Concussion Treatment and Recovery in New York

Introduction

What is a concussion? Van de Graaf’s Human Anatomy, sixth edition defines concussion as a violent jarring of the brain, normally resulting from a blow to the head, that results in injury. Concussion is especially common among athletes in contact and collision sports, and is generally accompanied by symptoms ranging from persistent headaches to dizziness to memory impairment and depression.

A concussion, by definition, is a serious injury that can create serious and long-lasting problems for the injured patient. According to the Center for Disease Control and Prevention (CDC), concussion is the most common type of traumatic brain injury (TBI) in the United States.

Relevant Anatomy

The brain and spinal cord are responsible for the workings of the body. The brain is encased in a thick, durable encasement known as the cranium, while the spinal cord is surrounded by a hard column of vertebrae known as the spinal column. Additionally, three membranous connective tissue coverings known as meninges work to protect the soft tissue of the CNS: the dura mater, the arachnoid, and the pia mater. Along with the cerebrospinal fluid, the main function of the meninges is to safeguard the nervous system from injury.

One of the most important safeguards against injury in the brain is the cerebrospinal fluid that surrounds it and helps to absorb light trauma. Cerebrospinal fluid is a clear fluid forming a protective cushion within and around the central nervous system, buoying the brain. CSF circulates through the brain’s ventricles, the central canal of the spinal cord, and the subarachnoid space, returning to the circulatory system by draining through venous capillaries.

Cerebrospinal fluid reduces the impact of a blow to the head by disseminating the force over a larger area. Similar to blood plasma in the sense that contains proteins, glucose, and white blood cells, CSF is produced by the constant filtration of plasma through specialized capillaries. The body produces up to 800 milliliters of CSF every day. However, only about 140-200 ml are guarding the nervous system at any given moment.

Diagnosis and Symptoms

Although cerebrospinal fluid, meninges, and the cranium offer limited protection against injury, they are not always able to protect the body from the impact of sudden trauma. A concussion results in traumatic paralysis of the tissues in the brain and is normally caused by a blow to the head. However, this paralysis is reversible and in most cases doesn’t last for more than a few minutes. Because concussions disrupt a part of the brain known as the reticular activating system (RAS) that helps regulate an individual’s sense of awareness, damage to the RAS may trigger symptoms such as loss of memory, unconsciousness, or mental confusion.

Because the heads of growing babies are delicate and fragile, they are especially prone to injuries. However, concussions can be hard to diagnose in the very young because they’re often incapable of verbally communicating their feelings. Additionally, the way a child responds to injury will vary depending on his or her age. The effects of baby concussion are not identical to those experienced by children and adolescents, and each period of development has its own post-concussion symptoms.

Infants can suffer concussion as a result of light bumps on the head. Initially it may not be obvious that the child is injured, though the most obvious indication is loss of consciousness. Other symptoms may include irritability, vomiting, and dramatic changes in sleeping or eating patterns.

Unusually long periods of silence or inactivity may also indicate head concussion. Babies suffering from concussion may be listless and insert. They may refuse to eat or play, and spend long hours in post-concussion sleep. On the other hand, they may cry continuously and inconsolably.

Perhaps most tellingly, he or she may develop a bulging of the anterior fontanelle, the soft spot at the top of the head. If this happens, the parent or guardian should consult a physician.

Symptoms of concussion in children and adolescents may include brief loss of consciousness, confusion, vertigo, headache, nausea, and anxiety or depression.

Concussion Recovery

Infants who have suffered concussions may temporarily lose the developmental skills they had most recently developed. Over time, however, they should regain these skills. For a time the child may be fussier and more irritable than usual. If the baby cries more when placed in a certain position, he or she may have developed vertigo. When this happens, the caregiver should carefully avoid placing the baby in that position for at least a few weeks. During the time of the baby’s recovery, the guardian must ensure that he or she maintains a normal and consistent schedule as fully as possible.

For children and adolescents, the best remedy for most concussions is rest. Recovery works faster when the young patient rests with regularity. This is especially critical in the first few days after injury. Initially, activity and movement must be as limited as possible. Gradually, after the symptoms subside, the child should return to normal living. If an increase in activities does not result in a corresponding increase in symptoms, then the child is not in immediate danger. However, if symptoms recur, a physician should be consulted. And, if the symptoms get significantly worse, the guardian should seek out an emergency physician immediately.

Treatment for Concussion at the New York DNR

Although there are relatively few treatment options available for post-concussion symptoms, the New York DNR does offer several that have proven safe and effective.

Virtual reality treatment of brain injuries is one of the most powerful treatments available for patients with concussions. It works by measuring the degree of injury in a completely computer-simulated setting without actually causing further injury or exacerbating an already existing one.

One such virtual reality modality, the Computer Assisted Rehabilitation Environment (C.A.R.E.N), has been successfully used in American military hospitals as well as research universities in America and Europe. It effectively treats traumatic brain injury, stroke, and related brain conditions through immersing the patient in a virtual-reality environment that monitors his or her movement and reactions using motion-capture technology. As the patient moves, every action is recorded and properly analyzed for aberrations that indicate the extent of injury. By presenting different type of puzzles while patient is moving in the virtual environment and his balance is pertubated balance-cognition axis is engaged. C.A.R.E.N also comes equipped with applications that stimulate the patient’s brain to react in certain ways, thus indicating to the physician the level of perception deficit and memory loss.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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