APEX Brain Centers

Concussion – Look To The Eyes

concussion-eye-exam

While a thorough neurological history and examination with a qualified professional should be performed for any suspected head injury, particular emphasis should be placed on the cranial nerves – the nerves that exit your brain and brainstem.  Of these cranial nerves, the most telling findings will likely come from the ones involved in vision and eye movement (cranial nerves 2, 3, 4, and 6).  It is also critical to assess higher brain centers that control various eye reflexes, which will be discussed later in this article, during the eye examination as well.

There are many types and causes of head injury, but, by far, the most common are concussions related to motor vehicle accidents and contact sports.  A concussion comes from the Latin ‘Concutere’, which means to shake violently.  Most experts would agree that these are the least serious type of brain injury; yet left untreated many can suffer devastating and debilitating consequences such as vertigo/dizziness, balance problems, cognitive dysfunction, emotional disorders, headaches, and many others.

Given concussions are ascribing to this ‘low severity’ status, timely evaluation and treatment are often poor or non-existent at best.  Patients are often treating with a ‘sit-and-wait’ approach; meaning it is only after signs and symptoms have manifested and worsened that people often seek the care of their own accord.  This is entirely unacceptable as early intervention is critical with concussions, as is the case with most disorders of humankind, and it may significantly decrease the likelihood of more serious consequences.  The longer one’s brain is adapting to negative changes incurred as a result of a head injury (referred to as maladaptive plasticity), the longer it will take to rehabilitate their way out of them!

Shifting our focus back to the eyes (pun intended); most individuals that have suffered a concussion will complain of some type of symptom related to eye function (e.g. blurry vision. Light sensitivity-photophobia, eye fatigue, double vision-diplopia, reading difficulties, etc.).  I cannot honestly recall a single case of concussion presenting to my office. In recent years that did not have some type of visual or oculomotor (eye movement) consequence.

We have all seen it at some point on TV or the ‘Big Screen’. A doctor shines a light in someone’s eyes to look for a lack of pupil constriction. As the one and only diagnostic factor for concussion.  Well, I’m here to tell you that they need to be looking at a great deal more than that!  Some basic tests to look for when you or a loved one is examining for suspected concussion are as follows:

1)     Observation for eye malposition
2)      Direct and indirect pupil response to light (as noted above)
3)      Cardinal fields of gaze (eye movements in all directions)
4)      Observation of slow and fast eye movements, and termination of said movements
5)      Eye convergence (crossing of the eyes – as your mother told you to never do!)
6)      Ophthalmoscopic examination (looking inside the eyes)
7)      Visual acuity/Snellen chart (how well you see)
8)      Eye cover/uncover testing (more sensitive test for eye deviation)
9)      Eye dominance and/or suppression testing

While not an exhaustive list, these tests can be done in a very short period of time (5 minutes or less). with very little equipment. And can reveal a great deal about the integrity of these cranial nerves. As well as the higher brain centers that regulate these functions.

That said, there are a host of other very sensitive tests that can offer clinicians incredibly valuable. Insight into the workings of the ocular (eye) system and its connections with most parts of the brain.

1)      Vestibulo-ocular reflex (VOR) testing – often performed with the patient focusing on an object while the examiner moves the head, or while the patient is rotated in a chair

2)      Testing for eye saccades (fast movements between targets) – movements are typically over or under-compensated with a concussion

3)      Cortical blind spot mapping – mapping of the visual defect created by the optic nerve attaching into your retina where there are no receptors for light (rods/cones)

4)      Testing for optokinetic nystagmus (OKN) – reflexive eye movement caused by tracking of movement within a visual field (i.e. similar to looking out a car’s side window while moving)

5)      Electronystagmography (ENG)– advanced electrical testing of various ocular capabilities

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Once again, this is by no means an exhaustive list of assessment tools available. To the practitioner for evaluation of the eyes and associated brain systems after a head injury. And evaluation options will vary depending on the type of practitioner utilized for assessment (e.g. DC, DO, MD, PT, Ph.D., etc).

