As a society, we are becoming increasingly aware of the lingering effects of Concussion, or mild Traumatic Brain Injury (mTBI). Many people have a tendency to underestimate head injury, in part because of how common it is. In the past, traumatic brain injury was thought to only occur in patients with Loss of Consciousness (LOC). We now know that LOC only occurs in about 10% of cases with mTBI. Many sports-related injuries and minor motor vehicle accidents result in mTBI. mTBI can result in long-term difficulties with cognitive functioning and emotional and behavioral regulation.
The acceleration-deceleration forces that impact the brain result from the brain traveling at a differential speed than the skull, resulting in coup- ContreCoup injuries often affecting multiple regions of the brain. These forces often result in axonal shearing in the brain’s neurons, which is unable to be detected by CT or MRI scans. This neuronal injury leads to a metabolic cascade marked by an efflux of potassium and an influx of calcium, which leads to over-excitability and scrambled neuronal communications within the brain. The impact of Concussion/mTBI affects multiple regions of brain functioning and the connectivity between these regions, often involving frontal, temporal and occipital regions of the brain.
RBH utilizes the Neuropsychological Impairment Scale and the Post Concussion Symptoms Scale to assess the clinical symptoms resulting from Concussion. Many ongoing cognitive and neurophysiological symptoms can linger from mTBI:
- Post-Traumatic Migraines
- Loss of Concentration
- Slowed Reaction Time/Neuromotor Inefficiency
- Visual Strain/Fatigue
- Light Sensitivity
- Brain Fog/Slowed Cognitive Processing Speed
RBH can additionally offer QEEG assessments of the brain’s neurophysiological sequalae from mTBI. QEEG findings associated with mTBI have included impairments in Absolute and Relative Power as well as connectivity measures of Coherence between regions of the brain.
RBH can offer Return-to-Play recommendations based on these specific assessments which are repeated throughout the course of the Concussion recovery period. Ample rest and protection to avoid Second Impact Syndrome are part of the Concussion Management Protocol Recommendations. Cognitive Task Load Adjustments are also often recommended, with appropriate workplace and/or academic accommodations as needed. Avoidance of Overstimulation of Visual and Auditory Information is important as well.
Chronic Traumatic Encephalopathy (CTE) has received increasing attention in the research based on chronic clinical difficulties experienced by NFL football players who have received repeated mTBIs. Severe cases of CTE have resulted in dementia-like symptoms, with marked neurocognitive impairment and difficulties with affective regulation associated with depression, anxiety, and suicidal ideation. Functional difficulties in managing daily activities, maintaining employment, and sustaining healthy and empathic relational function are often impaired. RBH is participating in a nationwide study of the clinical benefits of High Performance Neurofeedback for NFL players who have suffered repeated concussions. Neurofeedback has been shown to be very helpful in reducing some of the negative cognitive and emotional difficulties stemming from TBI.
RBH offers an integrative assessment of the Neurocognitive and Vestibular-Occulomotor symptoms associated with Concussion/mTBI. While there is no one test for concussion, RBH utilizes the well-respected IMPACT concussion testing to assess verbal and visual memory, processing speed, and reaction time.
Accurate assessment of the brain’s neurocognitive and Vestibular-Oculomotor function allows for a specific Concussion Management Protocol Plan for that individual. RBH follows the protocol developed by the UPMC Sports Medicine Program. The VOMS Assessment evaluates the brain’s integration of vestibular and sensorimotor functions to orient in space. This assessment can often be helpful in predicting outcome based on symptom provocation under activation of these systems. Follow-up with Vision Therapy may be helpful. VOMS assessment evaluates symptoms under Smooth Pursuit, Horizontal and Vertical saccades, Convergence, Horizontal and Vertical Vestibular Ocular Motor Reflex (VOR), and Visual Motion Sensitivity