Concussion: Diagnosis and Recovery with Functional Neurology

Functional neurology can be used to diagnose and treat concussions. Neurological and cranial nerve exams find areas of the brain that are not functioning properly and treatments are used to stimulate those areas to help them recover. Treatment methods may include using transcranial low-level laser therapy, pulsed electromagnetic field therapy, and diet and nutrition to decrease the neural inflammation.

I think most people have a general understanding of what a concussion is, but can you please explain what is really happening to the brain when someone gets a concussion?

Dr. Greg Olsen: With regard to concussions, we consider it to be, the term is a mild traumatic brain injury, so literally, it is an injury to the brain. In the concussion category we call it generally mild to moderate brain injury from a direct impact to the head or a rapid sudden movement. And those rapid sudden movements can create what is called a sheering stress to the brain. Most people don’t realize that the brain, despite what people oftentimes see in models where it’s a nice round shape and it’s firm, is actually a liquid structure. So, it is very vulnerable to movements in the skull.

How is a concussion diagnosed? And are there different levels of severity and health risks?

Dr. Greg Olsen: Most definitely. Currently, the American Academy of Neurology considers a concussion to be a time where there is a state of altered consciousness. So, if you get your head hit and you go, “Whoa, I don’t feel right,” even if it’s just for a moment, it can be considered a mild concussion. Now, in terms of grading them, kind of the simplest way to look at it is, we call it a grade one, grade two, and grade three concussions.

A grade one concussion has what we call, a term, transient confusion; just kind of got your head knocked and you’re kind of not knowing what’s going on for a moment, to varying degrees. In that grade one, there is no loss of consciousness, and it is generally 15 minutes or less as far as you kind of feeling, like, “Okay. That was short. I’m back.”

Then, grade two of the concussion, again, has that transient confusion. There is no loss of consciousness again. That one takes a little longer. It’s considered to be anything over 15 minutes.

Next up is the grade three concussion. That is really where there’s considered to be any loss of consciousness, whether brief or a longer period of time. So those are the symptoms related to it. When this happens, depending upon the severity of it, it is really considered to be impacting the whole brain. There can be what’s called reactive flowing, and damaged nerve tissue or cells in the brain.

With this, with regard to the diagnosis, one of the things we look at is obviously making sure that there is no brain bleeding or more serious damage like that. But beyond that, when we’re looking at somebody who may have had an injury to the head and going, “Okay, well, is there a concussion or not a concussion?” We do have a newer test. It is a lab test or a blood test, and it’s looking for something called brain-derived neurotrophic factor. In situations where there has been a head trauma, that will actually decrease. We look for a lower finding with regard to that.

There are other assessments that we use in terms of assessing what is called the cerebellum. The cerebellum is a structure in the brain that controls balance and coordination. It is also the distribution center for the brain. There is a test we use called a sway test. It is an electronic measurement of how you are able to maintain your posture and balance in different poses and positions, and it analyzes and measures that.

In terms of clinical findings, one of the things that I look for that’s most consistent is cranial nerve function. Those are the nerves that control the head and the facial areas. Cranial nerves three, four, and six control eye movements. In any degree of concussion that I’ve looked at, for me, what’s been the most sensitive and valuable findings is abnormal eye movements. It is basically what that comes down to when we assess those. Then, the second is looking at cerebellum function or that balance and coordination.

From a symptoms standpoint, things that can be experienced, we just go through the questionnaire, “Have you had any kind of loss of smell, sensitivity to light or sound, confusion, clumsiness, slurring of the speech, dizziness, vertigo, nausea, fatigue?” Very common. So those are some of the things we look for in a concussion.

After sustaining a concussion, what are the general guidelines for treatment and recovery time?

Dr. Greg Olsen: In terms of a concussion, for treatment and recovery time, that can vary so greatly depending upon what’s happened with the severity. It may be anything from 15 minutes or less in terms of the grading options, that you just recover and it wasn’t too bad. Most people tend to have longer, harder times with it if they’ve had that issue for 15 minutes or more, and then especially if there’s been any kind of loss of consciousness, is where we really see a greater difficulty in that recovery time.  Treatment options, self-treatment options include, obviously, rest. If you are having trouble with sleep or mood, we have things for supplements, things over-the-counter, even prescriptions related to those items.

So, recovery can be anything from a few minutes to months. One of the greater concerns right now is, we know that when there’s been a concussion, that it makes you more vulnerable to more severe injuries with subsequent head trauma. So that’s really led to the greater findings of that chronic traumatic encephalopathy, when the brain actually gets damaged and really affects the long-term health of how you’re doing because of that.

What is functional neurology? And how does it help to treat concussions?

Dr. Greg Olsen: Functional neurology is looking at the neurology of how the brain works and really identifying the functional component of it. There’s a really key difference between looking at strictly pathology or damage beyond repair, versus how is it functioning. From a function standpoint, if we can find areas that aren’t functioning properly, and we can provide stimulation to the body that goes to those areas, then we can say, “Hey, let’s send some stimulation up to this area and see what the brain does; how receptive it is to this.” And then measure the response to it. So, a really key part of the functional neurology is identifying the brain function. That’s done through a neurological exam, a cranial nerve exam. Things that, from a functional neurology standpoint, we do things like transcranial low-level laser therapy, pulsed electromagnetic field therapy, use diet and nutrition to help with the neural inflammation that is associated with concussions.

And a real interesting finding or some facts on this: if somebody has experienced a concussion, a concussion, in order for that injury to occur, takes up to 90 Gs of force for that to happen. A neck injury only requires 4 to 10 Gs of force. So virtually every time there is a concussion, there is always a neck injury. And some of the current medical hypothesis for a concussion has, what we call a cervicogenic origin, meaning a lot of the problems from that come from the trauma to the neck as well. And that is definitely something that we see clinically.

Do you have to meet certain requirements to get started with functional neurology treatments? And what is a typical treatment session like?

Dr. Greg Olsen: So, to get started with functional neurology, there are no special requirements. The first step is, is if you’re concerned about a concussion or something that’s happened with you is to just make the step and contact us for an evaluation. And that really determines as far as what the best treatment is and what the best options are.

If you did come in and you were to be evaluated, say for example through your evaluation we may have found, and we talked earlier about, the cerebellum. And I like that, because the cerebellum is such a valuable area to look at in the brain. So when there is a problem, say we find that there is a problem with how your cerebellum is working, a session with that may include anything from doing what we call unilateral adjustments to the spine. We could do certain types of exercises, cross-crawling exercises, balance-stimulating exercises, a wobble chair. Those are a couple of the examples of stimulating the cerebellum.

One of those areas also for the cerebellum is, we’re doing what’s called a warm caloric. So, if we find your cerebellum is not functioning properly on the right side, we may do warm stimulation to the right side ear canal to stimulate the cilia fibers in the ear, which stimulates the cerebellum.

Another example is if we find that maybe the parietal lobe in your brain is not working properly, that could be everything from doing vibration therapy, TENS units, exercises where you trace a maze with your finger. Those are a few examples of how those might work.

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