Review: Cracked the Musical

BY: HILARY PEARSON

One thing about this pandemic, there has been no shortage of creativity taking place online. Shot with the entire cast socially isolating, the short musical,Cracked, is no exception.

Vanessa is a high-achieving but emotionally distant woman who has had a concussion. As per the musical’s synopsis, “Vanessa gets conflicting doctors’ reports via her personal injury lawsuit – the doctor hired by her insurance company says she is fine, but the doctor hired by her lawyer says she is not. She then has to figure out who to believe, how to determine whether her symptoms are real or not, and how to proceed going forward – before her case goes to trial.”Cracked the Musical Poster

As a member of the brain injury community, I am glad there is something like this out there. This musical is truly unique. I am impressed with the production team’s creativity in composing their 16-minute mini-musical. Each cast member performs in their own living space, as is life right now.

A caution to all acquired brain injury (ABI) survivors that suffer from phonophobia or sound sensitivity, note that Vanessa sings with power and can definitely reach a high-C note.

Vanessa expresses very powerful thoughts after sustaining a head injury.

“Life as you know it is over.”

“Doctors say opposite things.”

“This is my life. It’s not a game.”

“I listened to them more than me.”

Vanesa refers to her lawyers, John and Chris, in the third song of the musical. She doubts herself throughout the process of recovery and pursuing a lawsuit. The pressure to make a decision is a very real and authentic experience of many ABI survivors.

The show asks the question of how a patient’s self-perception or sense of self-worth can be altered by the dramatic process of going through a personal injury lawsuit.

I think this concept is quite apparent throughout the performance. Vanessa has one line that I think all ABI survivors can relate to.

“The pain went away- wait, it’s back. I don’t know what’s real or fake. Am I fine?”

This rollercoaster of emotions, symptoms, pain, confusion, and uncertainty is absolutely a part of every patient with post concussion syndrome. The final song starts with Vanesa contemplating the concept of mindset. She consults reading material that suggests, “How you think you are, will directly impact your recovery.”

Vanessa has an interesting response.

“So what if I just decide I am better?”

Vanessa enthusiastically works through her opportunities ‘now that she is better.’ She can read books and visit her mom and her friends. She can return to work and excel in an environment that fosters a supportive community. I remember having the same thoughts during my recovery. I can resonate with the longing for relationships and contact with friends and family. After two and a half years of recovery, I was finally able to attempt reading again. I finished my first 200-page novel. That was a victory, a win.

Brain injury takes away so many luxuries I never knew I could miss. Like tying my hair up in a pony-tail. Surviving an entire day without a migraine attack. Meeting a friend at a coffee shop for a visit, an environment with loud noise and bright light.

Positive mindsets can be important for recovery. It is important to note that every single head injury is different. Every single path to recovery is different.

Cracked shows us one brain injury survivor’s journey. Vanessa’s journey is evidently painful, confusing and stressful. This is quite relatable. I personally cannot resonate with the concept that an instant change of mindset was the turning point in my recovery.

The Ontario Brain Injury Association (OBIA) provides their members with a Brain Injury Survivor Card. This card includes the following information:

NO TWO BRAIN INJURIES ARE ALIKE.

Symptoms of brain injury MAY include:

● Poor coordination or balance
● Slurred speech
● Confusion
● Impatience
● Impaired judgement
● Difficulty processing
● Agitation
● Communication difficulties
● Impulsivity
● Memory problems
● Disorientation
● Hearing or vision loss
● Seizure disorder

This card can be used to communicate with others in public if the individual is experiencing a flare up of symptoms. Many ABI victims can appear intoxicated to others who do not understand their behaviours while in pain or experiencing brain fog or sudden memory loss.

The survivor card also states, “You are not alone.”

I find this comforting. Just as I feel comfort in knowing there are other ABI survivors out there writing musicals about their concussion experience.

I hope that Vanessa’s message sparks some motivation for those who are still in the thick of their recovery, to fight for a mindset that masters a positive attitude. I applaud the cast members of Cracked in their initiative to create awareness of this life altering injury in a fantastic expression of art and music.

Tickets are available until May 31. Buy them and watch HERE

For more information, go to: http://crackedthemusical.mystrikingly.com


Hilary is a Toronto-based non-fiction writer and UofT master’s student. Hilary is recovering from TBI, PCS— and spends much of her free time on FaceTime with Isla, her baby niece.”

This post originally appeared on her Instagram, @halite_brain_beads

 

Logan: my story of living with multiple concussions

BY: LOGAN JUNG-RITCHIE

Hello everyone, my name is Logan and I live and work here in Toronto with my wife Renée. I have recently become a member of BIST in hopes to connect with others that have gone through similar injuries and challenges I have. So, to begin I thought I would share with you my story with concussion.

