Hope Health & Wellness

Traumatic Brain Injuries

Change Your Brain… Change Your Life

Check out the excessive head movement in these motor vehicle collisions that could cause a mTBI.

There is a wide range of injuries that can occur in a car crash. Neck, back, and other musculoskeletal injuries are the most common, but one of the most commonly ignored or undetected injuries is a concussion or TBI.  Mild TBI’s are often not diagnosed after a car accident, sports injury, or slip and fall injury. 

The diagnostic testing that is traditionally used to evaluate brain injury consists of imaging that looks at brain structure like CT, MRI, PET, or SPECT scans. While these tests can be pretty helpful, the results are often with in normal limits in patients suffering from traumatic brain injury because those diagnostic tests don’t tell us much about brain function.

The diagnostic testing we use in our offices to help evaluate traumatic brain injury is designed to measure brain function problems rather than structure. By assessing eye movements, balance, brain waves, memory, reaction time, sleep problems, and other parameters, we can better understand the ideal treatment options for patients suffering from a brain injury.

A traumatic brain injury (TBI) is a type of concussion.  A TBI is caused by a blow to the head (focal TBI) or forceful shaking or rapid head movement (diffuse TBI), both of which can occur in a car accident.  Even those involved in slow-speed car accidents can suffer from a mild TBI.  A whiplash-type injury is when the head whips front to back (Head-on impact), back to front (Rear-end impact), or side to side (T-Bone impact).  During a whiplash injury, sudden head movement may cause the brain to bounce back and forth against the skull, causing a minimal concussion or mild Traumatic Brain Injury (mTBI). Also known in the medical world as a contrecoup head injury.

In some cases, the victim may or may not lose consciousness.  Regardless of consciousness, a traumatic brain injury could affect your memory, balance, coordination, and other essential brain functions.

HOW COMMON ARE mTBI?

mTBI is a very common injury. When a person receives proper medical care after suffering an mTBI or concussion, there are usually no long-term effects. However, not receiving treatment can cause a person to suffer from lasting brain damage. The Centers for Disease Control (CDC) says that falls and car accidents are the two most common causes of brain injuries (including concussions) that resulted in hospitalization.  Unfortunately, hospitals are not appropriately equipped with the necessary diagnostic tools to properly diagnose or treat an mTBI, and therefore often go undiagnosed.

The Signs of a mTBI

Someone may suffer a mTBI and not even realize it. A mTBI or concussion left untreated can lead to long-term complications, such as chronic headaches, memory problems, vertigo, severe headaches, dizziness, mood swings, and brain fog that can last for months or years.  Recent research and literature confirm that a mTBI can lead to the early onset of Dementia, Alzheimer’s, or other neurological-related deficits in severe cases.  

Because any injury to the brain could have a lasting impact on your health and livelihood, it is vital to seek medical attention after any crash. The signs and symptoms of a mTBI may not display the same for every person. It is important to understand that adults and children may show signs differently. Many signs of a mTBI can be immediately apparent. However, some TBI symptoms may not appear for hours, days, weeks, or even months after a car crash.

According to the Mayo Clinic, the most common signs and symptoms of a car accident TBI include:

  1. Anxiety when driving or in a car
  2. Headaches, or pressure in the head
  3. Confusion or feeling “foggy.”
  4. Blurred or fuzzy vision in one or both eyes
  5. Mood swings – moody, irritable, sad
  6. Sleeping more or less than usual/trouble falling or staying asleep
  7. Difficulty concentrating or slowed thinking, Can’t seem to get your thoughts together.
  8. Lack of concentration and focus.  When reading a book, you feel you have to read a sentence over and over again to understand it.
  9. Balance problems or coordination concerns
  10. Slurred speech
  11. Nausea and vomiting 
  12. Loss of smell acuity – due to damage to the Olfactory Cranial Nerve
  13. Increased fatigue – Tired all the time despite getting enough sleep.
  14. Difficulty remembering new information
  15. Nauseous 
  16. Day-to-Day Anxiety/panic attacks
  17. Dizziness, light headed, seeing floating stars
  18. Forgetfulness – Forgetting where you put things, forgetting details about a recent or past event.
  19. Lose your train of thought mid-sentence

Sometimes these symptoms may appear to get better on their own, but frequently the body learns to cope with the mental confusion, or the patient learns to live with it.  If left untreated, a mTBI can manifest over time and develop long-standing severe mental and psychological difficulties, even Dementia or Altzheimers’s.  

CAR CRASHES AND TBI / CONCUSSION  

If you are involved in a motor vehicle collision, you should always seek medical care immediately. If you choose not to seek medical care, you could be putting your life or health at risk. Many people assume they are not injured because they feel no pain immediately after a crash, but this is often due to a release of adrenaline and other natural pain killers by our bodies when a crash occurs. A mTBI is frequently misdiagnosed, or worse, not diagnosed at all after a car crash.  Hospitals do not have the necessary equipment to test for TBI. After a car crash, most injuries are neck and back-related, and orthopedic physicians often overlook the common TBI complaints.

