No Minor Concussions
Nothing “Minor” About Head Injuries
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There is nothing “minor” about a minor traumatic brain injury. Evidence demonstrates that our ability to process new information may be reduced after minor head injury and that the severity and duration of functional impairment may be greater with repeated head injuries. (Robert Cantu, 1998). It has also been noted that traumatic brain injury (TBI) can result in long term physical, cognitive, behavioral and emotional consequences. (Langlois, Rutland-Brown, & Wald, 2006) Some of the associated consequences of TBI include depression, binge drinking, epilepsy and Alzheimer’s. (Langlois, Rutland-Brown, & Wald, 2006)
As many as 1.6 million to 3.8 million sports related TBI’s, occur each year. This number may be low given the significant number of unreported cases. Furthermore, only 8%-19.2% of TBI in sports involve loss of consciousness. (Langlois, Rutland-Brown, & Wald, 2006) Therefore, over 80% of brain injuries are lower grade without loss of consciousness. These lower grade concussions often go undetected as result of their subtle signs and the tendency of athletes to disregard their symptoms as minor or inconsequential.
Concussion awareness is improving. Thankfully, new technology like the CAPS force plate from Vestibular Technologies, may provide a very fast and valid assessment tool for detecting lower grade concussions. Sophisticated force plate technology, like the CAPS unit, can identify postural stability deficits lasting approximately 72 hours following sport-related concussion. “It appears that postural stability testing provides a useful tool for objectively assessing the motor domain of neurologic functioning and should be considered a reliable and valid addition to the assessment of athletes suffering from concussion…” (Paul McCrory, 2009).
From a prevention standpoint the vestibular system is directly responsible for joint stability. Poor integration from vestibular system equals unstable joints which results in greater likelihood of injury. When you consider things from a functional standpoint it is not an either or situation but a continuum. The vestibular system can always be strengthened just like a muscle can always be stronger.
Of course a better alternative would be to avoid head injuries all together. Robert Cantu points out that an “athlete’s head can sustain far greater forces without injury if the neck muscles are tensed, such as when the athlete sees the collision coming.” (Robert Cantu, 1998) Quicker thought processing, focus and improved motor coordination would logically decrease the likelihood of injury. In sports, things can happen in milliseconds. There are countless circumstances in competition where a visual, auditory or thought distraction would lead to injury.
Technology, like the Interactive Metronome, improves thought processing, focus and motor coordination and should prove beneficial not only for rehabilitation of TBI but also in the prevention of TBI or other injuries. Awareness, reaction time, and stability of joints (as noted above) are key elements to injury prevention.
Historically the Interactive Metronome has been used for ADHD, balance disorders and traumatic brain injury rehabilitation. It is becoming more common for athletes to not only use this technology for rehabilitation but also as a tool to improve their thought processing, focus and motor coordination above what would be considered “normal” function. Athletes will report that they are better able to tune out distractions; that things seem to slow down; that they have better “anticipation”. Faster thought processing and focus you gain quicker reaction time along with better motor coordination which should lead to injury prevention, not only of brain but knees, shoulders, neck or back etc.
The eyes have been said to be “windows to the soul”, while this may be true they are also a window (i.e. functional assessment tool) of brain function and balance centers of the nervous system. We know what areas of brain are responsible for tracking objects, quickly moving from target A to target B, accuracy of stopping eyes on intended target and which areas are responsible for keeping eyes fixed on a target. By measuring the speed and accuracy of these eye movements with videonystagmography or VNG, a level of function can be established and subtleties of dysfunction can be appreciated. So again by looking at the physical output of a motor skill we can establish baselines, use for diagnosis as well as implement a functional neurological rehabilitation plan.
What I am suggesting is that we need to start looking at other objective measures for evaluating brain function to complement the subjective evaluation tools. Moreover, from a preventative standpoint, I am suggesting that we should consider an individual’s ability to focus, their reaction time, motor coordination, strength and stability. Baseline testing of physical and mental faculties is extremely important especially for those under 20 years of age. This is particularly important for balance testing as there isn’t any data to compare scores against. Each individual’s score is best compared to their previous scores.
A comprehensive approach to prevention and optimization of function is recommended. CAPs, VNG and Interactive Metronome allow for both baseline testing and functional performance enhancement and rehabilitation.
“I believe we’re in the midst of proving that taking a functional approach to concussion management along with brain training will yield results like improved athletic performance (e.g. faster reaction times on the soccer field), increased academic performance (e.g. quicker processing of large volumes of information, quicker decision making at test time), increased quality of health (e.g. faster reaction times mean less on-field and off-field injuries) and theoretically increase the brains resiliency to trauma.”