I grew up in a very rural part of Canada, where hockey is a way of life. Everyone plays, watches, and has a favourite NHL team.

kids playing hockey
Photo by Arthur Brognoli from Pexels

In small town Northwestern Ontario, the local high school team is a community centrepiece. When I moved up North from a southern town just about an hour outside of Toronto, I was the new kid in town heading into grade two, and I just wanted to fit in. I had to join the hockey team.

While I never quite managed to fit in off the ice with the guys who were born and raised in town, but on the ice I did. I placed value on myself for how I performed. Part of the culture around the game is that showing any type of vulnerability is a weakness. Back then, concussions were viewed as a non-issue, “You just got your bell rung, sack up and get back out there!” is the polite way to put it.

I never expected to run into concussion issues and I never took the risk seriously. With the arrogance of a teenager I felt invincible; even though I had suffered two concussions between the ages of eight and 12. Neither was I terribly serious in terms of recovery time, but I mention them because they set the stage for more severe incidents later on.

I was one of two players to make the high school team as a freshman, and I thought that could be a springboard for me to play higher levels within a couple years. I was sufficiently self-aware to know that I wasn’t good enough to play any sort of professional level, but the idea of playing for a university team was realistic. Between the ages of 16 and 17, I received a few offers to play at a higher level. However, I never accepted any of them because by that time I had grown disillusioned with the ‘hockey culture’. There were some things I just wasn’t willing to do so I decided that going to university and focusing on my studies was more important to me. I still intended to be a part of the game, playing in recreational leagues, for example. I did not want to leave it all behind me, but I had simply changed my priorities.

Playoffs during my final year of high school were the end of a chapter. In what was to be my last home game, my parents were in the stands along with a lot of friends, so I was flying high with emotion. In the second period of the game, a puck got caught in my feet from an errant pass and I had to turn to face the boards to fish it out. The captain of the other team was on top of me quickly and while my back was turned, in the most dangerous position on the ice, he hit me ruthlessly from behind. I went into the boards head first, the point of impact being the crown of my head. Funnily enough, I cannot recall much about the days following, but I remember that moment crystal clear. The first thought that went through my head was my neck was broken. That hit is incredibly dangerous, and has left other players paralyzed. My parents happened to be sitting right where it happened so they had a front row view. My Dad told me afterwards he thought I was paralyzed with the way I was lying on the ice not moving. By some stroke of good fortune—I wasn’t, but I was severely concussed. I had a splitting headache, nausea, blurred vision, and my head felt like a pressure cooker. The team doctor diagnosed me right away and took me through the treatment protocol, which doesn’t amount to much besides rest and avoiding stimuli such as noise, light, and screens. My Dad helped me out of my gear and I showered barely able to stand upright.

Hockey players entering the rink
Photo by Francesco Paggiaro from Pexels

After the game, my coach’s main concern was if I could play the following night. I couldn’t be in a lit room never mind skate or take another hit. He looked at me as if I was a disappointment. I felt weak and his reaction filled me with a sense of shame. I was team captain. I was supposed to be the leader, strong and infallible. I now know that there was no reason to be ashamed; but at the time, some support from a person I’d looked up to for five years would have gone a long way.  I remember being in shock at how close I came to my life being forever changed, and it stung that he could brush that moment off as if nothing happened. If I’m being honest, that reaction created a lot of resentment and anger that I still hold onto today. At that point, I was grateful just to be walking out of the rink, so recovery was not something I was concerned with. That would change as the months wore on and the symptoms continued to remain persistent. It is because of this injury that I made the decision to walk away from hockey permanently.

I thought, at the time, it was the game that ended it for my brain, but really it was my brain that ended my game. I made the decision, no one else. It was the only way to ensure my brain could take care of itself.

Guilt Trash Can
Photo via durera_toujours on Flickr

Funny thing about concussions, the recovery process starts right away. But unlike a broken bone that feels less painful or a surgery scar that starts to fade, symptoms can ease and you feel better one day—only to wake up the next day worse off than a week before.