When Should I Get Tested Or Evaluated For mTBI?

The damage that occurs to the brain during a traumatic event is immediate.  Testing can be performed either within the first week of the accident, or years later. Once the damage or neuronal dysregualation occurs, it doesn’t get better on its own.  A mTBI left untreated will manifest into further brain damage and may cause irreversible damage to the brain.

 

Diagnosing mTBI at Hope Health & Wellness?

Diagnosing a mTBI is very tedious and precise.  At Hope Health & Wellness, we take mTBI seriously.  A doctor will conduct a neurological exam after a car accident or slip and fall to determine whether you have suffered an mTBI from the trauma.  We use sophisticated testing that includes:

Quantitative Electroencephalogram Testing – (qEEG)

A qEEG (Quantitative Electroencephalogram) is a diagnostic tool that measures electrical activity and brain wave patterns and records the findings onto an image. This is often referred to as “brain mapping.” Brainwaves are the rhythmic electrical impulses generated when the billions of neurons inside the brain communicate with each other. Brainwaves can reveal necessary information about overall brain function, including stress levels, thought patterns, and emotions.

A qEEG helps to identify areas of the brain where any dysregulation may have occurred after an MVC or traumatic event resulting in a TBI. A qEEG evaluates a person’s brainwave patterns objectively and scientifically. Think of a qEEG Brain map like an EKG recording…it provides us with accurate information about the entire brain and where problems may lie.

A qEEG generates a recording of your brain’s electrical activity through tiny sensors at different parts of your brain. 

After an MVC, we use a specific computerized qEEG TBI protocol with TBI biomarkers to record brainwave activity and determine the severity of the TBI (mild, moderate, severe). The results will pinpoint precisely where the TBI occurred in the brain, indicating the deficits that may present themselves.  

A qEEG recording of your brain wave activity typically takes less than 30 minutes.  We record your brain wave activity with your eyes open and closed, which provides enough raw data to formulate a diagnosis and determine where any dysregulation may occur in your brain.

We place you in a comfortable chair, it is essential that you relax as much as possible and limit your movement in the chair. Avoid excessive swallowing, and minimize any form of muscle tension as much as possible. It often helps to imagine and place yourself in the most relaxing frame of mind;  as if you are on the beach or getting a massage. 

The results are then analyzed to create a multi-color brain map, which we will review with you, in person, at your next appointment.

Oculomotor Tracking – Eye Movement Tracking

Oculomotor tracking technology allows us to see what the eyes are following. This is of great importance because one of the most common symptoms of TBI is disrupted communication between the eyes and the brain. 

When this happens, the eyes do not follow objects properly as we move our heads or as objects move in the visual field. Oculomotor tracking can provide visually compelling information as to just how dysfunctional eye movements might be. 

In the image on the right,  you can see what normal eye-tracking should look like when the patient  follows a circular path. The image on the left demonstrates what can happen after an accident with a patient that suffered a traumatic brain injury. 

Besides serving as a valuable diagnostic tool, our program also helps guide rehab exercises for the eye muscles. This is called sensory integration therapy, or oculomotor rehabilitation. It can be of tremendous benefit in helping to restore normal function to the eye movements and aid healing from a mTBI or concussion. 

Olfactory Testing – Smell Test

When the brain is injured, the sense of smell, known as olfactory function, is often altered. Many patients with TBI report alterations in their ability to smell or taste due to damage to the brain’s specific areas that control these functions. Our in-office olfactory testing allows us to assess any changes in these senses to better understand what areas of the brain have been affected. 

Computerized Balance Testing

Decreased balance and loss of coordination are some of the more commonly reported symptoms following traumatic brain injury. Studies show that between 30-65% of patients will report balance problems with TBI.

Injury to the brain can affect communication with the inner ear and the eyes, creating a sensory mismatch that can lead to balance dysfunction, dizziness, or vertigo.

In some patients, this becomes severe enough to become a danger to the patient as their fall risk increases.

We utilize a specialized form of balance testing called computerized dynamic posturography that measures the amount of sway and loss of equilibrium experienced by the injured patient.

This data helps provide objective evidence of problems related to TBI and can help guide the appropriate rehabilitation options for the patient to experience functional improvement.

Computerized Neuro-Cognitive Assessment Test: (CNS)

All patients complete a Computerized Neuro-Cognitive Assessment (CNS) test.  This procedure utilizes scientifically validated, objective, and reliable computerized neuropsychological tests to evaluate the patient’s neurocognitive status. This computerized evaluation will cover a range of mental processes from simple motor performance, attention, memory, processing speed, and executive functions.  

Neuropsychological testing for TBI is essential to perform so that one can see cognitive impairments. Our computerized test takes about 40 minutes to complete and is specific to assess and evaluate the presence of any cognitive impairment.

