Concussions, also known as mild traumatic brain injuries, is a topic of growing concern for clinicians. Research has shown that nearly 30% of individuals report experiencing at least one concussion in their lifetime, with the average number of concussions being two. When we sustain a concussion, whether that be from whiplash or a physical impact, our brain rattles around our skull and can cause bending and twisting of the brainstem and injury to the cerebral cortex by hitting the skull in one or more places. As a result, individuals tend to experience a wide range of symptoms. This is from neural inflammation, physiological injury in the brain, neurometabolic changes, and systemic inflammation. These symptoms can be divided into a few different, but interconnected, categories.
Seven Categories of Concussion
Cognitive - This can include motor functions, decision making, sensory processing, behavior, attention, mental processing speed, etc. These symptoms are usually a result of cortical involvement. The cortex is responsible for higher functions, which are essentially what makes us human. Providers can perform cognitive assessment to narrow down the regions of impairment.
Oculomotor - Abnormalities with various oculomotor movements are associated with concussions. In fact, just over 60% of individuals with concussion report that they have symptom provocation after eye movement testing. When our eyes have difficulty navigating our environment, this can result in blurry vision, headaches, difficulty focusing, impaired cognitive function, attention, working memory, and more! Each eye movement has a different pathway through the brain, so evaluating the oculomotor system can be very telling for providers. This can help providers narrow down the area of dysfunction, and perhaps even use those eye movements to exercise those parts of the brain! This is why it is so important to evaluate the oculomotor system with concussion patients.
Affect - A change in affect is part of the clinical expression of concussion. Affect is an individual’s experience of mood, emotion, attachment, or feelings. Affective symptoms are included in the concussion symptom scale and include fatigue, sadness, irritability, sleep / wake disturbances, being emotional or anxious. It is estimated that up to 36% of concussion patients have emotional dysregulation symptoms. An individual’s mood is affected by a concussion due to physiological changes, neurological injury, or preexisting vulnerabilities.
Cervical Spine - There is a significant overlap between whiplash and concussion. In fact, you do not need to hit your head to get a concussion, it can be a result of whiplash! Trauma to the cervical spine can affect the cervical nerve roots, cervico-thoracic and cervico-scapular musculature, intervertebral discs, joints, and the trigemino-cervical nucleus which receives information from the face and the top three cervical spine nerves. Trauma to this area can cause neck pain, headaches, dizziness, and balance issues.
Headaches - The most common symptom in concussion patients is a headache. However, there are different types of headaches that exist. Concussion patients can have migraines, tension headaches, cervic-genic headaches, or post-traumatic headaches. Migraines are typically unilateral, throbbing, and patients have sensitivity to movement, light, sound, and sensation. Tension headaches are usually preceded by stress and feel like a tightening sensation on both sides of the head. Cervico-genic headaches are unilateral, dull, achy, occasionally feel like a tightening sensation, and are provoked by neck movements or postures. Post traumatic headaches are secondary to trauma or injury. They can feel like migraines, or even like tension headaches.
Cardiovascular - Various cardiovascular manifestations are correlated with concussions. Exercise intolerance, altered heart rate variability, POTS, dysautonomia, tachycardia, and other symptoms have been reported. This is because when we sustain a concussion, we have bending and twisting of our brainstem, which controls 90% of our autonomic nervous system output! The autonomic nervous system is responsible for regulating heart rate, blood pressure, vascular tone, and more.
Vestibular - Up to 81% of concussion patients show vestibular abnormalities on initial examinations! The vestibular system receives input from the oculomotor system, the brainstem, cervical spine, spinal cord, cortex, cerebellum, and peripheral sensory systems. The vestibular system originates in our ears, but we also have central vestibular nuclei located in our brainstem. When we have vestibular dysfunction, we can have vertigo, dizziness, gait issues, oculomotor dysfunction, difficulties with balance, etc.
CFNC’s Approach
All of the doctors at CFNC are trained in the diagnosis and treatment of concussions and post-concussive syndrome. To find the area (or areas) of dysfunction in the brain, we need to use in depth diagnostics to measure oculomotor function, neural timing mechanisms, cognitive function, balance, coordination, and so much more. Treatment is tailored to the individual and their brain, so there is not a one size fits all treatment plan that is conducted. Therapies may include neuromodulation, vestibular therapy, eye movement therapy, red and near infrared light, neurosensory motor integration, interactive metronome, bemer, hyperbaric oxygen therapy, or another tools. If you have suffered a concussion or are dealing with post-concussive symptoms, it is important to get individualized treatment as soon as possible!