Hi, I’m Dr. Jared Nielsen. I’d like to talk to you about three components of concussion that are often missed because we’re so focused on a pre-screen, be it a concussion screening form or some type of a computer-generated, pre-performance screening. We need to allow an adult or a student athlete to understand that their brain has three components of potential injury.
Let me describe it this way. The brain, for simplicity’s sake, is like a melon resting on top of a stick. It’s not square. It’s round. Because of that rounded relationship, it fits into our skull in a way that has the ability to basically float in space. There’s a free fluid that actually holds the brain in place or allows it to float in place. Therefore, we have a tethering at different levels.
Let me describe it this way. The brain has a master gland behind the eyes called the pituitary gland. The brain also has connections that come out to the ears, and this is the cranial nerve eight or the vestibulocochlear nerve. From that, the brain rests on this central area that has to do with all of our life functions, our stability, our awareness of our body in space, meaning all the feedback and all the output is coming through this brain stem.
Which creates for us visual inputs, neck or body inputs, joint mechanoreceptor inputs, and, also, the balance centers in our ears. If you look at this, these three components of concussion mean that if a person experiences a head trauma here, the head’s going to slap forward, which means this area of the brain could be injured. But then as it’s sheering or shifting across here, we can have an injury to this infundibulum, or the connection between the hypothalamus and the pituitary itself.
If this occurs, our hormonal output as well as our neurotransmitter sensitization may be altered. That can affect mood as well as our general body function, meaning the thyroid here and the thyroid stimulating hormone, adrenal corticotropic hormones. Hormones associated with male and female cycles.
Consequently, the person may start to lose their affect or their sense of well-being. In addition to that, because of this balance center, we see a distribution of feeling unsteady or dizzy or unable to stand upright or resist gravity. This person will experience dizziness or something comparable, as described as vertigo.
These positional vertigos don’t have to do with a lesion that would be associated with some type of a cancerous tumor in the ear, but post-traumatic will experience the sense of sway or as if the world’s moving or they don’t have the coordination to find themselves.
As we look at this, this is so important that we start to understand these three components of the concussion and not just using a simple form that says I’m positive or I’m not as positive as I used to be. It takes a close, specific examination neurologically and a specific functional neurologic exam of the brain outputs and what we’d expect.
Eye movements, eye movements in different directions, looking at a person’s ability to balance, their ability to find their nose with their eyes closed. Their ability to balance with themselves on a cushion or an unstable surface with their head forward or head back, eyes closed, eyes open. Head tilts, head rotations.
Evaluating do they feel unstable, dizzy, or vertiginous episodes that come and go with position? Even lying down versus sitting up. As we look at those different components of the concussion, now we have to target, again, specific rehabilitative aspects of this. If there’s something that’s been changed in pituitary outputs, we need to understand has there been a chance in thyroid-stimulating hormone? Is there a decrease in T4 total?
A subtle downward trend of these hormones will give us an indication of potential injury at this area because of that shifting mechanism where the brain is slid across this holding spot of the pituitary. Are we looking at specific regions of the brain that have been evaluated correctly before and after that now we see a difference?
If it be the frontal lobes, is there a change in focus or ability to hold different thoughts to concentrate or organize the brain? Has my mood changed or my ability to experience humanness in this region of the brain? Do I have blurred vision or my long-term memory affected because of something injured in the back area of the brain?
Has my ability to speak or my ability to calculate or to create words, has that changed because of a temporal impact to my brain? Finally, finding where that dizziness or vestibular balance center maybe have been disrupted that we then target specific exercises to restore that brain’s potential to heal.
As we look at concussion, it can become very, very complex, but a trained professional can help us in seeing where can we heal from a brain injury. The neatest part of this, as we start to look, concussions can be, also, linked to post-traumatic stress disorders as well as mild traumatic brain injuries.
As we look at military men who are returning or women who have served in the Armed Forces who have experienced some type of a bomb blast, there will also be that rotational component, that dizziness, vertigo, brain injury. Here, specifically, hormonal changes because of pituitary injury.
I’m Dr. Jared Nielsen. I hope that this concussion explanation helps you as you seek healing. Have a great day.