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Concussion Puzzle’s Missing Piece

Much attention has recently been given to concussions, even calling them by their medical term – mild traumatic brain injury or TBI. However, despite much investigation into TBI and it’s much more insidious sibling, chronic traumatic encephalopathy or CTE, we still do no fully understand what happens, though we can see many of the symptoms. What are some of the facts about concussions? What is missing in the information? What should be done?

A point of information should be noted for those who would ask why we have not presented this information to those closely studying concussions. We have done exactly that. Regrettably, since we are a small private practice office and not an A-list research institute, our pleas have fallen on deaf ears.

Depending on which scale is used to identify the degree of a concussion (American Academy of Neurology, Colorado, Cantu, or Glasgow) concussions are given a grade of I, II or III. These are based on symptoms including such things as dizziness, tingling, or loss of consciousness (LOS). There are checklists to help onsite clinicians (doctors, other medical staff, and athletic trainers) assess for concussion symptoms and make return-to-play decisions. However, the reality is that no one really knows exactly what a concussion does, how long it takes the brain to return to normal or even if it ever truly returns to normal. Two days for a grade one? A week or two weeks for a grade two? Six weeks for a grade three? Different clinicians follow different guidelines because, in truth, no one really knows.

So what information is missing? Concussions do not show up on MRI’s or CT or SPECT or PET scans unless there is an anatomical change or a brain bleed because that’s not what happens 99% of the time. What happens is a disruption in the neuroelectrical system, the brain’s electrical system. We know this because in addition to several behavioral symptoms, the most prevalent symptom is the person’s inability to properly process information, whether it be verbal or visual. If I have trouble with my television signal and call the cable company, the first thing they check is the signal coming in. They bring a meter to quantify the signal. So why then don’t clinicians check the neuroelectrical system and quantify the signals to the brain and how they are being processed? Why don’t they use a “meter” to get information? Great questions!!

A neuroelectrical scan should measure brain waves, brain coherence, visual evoked responses (VER), and three different parts of the auditory processing, auditory evoked responses (AER), Frequency Modulated Auditory Evoked Responses (FMAER), and P300’s. In other words, it should measure all of the brain’s electrical activity, quantifies it, and locates any disruptions. And it does so without any invasive techniques or radioactive tracers. It literally is the missing piece of the concussion puzzle.

Right now clinicians indirectly measure processing by looking at the disruptions taking place as performances. The key is to go right to the source of the disruptions, changes in the brain’s neuroelectrical system. Athletes should have a baseline neuroelectrical scan. Once there is suspicion of a concussion, another scan should be administered and compared to the baseline. An athlete should not return to practice or play until all processing has returned to the baseline. Keeping in mind that any concussion lowers the threshold for another concussion (a topic for another day), it is exceedingly important to protect the body’s computer. We don’t need any more stories like Junior Seau, Mike Webster, or any of the other athletes who, in the words of Steve Hendrickson, former Cal Berkley and San Francisco 49’s football player once said after his scan, “I used to be a scholar-athlete. Now I can’t even spell it.”