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What is Concussion?

Questions and Answers

Neuro-sports Institute answers FAQs'

What is concussion or so called traumatic brain injury?

Traumatic brain injury (TBI) happens when a sudden, external, physical assault damages the brain. It is one of the most common causes of disability and death in adults. TBI is a broad term that describes a vast array of injuries that happen to the brain. The damage can be focal (confined to one area of the brain) or diffuse (happens in more than one area of the brain). The severity of a brain injury can range from a mild concussion to a severe injury that results in coma or even death.

What are the different types of TBI?

Brain injury may happen in one of two ways:

  • Closed brain injury. Closed brain injuries happen when there is a nonpenetrating injury to the brain with no break in the skull. A closed brain injury is caused by a rapid forward or backward movement and shaking of the brain inside the bony skull that results in bruising and tearing of brain tissue and blood vessels. Closed brain injuries are usually caused by car accidents, falls, and increasingly, in sports. Shaking a baby can also result in this type of injury (called shaken baby syndrome).

  • Penetrating brain injury. Penetrating, or open head injuries happen when there is a break in the skull, such as when a bullet pierces the brain.

What is diffuse axonal injury (DAI)?

Diffuse axonal injury is the shearing (tearing) of the brain's long connecting nerve fibers (axons) that happens when the brain is injured as it shifts and rotates inside the bony skull. DAI usually causes coma and injury to many different parts of the brain. The changes in the brain are often microscopic and may not be evident on computed tomography (CT scan) or magnetic resonance imaging (MRI) scans.

What is primary and secondary brain injury?

Primary brain injury refers to the sudden and profound injury to the brain that is considered to be more or less complete at the time of impact. This happens at the time of the car accident, gunshot wound, or fall.

Secondary brain injury refers to the changes that evolve over a period of hours to days after the primary brain injury. It includes an entire series of steps or stages of cellular, chemical, tissue, or blood vessel changes in the brain that contribute to further destruction of brain tissue.

What causes a head injury?

There are many causes of head injury in children and adults. The most common injuries are from motor vehicle accidents (where the person is either riding in the car or is struck as a pedestrian), violence, falls, or as a result of shaking a child (as seen in cases of child abuse). Recent years have shown an increasing reporting of acute and chronic traumatic brain injury.  Culminating in the movie 'concussion' and wealth of research highlighted in the following web page. Football & Rugby CTE>

What are the possible results of brain injury?

Some brain injuries are mild, with symptoms disappearing over time with proper attention. However this slow recover means detecting a long term complication is difficult as a comparison with a baseline of cognition and background symptoms is difficult to perceive. More severe and may result in permanent disability and in some cases can cause death, associated with a bleed within the skull that develops over the hours or possibly days following trauma. The long-term or permanent results of brain injure, both mild or severe TBI, may possibly lead to lifelong rehabilitation.

Growing evidence of the neural plasticity of the brain allows opportunity to recover neural pathways even when the previous pathways have been irreversibly damaged.  

New understanding is bringing hope of faster recovery (aRTP),management of symptoms and even significant improvements months and years after the injury was sustained. more information on the Neuro-sports treatments and rehabilitation pages.

Effects of brain injury may include:

  • Cognitive deficits

    • Coma

    • Confusion

    • Shortened attention span

    • Memory problems and amnesia

    • Problem-solving deficits

    • Problems with judgment

    • Inability to understand abstract concepts

    • Loss of sense of time and space

    • Decreased awareness of self and others

    • Inability to accept more than one- or two-step commands at the same time

  • Motor deficits

    • Paralysis or weakness

    • Spasticity (tightening and shortening of the muscles)

    • Poor balance

    • Decreased endurance

    • Inability to plan motor movements

    • Delays in getting started

    • Tremors

    • Swallowing problems

    • Poor coordination

  • Perceptual or sensory deficits

    • Changes in hearing, vision, taste, smell, and touch

    • Loss of sensation or heightened sensation of body parts

    • Left- or right-sided neglect

    • Difficulty understanding where limbs are in relation to the body

    • Vision problems, including double vision, lack of visual acuity, or limited range of vision

  • Communication and language deficits

    • Difficulty speaking and understanding speech (aphasia)