Once your symptoms decrease, doctors will tell you to take it slow and increase activity incrementally. I was impatient to return to myself, feeling weak and vulnerable were not welcome feelings for me. During this time, I’d often be reminded how close I came to paralysis, thoughts which would bring on episodes of panic. Instead of relief, I often felt depressed, anxious and guilty.  The other thing I felt was anger towards the player who hit me. It was a filthy, gutless play which all players are taught to avoid. I also felt anger towards my defence partner for putting me in that position (this was unfair on my part and nothing more than self-pity). I even felt anger at my coaches and teammates for ignoring me after the injury and for laughing when I attempted to express my anxiety. But the most anger I felt was towards myself. I was the one who turned my back. A former coach of mine would have been ashamed of me. You never turn your back, ever. But I did. That guilt still wears on me to this day.

Without the support of my parents, I think I would have sunk into a dark place. They always lifted me up and gave me the time I needed. But in that time following the injury, I felt very lost.

In hindsight, I recognize that I went back into training too soon. I probably should have taken the spring sports season to fully heal. But I was adamant I wanted one last hurrah before heading off to university, so I geared up for the soccer season. Soccer, the sport that involves hitting a flying object with your head, perhaps not my best decision. But I made it through the season with no incident and left high school onto a new adventure. I hoped that this injury was the last and all concussion issues were behind me.

In my first year at university, while attempting to adjust to a move 2000 km from home, I suffered my fourth concussion while playing intramural soccer (against a team from our Med School, no joke).

Each concussion is unique, like a hellish snowflake. Judging recovery time is difficult, even for specialists. Happening so close to my last concussion, I was sure that I would be feeling the effects for weeks if not months, which would have been catastrophic to my exam hopes. But, surprisingly, symptoms cleared within a week and I was back to my normal self. The guy who was the best man at my wedding took me to the emergency room, and he made sure I was able to sleep properly without complications from the injury. Such support meant everything to me and I believe it is vital to proper recovery.

Each concussion is unique, like a hellish snowflake, and judging recovery time is difficult, even for specialists.-4

After that, I went five years without one concussion. This was a relief to me as I started to learn more about some of the research concerning repetitive brain trauma and CTE in athletes. However, while I was on holiday with my girlfriend and parents in the summer of 2017, a late night, bleary eyed trip to the bathroom resulted in a significant collision with a door frame. As ridiculous and embarrassing as the accident was, I have never had a feeling like that. My head felt like it was in a vice grip. I was knocked loopy and could barely form a proper sentence. When I woke up in the morning, the pressure in my head was worse and I felt like I was in a fog. It was incredibly odd to be conscious and yet feel like everything around me was passing by while I was locked in my own mind. Not being unfamiliar with the drill, I knew rest was crucial—so naturally I had to jump on a flight the next day, to get back to school, where the pressure changes and noise would cause the symptoms to worsen. Once I arrived back at school, though, I was hopeful that the symptoms would clear up quickly.

They didn’t. After a couple days of not listening to my head and strangling pressure, I decided to take time away and rest. For two weeks I laid on the couch or in bed staring at the ceiling and sleeping. The most I allowed myself was to listen to the radio in an effort to avoid losing my mind. At the end of two weeks I wasn’t healed, not even close, but I convinced myself I needed to go back to school and finish my Master’s thesis. I was a month away from my defence and my funding was set to expire, so I felt delaying was not an option. So I fought through the headaches, dizziness, and fatigue. Somehow I made it through and successfully defended my thesis, but afterwards I was completely exhausted and needed to rest.

Here’s the thing about post-concussion syndrome. People can’t see the hurts or fog. As time wore on, and my symptoms remained the same, I felt at greater pains to explain to others and myself why I wasn’t healing. It made me feel like a wimp for not ‘grinding through’, and I think that frustration and embarrassment took a toll.

For the first time post-concussion, I experienced mood swings. Sharp mood swings. I could go from happy and upbeat, to sad, depressed, even tearful, and then into a blinding rage within minutes. From some of the reading I had done on recovery, I knew this was experienced by others who had suffered multiple injuries, but you are never prepared for it to happen to you. Being so far away from my parents and girlfriend (who had moved across the country for her first post-university job opportunity), physically separated me from my primary support system. Despite this, they did more than I could have ever asked for. They honestly pulled me through to the other side of my darkest time. I’m not sure what would have happened without them. Renée was even able to make me laugh! Through it all, they helped me keep faith that the pressure would ease and the headaches would go away.

Not that there is ever a good time to be concussed, but  getting one right at the end of my Master’s was extra difficult because it came right at a massive turning point in my life. After university, I started searching for my first job, feeling the stress of bills to pay and needing to find a new place to live. Everything was changing at once and I couldn’t keep up. It was all I could do to get out of bed in the morning. It felt like I was locked away in my head while life passed me by. My lowest point during recovery would be mid-November, three months after hitting my head, when I went for a walk on a trail as flat as a pancake and within five minutes my head felt like it would explode. This happened after what I thought was a series of ‘good days’, and left me feeling completely defeated, like I would never get better and that normal would never return. I remember thinking to myself: “I’m a geologist, how on earth could I make anything of myself if my brain is mush?”

