“Which Way Is Up?” Post Concussion

Written By: Dr. David Burns

When I talk to patients or even healthcare providers about the approach at Brain Centers NW, there is at times an erroneous belief that what I am suggesting is simply Dr. Burns’ philosophy and maybe has merit. To quote one of my teachers, “Nay, nay, we say”. Brain Centers NW’s clinical applications stem from present day research. The clinical recommendation that we should be paying attention to how well the brain is working versus simply symptom management is not just a nice daydreamed idea, it is sound clinical advice based off the research.

If you or someone you know is being managed for a traumatic brain injury simply by asking “How are you feeling today?”, than you or they are not be “treated” at all. The research below serves as example supporting Brain Centers NW’s approach to assessment and management of traumatic brain injuries. The research below would suggest that even after concussion symptom resolution an athlete’s brain may still be functionally compromised. “Well how are we to know Dr. Burns?” Simple…. you TEST them with advanced functional diagnostics and a functional neurological exam. For the record I’m not talking about an MRI or CT. The doctor needs to look through as many “windows” of brain function as he or she can. Oh! FYI a clean CT does NOT mean you don’t have a concussion.

This study also begs the questions, “If the athlete is still functionally compromised are they likely to be playing their best?” Answer… probably not. More importantly, “If the concussed athlete is still functionally compromised are they likely to be more at risk of another injury?” My money is on, YES.

 

CONCLUSIONS: Athletes with concussion appear to still show navigational deficits in environments well after being considered fully recovered according to current return-to-play protocols. Although still preliminary and requiring further study, the present findings suggest that functional assessment within complex environment contexts could be considered before sending athletes back to play following a concussion, even in the absence of postconcussion symptoms or with normal clinical outcomes.

 

J Head Trauma Rehabil. 2012 Apr 10.

Altered Integrated Locomotor and Cognitive Function in Elite Athletes 30 Days

Postconcussion: A Preliminary Study.

Fait P, Swaine B, Cantin JF, Leblond J, McFadyen BJ.

Université Laval (Drs Fait and McFadyen), Quebec Rehabilitation Institute (Dr Cantin), and Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Drs Fait, Leblond, and McFadyen), Quebec City, and Université de Montréal, Montreal (Dr Swaine), Quebec, Canada.

Abstract

OBJECTIVE: To begin to understand changes in locomotor navigation in elite athletes following concussion.

METHODS: Clinical measures and gait analysis were undertaken on average 37.33 days (SD = 4.8) postconcussion for 6 athletes as well as for a control group of athletes matched for age, sex, and team. The locomotor task consisted of walking at a self-selected speed along an unobstructed or obstructed path with and without a visual interference task. The trends for 4 dependent variables were described (2 for gait behavior and 2 for cognitive behavior). A principal component analysis was used to reduce data to root sources of variance among these variables. General group differences were tested with Wilcoxon matched-pairs tests on factorial scores.

RESULTS: Athletes with concussion were symptom free at the time of testing and their neuropsychological test results were not different from those of athletes in the control group. However, when the laboratory data between paired groups were compared, descriptive analyses suggested potential group differences in navigating the obstacle. The simultaneous Stroop task appeared to present difficulty for both groups. A significant group effect was found on the component of the factorial analysis that was highly loaded with both gait and cognitive variables (minimum clearance, Stroop task errors, and cognitive dual-task costs), generally supporting the descriptive analyses by suggesting that athletes with concussion do not navigate the targeted complex environments like the control group.

CONCLUSIONS: Athletes with concussion appear to still show navigational deficits in environments well after being considered fully recovered according to current return-to-play protocols. Although still preliminary and requiring further study, the present findings suggest that functional assessment within complex environment contexts could be considered before sending athletes back to play following a concussion, even in the absence of postconcussion symptoms or with normal clinical outcomes.

PMID: 22495102 [PubMed – as supplied by publisher]

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