Every March, Brain Injury Awareness Month, led by the Brain Injury Association of America, kicks into high gear to educate the public on this major public health crisis. From concussion and mild traumatic brain injury (mTBI) to severe brain injury and stroke; all of these conditions have a far-reaching impact. An impact on the individual who has suffered the injury, families and caregivers, communities, and our ever-burdened health care system.
The greatest challenge for those affected by these unfortunate, and often preventable, events is access to resources. Educational and treatment resources beyond the initial stage of injury is often hard to come by and folks are left to their own devices to put the pieces together for the most productive life possible. This, while being told by so many (including their doctors and family) that there is not much hope for further recovery.
Where to Look For Answers
What follows are links to a host of resources exploring many aspects of brain injury. Content related to understanding why so many continue to experience the symptoms they do. Some resources will explain symptoms in detail and why they occur, and others will look into what tests you can have done to determine what path of treatment is best for you. Most importantly, these resources demonstrate a clear message of hope for so many to get beyond their daily struggles. Be sure to watch the videos of those who have done just that!
We understand that those who have injured their brain digest information in different ways, therefore the content is made available in written (blog), audio (podcast), and video formats. Please enjoy, learn something, act on something; and pass the Brain Injury Awareness word on to others who can benefit and renew their hope.
…If I had a dime for every time someone with concussion said “my doctor doesn’t listen to me”. Nearly every day in clinical practice patients report to me one way or another this very real concern. While this is true across all areas of specialty at our center, it is far more prevalent in those suffering the effects of concussion and post-concussion syndrome.
There are several theories as to why many doctors don’t take the time to listen. These can be explored at length with a simple internet search. Here, I will briefly explore some of these more accepted views and, more importantly, what I have come to see is the real truth behind why so many are being ignored, and in many cases dismissed, by their ‘trusted’ health care providers.
The Usual Suspects
Time. Most primary care physicians are pressured by the demands of heavy patient loads and declining insurance reimbursements. That leaves you as the patient at the mercy of a provider that may only give you one minute or less to voice your concerns; which for those of you with concussion are often too many to list.
Distraction. Electronic records, insurance forms, mobile devices, and excessive patient volume can cause doctors to get caught up in things that are not right in front of them. That is you, the patient. If a doctor is distracted, they will not do a great job at listening.
Bias. It has been established that many doctors will spend less time with individuals based on race, gender, and other factors such as socio-economic status. Also, patients that come in with recurring complaints are more likely to be dismissed or ignored.
While I believe these are accurate (although unacceptable) reasons for many being short-changed when it comes to their health care provider’s attention; there are more specific reasons doctors don’t listen when it comes to the laundry list of life struggles that can accompany concussion and post-concussion syndrome.
The Real Story Doctors Don’t Listen to Those With Concussion
Ignorance. This may seem like a harsh term to many (particularly the doctors), although it simply means that most primary care providers lack the knowledge and information necessary to properly question and screen for these types of conditions.
Invisible. Concussions are not seen on CT scans or found in blood work. They are silent injuries that result in functional problems with balance, vision, cognitive abilities, and more. Conventional medical approaches are not well suited for these conditions; therefore, doctors are less inclined to listen to problems they cannot treat.
Overwhelming. The number of symptoms and conditions that can result from a hit to the head are staggering (we’ve compiled a list of over 50!). Most doctors when presented with 5, 10, or more complaints may focus only on 1 or 2 as this is what they are accustomed to.
Unknown. Even with all the attention given to concussion over the past several years in sports, the media, and movies, this is still uncharted territory for most providers in mainstream medicine. This is also true for many of the doctors those with concussion are being referred to.
So, What’s the Answer?
The internet is full of strategies to get your provider to listen better. This, however, is not the focus of this article. And, it will not serve you well to try and get those that don’t understand concussion to listen to you! What you need to do is seek out the services of a qualified functional neurologist who is well versed in the art of listening. And, who understands the multitude of symptoms those with concussion and post-concussion syndrome experience. Only then will you be able to get answers as to what the best method of treatment will be for you. Concussions are real, and so are the symptoms and solutions!