At that point, my family doctor decided to send me to a specialist. I was told that any more concussions would most likely result in a recovery time of at least six months. As an added bonus, I was strongly advised to quit all contact sports, which made all the sense in the world.

In a strange way, my experience has helped to understand my new normal. Not that I recommend going out and getting your head smashed in, but it did help me get to the point of accepting that some things needed to be kept in the past and I need to embrace new challenges and ideas to move forward. Scientific literature and anecdotal evidence will describe mood swings, changes in personality, and a tendency towards depression as potential lasting effects of multiple concussions, and I have noticed this to a certain extent in myself. I have to work harder to keep my mood up and it’s easier to fall into a depressive state. But it’s not scary anymore, it’s empowering.

These events happened to me, I cannot change that. I cannot change the nature of the game, I cannot prevent the next player from turning their back, and I cannot prevent the next late night bathroom trip (I am getting older). I also cannot change the choices I made while in recovery or the attitudes of others around me. But what I can do is reach out, learn, and listen; because I am far from the only person who has or is going through this.

And that brings me to the point of writing this and sharing my story in its entirety, for the first time. The only other person who I’ve told in this detail is my wife (Renée, who was my girlfriend I mentioned earlier in this story).  It is my hope that perhaps by sharing my experience that someone who is going through something similar or is a support to someone knows that even though it can feel like it they are not alone and things can get better with time and resilience.


Logan Jung-Ritchie lives in Toronto with his wife Renée. He is a former hockey player turned geologist working for an environmental consulting firm. He wants to write about my experiences with concussion not just in association to hockey, but also in everyday life. He says, “I hope that by sharing my journey with this brain injury that I can connect with others who have had or are having similar experiences.”

Making the subjective objective; how technology helps evaluate concussions

 BY: PHIL PALMER, DC AND DONALD D. SCHRUMP JR, DC, MS, CSCS

In the current climate of concussion clinics, many tools are being used to assess this type of serious injury, also known as traumatic brain injury (TBI), or acquired brain injury.

Assessments can include physical and mental status examination, Glasgow Coma Scale, Immediate Post-Concussion and Cognitive Testing (ImPACT) computer-based system, Balance Evaluation Scoring System (BESS), Inertial Sway measuring devices, and Optogait assessments. 1-3

 

Cognitive Symptoms of Concussion: difficulty remembering, feeling slowed down, feeling mentally foggy, difficulty concentrating, confused about recent events

 

Each assessment method is designed to evaluate the different aspects of the complex physical, cognitive and emotional disturbances that can result from a concussion.4

Establishing a ‘baseline’ with patients before a concussion occurs is useful in evaluating a person post-concussion to determine how the injury has affected them.1, 3, 5  This is not always possible given how and when a brain injury can occur.  An Assessment baseline can always be performed when commencing treatment and as an introduction to a rehabilitation program, and to compare against when re-evaluating a patient’s progress throughout their program.

One tool we are using to establish a patient’s baseline is the Optogait, which is considered a ‘gold-standard’ device for measuring gait (how a person walks), balance and movement symmetry.6-9

1

The simple 30-60 second test of walking on a treadmill can be recorded by a computer system using lasers to establish the individual characteristics of the patient’s gait, which can then be remeasured throughout the rehabilitation program.  This test gives objective data on all aspects of the gait cycle, as well as stability, balance and movement symmetry.

The amount you move when standing still (your postural sway), can also be measured by 3D accelerometers (which track acceleration), gyroscopes (which track orientation), and magnetometers (which, according to the journal, Karger, ‘measure the’ magnetic fields emitted by the brain, generated by neuronal activity).10 These tools allow a much precise measurement of sway  – up to 1,000 times per second more – compared to the current manual testing.

3

We also determine the speed of cognitive processing during walking by testing patients walking while counting backwards.  The movements of the eyes and head together (Vestibular Ocular Reflex) are also tested in order to determine concussive symptoms.

These tests are useful when a patient may feel that their concussion symptoms have resolved, but in fact, their cognitive processing is still poor.

The Gyko component of the protocol also tests sway, which is the movement of the centre of mass, and upper vs. lower body plus compensatory movement patterns made by the brain to return to a normal set point when standing and walking.

Screen Shot 2017-08-02 at 2.12.48 PM

These tests are blended nicely with the Optogait March in Place Tests (eyes open/eyes closed), and Gyko system to determine changes in physical functioning with changes in body position.

