What Is A Concussion?

Jul 27

Written By Dr. Glen Zielinski DC, DACNB, FACFN, CBIS

A concussion is a form of mild traumatic brain injury. A concussion results in abnormal brain function, and can have a profound impact on an individual’s quality of life.
Concussions are the most common form of mild traumatic brain injury, or mTBI. TBIs are usually the result of a blow to the head of some kind, however they can also be the result of rapid rotational forces that injure brain cells.

How Common are Concussions?

Traumatic brain injuries and concussions are serious problems. There are millions of mTBIs each year in the United States. According to the CDC, there were 2.87 million TBI-related emergency department visits, hospitalizations, and deaths in the US, including over 837,000 involving children (1).

What Causes Concussions?

Concussions are very common in sports, are often seen in motor vehicle collisions, and are very commonly the result of falls among older adults.

Most concussions are mild injuries, and their symptoms usually go away on their own without treatment. Unfortunately, a large number of people that have suffered concussions have symptoms that persist for months and years into the future. Up to 15% of concussions result in what is called Post-Concussion Syndrome, or PCS. This can be a profoundly disabling condition that impacts every aspect of the person’s life and those of their family (19).

What are the Symptoms of a Concussion?

People injured with concussions can struggle with headaches and head pressure. They can experience debilitating dizziness and vertigo, and may struggle with balance problems. They may have difficulty with blurry or double vision. They can struggle with sensitivity to light and sound, and are frequently overwhelmed in complicated sensory environments. Concussion sufferers may experience profound fatigue, and may struggle with concentration, attention and focus, memory, word-finding, and emotional regulation (20).

What are the Consequences of a Concussion?

Concussions can have profound impacts on every aspect of your life. You can lose the ability to function in the world. Simple tasks such as reading can become exhausting and provoke your headache and dizziness. Following conversations or even basic mental tasks can be exhausting. Going to a grocery store can become a special level of hell. Driving or riding in cars can provoke headaches, dizziness, and panic attacks. Using screens or working on computers can cause all of your symptoms to increase. In short, after a concussion even the simplest tasks can become insurmountable.

Depression, anxiety, post-traumatic stress disorder, and emotional distress are common long-term consequences of concussions. Rates of substance abuse are higher following concussions (2).

Sleep disorders are common long-term consequences of concussion (3), as is chronic pain (4). Job and academic performance are frequently decreased, leading to wage losses and increased rates of unemployment (5). Concussions also tragically increase the risk of suicide (6).

What Happens to the Brain in a Concussion?

Brains are made up of several types of cells. The type that most people think of when they hear “brain cell” is a neuron, the primary cell involved in the electrical activity of the brain. You brain has billions of individual neurons, all continuously sending electrical messages back and forth between each other. There are also several types of supporting cells called glia. Glial cells provide important structural functions, and do things ranging from helping neurons communicate with each other more efficiently to cleaning out metabolic waste.

Neurons have cell bodies, sites where other neurons attach called dendrites, and long thin projections called axons. Most of the brain’s cell bodies are found in the cerebral cortex, in the hills and valleys of the first few millimeters of the brain, also known as gray matter. The majority of the rest of the brain is white matter, made up of axons running back and forth between neurons in pathways. These axons can range from extremely short to several inches long. As axons are projections from a single cell, they are very fragile, and have poor resistance to stretch and shearing forces.

When the brain undergoes either an impact, a fast twisting force, or both, axons can become damaged. Depending on the trauma, this may injure an individual group of axons, or create a diffuse axonal injury that affects multiple brain regions and pathways. Neurons within particular pathways may be damaged such that they lose efficiency, or be lost altogether (21).

When brain cells are injured, a number of important processes take place. Cells called microglia become activated to promote inflammatory processes that help heal damaged tissue. Depending on the individual’s previous level of inflammation, sometimes the microglial response is exaggerated and leads to further damage. Fragile neurons have different needs for oxygen, nutrients, and blood sugar. In many cases the ability for the brain to properly fuel brain cells can be damaged, resulting in further injury (7).

As the brain heals, the neurons that remain are forced to take on the function of the damaged and lost cells. Depending on the extend of the injury, this may be easy or impossible. At times neurons are forced to do more than they can handle, which can overstimulate them and cause further injury. Neurons are not like muscle cells, in that with muscles the best way to build strength is to push them to the point of failure. When neurons are stimulated past their point of fatigue, they generally die off. One of the main problems we see in post-concussion syndrome is neural pathways that are continuously fatiguing as they are required to perform not only their previous functions but those of lost cells as well (22).

How are Concussions Usually Treated?

Concussions and other forms of mTBI are first treated with instructions to rest and avoid sensory input. Unfortunately, many people that we see have received no further guidance on how to improve their persistent concussion symptoms.