For more information please call us at 828.708.5274, or visit any of the following resources:
John is a 66-year-old grandfather and successful businessman from Asheville, NC who plays tennis and counts flying among his favorite hobbies. But he is concerned that his memory is starting to slip. There’s no family history of Alzheimer’s disease or dementia.
John, however, did have a car accident and subsequent skiing accident in which the fall he suffered was so serious that his helmet broke. He also admits that he is often dizzy, fatigued, easily angered, and frustrated over his physical and mental limitations.
Intervention for balance and cognitive decline
John underwent comprehensive Brain Training at a frequency of three times per day over the course of five days. His brain function was carefully monitored throughout the training process with measurement of EEG brainwaves, vital signs, eye movements, balance, mental and physical timing, and more to ensure he was receiving the proper amount of therapy without exceeding fatigue limits that might promote worsening of his symptoms as is often the case in more conventional rehabilitation programs.
Understanding the relationship between physical functions such as balance, timing and eye movements and higher cognitive functions like memory (both major challenges in his case), we implemented the following Brain Training procedures: EEG neurofeedback, Interactive Metronome, vestibular rehabilitation, metabolic/nutritional therapies, eye movement and neurological rehabilitation, electrical stimulation, breathing exercises, lifestyle changes and home care therapies.
Outcomes with Brain Training
John reported midway through his five-day training program that he had “one of his best games of tennis.” He also said he felt less dizzy and improvements in his mood and memory were noticeable to him and others. “I walk better, talk better and feel better,” he said.
Actual measurable, objective improvements recorded with post-intensive diagnostic testing included:
Interactive Metronome (Timing): 14% improvement in timing accuracy and normalization of hyper-anticipatory timing tendency with motor tasks (i.e. becoming more ‘in-sync’ with a specified reference tone).
Videonystagmography (Eye movements): Significant improvements in numerous aspects of oculomotor functionality including: gaze holding, slow and fast eye movements, optokinetic responses, and spontaneous/involuntary eye movements.
Computerized Assessment of Postural Stability (Balance): 24% improvement in balance under the most challenging circumstances (eyes closed on an unstable surface – noted as PSEC on charts below below). Near complete normalization of a hazardous posterior center of pressure (tendency to carry his body or sway to the rear):
Implications Following Treatment
After his treatment was completed, John says he was able to recapture the moments of joy and sense of accomplishment he experienced through playing tennis and flying his aircraft, his two favorite hobbies; as well as being more engaged with his family.
He reports his memory has improved, he has fewer symptoms of dizziness and fatigue, and most important – he is now a safer, happier pilot following his specific Brain Training program.
At the time of presentation to APEX Brain centers in Asheville, NC in late 2015, Jackie was a 55-year-old, soon to be retired professional female. Post-concussive symptoms of debilitating headaches, memory loss, learning and behavioral issues, fluctuations in heart rate, and difficulty handling visual stimulation such as driving, busy public places and computer screens were preventing her from leading a normal life. Prior to traveling to APEX from Charlotte, NC, Jackie had sought care from several different doctors in her area. Vestibular therapy and chiropractic care had given her some relief of symptoms, although her other experiences were not so positive. At one point a provider told her that she was mentally ill. Jackie was outraged and, as many with post-concussion syndrome report similarly, she offered this statement: “I’m not crazy. I didn’t have any of these symptoms before I had the injury and I am definitely not making them up”. This is the unfortunate reality of many who suffer with brain injury.