Most recently, a validation study was conducted to utilize the Optogait® equipment for evaluation of march-in-place tests traditionally used for vestibular (inner ear) testing, called the Fukuda or Uterberger Stepping Test. 3, 13-15

 

4

 

Using objective physical characteristics of the pathophysiology of TBI, the data collection with the OPTOGAIT equipment cannot be easily altered by the patient, thus you cannot under-estimate your symptoms with testing of gait, postural sway, or marching in place tests with your eyes open or closed.

This testing protocol provides an objective, evidence based protocol for both assessing, documenting and treating acquired brain injury.

Screen Shot 2017-08-02 at 2.13.07 PM


Dr. Philip Palmer is a chiropractor serving Toronto and the surrounding area. He is the clinical director of Genesis Rehabilitation, Physiotherapy and Sports Injury Clinic.

REFERENCES

  1. Hirsch MA, Grafton L, Runyon MS, et al. The Effect of Cognitive Task Complexity on Postural Sway in Adults Following Concussion. Archives of Physical Medicine and Rehabilitation. 2015;96(10):e51.
  2. Gaudet CE, Weyandt LL. Immediate Post-Concussion and Cognitive Testing (ImPACT): a systematic review of the prevalence and assessment of invalid performance. The Clinical neuropsychologist. 2017;31(1):43-58.
  3. Engelson MA, Bruns R, Nightingale CJ, et al. Validation of the OptoGait System for Monitoring Treatment and Recovery of Post-Concussion Athletes. Journal of chiropractic medicine.
  4. Harmon KG, Drezner JA, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. British journal of sports medicine. 2013;47(1):15-26.
  5. Alberts JL, Hirsch JR, Koop MM, et al. Using Accelerometer and Gyroscopic Measures to Quantify Postural Stability. Journal of athletic training. 2015;50(6):578-588.
  6. Lienhard K, Schneider D, Maffiuletti NA. Validity of the Optogait photoelectric system for the assessment of spatiotemporal gait parameters. Medical Engineering & Physics. 2013;35(4):500-504.
  7. Lee MM, Song CH, Lee KJ, Jung SW, Shin DC, Shin SH. Concurrent Validity and Test-retest Reliability of the OPTOGait Photoelectric Cell System for the Assessment of Spatio-temporal Parameters of the Gait of Young Adults. Journal of physical therapy science. 2014;26(1):81-85.
  8. Gomez Bernal A, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME. Reliability of the OptoGait portable photoelectric cell system for the quantification of spatial-temporal parameters of gait in young adults. Gait & Posture. 2016;50:196-200.
  9. Ammann R, Wyss T. Comaparison of Three Gold-Standards to Measure Ground Contact Time in Runners. SPORTWISSENSCHAFTLICHE. 2011.
  10. Neville C, Ludlow C, Rieger B. Measuring postural stability with an inertial sensor: validity and sensitivity. Medical devices (Auckland, NZ). 2015;8:447-455.
  11. Iosa M, Morone G, Bini F, Fusco A, Paolucci S, Marinozzi F. The connection between anthropometry and gait harmony unveiled through the lens of the golden ratio. Neuroscience letters. 2016;612:138-144.
  12. Iosa M, Bini F, Marinozzi F, et al. Stability and Harmony of Gait in Patients with Subacute Stroke. Journal of Medical and Biological Engineering. 2016;36(5):635-643.
  13. Zhang YB, Wang WQ. Reliability of the Fukuda stepping test to determine the side of vestibular dysfunction. The Journal of international medical research. 2011;39(4):1432-1437.
  14. Honaker JA, Boismier TE, Shepard NP, Shepard NT. Fukuda stepping test: sensitivity and specificity. Journal of the American Academy of Audiology. 2009;20(5):311-314; quiz 335.
  15. Grommes C, Conway D. The stepping test: a step back in history. Journal of the history of the neurosciences. 2011;20(1):29-33.
  16. Maerlender AC, Masterson CJ, James TD, et al. Test–retest, retest, and retest: Growth curve models of repeat testing with Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Journal of clinical and experimental neuropsychology. 2016;38(8):869-874.
  17. Schatz P, Glatts C. “Sandbagging” baseline test performance on ImPACT, without detection, is more difficult than it appears. Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists. 2013;28(3):236-244.

PHOTOS: Optogait Technologies Inc.

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How to best return to work following a concussion in the computer driven 21st century

BY: COLIN HARDING

One in five Canadians will experience a concussion from sport in their lifetime. Suffering a concussion can lead to a range of debilitating symptoms such as constant fatigue, changes in mood, headaches and difficulty concentrating.