Computerized Adaptive Test-Mental Health Evaluation:

All patients complete a CAT-MH computer adaptive test (CAT). The purpose of this test is to evaluate the level of depression, anxiety, PTSD, and other psychological conditions that may have manifested because of the accident.

Fukuda Stepping Test

The Fukuda Stepping test determines any vestibular system weakness on one side of the body.  This test could help rule out the cause and find the best treatment for dizziness or vertigo that may have manifested because of the accident.

Romberg’s maneuver

The Romberg maneuver assesses the function of the dorsal column in the spinal cord.  The dorsal column controls proprioception, the sense of body movement, and position.  Identifying issues with the proprioceptive system can help determine the best care plan for the patient.

Handgrip Strength Test

The handgrip test measures the maximum isometric (static muscle contraction) strength of the hand and forearm muscles.  Finding out which side is weaker and the other observations made from previous assessments will benefit the recovery process/outcome by narrowing down the best treatment options.

Radiologic Studies Used in TBI

A concussion is a metabolic brain injury that can be present without detectable structural brain injury. A patient who has suffered a TBI may have a normal CT/MRI scan, especially when the diffuse axonal injury may be microscopic.  However, we perform MRIs using diffuse tensor imaging (DTI) to quantify brain pathology and concussion.

 

**These tests are crucial and allow clinicians to accurately measure critical areas of central (brain) and peripheral nerve function to provide an objective diagnosis for post-traumatic symptoms of TBI such as dizziness, vertigo, fatigue, problems with balance, coordination, blurred vision, memory problems, anxiety, depression, personality changes, and neuronal dysregulation.  

 

**These specific tests allow for proper diagnosis and the development of a care plan for patient improvement and ongoing compensatory recovery. 

 

Treatment And How It Works 

Intensive Electroencephalogram Neurofeedback Therapy That (EEG – NFT)

We use a technique called Electroencephalogram Neurofeedback Therapy (EEG – NFT).

Neurofeedback uses operant conditioning protocol which is  a method of learning that employs positive and negative rewards. This is designed to retrain or reorganize brainwaves to help facilitate healing by utilizing visual and auditory stimuli.  Our program is specific to traumatic brain injury and monitors brainwave function.  Neurofeedback encourages the neurons to communicate better, allowing for stronger neural synapses that can reduce and improve the common symptoms related to traumatic brain injury (mTBI).  This treatment aims to retrain and repair the dysregulated brainwave frequencies to allow better neuronal communication. We repeat a qEEG test about every 3 months so we can modify the treatment accordingly.   

We typically recommend 12 neurofeedback sessions over six weeks followed by a repeat qEEG to monitor progress and make necessary changes in treatment protocols for further treatment if needed.  It’s not uncommon for some conditions to take months to years to reverse.

A follow-up qEEG and CNS is performed to assess and document any improvement or impairment and the need for any additional treatment.  Once we achieve the desired results and the qEEG more green patterns and less irregular brain wave patterns, the results are often permanent.

Our board-certified neurologist reviews the results of all testing before the implementation of any treatment.

CATEGORIES OF TRAUMATIC BRAIN INJURIES

Traumatic brain injury (TBI) is categorized as mild, moderate, or severe. If you’ve been diagnosed with a mild traumatic brain injury, this does not mean that your condition or symptoms are minor or insignificant.

MILD
  • Loss of consciousness of less than 30 minutes
  • Post-traumatic amnesia of less than 24 hours
  • Glascow Coma Scale of 13-15
    MODERATE
    • Loss of consciousness of 30 minutes to 24 hours
    • Post-traumatic amnesia of 1-7 days
    • Glascow Coma Scale of 9-12
      SEVERE
      • Loss of consciousness of more than 24 hours
      • Post-traumatic amnesia of more than 7 days
      • Glascow Coma Scale of 3-8

        What is the Difference Between EEG and qEEG?

        The difference between EEG and qEEG lies in the q. A standard electroencephalogram (EEG) records electrical activity or brainwaves that are representative of underlying cortical brain activity. A quantitative EEG (qEEG) applies sophisticated mathematical and statistical analysis to these brainwaves and compares them to age and gender controlled databases compiled from the EEGs of individuals with no known brain dysfunction. Both the EEG and qEEG give us valuable information about real-time function within the brain at the time of evaluation. The qEEG process allows us to create a brain map through this combination of precise measurement and quantitative comparison.

        Maps are critical when it comes to getting folks to their desired destination. A qEEG brain map allows us to identify patterns of dysfunction that are often consistent with varying disorders of the brain, such as learning and behavioral issues, emotional disorders, brain injury, and many others. Quantitative EEG is the map we use to guide individuals through their journey of improving brainwave activity and correcting dysfunctional patterns, step-by-step. We use these maps to specifically direct brain training modalities such as Neurofeedback and transcranial magnetic stimulation. These are the vehicles that will get you where you want to go in cases of brain-based disorders. Brain maps also allow us to fine-tune normally functioning brains for those interested in peak performance training.