Intervention for balance and cognitive decline
Jackie underwent comprehensive Brain Training at a frequency of 3 times per day over the course of 15 days (with 2 days off between each week for much needed rest and recovery). Her brain function was carefully monitored throughout the training process with measurement of EEG brainwaves, vital signs, eye movements, balance, mental and physical timing, and more to ensure she was receiving the proper amount of therapy to be effective without exceeding fatigue limits that could potentially promote worsening of her symptoms. Modalities implemented included, but were not limited to: neurofeedback, Interactive Metronome, vestibular rehabilitation, metabolic/nutritional therapies, eye movement and neurological rehabilitation, electrical stimulation, breathing exercises and home care therapies.
Outcomes after Brain Training
Jackie reported prior to brain training that she would have a constant headache of 6 on a 0-10 scale (0 being no pain and 10 being the worst possible pain) that would escalate into an 8-9 of 10 by the end of the day. The week after her program she reported the headaches were finally manageable at a level of 3-4 of 10 and would not escalate. Jackie has had continued success and reported at 3 weeks after her program that she is headache free, unless she spends too much time in front of a screen or in a busy public place. She also reports that when this occurs, her ‘at home’ brain exercises will relieve them. Aside from headaches, Jackie has reported that she no longer feels like she is in a constant brain fog. Her heart rate has also normalized and no longer fluctuates or spikes.
Actual, measurable objective improvements recorded with post-intensive diagnostic testing include, but are not limited to:
Cognitive Testing: Jackie showed an increase in her Neurocognition Index of 11%. This is a standardized overall score of cognitive performance. Significant improvements in specific areas of memory (one of her biggest concerns) are as follows: 65% in composite memory, 33% in verbal memory, and 67% in visual memory.
Interactive Metronome: 56% improvement in motor timing accuracy and normalization of hyper-anticipatory timing tendency with motor tasks (i.e. premature response to a specified reference tone).
Videonystagmography (VNG): Significant improvements in numerous aspects of oculomotor (eye movement) functionality including: gaze holding, slow and fast eye movements, optokinetic responses, and spontaneous/involuntary eye movements.
Implications for others:
Diagnostic and functional tests can be used to direct an effective Brain Training program and improve post-concussion symptoms. Increased sensory and environmental sensitivities are common symptoms of post-concussion syndrome. There are several areas of your brain that process information from your environment and from your body. If these areas are damaged then it becomes difficult for the brain to process sensory input, resulting in fogginess, memory and cognitive issues, impaired processing of pain, and the many other symptoms seen after concussions. The frustration felt by individuals being made to feel they are “crazy”, as Jackie noted, is entirely unnecessary and driven by a health care system that is largely focused on diagnostic testing and lacking significantly in functional treatment options. There is great hope for partial and full recovery in most cases of concussion given a thorough investigation and functional interventions addressing the physical, cognitive, metabolic and lifestyle factors that influence brain health.
If you or someone you care about is experiencing ANY of these symptoms, or anything out of the ordinary related to a head or brain injury, call APEX Brain Centers now at 828.708.5274. You may also email us at [email protected] for more information and to set up a free consultation.
Ali presented to APEX Brain Centers in August of 2015 in search of concussion relief. She was struggling with a host of debilitating complaints due to multiple head injuries and concussions over the years. Headaches, brain fog, memory loss, anxiety, emotional distress, restless legs, tightness in the chest, tingling in her limbs, postural orthostatic tachycardia syndrome (POTS), dizziness, spatial awareness difficulties, loss of muscle mass and hair, gastrointestinal (GI) difficulties and more were all part of her normal daily experience. She was in a constant search for concussion relief. She had been to a host of specialists with limited outcomes; including osteopaths, naturopaths, ENTs, cardiologists, allergists, chiropractors, physical therapists, acupuncturists and massage therapists. She was an exceptional student and athlete prior to her injuries.
Ali traveled from Virginia to seek care at APEX Brain Centers in Asheville, NC in late August, 2015 on referral from a friend who had similar problems with exceptional outcomes at APEX. She underwent an intensive course of Brain Training where she was admitted into in an individualized program directed by extensive diagnostic testing, and led by clinicians highly experienced in functional neurology and functional medicine. What follows is a sampling of some of the cutting-edge clinical interventions and amazing functional gains Ali experienced during her time at APEX.
