Concussion Treatment

Virtual Reality Concussion Treatment

Concussion Treatment

A concussion is the most common type of traumatic brain injury (TBI). It is an injury to the brain caused by a force to the head. You brain is protected by the skull and the fluid around it. The fluid around the brain acts as a barrier between the skull and the organ itself in turn protecting it from hitting the skull bone.  Athletes in contact sports such as soccer, football, rugby etc… are more prone to suffering a concussion but it doesn’t exclude every day occurrences as well. For instance, a person can suffer a concussion by hitting their head accidentally against anything; the degree of impact will indicate the severity of the injury. Children are very likely to suffer from a concussion was well. Such as playing in the park or falling.

While the degree of injury ranges from mild to severe, there are many ways a doctor can diagnose a concussion. Symptoms of a concussion may include loss of consciousness, not thinking clearly, difficulty concentrating, loss of memory, headache, blurred/doubled vision, dizziness, nausea/vomiting, not being able to stand straight (falling or loss of balance). There is a population of people that are more at risk of suffering a concussion and that is people with balance disorders, vertigo, and epilepsy which can cause them to either faint, loose their balance or fall resulting in hitting the head. Suffering multiple concussion over time can predispose a person to suffering other neurologic disorders that are similar to conditions such as Parkinson and/or Alzheimer’s. As previously mentioned athletes have a much greater chance of falling victim to long term neurologic conditions due to contact sports and increased risk of brain injury.

Research data suggests that athletes who suffered a concussion and return to playing sports to soon without completely recovering are at least 5 times more likely to have a re-injury. It is absolutely crucial to properly and entirely complete treatment before returning to the sport.

Diagnosing a concussion may be tricky due to its combination of symptoms is easier than treating a patient that has one.

Most patients suffer from post-concussion syndrome or (PCS) “shell shock”. These symptoms could last anywhere from a few days to occasionally over a year. Typically 40-80% of patients that have a PCS are from mild head injuries. A doctor will diagnose a patient with PCS if symptoms of a concussion last more than 7-10 days or in some cases it could even be made months after suffering the injury. The condition causes longer effects of concussion symptoms such as difficulty concentrating and headaches, nausea and emotional disturbances and dizziness being the most reported symptom.Concussion Treatment

Unfortunately, symptoms of post-concussion syndrome are often misdiagnosed or dismissed all together. It is very important as a patient or a medical professional to carefully keep track of the symptoms for proper treatment of PCS as there is no cure as of yet. Post-concussion syndrome often disappears on its own that is if proper treatment and steps are taken on both the parts of the patient and the medical professional.

Some patients that suffer a concussion even on the more severe forms will not be effected by PCS. It is not known why some people are effected while others are not. In either case a patient with TBI should be closely monitored and watched and treatment should ensure as soon as possible.

In more severe cases of post-concussion syndrome some symptoms may include amnesia and changes in personality. In cases like these it is also very important to incorporate and combine treatment with behavioral therapy as stress reduction is very important. Reducing stress and stressful situations will minimize the risks associated with a concussion and/or post-concussion syndrome in patients with symptoms of changes in behavior or personality. Treatment is very important in patients with more complex conditions and is imperative right away.  With delays in treatment or diagnosis there is a chance for a longer lasting effect of TBI’s.

TBI’s are a growing concern for medical practitioners and sport coaches and the general public alike. As of today there are a numerous amount of studies and researches being conducted on traumatic brain injuries. While science is gathering more data on treatment and prevention, one common agreement in the medical community is the current rehabilitation method that is available and that is the science of Virtual Reality.

Concussion Treatment

Even though, there aren’t many treatments options available after suffering a concussion, a method of treatment that is proven safe and effective and can rehabilitate the patient safely and efficiently is virtual reality.

Virtual Reality (VR) treatment of brain injuries is one of the most successful and unsurpassed modalities that a practitioner can offer his patient. By immersing the patient in a virtual reality the treatment can be focused on safely rehabbing the patient without causing more damage. How is this possible? While being in a virtual reality setting the patient thinks, feels and acts in real time, his reality at this point is completely computer stimulated. The treatment can measure the degree of injury without actually causing injury or progressing the current injury to a more severe state.

One of the most effective virtual reality modalities is the C.A.R.E.N (Computer Assisted Rehabilitation Environment). While the patient is on a platform that has 6 degrees of freedom and is immersed in virtual environment by being surrounded in six meter semicircular screen set up with markers to monitor the patient’s movement and reactions by motion capture system, he will feel like he is actually doing the task. Which he is; but in a virtual reality. In a medical setting, any action or reaction a patient will have will be received and transcribed as feedback and analyzed to properly treat the patient based on that data.

Each action and reaction of the patient indicates the severity of the injury and will help set up a treatment plan that will consist of various therapies primarily the VR. There are a number of applications available on C.A.R.E.N that will stimulate the patient’s brain to act and react in a specific way. These applications are directly designed to encourage activities in the brain will indicate to the practitioner if there is a deficit in the axis of cognition perception and balance or possibly problems with memory loss.

At DNR we are the only private clinic in the United States to offer this type of treatment. This technology has been invented by Israeli neuroscientists for treatment of TBI, stroke and other types of brain damage. This advanced technology has been successfully used in many US military hospitals as well as research universities in US and Europe. At DNR we have been trained in use of this technology for treatment of patients with concussions and other forms of TBI.

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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)

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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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