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Concussion Or Mild Traumatic Brain Injury: Literature Review
Introduction
Concussions or mild traumatic brain injury has gain more attention in the past 10 years. The center of disease control describes a concussion as a type of traumatic brain injuryor TBIcaused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells. (Center of Disease Control and prevention, 2019). With this being said there is a glaring need for chiropractic to be at the forefront of concussion recovery now more than ever. With the discovery of what chiropractic is doing for the neurology of the brain it seems like matcha made in heaven in terms of treatment.
Methods
For this literature review I used the databases offered by life university which are PubMed and Index of chiropractic. When using the PudMed and Index to Chiropractic data bases the terms used for the review were concussion, post-concussion syndrome, sports, manipulation, mTBI(mild traumatic brain injury) and chiropractic. Each search was filtered by only looking at articles that were published in the last five years and were peer-reviewed. The purpose of this article was to look into the population that has experienced a concussion and seek out help outside of the gold standard of care whioch is to rest to decrease concussion symptoms. The last method used was the observation of YouTube videos on concussions. This was only used as means to find keywords that would help me find more keywords that could expand my research article search.
Results
When searching the PubMed and Index to chiropractic literature 4 articles were found to be of great use that match and yet challanged my topic. I was able to find two from each database. The first search gave me the article Management of Mild Traumatic Brain Injury Symptoms in a 31-Year-Old Woman Using Cervical Manipulation and Acupuncture . This article was found on PubMed Literature using the keywords mild traumatic brain and manipulation. This search gave me 22 articles. The significance of this article was due to its ability to give some step by step information on the process of treating concussions. It also was due to the fact that it brought about a new component in treating concussions alongside chiropractic.
The next article found in the PubMed database was Sports-related concussion: evaluation, treatment and future direction . This article was found using the keywords sports, concussion and manipulation. There were 3 articles found with this search. The significance of this study was the numerous amount of details and components that currently are apart of treating concussions.
The next two articles found come from the Index to Chiropractic Database. The first article was Concussion management in an adolescent football player using individualized rehabilitation along with spinal manipulation . This article was found using the keywords sports and concussion. There were 17 articles found with this search. The significance of this study was how it showcased chiropractic care as a treatment for concussions. This active treatment is different from the standard protocol which is to rest just.
The final article obtained was Chiropractic Management of the craniocervical junction in post-concussion syndrome This article was found in the index to chiropractic using the term post-concussion syndrome. There were 25 articles on this search. The significance of this study is how it goes into detail about the benefits of upper cervical care in patients with post-concussion syndrome.
Discussion
In the article, Management of Mild Traumatic Brain Injury Symptoms in a 31-Year-Old Woman Using Cervical Manipulation and Acupuncture, a 31-year-old woman presents to a chiropractor after a face first fall on ice and was knocked unconscious for 4 minutes. She gave a subjective complaint of neck pain, frontal and occipital headaches, nausea, vomiting, dizziness, fatigue, tinnitus and cognitive fogginess. Her exam consists of static rotational changes in the occiput, motion restriction of C3-C7 and no evidence of cranial trauma. After 3 adjustments for 2 weeks in a combination of trigger point therapy to the trapezius and suboccipital muscles, the patients pain reduced but there was still symptoms. The symptoms included nausea, dizziness, fatigue and tinnitus. This led to the doctor to comanaging the patients last 2 adjustments with another care provider leading to a better overall quality of life. After 2 treatments combining chiropractic manipulation and acupuncture over 3 days, the patient reported neck and headache pain levels to be 0/10 NPS and a complete resolution of the physical and cognitive mTBI symptoms. (Gergen, 2015) This article supports my hypothesis of chiropractic helping with concussions but only to a certain degree. The savior in this case seems to be the acupuncture in terms of the concussion symptoms. The hole in this research is that it does not inform the reader of why the acupuncture doctor was picked. Another limiting factor was the compatibility to other patients. The findings of this case report may not necessarily be applicable to other patients with similar symptoms. More participants in a more distributed population are needed to test the results of these treatment methods with more objective evaluation measures. (Gergen, 2015)
In the article, Sports-related concussion: evaluation, treatment and future direction , the article talks about post-concussion syndrome and where the feel medicine field is leaning in terms of activity recovery. It starts out with understanding the syndrome and the evaluation of post-concussion syndrome. One of the main points in this article was the perspective of active recovery. This includes submaximal aerobic therapy, treadmill exericses, visualization training and light coordination activity. The holes in this article are due to lack of explanation on what these activities are suppose to do for the patient. They do mention that activities is better than rest but in the same breathe doesnt give an explanation. Third, early evidence suggests that active rehabilitation may improve symptom recovery more than prescribed rest alone, and this calls for matching specific treatments to individual clinical profiles. (Lydia McKeithan N. H., 2019) Chiropractic is nowhere to be found in this article and therefore did not support my hypothesis. This article supported more physical therapies.