Returning to work after a concussion can be challenging and if not done properly may slow recovery. There are activities and techniques that allow for the smoothest transition back to normal life and the best chance for a full recovery.

The following are some tips on how to recover from a concussion and return back to work while maintaining your health.

There are good days and bad days and accepting that things will take time is important to maintaining a high level of mental health.

Say yes to help & support

The Centre of Disease Control and Prevention recommends gathering support as an important part of recovery and may help lift the burden of a concussion off an individual’s shoulders. Support can come from many places: a partner, a family member, a healthcare professional or a manager at work.

Having open channels of communication can lead to a greater understanding and empathy during recovery. It is easier for your peers to understand your situation and support you through the process if they know what has happened.

For example, a manager who knows their co-worker has recently experienced a concussion should lessen the workload initially as the individual begins the transition from rest back to work and this may help decrease their symptoms and stress.

Woman at her desk with head in her hands
PHOTO: enerpic.com

Avoid triggers

Once someone has experienced a concussion it is important to recognize what triggers his or her symptoms. Every concussion is different and these triggers may range from person to person. The backlight on a computer screen may cause headaches, exercise may cause nausea, and conversations may cause fatigue.

Every individual has a different set of factors that will influence their symptoms. If an activity makes symptoms worse, then it is important to stop that activity and rest. For instance, if conversations’ are overwhelming, take a break from social engagements.

Manage your energy

It may sound simple, but managing symptoms and energy amongst all of the different aspects in your life can be a real challenge. Once the symptoms are resolved someone may wish to return to work. Returning with a decreased workload, taking scheduled breaks and being cognisant and respecting symptoms are helpful to ensure that transition goes smoothly.

Accepting that an injury has happened, and that it will take some time to recover from, is another important aspect to consider when living with a concussion.

Be patient

There are good days and bad days and accepting that things will take time is important to maintaining a high level of mental health. The recovery process and managing setbacks can be incredibly frustrating, and patience can be one of the most important aspects of a recovery.

A person should focus on the activities that they can control and feel like they are making progress on, as opposed to the activities that are out of their control. Light exercise (As long as a person does not experience worsening symptoms), a balanced diet, and getting enough sleep are part of the foundation to achieve health and could be part of a recovery plan.

Having a concussion can initially be draining and frustrating. Having the support from work and peers, being aware, managing symptoms, and accepting that recovery takes time can go a long way towards making the transition back to normal life successful.

 


Colin Harding is the CEO and founder of Iris Technologiesa Canadian healthcare technology company that is improving the lives of peoplewho have suffered from a mild traumatic brain injury (MTBI) or live with chronic migraines.

A version of this article originally appeared on the Iris Technologies Blog

Post Concussion Syndrome: Why giving up screen time is part of the solution & problem

LCD screens surround us. Many people stare at computer screens throughout their workdays, taking breaks only to check social media on their smartphones.

While there are far fewer concussions in the world than there are screens, the frequency with which these injuries occur has been increasingly acknowledged in the mainstream media. Athletes such as Sydney Crosby, Steve Young, and Eric Lindros just to name a few, have brought the severity of Post Concussion Syndrome (PCS) to the forefront of public discourse.

A person who suffers from PCS will experience symptoms such as dizziness, nausea and headaches for an extended period of time after the initial injury. This can last for weeks or months, and there is no clear answer as to how it can be minimized.

image of an office with a laptop and no one at the desk, next to a close up of a man who looks like he has a headache

The few treatment options that health professionals agree to are: rest, and a complete break from LCD screens.

While all cognitive activity can worsen the severity of headaches and dizziness in people with concussions, there are several reasons why the use of LCD screens in particular can exacerbate these symptoms:

  • Images that appear on LCD screens are made up of pixels that refresh at a rate of 60 times per second, even when the content on the screen is not changing.
  • The rapid movement of these pixels means when we look at screens for too long, we strain our eye muscles.
  • For someone who has suffered a brain injury, this strain can be detrimental.
  • Further, the backlighting of LCD screens can cause cognitive fatigue, headaches, dizziness and nausea in concussion patients.

22-year-old Maggie Callaghan, a varsity athlete who has suffered several sports related concussions over the past few years says she tried to avoid computer screens all together for weeks after her first concussion.

“I couldn’t look at a screen for more than a few minutes without feeling intense pain behind my eyes that would quickly evolve into a full blown migraine” Callaghan said. “I tried to avoid computer screens altogether for as long as I could.”

