to any other on-field symptom, in predicting protracted (>21 days) recovery. The most common cause of concussions seen in our office occur as a result of  automobile accidents; these patients often report a feeling of ‘ being dizzy or off balance ‘ following their collision. 

 

The vestibular system is a complex network that includes small sensory organs of the inner ear (utricle, saccule, and semicircular canals) and connections to the brain stem, cerebellum, cerebral cortex, ocular ( eyes) system, and postural muscles.

26323263 - ear anatomy in colour background

This system provides information regarding head movements and positions to maintain visual and balance control.

The vestibular system is organized into 2 distinct functional units:

  • The vestibulo-ocular system ( the inner ear/eye relationship system) maintains visual stability during head movements ( so you don’t feel dizzy or visually unstable )
  • The vestibulo-spinal system ( the inner ear/spine/extremities relationship system ) is responsible for postural control. ( commonly disrupting balance )

You can have imbalances in one system, without imbalances in the other.

Vestibulospinal ( inner ear/spine/extremeties system ),(ie, balance) impairments are common within the first few days after a concussion. Subjectively, nearly 40% of athletes report balance disruption in the first week after a sport-related concussion. Balance impairments alone as a measure of a vestibular system injury may be limited because objective clinical balance impairments recover for the majority of athletes and some car accident patients, within 3 to 5 days after the injury. These balance impairments are often distinct from other vestibular-related impairments and symptoms.

 

22380411 - future technology, medicine and vision concept - woman and eye chart

Ocular motor ( eye/ muscle co-ordination system) impairments are also common after concussions. Nearly 30% of concussed athletes report visual problems during the first week after the injury. This figure is higher in motor vehicle accident cases. Common ocular motor ( eye/muscle system ), impairments and symptoms may manifest as blurred vision, double vision ( diplopia ), impaired eye movements, difficulty in reading, dizziness, headaches, ocular ( eye ) pain, and poor visual-based concentration ( i.e. can’t concentrate when trying to read or watch)

The identification of these vestibular and visual-related impairments and symptoms, can often be missed in initial examinations by doctors who do not have training in these areas. It represents an emerging component of assessment that positively augments current approaches to the evaluation and management of concussions.

 

We have adopted these assessments in the clinic, along with various cutting edge evaluation, treatment procedures and protocols to comprehensively rehabilitate the vestibular ( inner ear), ocular ( eyes), spinal and extremity ( limb co-ordination/ posture ) brain functions.

Both new and existing patients suspected of a concussion will undergo these vestibular ocular motor evaluations, in addition to their cranial nerve, cerebellar and existing vestibular testing.

As the concept of rehabilitation from concussion evolves, so far, vestibular rehabilitation has been shown to be effective in the management of specific conditions such as vestibular hypofunction, benign paroxysmal positional vertigo ( BPPV ), migraine-related dizziness, and central vestibular disorders ( a dysfunction of one or more parts of the central nervous system that helps to process balance and spatial awareness ). The emerging literature also supports vestibular rehabilitation for dizziness, balance, and vestibulo-ocular impairments after concussions.

Many of you who are Chiropractic patients are familiar with Chiropractic adjustments improving Dizziness, and other concussive symptoms, with appropriately delivered Shoulder Stabilization Exerciseadjustments, ( delivered at the right place, at the right time, so ensuring that they don’t overstimulate inflamed brain tissue.), this is due, in part, to the adjustments effect in restoring appropriate proprioception ( the ability of your brain to be aware with where your body is in space, i.e. your spatial awareness.). It is also a result of the adjustment addressing cervical ( neck) pain referral patterns into parts of the head or eyes, and similar sorts of pain referral patterns from the upper back/neck structures into the head, by reducing the source of the pain.

If you, a family member or loved one, has been involved in a collision, sporting injury, with or without loss of consciousness, ( you do not need to lose consciousness to suffer a concussion ), a thorough evaluation is warranted at our clinic. We will determine what imaging needs to be performed ( CT scan, plain film Davis series, MRI ), if any labs need to be performed, the area of the brain injured, how extensive the injury is, whether a referral is needed to co-treat ( we work with many Medical Doctors and neurologists ), and most importantly, where to get started to reduce the symptoms, get rehabilitated and get you on your way to healing!

If there are frank concussion signs and symptoms ( loss of consciousness, inability to remember 30 minutes before the event, vomiting twice within an hour, clear fluid eminating from either the nose or ears that is sweet tasting ( CSF ), eyes that don’t look right, etc..) take to the EMERGENCY ROOM at your closest Hospital. Then follow up with our Clinic.