In the article, Concussion management in an adolescent football player using individualized rehabilitation along with spinal manipulation, a 17 year old football player is treated after suffering a concussion at his high school football game. The patient symptoms presented red flags due to vomiting while concentrating on homework, increased headache, decreased left upper extremity strength. (Tiffanee McArthur, 2019). He also hard soft tissue tenderness, decrease orientation and memory. When he returned to the chiropractic office 3 days later her began care. The team had a team chiropractor who diagnosed and referred him. His care plan consisted soft tissue therapy to the all muscles of the neck and spinal manipulation. The text did not specific say which manipulation it was performing but did note cervical dysfunction. The patient was given an individualized active exercise program and in-clinic treatment was geared at restoring both cervical and vestibular dysfunctions (Tiffanee McArthur, 2019) They also talked about how they were adjusting him as well. The cervical dysfunction was addressed with high-velocity low-amplitude (HVLA) manipulation in the cervical and thoracic spine, and therapeutic exercises were prescribed that included various forms of vestibular rehabilitation exercises. (Tiffanee McArthur, 2019). By his 6th and final visit which was 27 days after his concussion, he was asymptomatic with no restriction with football or school. This article was supportive of my hypothesis. In fact that it gives hope that football-related concussions can be treated with chiropractic care. A larger sample size is needed for validity purposes as well as other factors like age, race, gender and number of concussions received prior to.
In the article, Chiropractic Management of the craniocervical junction in post-concussion syndrome 6 patients went through a 12-week trial of chiropractic care with a history of concussion. The patient rated from 39 to 82 years old. Before they started care they tested to ensure they had upper cervical subluxations via posture scan, leg checks, bilateral weight scale and spinal palpation. Once confirm they had patients do head, neck and concussion survey to obtain a baseline of where they were. They also talked about the type adjustment which is specific to C1. The NUCCA adjustment consists of placing the patient in side posture on the NUCCA adjusting table with the head specifically braced using a mastoid support system, and a specific force was directed into the transverse process of the Atlas. (James Moore, 2019). With the doctor care plan and patient compliance doctors saw a significant decrease in sign and symptoms post-concussion syndrome. In this case series of 6 post-concussion patients, there were improvements in many of the measures assessed after the NUCCA intervention. This is suggesting that trauma significant enough to cause post-concussion syndrome can also influence cervical spine function. (James Moore, 2019). This article does support my hypothesis of chiropractic care being an active source of treatment for concussions. The one thing that I didnt find was would make this better would be a diversity in age, occupation and a larger sample size.
Conclusion
The centers for disease control (CDC) estimate that 1.6 to 3.8 million sports-related traumatic brain injuries (TBI) occur every year . This is widely regarded as an underestimation, as many people suffering from mild TBI (mTBI) do not seek medical attention. (Lydia McKeithan, 2019). With this being said it is fair to say that there are a lot of individuals with concussion-like symptoms. This includes but is not limited to disorientation, dizziness, nausea, vomiting, fatigue and neck pain. These symptoms are often times found at the onset of impact but if not, it causes issues for professionals to diagnose a cause linked to the symptoms. Better educating patients, as well as more referrals to chiropractors, is one more step to leading patients to getting better quality of care for post-concussion patients everywhere. Also putting chiropractors in the places where concussions are most common like all sports.
The majority of the articles had a substantial amount of information supporting that chiropractic care does in fact help with patients suffering from concussions. One of the major agreed points on each of the articles was that upper cervical chiropractic care give us the best results. One major difference is the route of how they diagnose concussion and they way they plan to fix them whether it be chiropractic or physical rehab. Though each article was detailed and good for the most part each one should increase their testing sample size for data validity. Another thing would be to talk more about the significance of atlas and its relationship with the brainstem. Overall this topic is one that should become addressed in the medical community. While rest is the norm with concussions, active treatment should become talked about once the patient is stable. In my practice, I will definitely love to see this type of patient and will always be aware of the occiput, atlas and axis junction first.
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