Maggie is one of many young concussion victims for whom the inability to study using a computer screen resulted in severe stress.

“It sort of becomes a cycle,” says Joe Ross, a 20-year-old student who, like Maggie, has suffered from concussions. “You feel sick when you use your computer to do school work, but when you aren’t able to keep up with your school work you feel anxious which can be harmful to the recovery process.”

Anxiety is just one of many mental health problems that disproportionately affects concussion patients. In fact, two out of three concussion patients experience depression following their recovery.

The social isolation that comes from being unable to communicate using computer and phone screens, as well as the stress associated with being unable to complete day-to-day tasks, are thought to be two of the primary causes of depression in concussion victims.

As difficult as it can be for students to abstain from using screens following their concussions, the struggle to recover from PCS without the use of computers can be even more intense for working adults.

“The recovery process would have been even more stressful if I had been working in a professional environment at the time of my concussions,” says Maggie. “So many jobs involve, if not completely revolve around, using computers. Being unable to work and not knowing when I would get better would be seriously nerve-wracking.”

Currently, treatment options for PCS do very little to account for the importance of screens in the average person’s everyday life. Patients have to work hard to engage in society and keep up with school or work without the use of their computer screens.

This can often be one of the most unexpected challenges of dealing with PCS.

So where does this leave people needing to return to a pre-concussion life while dealing with PCS?

While there are no solutions, one recent pilot study commissioned by the Canadian Concussion Centre indicated that people experiencing PCS were able to use a non-LCD screen, thus enabling a quicker return to school or work life.

PHOTOS via pixabay


Colin Harding is the CEO & Co-founder of Iris Technologies – a Canadian healthcare technology company that is improving the lives of people who have suffered from a mild traumatic brain injury (MTBI) or live with chronic migraines.
 
A version of this article appeared on the Iris Technologies Blog

Why didn’t my bike helmet prevent my TBI?

BY: SOPHIA VOUMVAKIS

15 per cent of the approximately 18,000 traumatic brain injuries (TBIs) that occur in a year in Ontario are a result of a cycling accident. Every year in Canada, over 11,000 people die as a result of a traumatic brain injury (TBI) – using the same 15 per cent – that’s over 1600 people in Canada who die as a result of a TBI caused by a cycling accident. 85 per cent of all cyclists’ deaths in Canada involve a brain injury.

A little over five years ago, I sustained a TBI while riding my bike. It was a beautiful spring morning, and I was riding my bike to work, as I had hundreds of times before. I remember leaving my home that morning, and then waking up in the emergency room at St. Michael’s Hospital, several hours later. I was told by the doctors in the emergency department that I had been knocked off my bike, hit the ground, passed out, and taken to the ER by ambulance. Several hours later I was diagnosed with a brain injury. To this day, I have no memory of the incident.

I was wearing a bike helmet, which I always did, but my helmet did not protect me against acquiring a TBI. I’d always wondered why, and recently I got my answer. I came across a TED Talk by bioengineer (and former football player) David Camarillo, who, along with his team at Stanford University, has been able to demonstrate what really happens to our brain during a concussion, and why bike helmets, and other sports helmets, such as football helmets are not designed to protect against concussion, but rather, they are designed and tested to determine how well they protect against skull fracture.

What happens to your brain during a concussion?

The standard thinking of what happens to your brain during a concussion is that the head moves, the brain lags behind, catches up, smashes into the skull, rebounds off the skull and then proceeds to run into the other side of the skull. This dynamic is repeated many times. This understanding of what happens to the brain during concussion suggests that the brain is damaged on the outer edges.

In his Stanford University lab, Camarillo and his team, with the aid of new technology, have looked closely at what happens to the brain when it is experiencing a concussion. Their investigations suggest that the current thinking about what occurs to the brain during a concussion is not entirely accurate. Firstly, he does not believe that the brain moves around as much as current wisdom suggests. Camarillo argues that there is very little room in our cranial cavity for movement, perhaps a few millimetres, and our cranial cavity is filled with spinal fluid, which acts as a protective layer. Secondly, he suggests that the brain does not move as a whole.

Football player with ball about to fall to the ground

Our brain is one of the softest organs in our body – the consistency of Jell-O – and as the brain moves around in our skull during a concussion, it is probably twisting and turning and contorting – the tissue is getting stretched. Concussion does not appear to be something that is happening to the outer edges of the brain, but rather it is happening somewhere much deeper, in the centre of the brain.

