Hi, I’m Dr. Jared Nielsen here in Heber City, Utah. I like to share with you a video that is a reference to a discussion that we have regarding concussion. A lot of parents come to us asking, what do I do for my child after concussion? There are actually some assessments steps in this video that will give you a personal way to evaluate your child and determine do they need additional help or care after an injury. I hope you enjoy this video and it’s a help to you. Thanks.
When we look at concussion from a functional perspective, we look at the brain as a living organism that has an environment that’s completely in case in water. When you look at the brain truly, if you make a fist, two fist together, you have your brain that’s just basically in a balloon and it’s suspended or floating in water and the neat thing about that is really it should not have any contact points.
There’s a line around the brain called the dura mater and when you look at dura in Latin that means tough and mater is mother so the tough mother is what protects that brain. The tough mother has this connections to the skull itself and because of those connection regions, if there is nothing but trauma, it can actually pull that away and the bleed can occur just below or what we call as subdural hemorrhage.
We end up getting that bleeding underneath that interface between the skull and the tough mother.
When we talk about brain and brain environment, oftentimes it’s not the immediate effect, but later the effect. How many of you have ever sprained your ankle, and while you’re still able to walk, the pain isn’t too bad, but the next morning, when you wake up and it’s all black and blue, and you go to step on it, it’s so painful?
That’s the unique thing about concussion. We’re talking about concussion especially to parents. You need to be able to learn how to look for some simple signs and symptoms of concussion. If your child’s complained of a head injury, or if they’ve been a sports injury, the morning after is really the time when you need to know how are they doing.
Did they vomit during the night? Did they awake with a headache? When you come to them, are they complaining now of feeling like they’re spinning? Do they sleep longer than they normally do? Usually, your kid that just pops right up in the morning is delayed or unresponsive, and even then, two days and three days later.
When we look at swelling in the brain, just like in the angle, again, as was introduced earlier with the sketching, the ankle slowly swells, but it has no hard compartment outside of it to stop that swelling, so it just keeps swelling, whereas the brain, because it’s hard, once the swelling begins, it can only swell to a certain size. Then it actually starts to swell back against itself, and that’s where the problem begins.
The other thing that we see the mild concussions is it changes that brain environment, so now the brain actually releases inflammatory chemicals, or neurochemicals, to try to help it to heal, but what starts to happen is we start to see what we call “spontaneous depolarization” of regions around that injured area, so it actually starts to spread comparable to a migraine.
The fascinating thing about traumatic brain injuries is, when we look at the need for them to heal, a lot of people think, “Now let’s get the inflammation down immediately.”
But when we look at the research by Dr. Carrick, who actually took care of Sid Crosby, what they’ve proven now is that there’s a window of healing that the brain actually needs those neurochemicals. If we take them down too quickly, the brain doesn’t have the building blocks that it needs. But if we let it go on too long, then it can actually become this neurochemical cesspool, if you will, that doesn’t allow the brain to heal.
Roughly, we have about a 10 to 14 day window that the brain needs those neurochemical to begin healing. Once that time period has passed, now we want to intervene and start to implement some supplementation to reduce the inflammation of the brain [inaudible 13:35] functioning.
When we actually take the hand and just take the hand and trace on the arm around the hand a letter, have them close their eyes, close your eyes, tell me what letter is this. We do capital letters.
Again, higher executive functioning is just present. But you’ll see, when a child’s had a concussion or your spouse has had a concussion, in those regions, they’ll lose that ability to recognize.
The parietal strip, or sensory strip, of the brain can be quickly assessed by just looking at their ability to recognize a touch right touch. Close your eyes. Use the opposite hand to touch right touch. We look for accuracy. We’re pretty accurate on that arm. We go to the opposite side. Eyes closed again. Touch right touch. Pretty accurate there as well.
Oftentimes, when we have post-concussed brain, we’ll touch here and they’ll actually touch two to three and even four inches away from where you touch and have no idea, sometimes even which arm you’ve touched. You’ll touch this arm and they’ll think you’ve touched this arm. That depends again on that global presentation of the brain.
When we look at the ability of the brain in coordination again, when we turn the head, the cerebellum is this basal area. That area has to do with the coordination. We can quickly assess that by just having them hold their hands out in front. Both hands, eyes closed, touch the tip of the nose with the tip of this finger. Good. And the opposite side.
As you noticed, the first time, just a little bit low. Touch again with the left, and you look at that response. It actually has the pass point on the left side. We go from there, eyes open, to then waving the hands quickly. Turn the hands here, waving quickly, quickly, quickly, quickly. Good. Keep going nice and quickly.
In this position, you’re actually looking for the breakdown in the shoulders. You see this shoulder start to wave a little bit more than the right. Bring the elbows down to your side, then waving the hands again, quickly. Good. You can see a little bit of the slowness on that side. Good. That’s just a quick assessment. If you see something different, you don’t need to know what it is. Just observe for a difference in side to side.
When we bring the finger to the nose, if you see there’s a difference…”Hmm, something’s off. My son doesn’t look like he’s got the balance that he needs.”
When we look at a functional neurologic exam, also, again, learning how to look at the eyes quickly, when he says his clinician runs out to the field with the light and looks at the eyes quickly. Have you all seen the eyes, how they dilate and constrict when you shine a light at the eye, the eye should constrict quickly. Have you all seen that? Is everyone seeing that?
You can use, actually, the light on your cell phone and just shine that quickly at the eye and make sure that the eye actually constricts. If it doesn’t, that’s a problem. Again, when we look at this type of an injury, quickly, you, as a parent, can just see where is their imbalance.