In my humble opinion, given their astute focus on ‘functional’ abnormalities of the nervous system, functional neurologists such as Chiropractic Neurologists are best equipped to deal with these types of conditions; meaning those injuries where there is no observable ‘structural’ damage to the brain.  It is no secret that our modern health care system fails to acknowledge and treat these ‘functional’. Brain injuries effectively and the long-term ramifications of this ‘sit-and-wait’. Behavior can be absolutely devastating.

While I agree there is a greater awareness of brain injury given the publicity. Provided to it primarily from the great men and women. That injured serving our country in the past decade. Along with all the attention more recently in professional sports; I still feel the attention and treatment given to those with ‘milder’ brain injuries. Like concussion is poor at best within our current system. And this opinion is validating and reinforced daily in my clinic. When I see the changes in folks and their families that have been advising to ‘sit-and-wait’. While many sports programs at all levels are implementing strategies. Such as sideline visual tests like the King-Devick test that are remarkable for evaluating concussion within minutes of the injury. Please help us in this mission and pass this on to everyone. You know as no one is immune to the possibility of head injury!

~Please check back soon for a follow-up article discussing successful non-pharmaceutical treatment interventions for concussion and TBI~

Dr. Michael S. Trayford is a Board Certified Chiropractic Neurologist and Neurofeedback Specialist with over 20 years of experience in the practice of advanced functional neurology. He is one of the most highly sought-after brain rehabilitation specialists because of the life-changing outcomes his patients consistently experience. After over a decade in private practice and working alongside other pioneers in the field, Dr. Trayford developed his multimodal intensive brain training and rehabilitation program built around the science of Neuroplasticity – the ability of the brain to learn and grow dependent upon the stimulation it receives from its environment. He later founded APEX Brain Centers to combine his ground-breaking rehabilitation approach with a unique patient and caretaker-centered care model. Under Dr. Trayford’s leadership, APEX Brain Centers has successfully treated thousands of patients and earned the reputation of a world-renowned brain training and rehabilitation practice. Since its inception, Dr. Trayford has been a leader of the Brain Training revolution treating patients worldwide. In addition, he is a published journal contributor and international lecturer. His experience with various patients of all ages and neurological conditions has given him a unique perspective on brain health and human performance. He is also well-versed in collaborating with other health care professionals, making him an invaluable asset to any care team. Dr. Trayford was awarded the Functional Neurologist of the Year distinction by the International Association of Functional Neurology and Rehabilitation, where he is a proud member and conference lecturer. Currently, he serves on the Advisory Council for the Dementia Society of America and the Board of Directors for the International Society for Neuroregulation and Research. He is also a servant leader who has dedicated his adult life to serving multiple communities through Rotary International and other notable causes. When he’s not treating patients, Dr. Trayford usually reads or researches anything related to the brain, human performance, and leadership. He also loves spending time outdoors with his wife Denise, their two daughters, and dogs in the beautiful mountains of western North Carolina. https://www.linkedin.com/in/drmichaeltrayford/

4 Comments

  1. Tresa on June 13, 2016 at 7:20 am

    Being recently injured with severe whiplash is taking it’s toll. I’m told no simulation to the brain, but at the same time there must be more I can do to help myself along. Your article has given me those insights. Thank you.

    • Dr. Michael Trayford on June 21, 2016 at 5:31 pm

      Tresa:

      There is always more that can be done to help those along that have had whiplash and possible concussion.

      Please call us at 828-708-5274 for a free consultation of you’d like to discuss further.

  2. Tresa on June 13, 2016 at 7:20 am

    Being recently injured with severe whiplash is taking it’s toll. I’m told no simulation to the brain, but at the same time there must be more I can do to help myself along. Your article has given me those insights. Thank you.

    • Dr. Michael Trayford on June 21, 2016 at 5:31 pm

      Tresa:

      There is always more that can be done to help those along that have had whiplash and possible concussion.

      Please call us at 828-708-5274 for a free consultation of you’d like to discuss further.

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