Concussion / Post Commotio

A concussion, a type of mild traumatic head injury (mTBI) that disrupts normal brain function and can significantly affect a person's quality of life. Concussions are the most common form of mild traumatic head injury and can be caused by a direct blow to the head, face, neck or other parts of the body with an impulsive force that is transferred to the head (you do not have to hit your head). According to FHI, well over 30,000 Norwegians suffer concussions every year. There are dark figures here.

What causes concussions?

Concussions are commonly observed in sports, motor vehicle accidents and falls among older adults. Most concussions are considered mild, transient injuries, and their symptoms often resolve without treatment - typically 10-14 days for adults, and 2-4 weeks for children and adolescents. Unfortunately, many people who have suffered concussions experience persistent symptoms for months or even years. Between 10 and 30% of concussions lead to a diagnosis called post-concussion syndrome (PCS), which can be profoundly disabling and affect all aspects of a person's life, including close family.

What are the symptoms of a concussion?

People with concussions may experience headaches and pressure in the head. They may struggle with severe dizziness and balance problems. Blurred or double vision can be a problem, as well as sensitivity to light and sound, which can lead to overwhelming experiences in complex sensory environments. Dysautonomia, memory loss, nausea, profound fatigue, problems with concentration, attention, focus, word retrieval and emotion regulation are common among people who have suffered a concussion. If the symptoms last longer than 10-14 days in adults or 3-4 weeks in children, the diagnosis will be changed to post-concussion.

- Somatic (e.g. headache), cognitive (e.g. feeling like in a fog) and/or emotional symptoms (e.g. lability)
- Physical signs (e.g. loss of consciousness, memory loss, neurological instability)
- Impaired balance (e.g. unstable gait)
- Behavioral changes (e.g. irritability)
- Cognitive impairment (e.g. reduced reaction times)
- Sleep/wakefulness disturbances (e.g. sleepiness, drowsiness)
- Dizziness
- Impaired eye motor function (e.g. visual disturbances).
- Neck stiffness

It is very rare for CT or MRI to show any clinical findings after a concussion. Both CT and MRI have different sensitivity and specificity depending on the pathological condition you want to assess and in which tissue and organ you are examining. This is why these two imaging modalities are not always equally informative. Mild traumatic head injuries such as concussions are a good example of this, but this does not mean that an injury or change has not occurred in the brain or nearby structures.

What are the consequences of a concussion?

Concussions can have profound effects on all aspects of a person's life and hinder their ability to function in the world. Simple tasks such as reading can become exhausting, triggering headaches and dizziness. Following conversations or performing basic mental tasks can be exhausting. Everyday activities, such as grocery shopping, driving or using screens, can trigger symptoms and make even the simplest tasks difficult.

Depression, anxiety, post-traumatic stress disorder and emotional distress are common long-term consequences of concussions. Substance use is higher among people who have suffered concussions.

Sleep disturbances and chronic somatic pain are examples of the long-term effects of concussions, affecting job and school performance, leading to lost wages, increased unemployment and, tragically, an increased risk of suicide.

What happens in the brain during a concussion?

 

A concussion can lead to changes in cerebral blood circulation, ATP production, damage to nerve cells and the blood-brain barrier, as well as a neuroinflammatory response. The brain consists of neurons and glia, where neurons are responsible for electrical activity. Neurons send electrical messages, while glia provide structural support and improve communication between neurons.

Neurons have cell bodies, dendrites and axons. Cell bodies are in the cerebral cortex, and axons form pathways that connect the neurons together. Damage to the axons can occur from impact or twisting forces. This can lead to damage to specific or multiple neurons, affecting their function. When brain cells are damaged, microglia are activated to promote healing, but excessive response can cause more damage.

Impaired supply of oxygen and nutrients to the brain cells can also lead to more damage. The remaining neurons attempt to compensate for the damaged cells, but if the damage is extensive, this can lead to overstimulation and further damage. Post commotio syndrome often involves the exhaustion of neural pathways as they have to perform both previous functions and the functions of lost cells.

How are concussions usually treated?

Concussions and other mild traumatic head injuries (mTBI) are initially managed by asking the individual to rest and avoid sensory stimulation. Unfortunately, many people who experience persistent symptoms after a concussion do not receive further guidance on how to improve their condition.

As symptoms improve, individuals are gradually guided through a process of increasing activity levels, with the goal of resuming their previous level of function. This approach can be successful in some cases. However, in more complex cases where individuals are struggling to improve, a rehabilitation process with various therapies may be recommended. These therapies may include physiotherapy, speech and occupational therapy, vision therapy and vestibular therapy.
While many people experience improvement with therapy, there are unfortunately cases where people do not have complete recovery. Many people suffer from the long-term effects of head injuries, and many have lost hope of regaining their previous quality of life.

One of the brain's primary functions is to help us understand our position in the world. The brain uses input from the inner ear to determine the position and movement of the head in relation to gravity. It also processes input from our muscles, joints and eyes to understand the position of our body in relation to our head and visual environment.
Concussions often result in damage to various pathways involved in vision, the inner ear, muscles and joints.

Our approach

  1. Our process starts with a thorough medical history, which can reveal any relevant issues or other health problems that may be hampering your progress.
  2. Through our examination, we identify the specific areas and pathways in your brain that are affected by the injury. We use advanced technology to measure the function of your visual, vestibular and proprioceptive systems, as well as your balance under different sensory conditions. We also use neurosensory-motor integration testing, hand-eye coordination and cognition.
  3. In addition to these tests, we perform a comprehensive physical and neurological examination of your sensory, motor, autonomic and cognitive systems. We review relevant laboratory tests, radiologic images and previous neuro-diagnostic results to integrate all available information.
    This comprehensive evaluation allows us to determine which parts of your brain are functioning properly, which systems are struggling and at what point your systems become fatigued.

With this knowledge, we design a personalized treatment plan exclusively for your brain and its needs. The treatment aims to renew and reintegrate dysfunctional, damaged neurons and pathways, improving energy, stamina and functional ability.

All our therapies are based on the latest neuroscience research. They may involve eye exercises to improve gaze stability and the ability to hit targets with the eyes, exercises to restore inner ear and neck reflexes, exercises to improve balance in specific conditions, manipulation, vision training using different modalities simultaneously, specific types of electrical stimulation and infrared laser.

Our technology and procedure not only guides us in identifying the areas that need attention, but also informs us when it is necessary for you to rest. We address your impaired neurological function through a versatile therapeutic approach while providing metabolic support to enhance neurological recovery. By focusing on system integration, we strive not only to improve individual pathways, but also to restore their cooperation. This gives you the best opportunity to regain control of a healthy, vibrant and meaningful life.

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