Intervention for Concussion Relief
Ali underwent comprehensive Brain Training at a frequency of 3 times per day over the course of 10 days (with 2 days off between each week for much needed rest and recovery). Her brain function was carefully monitored throughout the training process with measurement of EEG brainwaves, vital signs (particularly important in those with POTS), eye movements, balance, mental and physical timing, and more to ensure she was receiving the proper amount therapy to be effective; but not too much so as to reproduce/amplify symptoms. Laboratory tests were ordered to evaluate for suspected food reactivity, markers of inflammation, altered stress responses and amino acid insufficiencies; among other factors. Modalities implemented included, but were not limited to: neurofeedback (NFB), Interactive Metronome, vestibular rehabilitation, metabolic/nutritional therapies, eye movement and neurological rehabilitation, whole body vibration, electrical stimulation, cognitive training, breathing exercises and home care protocols.
Ali’s Outcomes after Brain Training
Subsequent to her initial Brain Training program, Ali reported subjective improvements in all areas of pre-intensive complaint. What follows are a sampling of Ali’s words describing outcomes in several of these areas:
My heart rate is down significantly and I have fewer palpitations
I rarely feel unbalanced anymore
The tingling in my hands and feet is gone
Brain Training has greatly decreased my widespread pain
Since leaving APEX I have only had a few minor headaches, and none that have turned into a migraine
Now I can really engage with my children for long periods of time
My emotions are on a more even keel
I can recover from a workout and exercise again the next day
My immune function is improved
I expect all of my capabilities to return and even excel beyond what they used to be in light of the new and better lifestyle I’ve adapted!
Cognitive Testing: Increase in her Neurocognition Index of 13%, which is a standardized overall measurement of cognitive performance. Executive function (reasoning) scores were improved by 35%. Increases in various aspects of memory, attention, processing speed and more were as high as 13%.
Interactive Metronome: 43% improvement in task average with motor timing and 15% improvement in hyper-anticipatory timing tendency with motor tasks (i.e. responding prior to a pre-set reference tone).
Computerized Assessment of Postural Stability (CAPS): 8.2% improvement in balance on an unstable surface with eyes closed; which brought her from a moderate to mild reduction in balance compared to her age and gender matched peers.
Videonystagmography (VNG): Significant improvements in numerous aspects of oculomotor (eye movement) functionality including: gaze holding, slow and fast eye movements, optokinetic responses, and spontaneous/involuntary eye movements.
It should be noted that due to the overwhelming success of her first program Ali returned for a second intensive Brain Training program in November of 2015. She experienced further objective and subjective benefit and continues to update us on her progress.
Concussion Relief IS Possible
An alarming number of individuals do not seeking care for head injuries. It is important to recognize the symptoms of these debilitating injuries and that something can be done about them. The ‘wait and see’ approach to concussion and mild traumatic brain injury is no longer acceptable. Early intervention is key! The longer one waits, the more difficult it is to recover and have full engagement with life!
If you or someone you love is experiencing ANY of these symptoms, call APEX now at 828.708.5274. You may also email us at [email protected] for more information, or to set up a free consultation.
As the buzz surrounding the release of the projected Christmas blockbuster movie Concussion grows; the evidence continues to mount in support of the seemingly insurmountable challenges posed by this ‘silent epidemic’.
Continued reporting from one of America’s most trusted public television investigative news sources, PBS’s FRONTLINE, demonstrates the urgency of the matter at hand; and the extremes to which it can lead… Dementia and, in severe cases, death!