The Laboratory – The Stanford Football Team

To help Camarillo and his team better understand what is happening to the brain during a concussion they utilized a mouth guard equipped with sensors and a gyroscope, which most experts believe can tell us what happens to the brain during a concussion. When someone is struck in the head, the mouth guard records how the skull moves at a thousand samples per second.

The study’s laboratory is the Stanford football team, young men who regularly go out and hit their heads.  This allows for rich information to be obtained when the researchers extract the data out of the mouth guard.

When the data from the mouth guard, was combined with a finite element model of the brain, developed by Svein Kleiven in Sweden, it showed that the brain of football players, who have suffered a concussion does not smash around in the skull, as current thinking would lead us to believe, but rather twists and contorts. The data shows that the greatest amount of stretching occurs very close to the centre of the brain.

What’s there? The corpus callosum, the wiring which connects the left and right hemispheres of your brain. Camarillo believes that this might be one of the most common mechanisms of concussion, the wiring is being disrupted, which causes a disassociation between your right and left brain and could explain a lot of the symptoms one sees in concussion. This is consistent with what researchers see with Chronic Traumatic Encephalopathy (CTE) – when the corpus callosum of a middle aged, former football player is viewed, and compared to an individual who does not have CTE, his corpus callosum is greatly atrophied.

Although there is a rapid transmission of forces down to the corpus callosum when the head is struck, it does take a certain amount of time. What Camarillo and his team believe is that if we can slow the head down just enough so that the brain does not lag behind the skull, but instead moves in synchrony with the skull, then we might be able to prevent this mechanism of concussion.

How can we slow the head down?

The most currently used bicycle helmet is constructed of expanded polystyrene (EPS) foam within a thin plastic shell. The EPS liner absorbs the force of an impact by deforming, while the outer shell increases the area over which the force is dissipates. The main considerations when designing a bike helmet is the size and stiffness of the helmet, which impacts how efficiently energy is absorbed. As a result of the materials used in constructing an EPS helmet, the size of the helmet has been limited to a few inches. This does not slow down the head enough to enable the brain to move in synchrony with the skull, rather than lag behind the skull. It turns out that air, in an expandable helmet would be the ideal mechanism for slowing the head down enough during impact, so that the brain moves in synchrony with the skull, rather than lagging behind.

woman wearing a skirt standing with her bike

It turns out that a company in Sweden called Hovding, is using the principle of air to give the wearer of their ‘helmet’ some extra space to prevent concussion. Hovding has created what is essentially the world’s first airbag for cyclists. The Hovding is a collar, worn around the cyclist’s neck, that uses advanced sensors, similar to the sensors used in the mouth guards described in Camarillo’s research above, that can sense the cyclist’s movement patterns and will react in case of an accident. The airbag will then inflate, fixate your neck and provide a shock absorption. In experiments conducted by Camarillo and his team they have found that the Hovding collar can greatly reduce the risk of concussion in some scenarios, compared to a standard EPS bike helmet. The Hovding is currently for sale in Europe and Japan, and is CE labelled, which means it complies with European Union safety standards, but not for sale in the United States, and alas, Canada.

In the US, bike helmets are federally regulated by The Consumer Product Safety Commission. The Commission has jurisdiction over the type of helmets they approve. The test they use in order to grant approval to a bike helmet is testing the helmets capacity to prevent skull fractures, not whether the helmet is likely to prevent concussion. In Canada, The Canadian Standards Association accredits organizations to certify that bicycle helmets meet certain standards, such as CPSC bicycle helmet standard, which uses the tests described above by Camarillo.

I contacted Hovding and asked about the availability of their helmet in Canada – alas, it is not available here. They replied that, at this time, they have not investigated helmet certification in Canada. So it might take some time to get my head into one!

Even so, any helmet is better than no helmet, so keep wearing whatever helmet you have, and wear it properly.

 Resources

Modelling and Optimization of Airbag Helmets for Preventing Head Injuries,  published in The Annals of Biomedical Engineering in September 2016.


Since her TBI in 2011, Sophia has educated herself about TBI. She is interested in making research into TBI accessible to other survivors.

17 activities you can do when you’re recovering from a concussion

BY: ALISON

When I was in the acute phase of my concussion, I couldn’t do anything. I thought the boredom would kill me if my symptoms didn’t (new research suggests I was somewhat right).

I felt even more frustrated when my partner’s online search for fun activities for concussed people turned up countless suggestions that weren’t possible for me. All forms of stimuli were excruciatingly painful. I couldn’t do anything that involved electronic devices, lights, eye strain, sound, or physical activity.

Here is a list of activities that I gradually worked my way up to doing.

Please feel free to write a comment below and share what you did while recovering from your brain injury.

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