    • Difficulty choosing the right words to say (aphasia)

    • Difficulty reading (alexia) or writing (agraphia)

    • Difficulty knowing how to perform certain very common actions, like brushing one's teeth (apraxia)

    • Slow, hesitant speech and decreased vocabulary

    • Difficulty forming sentences that make sense

    • Problems identifying objects and their function

    • Problems with reading, writing, and ability to work with numbers

  • Functional deficits

    • Impaired ability with activities of daily living (ADLs), such as dressing, bathing, and eating

    • Problems with organization, shopping, or paying bills

    • Inability to drive a car or operate machinery

  • Social difficulties

    • Impaired social capacity resulting in difficult interpersonal relationships

    • Difficulties in making and keeping friends

    • Difficulties understanding and responding to the nuances of social interaction

  • Regulatory disturbances

    • Fatigue

    • Changes in sleep patterns and eating habits

    • Dizziness

    • Headache

    • Loss of bowel and bladder control

  • Personality or psychiatric changes

    Certain psychiatric disorders are more likely to develop if damage changes the chemical composition of the brain.

    • Apathy

    • Decreased motivation

    • Emotional lability

    • Irritability

    • Anxiety and depression

    • Disinhibition, including temper flare-ups, aggression, cursing, lowered frustration tolerance, and inappropriate sexual behavior

  • Chronic conditions later only recognized years after the trauma such as

  • Parkinsons

  • Altzheimers

  • Chronic Traumatic Encephalopathy CTE (read more)

Can the brain heal after being injured?

Most studies suggest that once brain cells are destroyed or damaged, for the most part, they do not regenerate. However, recovery after brain injury can take place, especially in younger people, as, in some cases, other areas of the brain make up for the injured tissue. In other cases, the brain learns to reroute information and function around the damaged areas. The exact amount of recovery is not predictable at the time of injury and may be unknown for months or even years. Each brain injury and rate of recovery is unique. Recovery from a severe brain injury often involves a prolonged or lifelong process of treatment and rehabilitation.

Treatments and Rehabilitation from traumatic brain injury

read more

Concussion

Syndrome

Concussion Syndrome - describes the range of experinecs and symptoms people experience,

It can be scary experiencing physical and emotional symptoms of a mild traumatic brain injury without knowing how or when they might cease.

The most severe and acute resolve within a few weeks or months, some rumble on to develop 'post-concussion syndrome'. Often those 'mild, residual symptoms are the biological warning lights to an even at greater risk for long term effects such as

dizziness, disorientation, (vestibular)

light sensitivity and double vision, (ocular)

migraine and headache, (brain)

brain fog, difficulty concentrating, (cognitive)

depression (emotional)

neuro-degenerative diseases

and many others

"Do not accept or assume  the mild symptoms will simply 'go away'. These are often early signs of a deeper neurological issues needing to be evaluated and treated."

There’s is concerning evidence, the longer you have post-concussive symptoms (3 or more years), the more difficult the recovery. The sooner action is taken, the easier and greater the success. However even long term post concussion syndrome can be treated, albeit with a longer road to recovery and lesser expectations of a full recovery especially in repetitive concussive events.

 

Migraine and Headache


Headaches are noted to be the most common symptom experienced by those who have sustained a concussion and can last for an extended duration of time. Among those who develop post-concussion headaches or migraines, nearly one-quarter can have recurring or chronic attacks for more than a year.


Light Sensitivity and Photophobia


It is well known that post-concussion syndrome can produce light sensitivity and photophobia, especially if headaches are also a byproduct of the condition. The unfortunate truth is that post-concussive patients have a higher likelihood of light sensitivity symptoms lasting beyond 6 months, further delaying recovery. Veterans who experienced a blast-induced concussion may be even more vulnerable to persistent photophobia.
Related: Vision: Light Sensitivity after a Concussion ➜


Dizziness and Vertigo


It is a terrible reality for perhaps as many as 20% of people who sustain any type of head injury do so many months and years after the tbi . Additional mitigating factors may affect the duration of symptoms, including the onset of vestibular migraine or even emotional symptoms like depression.