The most recent FRONTLINE update from September 18, 2015, based on research from the Department of Veterans Affairs and Boston University, can be viewed in their article entitled New: 87 Deceased NFL Players Test Positive for Brain Disease. The most shocking part of this reporting is that the disease, chronic traumatic encephalopathy (CTE), was found in 87 of 91 player’s brains tested. Let that soak in for a moment… That is 96% of the brains tested in this particular ongoing study showing signs of a potentially avoidable killer disease. We will come back to this in a moment.
Some definitions, facts, and stats to ponder:
Concussion is a traumatic brain injury that alters the way your brain functions
Most sport-related concussions (almost 90%) occur with NO loss of consciousness (LOC)
A median 2.7 million TBIs occur in the US each year (think about how many go unreported), at a cost of nearly $50 billion annually
Symptoms of concussion include: headache, dizziness, balance and speech problems, nausea, light and noise sensitivities, memory and concentration difficulties, behavioral and emotional struggles, and anything out of the ordinary observed that was not an issue prior to the event/s
Risk factors for concussion include: prior concussion, vertigo/dizziness, alcohol/drugs, high-risk behaviors and sports (e.g. football, hockey, soccer, etc.), military conflict, abusive relationships, driving, and high-risk occupations (e.g. construction, utility work, etc.)
Mild traumatic brain injury (mTBI) is another word for concussion; even though, in my opinion, there is no such thing as a ‘mild’ brain injury
Chronic traumatic encephalopathy (CTE) is a progressive degenerative disorder of the brain found in those with a history of repetitive brain trauma
Symptoms of CTE include: memory and executive function decline, depression, irritability, impulsivity, aggressiveness, suicidal behavior, eventual progression to dementia
(All facts and figures presented are courtesy of the Centers for Disease Control and Prevention and The Mayo Clinic)
***Did you know??? Those with ADHD are significantly more likely to experience worse outcomes with a concussion than their non-ADHD peers. This is of extremely important note as many children are placed in sports to control problematic behavioral and academic challenges. Read the abstract from a paper on this topic presented in the Journal of Neurosurgery: Pediatrics***
Back to the FRONTLINE reporting of 96% of the NFL players’ brains containing direct indications of CTE. What is being revealed in this ongoing study is one of, if not the most, statistically significant findings of our times. Consider for a moment if you will… If there were an outbreak of any communicable disease in a family, school, small town, cruise ship, or some similar controlled group separate from our general U.S. population; it would take, in most cases, less than 1% of the population being affected to mobilize critical resources to control and eliminate such an outbreak. Why is nothing being done to prevent and treat this largely controllable epidemic that has been unfolding before our very eyes for some time now?
While there is an extraordinary amount of activity and funding being directed towards this catastrophe, we are still largely no further along in the detection, advocacy, and treatment for this ‘silent epidemic’. As a clinician who has been in the trenches working with concussion and TBI for over 15 years, the stark reality is that the vast majority of patients that have walked through the doors of our Center have been given the same advice: “Wait and see”. That is, to go without treatment in hopes of symptoms subsiding; which, in rough estimates from various sources, will not happen in approximately 25% of cases! In other words, at least one in 4 will continue with any or all of the debilitating symptoms listed above long after a blow to the head.
Why “wait and see”? The primary tests utilized after one has sustained a hit to the head and suspected brain injury are structural in nature. What this means is if you have nothing that shows up on a CT scan or MRI, you are structurally ‘OK’ and sent on your own to wait out the symptoms – possibly with the assistance of medications for pain, dizziness, nausea, etc.
What are often overlooked, or not acted upon if they are in fact implemented, are tests of brain function. There are a great number of ‘biomarkers’ of brain function that can be measured with great precision – that is, tests that tell us what’s going on in the body as a result of commands from the brain; and what might not be working well after a particular region of the brain area has been injured. What follows are some examples of these biomarkers that can be measured and improved in most cases of concussion and TBI:
Blood sugar, hormone regulation, and other metabolic functions
Once functional deficits are identified; a host of neurological, cognitive, and metabolic rehabilitative interventions and processes can be employed to normalize these functions as best possible – and, in many cases, entirely! Examples of such would include: eye movement therapies, gait training, neurofeedback, physiotherapeutic modalities such as electrical stimulation and vibration, nutritional therapies, aromatherapy, visual and auditory training, meditation, lifestyle changes, and more.