As symptoms improve, people are guided through a process of graduated activity, with the goal of return to their full previous activity level. In some cases, this is successful. In more complicated cases where people are struggling to improve, they can be guided through a process that involves rehabilitation involving physical therapy, speech and occupational therapy, vision therapy, and vestibular therapy (23).

Many people get better with therapy, but unfortunately many others have incomplete recoveries. Millions of people suffer with long-term effects of brain injuries, and many of them have given up hope of ever living a life like they once had.

How is the NeuroRescue Program Different?

One of the main things your brain does, and maybe even the primary thing, is help you determine where you are in the world. Your brain uses inputs from your inner ear to figure out where your head is in relation to gravity and how it is moving. It uses inputs from your muscles and joints to figure out where your body is in relation to your head and what your body is doing. It uses inputs from your eyes to figure out where your body is in relation to the visual environment.

Your brain needs to put all of that together to make sense of where the world is, and where you are in relation to the world. It needs to be able to localize you effectively in the environment, in order for you to be able to respond to the environment properly.

When your brain is injured by a concussion, we regularly see damage to pathways that involve the eyes, the inner ear, muscles and joints, among many others. It is important to understand that concussions are rarely only about injuries to the visual system, the inner ear, or the neck. Perhaps the primary problem in concussion and mTBI is damage to the neurological mechanisms that allow all of these systems to work together. In most cases of mTBI and post-concussion syndrome, at a foundational level a failure of integration exists between the eyes, the vestibular system, and proprioceptive feedback from muscles and joints.

This is why many patients fail to fully resolve their concussion and mTBI challenges with vision therapy, vestibular therapy, physical therapy, chiropractic treatment, manual or massage therapy, and medication management. While all of these therapies can help with problems in the individual systems, none of them take the comprehensive NeuroRescue Program approach to address all of the systems involved in a brain injury and their ability to work together in harmony.

How Does the NeuroRescue Program Work?

We design your unique NeuroRescue Program to be among the most comprehensive diagnostic and therapeutic protocols available today. We create individual NeuroRescue Programs based on a comprehensive analysis of every relevant neurological system and pathway, using gold-standard, cutting edge neurodiagnostic technologies and examination procedures and state-of-the-art therapies.

We begin with your Discovery Day, wherein we perform a comprehensive history of not only your condition, but your life on a timeline. This allows us to dive deeply into your case and see all of the factors that led to where you are now. It helps us uncover hidden problems and associated conditions that may be making it difficult for you to move your recovery forward.

Our examination allows us to identify the areas and pathways of your brain that have been impacted by your brain injury. We begin by precisely quantifying the function of your visual, vestibular, and proprioceptive systems through computerized analysis of your eye movements, your inner ear reflexes, and your balance in a host of different sensory conditions.

We employ technologies including Videooculography and Saccadometry to measure several classes of eye movements. We use Video Head Impulse Testing to measure the function of your inner ear, and Computerized Dynamic Posturography to assess your balance in different sensory conditions.

We use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and perception of vertical in a virtual reality environment.

We combine all of this with a comprehensive physical and neurological examination of your sensory, motor, autonomic, and cognitive systems. We review any relevant laboratory testing, radiological imaging, and prior neurodiagnostic testing, and integrate that information with our findings.

We use this information to identify which parts of your brain are working properly, which systems are struggling, and the precise point at which your systems fatigue.

We can then design a NeuroRescue Program that is unique and specific to your brain, and yours alone. Your NeuroRescue Program works to rejuvenate and reintegrate the damaged neurons and pathways in your brain. It works to improve energy, endurance, and functional capacity within your fragile systems.

All of our therapies are backed by the latest neuroscience research. Our therapies may involve eye exercises designed to improve gaze stability (8), or the ability to successfully hit targets with your eyes (9). They may involve exercises to restore reflexes involving your inner ear, your neck, or both (10). They may include exercises to improve your balance under specific conditions (11). They may involve vision training exercises using specific therapies that integrate several modalities at the same time (12). They may involve things like specific types of electrical stimulation (13), transcranial magnetic stimulation (14), or even specific exercises performed in a virtual reality environment (15). Research shows that taking a multimodal functional neurological approach to treating traumatic brain injuries is extremely effective, and that the effects are lasting (16,17,18).

We use our technologies and procedures to not only see what we need to address, but also when it is time to stop and let you rest. We address your impaired neurological function from multiple angles of therapy, and provide metabolic support to improve neurological recovery.

While we cannot bring back neurons that have been lost, your NeuroRescue Program allows us to take the pathways that remain and maximize their efficiency and endurance. And by focusing on the integration of systems, we can do more than just get pathways working better, we can get them working together again. This gives us our best opportunity to return you to living a healthy, vibrant, and fulfilling life.

Your Next Best Step:

Living with the consequences of a concussion can be challenging, but there is hope for recovery. Symptoms can often be improved, function can be regained, and quality of life can be restored.

To see if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.

And remember, it’s never too late to start getting better.