A Clinical Evaluation of Concussions in the Athletic Environment

Dr. Stuart E. Lakernick, D.C., NRCME

Functional Neurologist

Professor, Anatomy and Physiology,†Burlington County Community College SMT Department

Owner, Lakernick Brain Center

Owner, Lakernick Health and Wellness

Email: info@lakernickbraincenter.com

Concussions are an epidemic especially among athletes.† They sacrifice their bodies for their sport without regard for the future.†† Any concussion that has not resolved within a month NEEDS to be evaluated and treated.†† The traditional treatment of ďbrain restĒ and symptom management is an outdated model.† The latest research bears this out. John was discharged and released. He is now available for a return to play.

Below is a case that was referred to our center.

Case Study:

John Doe, 20 year old male wrestler sustained a traumatic brain injury 10/30/2014.† He entered our center for an evaluation and for treatment on March 23, 2015.† He was injured during a wrestling meet where he was hit in the head and lost consciousness briefly.† His history is as follows: He sustained two prior concussions.† His last concussion was March 2014 and was taken off of the teamsí active roster for three months.

His presenting symptoms on March 23, 2015 included headaches, photophobia, pressure in his head, neck pain, dizziness, balance problems, sensitivity to noise, feeling like he is in a fog, difficulty concentrating, difficulty remembering, trouble falling asleep, he felt more emotional, irritable, sad, and had a lot of severe anxiety.

My exam pinpointed the region of his brain that he injured.† I devised a specific set of strategies aimed to the damaged pathways.† Our approach utilizes the concept of neuroplasticity, or the ability of the brain to reorganize and grow new neural pathways.

We ran a set of baseline diagnostics before the commencement of treatment† and the results were:

Dynavision D2, measures eye/hand coordination and visual perception and motor speed.† This test is performed in front of a 3 foot by 3 foot board with 64 LEDís.† I mostly pay attention to visual perception.

The baseline tests for horizontal gaze measured on 3/21/2015:

Rt - .35 seconds

Lt - .37 seconds

Peripheral gaze:

Rt - .37 seconds

Lt - .40 seconds

Central gaze:

Rt - .32 seconds

Lt - .27 seconds

His visual response time for peripheral gaze was very slow.

Dynamic Posturography measures balance under four different circumstances.† We utilize the MCTSIB (Modified Clinical Test Of Sensory Interaction on Balance) protocol.

Eyes open on a stable surface looking forward (EOSS), eyes closed on a stable surface (ECSS), eyes open on a foam surface (EOFS), and eyes closed on a foam surface (ECFS). Sway patterns are evaluated and stability scores are given.

John was more than three standard deviations from the norm with his eyes open on a stable surface (EOSS). This finding makes him a fall risk.

VNG (Videonystagography) testing was performed.† The VNG utilizes goggles with infrared cameras focused on your eyes.† VNG tests your ability to track items with your eyes.† We look very carefully at reflexes concerning eye movements.† Your ability to track, pursue, and saccade (move your eyes from one object of intention to another) is closely tested and evaluated.† John had a lot of square wave jerks(SWJ) when pursuing a target left to right.† A square wave jerk is an inappropriate movement of the eyes that take the eyes off of a target followed by the eyes again attaining the target.† This is a sign of a pathological central neurologic lesion.† This is a frequent finding with head injuries.

The program is an immersive program.† The patient is typically in the office for five days, four to six hours a day getting between two and four treatments a day.† Each treatment takes about an hour to perform. John was here 3/23 to 3/27/2015 and received a total of 18 treatments. His results were great.

Diagnostic testing 3/27/2015

Dynavision D2 results:

Horizontal gaze measured:

Rt - .32 seconds

Lt - .32 seconds

Peripheral gaze:

Rt - .35 seconds

Lt - .28 seconds

Central gaze:

Rt - .27 seconds

Lt - .25 seconds

(Note the increased visual perception speeds globally)

VNG (Videonystagography) Testing:

There were no longer any square wave jerks on horizontal pursuits.

Dynamic Posturography Testing:

All were within normal limits and showed no instability.

Johnís symptomatology on his discharge 3/27/2015:

Mild sensitivity to light

Mild feeling of mental fogginess.

He was given at home gaze stabilization exercises to be done two times per day.

We brought John back to the center for a seven-week follow up exam and diagnostic testing on 5/21/2015.† His results were:

Diagnostic Testing 5/21/2015

Dynavision D2 results:

Horizontal gaze measured:

Rt - .31 seconds

Lt - .27 seconds

Peripheral gaze:

Rt - .34 seconds

Lt - .33 seconds

Central gaze:

Rt - .26 seconds

Lt - .28 seconds

Take note at how much faster his visual perception was on peripheral gaze. He is now .03 and .07 seconds faster on visual perception. This finding is now in the range of normal.

VNG (Videonystagography) Testing:

The results were all within normal limits.

Dynamic Posturography Testing:

All were within normal limits.

Johnís symptomatology 5/21/2015:

None

Conclusion:

Our exam is pretty much the same as a traditional neurologist. It is the treatment style that differs. A traditional neurological approach to concussion management deals with managing symptoms pharmacologically. They parcel out to different therapists, depending on the patients problems. For example if the patient is dizzy, then he/she would be referred to a vestibular therapist for a course of treatment and return to the neurologist at the conclusion of the treatment. Same if he/she had trouble visually tracking objects he/she would be referred for vision therapy, etc.

Functional neurologists operate differently. Vision therapy, vestibular therapy, balance therapy are all incorporated in an immersive program that is monitored in real time as its happening. If a strategy or exercise is not working, it is changed immediately. This type of therapy is like a reboot for the brain. Specifically, we target, from the information gleaned from the exam, individual therapies aimed to the specific area of the brain that has been injured. This is the difference from a mainstream neurological approach.

I have been asked " is this method of treatment medically accepted"? The answer to this is yes. The approach is formed right out of the latest brain research. The strategy of aiming therapies directly to the part of the brain that has been injured is the most current in medical literature.

There is hope on the horizon for the treatment of traumatic brain injuries (TBI).† These new therapies are exciting and offer new light to people that have been suffering.† With these new treatments, people are being finally able to return to their normal activities.†