Traumatic brain injury: Modern technology is game changer in diagnosis treatment

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By: Dr. John Conde DC, DACNB Special to the Boca and Delray Newspapers

Traumatic brain injuries (TBI) are usually caused by a bump, blow, penetrating injury or jolt to the head. The jolt can be described as an acceleration/deceleration force put upon the head where the brain “shakes violently” within the skull. In many instances, the trauma does not have to be overwhelmingly violent to affect the function of the brain. Everyone’s nervous system is different therefore not all individuals respond the same to injury. A trivial blow can induce lifelong handicaps for some individuals.

The major concerns immediately following a head injury are making sure that there is adequate oxygen supply, maintaining blood flow to the brain, and controlling raised intracranial pressure.  Axonal injury is typically a direct result of the accident as well as blood supply compromise which can lead to intracranial hemorrhaging (brain-bleed) or ischemia which robs the brain of oxygen. This is termed the acute stage of injury and is the most critical for sustaining life and may last for a couple of weeks. The chronic stage, however, describes the significant impairments left in the wake of the injury which can have a detrimental impact on activities of daily living such that it can leave an individual in a vegetative state.

In regard to the chronic state some of the main signs and symptoms are the following: motor signs such as spasticity or hemiplegia/ quadriplegia, mood impairments such as docility or aggresivity, emotional impairments such as anxiety or depression, impairments of executive function such as difficulty with planning and problem solving and short term memory, and lastly difficulty with cognition such as visuo-spatial awareness and focus and attention. The chronic state is where technology can truly change lives through the physiological phenomenon of plasticity, the ability for the brain to change and re-organize according to the environmental stimulus applied.

The most essential component in the management and treatment of a chronic brain injury is the examination. Isolating the injury to a generalized area is of upmost importance in setting up the correct treatment regimen. The following technological advances set the stage for proper targeted treatment; video-oculography (VOG) evaluates the precision of eye movements and the correlation to brain dysfunction, computerized dynamic posturography (CAPS) essentially looks at balance as this is most often affected with TBI, pupillometry investigates the relationship with pupillary diameter and responses to light and compares it to norms in identifying dysfunction in brain, Dynavision D2 is a visuo-motor-spatial assessment LED computerized board that measures processing speeds, and EQ Active Brain Tracking software is able to quantify cognitive impairment from the comfort of your own home. These are just some of the new tools available for creating a precise treatment plan.

Brain-based rehabilitation is truly where technology shines for TBI patients. Current treatments are highly objective and usually can generate statistically significant, real-time numbers for patient progress. The main objective of any cutting-edge, evidence-based rehabilitation program is to be able to quantify results, not just rely on subjective input. These therapeutic tools do just that; Interactive Metronome is a computer-generated timing program which improves cognitive and motor timing and processing, FitLights Trainer is a wireless RGB LED powered light system which focuses on speed and cognitive training and allows the doctor to customize the rehabilitation for the deficiency of the patient, Dynavision D2  promotes significant integration and activation of key regions in the brain affected by TBI especially the frontal lobe network, and repetitive peripheral somatosensory stimulation (RPSS) is a technology that enhances the appreciation of the affected body region by the brain thus creating a larger representation in the brain and increasing function. These are just a small list of technological innovations which have changed the landscape of TBI rehabilitation.

Dr. John Conde is a Board Certified Chiropractic Neurologist. His office is located at the Atlantic Grove in Delray Beach and can be reached at 561-330-6096, drconde@thecondecenter.com, www.thecondecenter.com