A recent systemic review of the literature, just published in the Journal of Athletic Training, 2024; 59(1): 49-64, concludes that “vestibular and oculomotor screening are prognostic of time to recovery” from concussion.
Positive findings on these assessments “consistently predict longer recovery.” The authors therefore recommend that vestibular and ocular motor screening be part of the standard of care for assessment of concussion patients. Read the full study.Read More
As reflected in the posts on this blog over the last several years, scientific understanding of “mild traumatic brain injury” (Mtbi) – often referred to as “concussion” – has advanced considerably over the last 30 years. Unfortunately many physicians, including those on the “front lines” for these injuries–in emergency rooms and primary care clinics–have not kept up with this evolving science. In emergency rooms, the focus is typically on ruling out catastrophic injuries. The signs and symptoms of concussion are often missed. Even where the symptoms are recognized, many physicians mistakenly believe, based on outdated information, that the symptoms of mTBI can be ignored and that virtually everyone recovers spontaneously. Compounding this misinformation is inconsistency in the definitions found in the literature, in many cases depending on when the definition was adopted.
In 2019 – to address some of these problems – the mTBI Task Force of the American College of Rehabilitation Medicine (ACRM) Brain Injury Special Interest Group undertook an updating of the 1993 ACRM definition of mTBI – one of the most widely recognized definitions. This work included rapid evidence reviews, an expert survey (to rate the diagnostic importance of various clinical signs, symptoms, test findings, and contextual factors), public and stakeholder engagement, and a Delphi consensus process with an international, interdisciplinary panel of clinician-scientists. The working group included 17 ACRM mTBI Task Force members and an external interdisciplinary expert panel of 32 clinician-scientists from seven countries and various fields such as sports, civilian trauma, and military settings. The new criteria adopted by this group are based on syntheses of current research evidence and went through several rounds of revision until more than 90 per cent of the expert panel agreed with what they were proposing. Read More
A recent study published in JAMA Network Open finds that patients with a history of traumatic brain injury (TBI), including mild TBI (mTBI), are at significantly greater risk of developing chronic cardiovascular, endocrine, neurological and psychiatric disorders. This proved to be true in all age groups, including younger adults (18-40).
This study is important because, as the authors note, “the risks of incident comorbidities in previously healthy patients who sustained mTBI and msTBI (moderate-severe TBI) has not previously been reported.” The most important takeaway of the study is that “patients with TBI in all age groups may benefit from a proactive targeted screening program for chronic multisystem diseases, particularly cardiometabolic diseases.” Read More
Israeli study finds that one in four children with mild traumatic brain injury (mTBI) suffer from persistent post-concussive symptoms
In a large multi-center retrospective matched cohort study, Israeli scientists recently found that one in four children (25.3%) who have been discharged from the emergency room after a mild head injury suffered from persistent post- concussive symptoms.
Among the chronic symptoms seen in these children were forgetfulness, memory problems, sensitivity to light and noise, ADHD and even psychological problems. Sadly, many of these children had been misdiagnosed as suffering from unrelated ADHD, sleep disorders, depression, etc. This misdiagnosis, the researchers noted, leads to treatment that is not suited to the problem, thus causing the children prolonged suffering. Read More
Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) have been often been viewed as two distinct conditions, one with an “emotional” cause and the other with a “physical” cause. It has been recognized for some time that these conditions can produce similar symptoms, such as problems with sleep, concentration, memory and mood. As noted by the authors of a literature review published in Current Neurology and Neuroscience Reports, “increasingly symptoms previously presumed to be specific to PTSD or TBI are being identified in both disorders.” These include symptoms more commonly associated with TBI such as headache, dizziness, balance and vision problems. Evidence has also demonstrated that patients with a history of TBI are more likely to meet criteria for PTSD than others with similar intensity injuries and that patients who are also diagnosed with PTSD are significantly more likely to report persistent cognitive or sensory problems after a TBI. Read More
Several of my traumatic brain injury (TBI) clients have been treated for gut issues – issues that were not present prior to their TBI. Insurers, of course, insist that this treatment cannot be related to the brain injury. The scientific literature indicates otherwise. Researchers at the University of Maryland School of Medicine recently found a two-way link between TBI and intestinal changes.
The findings indicate that this two way interaction may contribute to increased infections in TBI patients and may also worsen chronic brain damage. Read More
A review published in the September 2017 issue of Frontiers in Neurology proposes use of “systems science” to better understand concussion diagnosis and prognosis. This is a discipline that analyzes complex problems as whole systems and integrates research findings from different disciplines. In explaining the need for a systems approach, the reviewers note one description of concussion that is uniformly recognized – that it is a highly heterogeneous phenomenon, with numerous factors interacting dynamically to influence an individual’s recovery trajectory. (This concept is highlighted in the title of one of the Concussion WebCasts made available by the American Association of Family Physicians : “If you have seen one concussion, you have seen one concussion.”) Read More
One of the most common symptoms following TBI is photophobia, an intense intolerance to light that can cause significant discomfort, interfere with activities of daily living, and contribute to post traumatic headaches. It can impact the ability to work at computer screens and in well-lit offices and can cause a great deal of fatigue for patients who try to return to usual activities. Avoiding light can be very limiting. Read More
The May 16, 2017 issue of The American Journal of Sports Medicine highlights the significance of subtle changes in vision following concussion in predicting more prolonged recovery. The study found that a diagnosis of “convergence insufficiency” increased the odds of prolonged recovery by 12.3 fold. Read More
In recent years a great deal of research has been done to identify an objective “biomarker” of concussion. As reported in this blog, some promise has been found in blood biomarkers (measuring plasma tau protein levels) and neuroimaging, such as the DTI MRI sequence. Unfortunately, these approaches are invasive and/or expensive and are not always a reliable indicator of concussion and concussion recovery. As reported in our November 27, 2016 blog post, until now, one of the most promising concussion screening tools was a series of vision tests endorsed by the Department of Defense.
Scientists at Northwestern University have now found a related, and what appears to be an even more precise and accurate tool, a measure of the brain’s electrophysiological response to sound. Read More
