Traumatic Brain Injury & Concussion Assistance:
TBI/Concussion Assistance During a concussion the membrane to the neuron stretches, potassium leaves the cell (hyper-glycolysis), and calcium enters the cell causing vasoconstrictions, decreased cerebral blood flow, and decreased energy supply. So as the brain is demanding more energy due to hyper-glycolysis, it’s limited. Therefore, a concussion is mismatch between demand and supply of energy to the cell. Possibly an autoimmune response causing cognitive decline after a brain injury. If you can’t do pre-testing for concussion protocol, then do VOR and vision testing along with dynamic balance, testing related to the sport.
Dizziness is the number one predictor of a concussion.
Primary physical trauma and secondary biochemical/physiologic perturbations leading to: Neuronal Loss and Diffuse Axonal Injury (DAI)
Legend:
0 – Day zero to weeks after the accident
1 – A couple months after accident
2 – Several months after accident
3 – A year after accident
4 – Several years after accident
Limit:
0 Limit all stimuli’
0-4 Limit Florescent/Brights Lights
0-4 Limit Contrasting Light Areas
0-1 Limit Loud Noises
0-1 Limit Thoughts
0-1 Limit Rubbing Eyes
0-3 No/Limit Screens
Most Important:
0-4 Lots of sleep!
0-1 REM Cycle necessary when having flare up
0-4 Meditation- Helps the most!
0-3 Drink lots of water (Always!)
0-4 25-40 mins of tolerant daily (sub symptom aerobic activity) aerobic exercise (before other training to increase blood flow/oxygen to help neurons in brain)- before other activity!
0-1 Vagus Nerve Stimulation
0-4 Intermittent Hypoxic Training (diaphragmatic breathing followed by a normal exhale, then breath in followed by a normal exhale + a little bit more, then hold breath for about 5-10s [eventually 20-30s + movement], then breath normally for 30s; do this 6-8 times)
2-4 Go out into sunlight Rehabilitation task (the Peg Forest)/Novel environment
Helpful:
0-4 Eat Regularly- if long gap limit glucose/sugar
2-4 Try changing diet
2-4 Breathing/Tongue/Face Exercises
0-4 Sea Bands (help with dizziness) 0-4 Essential Oil (Relaxation and calming)
1-4 Message Temples (help with pain)
1-4 Ice (helps with headaches)
2-4 The Cold Psilocybin Treatment Transnasal and transcranial photobiomodulation (PBM)
Working the Brain:
1-3 VOR Chart
1-3 Smooth pursuit exercise- one eye or both (full eye movements)
1-3 Saccades (low to 180bpm [avg.])- wide to unbalanced surfaces & letter charts-Horizontal/Vertical/Diagonal
2-3 ^ (read letters diagonally)
1-3 Head tilts
1-3 Place pin into straw focusing straight (eye convergence)- far to close
1-3 Brock String
1-3 Rapid naming
1-3 Speech; Reaction time; Cross-lateral tests
1-3 Puzzles/Thinking Games
1-3 Instant Memory/Delayed Memory/Longer Memory (Reading & Listening)
1-3 Swing (Ball Vision Therapy with Letters)- read letters
1-4 Eye convergence & divergence
1-4 Remember List (sometimes talk in-between)
1-4 Meditative & Exercise Yoga 2 Small letter to big letter up-down head tilts (VOR)
2 Find letter in a jumble/word finds/puzzles
2 Bounce ball & find displaced letters
2 Name any word starting with a certain letter (concrete/ convergent naming)
2-3 Symbol Search
2-4 Abstract naming (divergent/conformational naming) [smells/ hot things]
2-4 Tower of London/Digit span test/Corsi block tapping
2-3 Charades & mental games
2-3 Opposite Hand Exercises (Match shapes/clock exercises [add numbers/hands with odd/even)
2-4 Aperture-Rule Trainer
2-4 Neurofeedback
2-4 Aperature
2-3 Charades & mental games
2-4 Balance/follow laser/ foot to foot cone walk sometimes with head movements (Saccades)
3 Small amount of remembering with background noice
3 Read but ease into length
3-4 Speak in Foreign Language (if competent)
3-4 Large amount of remembering
3-4 Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES Test)
3-4 Juggle
4 Multitasking work
4 Name group; put words in order; say words in reverse order
4 Add one task
4 Trampoline or Jump Rope
Memory Recall Tips:
Grouping
Picturing
Repeat
Glasses:
Red/Green Lensed
Sunglasses
Pinhole Glasses (help with eyesight)
Use Blue Light Filters- Hardware & Software)
Prism Glasses
Supplements:
1st (0-4)- (Multivitamin, Fish Oil, Magnesium L-threonate, Riboflavin [B2])
2nd (0-3)- (Antioxidant, Zinc, Brain Health [B12/Acetyl-L Carnitine/Phosphatidylserine/Alpha Lipoic Acid), Aminos, CBD)
3rd (4)- Electrolytes, Shilajit
4th (4)- Lions Mane, L-Theanine (Nootropic), Antarctic Krill Oil
Medicine (decreased arousal):
0-2 Psychostimulants (Vyvance), dopaminergic agonists, norepinephrine reuptake inhibitors)
4 Modafinil 100mg (sleep)
4 Vyvance 15 or 30mg (wakefulness)
4 Wakix/Sunosi 75 mg
Doctors:
Sports Med Concussion Doctor (Biofeedback)
Neurologist (EEG)
Speech Pathology (Memory)
Occupational Therapy (Vision)
Neuropsychologist (Neurofeedback/QEEG)
Sleep Medicine Doctor
Vestibular Specialist (Videonystagmography/ Rotational Chair Testing)
Neuro-Ophthalmologist Audiologist (Audiometry Test)
Optometrist-Eye Doctor
General Practitioner (Echocardiogram)
Tests:
fMRI/CT Scans
Vestibular Ocular Motor Screening
Impact Testing Neurocognitive Tests and Correlates
Cognitive Tests/ImPACT Test (Immediate Post-Concussion Assessment and Cognitive Testing)
Balance Testing
Vision and Reaction Time Testing
Post-Injury Comparison (comparison of a baseline test before the sports season to a month post concussion)
Non-Invasive Devices:
Transcranial Magnetic Stimulation (TMS)
Low-Level Laser Therapy (LLLT)
Transcranial Doppler Sonography (TCD)
Transcranial Current Brain Stimulation (tCS):
-Direct Current (tDCS)
-Alternating Current (tACS)
-Random Noise Current Stimulation (tRNS)
-Electrical Current Stimulation (tES)