 

Some fundamentals for concussion care that you need to know:

 

Fundamental preventative strategies:

Wearing a MIPS bike/ski-ing/skating helmet will decrease torsional stress in your brain if you sustain a head impact. They are not expensive.

Taking fish oils aids brain function ( see below)

 

Fundamental treatment paradigms:

 

Call us for an evaluation, either directly, or via the ER ( see above).

41069459 - close up of an eye and vision test chart

Rest cognitively and physically ( limit stimulation from computer screens, phones, tablets, etc); don’t do a load of exertion initially.

Eliminate bright lights ( wear sunglasses) and avoid loud noises.

Avoid crowds, supermarkets, driving.

(If concussed athlete, he/she can become de-conditioned and depressed, ( depression can be common, because the injured brain cannot make serotonin as well, this is a symptom of the inflammation )

There is no scientific evidence that prolonged rest for more than several weeks is beneficial.

In children, most Post Concussive Syndrome ( PCS ) cases resolve within 1 month ( unless previous head injury, learning difficulties, family stressors, concurrent health problems)

Glute Facilitation Side LyingLow level exercise at 1 month post injury is proposed in the current literature. However, Aerobic exercise 14-21 days after TBI, upregulated a protein involved in healing nerves in the brain (called brain derived neurotrophic factor ( BDNF) ), in association with cognition ( thinking and processing ). The bottom line here is to go easy with exercises and monitor response, and adjust appropriately.

Medications: no information scientifically that shows medication speeds concussion recovery in humans. The 2 most common prescribed by Medical Doctors are antidepressants/ ( serotonin reuptake inhibitors, (SSRI’s)), for associated depression ( see above) / cognitive defects; these can help with those symptoms. Amitriptyline is also used, it tries to aid sleep & headaches, but has no controlled trials for restoring normal brain function.

 

 

Nutrition:

herbal_medicine_gardensOmega (w-3), specifically, DHA, addresses hallmark features of concussion, such as excitotoxicity,( this is a whole blog in itself!! where the inflammed brain fires messages too fast and often in incoherent sequences, creating more inflammation and resistance to healing),  oxidative stress, ( destructive chemicals called free radicals can proliferate in a brain injury, whether this occurs in the brain, or the rest of the body, this is called oxidative stress), inflammation, NMDA & ROS.( N-Metyl D-Aspartamate & Reactive oxygen species are both pro inflammatory molecules that harm the brain) [Advances in Nutrition 2014] { currently extrapolated from animal studies } human studies underway! Based on animal models, they think 387mg/day DHA. ( 2 tuna oil perles, from Standard Process, is 300mg DHA.). Another study, using both EPA and DHA  ( 2 different essential fatty acids in fish oil ), before/ after injury creates neuroplasticity ( increased functional flexibility in the brain ) and neuro-protection ( animal models).

Resveratrol  ( in rats 100mg / kg ) and vitamin C suppress production of Reactive oxygen species ( ROS), and thus, reduced cell death. Obviously, transporting this type of study in to human consumption would translate to an enormous amount of resveratrol which has no precedent in the literature, or clinically, to my knowledge. Food sources include: Grape skins/wine/nuts. [N.B. 1 six ounce glass of red wine contains 1 mg of Resveratrol ]

Curcumin ( an active ingredient in Tumeric) was demonstrated in rats, ( dose of 500ppm) to counteract the outcome of traumatic brain injury on synaptic plasticity and cognition. Again, translating these into meaningful therapeutic dosages for humans is Sketchey!!. Standard anti-inflammatory dosages would be 4- 10 grams/day, (high doses cautioned in patients on anti coagulant drugs).[ MediHerb Boswellia complex has 80mg/tab curcumin; Vitanox 80mg/tab curcumin. Apex Tumero-active 400mg/5ml, Biotics CurcumRx  ]. Many studies cite up to 2000mg/day.

Avoid Calcium supplements, calcium metabolism is altered in brain injury. Further Calcium influxes destroy injured brain cells.

Magnesium helps with brain circulation. 500mg/day or to bowel tolerance ( i.e. at the point your stools get loose, back off a little to remedy this and that is your dose! ).

Avoid nitric oxide precursors, such as large doses of the amino acid L-Arginine ( this causes cell death by increasing inducible Nitric Oxide; some Doctors erronnously think they are going to increase blood flow following a concussion by supporting the body with such large amounts, instead, it can cause cell death ).

Avoid Glutamate containing foods. These are common excitotoxins. Even more profound problems post TBI. Call for our handout on excito-toxins.

 

For further information, evaluation, or discourse regarding concussion treatment, call us or email info@aggerchiro.comthumbs up woman