Traumatic Brain Injuries, Concussions and Post Concussion Syndrome
Updated: Mar 13, 2020
Brain Injuries have three distinct presentations that can be improved upon from a SensoriMotor Repatterning (SMR) Therapy perspective. Firstly, a brain injury causes the nervous system to become hyper-protective, triggering threat response mechanisms in situations that should not be considered a threat. Secondly, a brain injury causes the filter that allows us to distinguish between crucial sensory input and useless sensory input to become non-optimal, causing sensory overload in everyday life. Thirdly, a brain injury causes the nervous system to re-engage primitive reflexes that were turned off in childhood.
SMR has a fine-tuned concussion protocol, developed over years of treating post-concussion syndrome, that takes roughly three sessions to implement. SMR can help the recovery process, both by decreasing symptoms and increasing tolerance to rehabilitative interventions that are useful/necessary, but not always well tolerated (such as vestibular and vision therapy).
If you are reading this post because you or a friend have recently had a brain injury, please be advised that it is imperative to see a Doctor for assessment to rule out bleeding of the brain, which is a medical emergency.
The irony of this post is, sufferers who need this info the most can’t tolerate reading through the whole text. I have split it into the key points below:
SMR can help reduce the red alert response of the brain post-injury.
SMR can teach the brain to filter out sensory inputs that the brain mistakenly identifies as threats.
SMR can detect primitive reflexes and re-integrate them.
Despite what is commonly told to Brain Injury sufferers, there are many ways that recovery can be improved, other than - “rest, and see how it turns out”.
How to book an SMR session.
The complexity of Brain Injury treatments in an SMR clinic.
1. SMR Can Help Reduce The Red Alert Response Of The Brain Post-injury.
Our nervous system is pre-built with defensive mechanisms leftover from our reptilian and mammalian past. We have two distinct mechanisms that can occur: a fight or flight response, or a freeze response. Both defensive mechanisms cause a cascade of complex reactions that occur at the hormone, blood, cell, and lymphatic level. Reflectively, as an adaptive strategy, these responses also cause the motor control system to command the muscles of our body to respond in either an overactive state (fight or flight) or the protective inhibitory mechanism of being underactive (freeze).
Post brain injury, these defensive responses become hypersensitive and dysregulated. With SMR, we can test the muscles of the body to see if the nervous system has set them into a state of overactivity or underactivity and use this as a gateway to assessing the state of the nervous system. The brain can then be taught to respond to various situations and stimuli in a more practical way, restoring it towards a healthy state, where it does not see regular everyday routines as threats.
2. SMR Can Teach The Brain To Filter Out Sensory Inputs That The Brain Has Mistakenly Identified As Threats.
The RAS, or Reticular Activating System, is a filter for the eight million bits of information (subconsciously) flowing through our brain. It eliminates the white noise, isolating only the needed information. Unfortunately, it can be damaged post brain injury.
When my children were the age of 1 or 2, upon entering a shopping center, they would be awestruck for a short while; thereafter, they would become overstimulated and distraught. Their filters were still developing; thus, they took in every sensory input that was around them, becoming overstimulated and therefore screamed to get the hell out of there.
For post brain injury people, the same thing can occur. They tend to have particular situations that will trigger an overload of the system, and start to build a list of places or activities that need to be limited or avoided altogether.
With SMR, we can expose the nervous system to specific stimuli and change the neural reaction from a negative response to a neutral response. The nervous system is on the lookout for threats; the RAS can relearn to better filter when it understands that sensory input is not a threat. I recall an email from a client post-treatment, “Hey Colin, I heard a loud car muffler outside today and didn’t want to go injure the driver.”
3. SMR Can Detect Primitive Reflexes And Re-integrate Them.
Primitive reflexes are reflex actions present in newborns that integrate from one reflex to another and eventually disappear with the transition to a toddler and then a child. In clinical assessment, I realized that primitive reflexes are usually reactivated at a low level in clients who have had a brain injury, theoretically as a strategy of the nervous system to reset itself. When I went looking to see if there was any research on the subject, I found a study from 2008 that identified that 98% of the patients in the research project with post-traumatic brain injury demonstrated at least one active primitive reflex.
4. Despite What Is Commonly Told to Brain Injury Sufferers, There Are Many Ways That Recovery Can Be Improved, Other Than - “Rest, And See How It Turns Out”.
I meet many people who were told post brain injury to rest and come back in a month, then a couple of months, and finally a year post-injury are told that their current level of symptoms is where they are likely to remain.
Actually, many interventions can help with recovery. There is no one-stop-shop; it takes a team of professionals; some interventions will work better for some than others, and healing can occur well beyond the first year.
Here is a list of just some interventions:
Please note that any of the interventions listed below should not be undertaken without the consultation of your primary health care provider.
Dr. Komer’s book “New Hope for Concussions TBI & PTSD” states that 36% of people who suffer a concussion have abnormal hormone levels 1-year post-concussion and if there have been multiple concussions that it is almost 100%. Having hormone levels assessed by a specialist who understands optimal levels of hormones related to concussion recovery can be an excellent boost for anyone who has plateaued in their recovery.
