I just returned from a seminar on Mild Traumatic Brain Injury (MTBI). While our focus at Lake Oswego Chiropractic Clinic is wellness, courses of study which affect other areas of my patients’ health are often useful. A course in brain injury recovery can provide all sorts of insights into keeping your brain and nervous system healthy long into old age.
Seminar participants were quickly reminded that there is no such thing as a “mild” brain injury except that it is less severe than a “major” one. Major brain injuries usually involve hemorrhage and coma so the mild ones are more likely to be seen in a clinic. (They are, but they often go unnoticed).
The most common source of MTBI is car accidents. Car occupant’s heads frequently strike the headrest causing bruising of the brain. The snapping of the head forward in a whiplash often causes the brain to strike the front of the skull.
After years of dissenting discussion about whether whiplash causes neck injuries, MRI and CT imaging has allowed us to prove that real damage does occur to neck tissues when involved in “acceleration/deceleration” accidents. Similarly, newer imaging is showing brain damage from injuries previously considered to be fairly mild.
As the tragic story of Liam Neeson's wife,
Natasha Richardson demonstrated, a skilled doctor evaluates a head injury and looks for obvious signs of major damage; sometimes they don’t tell us enough. Most mild head injuries only require a “wait and see” protocol. If nothing major arises, as in most cases, the remarkable human body has protected itself and nothing further needs to be done.
Some of the “red flags” we look for include:
* Unconsciousness
* abnormal breathing
* obvious serious wound or fracture
* bleeding or clear fluid from the nose, ear, or mouth (cerebrospinal fluid)
* disturbance of speech or vision
* pupils of unequal size
* weakness or paralysis
* dizziness
* neck pain or stiffness
* seizure
* vomiting more than two to three times
* loss of bladder or bowel control
Signs of a possible concussion include:
* "seeing stars" and feeling dazed, dizzy, or lightheaded
* memory loss, especially right before and after the injury
* nausea or vomiting
* headaches
* blurred vision and sensitivity to light
* slurred speech or saying things that don't make sense
* difficulty concentrating, thinking, or making decisions
* difficulty with coordination or balance
* feeling anxious or irritable for no apparent reason
* feeling overly tired
The fact remains that most brain injuries are mild. While not exciting in the emergency room they can have a profound effect on the victim’s life for months or years to come.
As a clinician, my task is to assess the amount of brain injury and manage recovery. Frequently, there is little to do with brain trauma such a concussion, except advise the patient to avoid further injury and rest.
It is also a fact that a clinician must be able to discuss the amount of injury and recovery with insurance carriers, employers, and occasionally juries.
There is very little in technology, that the doctor can rely upon to measure mild brain injuries. MRI and CT scans will rarely show any damage from a concussion. Some promising new
PET scans may be helpful in discovering the level of damage from head trauma. The scanners are expensive and are not readily available in all areas.
The current methods that are the most reliable are assessments of the patient’s mental function. There are a dizzying array of pain diagrams, lifestyle indexes, questionnaires, and assessment tools to choose from. Everything is questioned from forgetfulness to balance, to quality of life. Of course, it may be the height of folly to ask the brain to evaluate its own function. (Will it tell the truth? Does it pridefully overstate its health?)
It is often helpful to have a family member help with any subjective assessment. Although possibly embarrassing, a patient might not realize that they have been forgetful, irritable, or more clumsy.
A condition called
post-concussion syndrome which includes all of the problems “left over” after a concussion can take up to 2 years to resolve. Some of them are permanent.
From a natural health perspective it is important to remember that the human body is a miracle of nature. It has thousands of restorative and reparative processes which occur around the clock. The body needs us to be certain that we don’t thwart its own efforts at recovery. Protein and vitamin C are needed to make collagen, the basic building block of all connective tissue. Essential fatty acids (
fish oil) are necessary for restoring brain cells and the nerves they supply. Rest is critical for the body to orient its energy toward repair. Proper hydration is necessary for carrying good nutrients to repair sites and washing away debris, which can turn toxic if allowed to accumulate.
Appropriate movement is necessary to stimulate the cerebellar region of the brain which in turn stimulates all sorts of mental, emotional, and even hormonal states to support recovery. Spinal adjustments are a critical part of proper movement. The spine has millions of movement receptors which can only be stimulated if the joints are mobile. If they are stuck, they not only fail to send movement signals to the brain, they actually send “alarm signals” to the brain which counteract healing processes.
Mild traumatic brain injury is a very serious condition. Proper evaluation and management is something we aspire to achieve at Lake Oswego Chiropractic Clinic. Acknowledging and aligning ourselves with the powerful healing force of nature is our greatest strength.