TBI/traumatic brain injury

Multiple areas of the brain are involved in TBI and concussion.

Concussion, or traumatic brain injury is common among contact sports participants. Concussion has been defined as a condition in which there is a traumatically induced alteration in mental status, with or without an associated loss of consciousness. In reviewing the scope of symptoms of actual concussion patients, further specificity can be discussed. Dizziness or vertigo is an erroneous perception of self motion or perception of environmental motion and of gravitational orientation. Most patients who have suffered a concussion experience this phenomena of symptomatology. Typically this perception is created through a mismatch between the vestibular, visual and proprioceptive, (sensation of the earth under your feet), systems. Because of the overlap of these systems, they each tend to compensate for deficiencies of the others by design. This is why when the lights suddenly go out, or you suddenly step onto a soft spongy surface such as wet sod from a hard surface such as concrete, the normal brain can quickly compensate by changing between these three systems to prevent falling. TBI does not produce a specific disease entity, rather, it causes a syndrome of mismatches of the stabilizing systems described above, in addition to headache and other symptoms. There is no evidence that medication improves recovery after concussion. Further, research has found that overuse of analgesics following injury may exacerbate concussion-related headaches or make them chronic. The most common treatment recommendations for concussion are rest. But this too has not met with satisfactory results as concussion symptoms commonly continue or worsen. An athlete who has a history of one or more concussions is at greater risk for being diagnosed with another concussion. The first ten days following a concussion appear to be the greatest risk for being diagnosed with another concussion. Second concussions are bad for several reasons. The brain has not yet recovered from the first concussion, so the damage becomes cumulative. Second impact syndromes are often the cause of fatalities in concussions, sports related, (adolescent and pro), or other causes. Although rest initially following a concussion is often advisable, it is not solely the best treatment for concussions. Our office uses the most contemporary and proactive treatment methods in the management of concussion brain injuries. We do this by directly affecting the aforementioned systems of balance for as long as these systems continue to be mismatched, there can be no recovery, and as long as these systems remain mismatched, they will perseverate the other concomitant symptoms associated with concussion and traumatic brain injury. More information on traumatic brain injury and treatment can be found on my website at



The main causes of concussions are typically anything that involves a head injury. This can include sports activities, and all too frequently, automobile accidents. Severe concussions, because of the immediate symptoms, are often followed up upon with medical care. It is however the less severe impacts that can become more problematic as these are not always brought to the attention of a medical person. In addition to neurologic symptoms which can develop following even a mild concussion, even more serious is something called second impact syndrome, whereby an individual with a concussion has a second one and has not yet recovered from the first. This can be so severe that it can actually be life threatening. For these reasons any suspect concussion, i.e. any head trauma, should be followed up for appropriate examination by a medical person well trained in post concussive injuries. The most common symptoms following a concussion include sensitivity to lights and sounds, and often altered sense of smell and difficulty reading. The latter is often inappropriately thought to be due to age related deterioration in vision, but is in fact due to an inability to properly place the eyes in the correct position and keep them there while viewing a target, or while moving the eyes from one target to another, or while following a target, as occurs with reading. My office is used to seeing patients who have had an untreated concussion years ago only to find worsening symptoms now. Naturally these are much easier to treat earlier on.

Things that you can do if you believe you may have had a concussion: The simplest thing you can do is come in to our office for a balance test. The test takes less than one minute to perform and yields an extraordinary amount of data relative to you postural systems and your brains ability to resist the earth’s gravitational pull properly, i.e. risk of fall. Our office does not charge for this service as we offer it as a free community service. Our office is additionally equipped with a complete balance center, including infrared video goggles which allow us to record and watch your eyes while following targets on a computer screen in real time. This information is essential to properly treat someone whose brain has been injured.



In the United States, sports-related head injuries occur frequently. The Centers for Disease Control, (CDC), estimates more than 300,000 sports-related concussions occur each year just in the US. There are a number of myths and misunderstandings among health care professionals regarding concussions.  Many physicians serve as the team doctor for their community high schools. The demands of clinical practice may preclude them for staying abreast of the latest evidence-based information regarding management of concussions in their student athletes. From 1982 through 1996, only 101 articles had appeared in the literature on concussion whereas recently this number has more than tripled.  The following new findings have all been demonstrated in recent research: 1. High school athletes are more vulnerable to concussions than older athletes and may take longer to recover.  2. Failure to properly manage concussion may lead to long-term cumulative consequences.  3. Loss of consciousness is not an appropriate marker for the presence or absence of concussion.  4. High school athletes are 3 times more likely to experience a second concussion if concussed once during a season.  5. More than 5% of high school athletes are concussed each year while participating in contact sports. There are a number of myths and misunderstandings among health care professionals regarding concussions.  Failure to recognize that a concussion has occurred increases the susceptibility of the student athlete in three ways: 1. A rare but fatal event, second impact syndrome, can occur in which there is massive brain swelling. Typically, this can occur when the student athlete receives a second blow to the head while still experiencing symptoms from the initial concussion.  2. A less serious, but nevertheless debilitating, sequelae is the development of a post-concussion syndrome in which headaches, dizziness, irritability, and eventually depression continue to persist for more than 6 weeks. The activities of daily living for the student athlete become disrupted secondary to their symptoms. Both academic performance and social interactions are impacted, primarily because no explanation for these symptoms has been offered to the athlete, family, or teachers. If an understanding is gained of the changes observed in the athlete being secondary to neurophysiologic mechanisms, support and accommodations are more likely to be offered.  3. There is now clear evidence that effects of concussions are cumulative.  It is, therefore, important to know the concussion history of the athlete when formulating a return to play decision. More information on concussion/traumatic brain injury can be found on my TBI/concussion page.