In Dr. Chapel’s book “Concussion Rescue” he advocates for an emergency nutritional protocol to be administered post brain injury, with a thorough thought process and research to back it up. For example, NAC or N-Acetyl-l-Cysteine is a precursor to glutathione, one of our bodies’ primary antioxidants. In a double-blind study of active military personnel concussed in war, half were immediately given a hefty dose of NAC. A week later, double the amount of personal had improved in their Concussion symptoms in comparison to those who had not been given the supplement. Dr. Chapel and Dr. Komer both advocate nutritional supplements for chronic sufferers.
An injured brain is an inflamed brain, and inflammation in the brain can be very long-lasting. A study on rats showed that having the rats on a high fructose diet greatly affected the rats’ cognitive ability post-concussion (by 30%) in comparison to rats with no sugar in their diet, 1-week post-concussion. Both the books mentioned above have anti-inflammatory dietary suggestions.
Timing is everything with exercise, as rest is paramount in acute concussion, and your primary healthcare practitioner should be able to guide you back. Dr. Chapel’s rule of thumb is if you are five weeks post-injury or later, you should exercise up to the point where you start to have worsening symptoms, then back off. Low-impact exercise such as swimming, StairMaster, elliptical, stationary bike, are preferred over jarring exercise such as running.
Research has shown that exercise improves mood and self-esteem. Exercise is the most potent factor in the production of BDNF (brain-derived neurotrophic factor), which increases the sprouting of new neurons and increases connections of existing neurons.
Many people who suffer from brain injuries lose the ability to sleep efficiently. Dr. Chapel states, “it is almost impossible to fully heal from a brain injury if sleep is chronically disrupted.” Good sleep hygiene includes reduced screen time close to bedtime, same schedule to bed every night, darkened room, silence, no phone in the room.
One study showed that melatonin improved sleep in post-TBI sleep disturbance greater than the commonly prescribed sleep medication amitriptyline, without the drowsiness the following day. This it may be worth discussing with your doctor.
Multiple research papers strongly recommend that patients with concussions, post-concussion syndrome, or any type of brain injury should be given a comprehensive vision examination, specifically testing for convergence, eye movement, and accommodative function. These types of tests are not done by your family optometrist or a neurologist, but by an optometrist specializing in vision development or an optometrist trained in neuro-optometric rehabilitation. The vision exam will include visual acuity at near, eye teaming skills, eye focusing skills, and eye movement skills.
Vestibular Rehabilitation Therapy:
Vestibular rehabilitation is a type of therapy that focuses on improving the relationship between the inner ear, brain, eyes, muscles, and nerves. During the evaluation, the therapist will look at balance, strength, range of motion, eye movements, mental awareness, and positional testing. From there, a plan of care will be developed with treatments individualized to the patient’s needs.
In the book “The Concussion Repair Manual” Dr. Engle was a big advocate of Floatation Therapy as a means of recovery. Concussion sufferers are often overwhelmed by the amount of stimulation they receive, the use of a sensory deprivation tank can be a welcome break. In a meta-analysis, researchers found floating has positive effects on physiology (e.g., lower levels of cortisol, lower blood pressure), well-being, and performance. It is not the right choice for those who suffer from claustrophobia or panic attacks.
5. How To Book An SMR Session.
Treatments for brain injury clients are an hour long. I like to warn people with TBI’s that they may get increased fatigue and possibly some fogginess/headaches for 24 hours after the first session. We may shorten the session accordingly to try and minimize this.
As an RMT, I can’t diagnose, but I can say that testing of TBI clients indicates a down-regulation of the lymphatic system. I correct this on the first session, this, in turn, can temporarily increase the number of toxins in the blood, meaning the liver has to work harder for roughly 24 hours (causing tiredness), and some of those toxins may cross the blood-brain barrier, (causing fogginess/headaches).
I have three sessions worth of concussion specific treatments; I suggest spreading them out every four or five days. This is so we can get to the third treatment sooner than later. It is equally fine to spread the treatments out over weeks or even months, but most clients want improvement sooner than later. Typically, in total I treat concussion clients for 4 - 6 sessions, and will refer to other concussion therapies, or back to the referring practitioner, once the recover curve starts to flatten.
Bookings can be made by clicking here
Follow-up sessions are also 1 hour long, and won’t have the same potential for negative side effects.
If you have severe symptoms or react strongly to any intervention, please contact me, and we will decide if a 25-minute session is the best starting point.
For some clients, three sessions is a good amount, and then I refer them on, for others, there are more positive changes that can occur with further treatments. I am mindful of time/budget restrictions and always lookout for a flattening of the recovery curve; I will happily refer on to the most suitable therapists on my concussion specific referral list.
6. The Complexity Of Brain Injury Treatments In An SMR Clinic.
This is more a note for any therapists who stumble upon this post. Most clients who see me have usually tried just about everything else out there and have been working on their recovery for years. I’m delighted to put the wind back in their sails by giving them new hope via a new direction towards recovery.
There is, however, an irony in treating brain injuries with SMR. The people who have been struggling for so long to recover, immediately see the potential of SMR and how it would have been great to have had the SMR sessions before most other interventions. On the other hand, most people who have recently had a brain injury typically think they will get better sooner than later. Thus their expectations are always likely to fall short of the outcomes.
So though I’d love to help people at an earlier stage post brain injury, I gain more reward from assisting those who have suffered for longer.
If you have made it this far, congratulations, I wish you the best in your recovery!!!