Mild Traumatic Injury

A Commentary on Concussion, Mild Traumatic Brain Injury (mTBI), and Chronic Traumatic Encephalopathy (CTE)

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:

• Balance/Gait
• Eye movements
• Physical timing
• Smell
• Cognitive abilities (e.g. memory, focus, attention)
• Brainwaves
• 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. 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” which 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 too, 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”?