Allied Psychophysiology
Lee Porter, MSN, NP, CNS
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Brain injury - post-concussive syndrome

Traumatic Brain Injury Assessment and Treatment

Allied Psychophysiology offers state of the art assessment and treatment of mild to moderate (closed head) traumatic brain injury (TBI). Based on the type and severity of the presenting symptoms, a brain injury may be classed as a mild to moderate TBI (mTBI) even if there is no need for immediate neurosurgical intervention. According to the American College of Emergency Physicians, most people with mild to moderate TBI (mTBI) will not need acute treatment after their injuries are assessed. While mTBI is usually not life-threatening or requiring of hospital care, it still can be life changing. Up to 50% of people with mTBI will experience residual symptoms from their head injury. This injury can have a serious and long-term impact on a person’s cognitive, physical and psychological function. This disorder is formally referred to as post concussive syndrome. It can be a disabling condition.

Allied Psychophysiology works with patients with brain injuries (mTBI) who have residual symptoms.  Appropriate diagnosis, referral, and patient, family or caregiver education are critical for helping patients with post concussive syndrome achieve optimal recovery and to reduce or avoid adverse health outcomes. However, diagnosing post concussive syndrome can be challenging as the symptoms are common to those of other medical conditions; and the onset or recognition of symptoms may occur days or weeks after the initial injury.

Symptoms of Post-Concussive Syndrome (source: US Centers for Disease Control- CDC)

Symptoms of Post Concussive Syndrome

The signs and symptoms of a concussion can be difficult to identify.  Some of the symptoms of post concussion syndrome may appear right away, while others may not be noticed for days or months after the injury, or until the person starts resuming their everyday life and more demands are placed upon them. Sometimes, people do not recognize or admit that they are having problems. Early on, problems may be missed by the person with the concussion, family members, or doctors. People may look fine even though they are feeling or thinking differently.

Frequently, people who receive a head injury may also experience post traumatic stress disorder (PTSD) and these symptoms can overlap or compound symptoms of post concussive syndrome. Both of these disorders are treatable, but both can be very serious if left untreated.

When is a head injury an emergency?
Traumatic brain injuries are not limited to penetrating injuries that cause visible bleeding or swelling. Any bump, blow or jolt to the head that causes (even brief) loss of consciousness, loss of memory, confusion, severe headache, visual or speech problems, balance problems or dizziness, changes in mental status, vomiting, incontinence, or seizures constitutes a medical emergency and the individual should go to an emergency room immediately. This could be a life threatening condition.

My CT Scan and MRI were negative – can I still have a brain injury?
Yes. Unlike severe, acute brain injury, the disturbance of brain function from mTBI is related more to dysfunction of brain metabolism rather than to relatively large scale structural injury or damage. The current understanding of the underlying pathology of mTBI involves a paradigm shift away from a focus on anatomic damage to an emphasis on neuronal dysfunction (CDC “Facts for Physicians about Mild Traumatic Brain Injury”, updated 2009). Clinical signs and symptoms manifest themselves in brain function. Symptoms of mTBI such as poor memory, speed of processing, fatigue, and dizziness result from this underlying neurometabolic alteration.

Lee Porter, MSN, NP, CNS offers special care for treating the residual symptoms of concussion. Early treatment of symptoms by a specialist may speed recovery. After an initial assessment to discuss the injury and your symptoms, a QEEG may be recommended, which is reported to have better than 95% accuracy in detecting abnormal brain wave activity correlated with mTBI when it is done within 15 months of the original injury. Other tests, neurological evaluation, or other specialty consults may also be ordered to refine the diagnosis and treatment.

Sometimes post concussive symptoms resolve over time without further treatment. Most recovery occurs in the first weeks after injury. After that, more intensive treatment may be warranted if symptoms persist. Treatment options may include cognitive rehabilitation training or neurofeedback therapy, as well as medication to manage some of the symptoms.

References:

Bazarian JJ, Blyth B, Cimpello L. Bench to bedside: evidence for brain injury after concussion–looking beyond the computed tomography scan. Acad Emerg Med. 2006 Feb;13(2):199-214.

Duff J. The usefulness of quantitative EEG (QEEG) and neurotherapy in the assessment and treatment of post-concussion syndrome. Clin EEG Neurosci. 2004; 35(4):198-209.

Thatcher RW, Walker RA, Gerson I, Geisler FH. EEG discriminant analyses of mild head trauma. EEG Clin Neurophysiol 1989; 73:94-106.

Thatcher RW, Biver C, Mc Alaster R, Camacho M, Salazar, A. Biophysical Linkage between MRI and EEG Amplitude in Closed Head Injury. Neuroimage. 1998; 7, 352-367.

Thatcher RW, et all. An EEG severity index of traumatic brain injury. J Neuropsychiatry Clin Neurosci 2001; 13, 77-81.



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