Vertigo immediately following the injury is “the single greatest risk factor for a prolonged recovery,” according to some researchers.
Related: Vestibular: Post-Concussion Dizziness & Vertigo ➜


Depression and Other Emotional Symptoms


Emotional symptoms are often a feature of post-concussion syndrome. Immediate and long term changes in personality, emotional symptoms, depression, anxiety, as well as cognitive issues such as concentration difficulties are features of post concussion symptoms.

The neuro basis of this is believed to be founded within the neurological psychology as well as neuro-physiology and aneuro-anatomy. Supporting a neuro-regenerative process may mitigate or reduce these effects.So a combination of neuronal rehabilitation as well as psychological support is indicated.

Related: Depression: Post-Concussion Depression & Personality ➜


Chronic Traumatic Encephalopathy (CTE)


Most people associate chronic traumatic encephalopathy—a degenerative brain disease—with sports, notably professional football. However, concussions are the key ingredient to the onset of CTE. Although a single concussive injury is unlikely to bring about CTE, there may be greater possibility for those with multiple and more severe head traumas. Symptoms typically start to show an average of 15 years after exposure and might include:
    •    Cognitive impairments including memory loss, changes in thinking
    •    Psychological changes including impulsive behavior, depression, aggression, suicidal thoughts
    •    Substance abuse
    •    Speech and language changes or difficulties
    •    Difficulty walking, weakness and tremor
    •    Changes in vision and smell
    •    Dementia
A person does not need to have been diagnosed with a concussion to develop CTE. You don't need to be  'knocked out or loose consciousness to develop brain or neurological trauma (mild brain trauma), instead, anybody who has endured repetitive hits to the head may be susceptible to neurological brain damage and re-organization. Science suggests 'early support' to reduce the inflammatory cascades can reduce the collateral damage that occur in the hours and days after the traumatic brain injury, thereafter supporting the neural re-genesis (neurological restructuring) may reduce symptoms and effects.

Related: CTE: Chronic Traumatic Encephalopathy ➜


Alzheimer’s Disease


Alzheimer’s disease is a type of progressive dementia which affects a patient’s memory, thoughts and speech—and is similarly a possible long-term effect of post-concussion syndrome. In fact, mild traumatic brain injuries have been shown to double the risk for Alzheimer’s—and it only increases the more severe the associating concussion(s).


Parkinson’s Disease


Concussions, particularly those which were characterized by a loss of consciousness, have been associated with greater instances of Parkinson’s disease too.8 It is believed that inflammation in and around the brain is the primary cause for the condition, which can lead to physical symptoms such as tremors, muscle weakness, and balance issues.

Top Symptoms of Post-Concussion Syndrome ➜


 

Post-Concussion Therapy

Diagnosing Concussion

Standard strategies
SCAT5 (subjective only)
VOMS - Vestibular (Subjective and Objective Tests based on thousands of Military subjects)

 

Clinic functional tests
Electro neuro diagnostics

Innovative Computer Devices

Mobile Apps

Eye Tracking (Tobii Devices) pupil reactions and Eye Movement..

Virtual Reality

Concussion First Aid

First Aid Box (IONIC)

Nutrition  (IONIC first aid box)

Hour 1

Hour 2-12 (stim-)

Hour 12-72 (stim-/+)

Hour 72+(stim ++)
Senses: Vestibular and Balance
 

Assessment and re-assessment app

Test Concussion App

Concussion Intervention step by step

IONIC - intervene  to Optmize  Nerves, in Concussion

Return to Play Protocol

Standardized Protocols


Accelerated and Individualized Protocol
Presentation and symptoms
Utilizing Innovative diagnostics to customized to the individual.
Accelerated return to play
 

Mature Neuro Rehabilitation

Neural Plasticity extends for years following  concussion.

Consussion Rehabilitation

Recovery from Concussion

based on the science of Neuro-Plasticity

 

  • Controlled neuro-genesis

  • First Aid Kit for Concussion

  • Immediate action to reduce 'concussion cascades'

  • Accelerated 'safe' Return to Play

  • Reducing chronic symptoms

  • Recovery from post-concussion syndrome

  • CTE,  ALzheimer's, Parkinson's Disease.