It’s All About Resources
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.
Brain Injury Awareness Links
As the Old Saying Goes…
…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:
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:
- Eye movements
- Physical timing
- Cognitive abilities (e.g. memory, focus, attention)
- Vital signs (e.g. heart rate, blood pressure, breathing)
- 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”?
Google defines ‘boot camp’ as: a short, intensive, and rigorous course of training. Aside from the obvious military style boot camp, many are seeking out boot camps in all shapes and sizes to help with everything from fitness to addiction.
Why not boot camp for your brain???
A basic understanding of how the brain works will help you realize that a boot camp is the most effective way to train your brain. From those with neurological issues, to those looking to elevate their level of performance to new heights, a well-trained brain will help ensure you are functioning at your highest possible level (both physically and mentally).
Neuron Theory, 101
Your brain’s sole purpose in life is to receive and transmit information. Sensory information from the environment and your body travels up to your brain to be processed; and thoughts, actions, hormone circulation and more are the end result of that input. The brain receives and transmits information through neurons (nerve cells), more specifically networks of neurons, in the brain and body. The more powerful the information traveling in those networks, or pathways, the stronger they become. In short, from a theory developed in the mid-20th century by the psychologist, Donald Hebb: cells that fire together, wire together!
What determines if cells get ‘wired’ together is the intensity and frequency of the stimulation delivered to them. There can be equal parts frequency and intensity, or more of one or the other. Using the example of learning how to play a guitar; one can play 10 minutes per day, 5 days per week – representing moderate frequency and low intensity – and could expect slow gains in the ability to play guitar. The same individual could participate in a ‘guitar boot camp’ playing for 1-2 hours, 3-5 times per day, for 5 days – very high frequency AND intensity – and expect to make much larger gains in their skills on 6 strings.
Now, About that Brain Boot Camp
Paying respect to the understanding that cells that fire together, wire together, it should now make good sense that training of brain function would yield the greatest outcomes in this high frequency, high intensity boot camp model. Every brain is different and unique, and faced with its own sets of strengths and challenges; and the frequency and intensity of individual aspects of Brain Training can be adapted to fit these unique needs.
Another added benefit of the boot camp training model is that of fitting a great deal of learning into a very short period of time. Moms and dads, sons and daughters, athletes and CEOs, brain injured and infirmed – time is a valuable commodity, and to compress months (if not years) of benefit and improved quality of life into a 5, 10, or 15 day period of time is something most folks could not put a price tag on. Further, the longer we wait (and the longer it takes) to train our brains, the less benefit we will gain from the experience.
To learn more about our Asheville, NC based Brain Boot Camps for learning and behavioral issues, peak performance, concussion and brain injury, and more; contact us at 828.708.5274 for a FREE 15 minute consultation.
A young soccer player, a third grade girl I’ll call Annabelle, came to see me seeking relief from disabling eye pain, lack of visual focus, depression, and anxiety. Annabelle had been living with these symptoms for quite some time, ever since she suffered a mild blow to her head during a game. After the injury her family took her for treatment immediately, and she was diagnosed with a concussion. The physician who saw her told her family to “wait out” the symptoms. So they waited. And waited. The longer Annabelle waited, the worse her symptoms seemed to get. Annabelle had to give up soccer, and started missing an extraordinary amount of school. In my practice I see head injury victims like Annabelle, and the long-term effects of the “wait and see” approach to concussions all too often.
Concussions are one of the greatest concerns for young athletes in this country today. One quarter of a million young people visit emergency rooms every year to seek treatment for sport or recreation related brain injuries, according to the Center for Disease Control. It is thought that many more concussions go untreated because of lack of awareness about the dangers of head injuries. Research into the problem suggests other reasons why concussions go unreported. A study conducted by The Institute of Medicine and the National Research Council concluded that there is a “culture of resistance” among athletes to report concussion symptoms. Many young sports players, their coaches, and families take the wait and see approach. Annabelle’s story demonstrates that many health care practitioners do the same.
The White House Concussion Summit
Recently, President Obama hosted the first ever White House Healthy Kids and Safe Sports Concussion Summit to spread awareness of brain injury prevention and offer resources to recognize and appropriately respond to concussions in young people. After the event, the White House released a fact sheet on sports related concussions aimed at young athletes and their families. What is most striking to me in this release is the continued realization that there are significant gaps in concussion research knowledge, and the statement of, “The truth is we still do not know enough about the consequences of traumatic brain injuries, (whether) it’s a hard knock on the playing field or head injury sustained by one of our troops serving abroad.”
I have personally observed the consequences of mild to severe traumatic brain injury (TBI) in clinical practice for nearly 15 years now, and this perceived lack of understanding of the consequences, in my humble opinion, is the primary reason for the general apathy and “sit and wait” approach most follow when it comes to dealing with mild brain injury or concussion. The greater issue, which is suggested in the White House release from the summit, is the need for better education for and coordination between athletes, parents, coaches, educators, providers, and other stakeholders.
The White House concussion summit offered a lot of reasons for hope, including new research that is being funded by the NCAA, the NFL, and many educational, governmental and non-profit institutions. While it’s encouraging that communication barriers are being broken down and much needed research and guidelines are being assembled, the truth is that today’s young athletes could be receiving much better and swifter care for concussion injuries. There are already effective methods for dealing with brain injuries that deserve more attention. The symptoms, objective markers and testing, treatment options, and long term dangers of concussion are in fact well understood by those clinicians dealing with brain injury on a regular basis.
A Different Approach to Concussion Injuries for Today’s Young Athletes
Functional neurologists are very likely the best equipped clinicians to deal with the ramifications of brain injury in youth, as they are well-versed in function of motor, balance, eye movement, cognitive and emotional, autonomic, and other systems often impacted by blows to the head. They also have at their disposal diagnostic testing procedures to assess function in all of these areas and, most importantly, an exhaustive list of rehabilitative tools to effectively treat these potentially devastating injuries.
As a Functional Neurologist, I have a different approach to concussion. When Annabelle came into my office I did not tell her to “wait and see.” I gave her a full neurological evaluation and ran many other test regimens, including eye movement testing with videonystagmography. Her results revealed that the parts of her brain responsible for visual focus, object tracking, and balance were not performing functionally. Other problems were uncovered as well, including measurable challenges with sequencing and planning in the front part of her brain. After an intensive 5 day course of brain training specific for her measured deficits she returned to school, and was able to finish the rest of her school year without any further problems. She told me, “I am normal again.”
With greater education and awareness of treatment options available today, we can help young athletes like Annabelle get back on their feet, and back to enjoying the quality of life they deserve, without waiting a second longer!