A concussion is a form of mild traumatic brain injury (mTBI). It changes how the brain works and can have a major impact on quality of life.
Concussions are the most common type of mild traumatic brain injury. They usually result from a blow to the head, but they can also be caused by fast twisting or whipping forces that injure brain cells, even without a direct hit.
After any head injury, get emergency care right away for a headache that keeps getting worse, repeated vomiting, confusion, unusual drowsiness or trouble waking up, slurred speech, weakness or numbness, a seizure, or one pupil larger than the other. If you are having thoughts of harming yourself, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or call 911.
How Common Are Concussions?
Traumatic brain injuries and concussions are a serious problem. Millions happen in the United States each year. The CDC reported that in 2014, there were about 2.87 million emergency department visits, hospitalizations and deaths related to traumatic brain injury in the U.S., including more than 837,000 involving children (1).
What Causes Concussions?
Concussions are common in sports and car crashes, and they very often result from falls in older adults.
Most concussions are mild, and symptoms usually go away on their own. But many people have symptoms that last for months or even years. Up to 15% of concussions lead to post-concussion syndrome, which can be deeply disabling and affect every part of a person’s life, and their family’s (2).
What Are the Symptoms of a Concussion?
People with concussions may have headaches and head pressure, dizziness and vertigo, and balance problems. They may have blurry or double vision, sensitivity to light and sound, and feel easily overwhelmed in busy environments. Many experience deep fatigue and trouble with concentration, attention, memory, finding words and managing emotions (3).
How Does a Concussion Affect Your Life?
A concussion can affect every part of your life. Simple tasks like reading can become exhausting and set off headaches and dizziness. Following a conversation or doing basic mental tasks can wear you out. A trip to the grocery store can feel overwhelming. Driving or riding in a car can trigger headaches, dizziness and panic. Screens and computer work can make every symptom worse. After a concussion, even the simplest tasks can feel impossible.
Depression, anxiety, post-traumatic stress disorder and emotional distress are common long-term effects of concussion, and rates of substance use problems are higher after a concussion (4).
Sleep problems (5) and chronic pain (6) are also common long-term effects. Job and school performance often suffer, leading to lost wages and higher rates of unemployment (7). Tragically, concussions also raise the risk of suicide (8), which is why getting support matters.
What Happens in the Brain During a Concussion?
Your brain is made up of several types of cells. The ones most people think of as “brain cells” are neurons, which carry the brain’s electrical signals. You have billions of them, constantly sending messages to each other. Your brain also has supporting cells called glia, which do everything from helping neurons communicate efficiently to clearing away waste.
Neurons have a cell body, branches called dendrites that receive signals from other neurons, and long, thin fibers called axons that send signals. Most cell bodies are in the brain’s outer layer, the cerebral cortex, also called gray matter. Much of the rest of the brain is white matter, made up of axons running between neurons. Axons can be very short or several inches long. Because they are long, thin extensions of a single cell, they are fragile and easily damaged by stretching and shearing.
When the brain is hit or twisted quickly, or both, axons can be damaged. Depending on the injury, this may affect one group of axons or cause widespread injury across many brain regions and pathways, called diffuse axonal injury. Neurons in these pathways may work less efficiently or be lost (9).
When brain cells are injured, immune cells in the brain called microglia become active and start an inflammatory response to help heal the damaged tissue. Sometimes this response is stronger than it should be, which may cause additional damage. Injured neurons may also have trouble getting the oxygen, nutrients and blood sugar they need, which can add to the injury (10).
As the brain heals, the remaining neurons have to take over for those that were damaged or lost. Depending on the extent of the injury, this may be easy or very hard. Unlike muscles, which get stronger when you push them to the point of failure, injured brain pathways can be set back when pushed too far past their limits. In post-concussion syndrome, pathways may tire quickly because they’re doing their own job and also covering for injured cells. That’s why knowing when to push and when to rest matters so much in concussion recovery (11).
How Are Concussions Usually Treated?
Concussions are usually first treated with a short period of rest and reduced activity and screen time. Unfortunately, many people receive little guidance on what to do if their symptoms don’t go away.
As symptoms improve, people are usually guided through a gradual return to activity, with the goal of getting back to their usual level. For many people, this works well. For people who are struggling to improve, rehabilitation may include physical therapy, speech and occupational therapy, vision therapy and vestibular therapy (12).
Many people improve with treatment, but some continue to have symptoms. Millions of people live with long-term effects of brain injuries, and some have nearly given up hope of getting their lives back.
How the NeuroRescue Program Can Help
Our care is designed to work alongside your physician and other providers, never in place of them. Please don’t change or stop any medication without talking with your prescriber.
One of the brain’s most important jobs is figuring out where you are in the world. It uses your inner ear to sense where your head is in relation to gravity and how it’s moving, your muscles and joints to sense where your body is and what it’s doing, and your eyes to sense where you are in relation to everything around you. Your brain combines all of this into a picture of where you are, so you can respond to the world around you.
A concussion is rarely just an injury to the eyes, the inner ear or the neck alone. It often affects how well these systems work together. That’s why we look at all of these systems together, and at how they work as a team.
Depending on your needs and test results, your program may include eye exercises to improve gaze stability (13) and the accuracy of your eye movements (14); exercises for reflexes involving your inner ear, neck or both (15); balance training under specific conditions and vision training that combines several types of input at once (16); care for the muscles and joints of your neck, including chiropractic adjustments when appropriate; electrical stimulation (17); and exercises in a virtual reality environment (18). Transcranial magnetic stimulation (TMS) has been studied for symptoms after brain injury (19). At our clinic, TMS is provided by our psychiatric mental health nurse practitioner, who will evaluate whether it may be appropriate for you. Your program may also include computerized cognitive training to support attention, memory and processing speed. A randomized trial in people with ongoing symptoms after mild traumatic brain injury found that a computerized, brain plasticity-based training program improved overall thinking skills more than ordinary computer games (20).
Studies of approaches that combine several of these therapies after brain injury have reported improvements in symptoms, in some cases lasting over time (21, 22, 23). The therapies we recommend are always chosen based on your testing and exam findings.
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward.
We measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions. Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure how each semicircular canal is working, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at improving function in the systems that need support and helping them work together. Our testing also helps us decide when to push and when to let you rest.
Our goal is to help you think more clearly, feel steadier and get back to more of the things you enjoy.
Your Next Step
Living with the effects of a concussion can be exhausting and isolating, especially when people can’t see what you’re going through. You don’t have to keep figuring it out alone. To find out if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.