While the quest continues to identify the best, evidence-based practices to combat this growing epidemic with little to no therapeutic intervention being rendered in most cases; there are a small number of progressive centers that strive to provide highly effective functional clinical interventions, as opposed to “wait and see” that has failed so many. Given the apparent lack of immediate shifts in the cultural circumstances that are causing brain injuries, and the inability or lack of desire of many to abstain from behaviors that are causing them, it is imperative that intervention with any head injury be focused largely on the therapeutic aspects once adequate healing time has passed.
One parting thought: There remains a sentiment in opposition to studies of the nature of the one referenced in FRONTLINE; dismissing the evidence as an overreaction to, and sensationalizing of, data from a highly specific group of individuals (i.e. football players get head injuries). My question to you is: If just one person in your family, community, etc. were to contract a disease like polio; do you think there would be any discussion of overreaction to the impending action that would be taken to remediate the cause of this potentially crippling disease?
If you knew there was something you could do, then why “wait and see”?
No one is immune to the possibility of concussion; although athletes, children, senior citizens, and those with ‘high-risk’ jobs are much more likely to suffer head and brain injuries. No blow to the head should be taken lightly. The long-term effects of untreated concussions, under-treated concussions, or mistreated concussions can be wide ranging. The dysfunction caused by post-concussion syndrome can show up in many areas of life, including some areas you may not suspect. Here are 5 areas of life where a person with untreated concussion symptoms may struggle long after the injury has occurred:
Student athletes who suffer concussions may be sidelined; not only from sports activities, but also from classes. It is not uncommon for students to miss weeks or even months of school while dealing with symptoms of concussion. Symptoms such as eye pain, blurred vision, memory loss, attention disorders, reading comprehension problems, and fatigue can make it nearly impossible for children and adolescents to focus and concentrate on schoolwork with any degree of success.
It can be difficult to cultivate or nurture meaningful relationships when you are dealing with long-term challenges caused by brain injury. Symptoms such as ‘brain fog’, chronic pain, and emotional dysregulation can damage relationships with family members, friends, and colleagues.
Focus, attention, coordination, and mental timing are significantly impaired with most head injuries. These problems can have a profound negative impact on job performance. Left untreated, or inappropriately treated, the effects of these injuries can be long lasting and often lead to decreased hours on the job, extended leaves of absence, demotions, further injury, and even termination of employment.
Balance issues, vertigo, dizziness, headaches and other pain syndromes, heart rate irregularities, digestive issues, and even seizures are just some of the physical problems experienced by those with one or more concussions.
Mental illness and behavioral disorders including ADHD, anxiety, depression, phobias, PTSD, and addiction are often the end result for many with untreated head injuries. Stress and emotional turmoil, as well as long-term inflammatory responses and altered neurotransmitter function caused by head injury will very likely cause mental health challenges left untreated.
The bottom line is – you should always seek a thorough examination by a qualified practitioner after any head injury. There absolutely is hope for those suffering from the after-effects of concussions and post-concussion syndrome. Proper assessments and intervention strategies specific for your injury are the keys to improvement. For instance: quantitative EEG (qEEG) and neurofeedback, vestibular and balance therapy, assessment and treatment of eye movement, and physical training modalities such as the Interactive Metronome, are just some of the strategies that, if applied appropriately, can help you reduce and even eliminate many of the challenges and symptoms listed above. At APEX Brain Centers we offer this hope through specific, comprehensive Brain Training for these treatable injuries.
Call us now at 828.708.5274 if you or a loved one has, or thinks they may have, suffered a concussion.