Unmarked Detour: Concussion Treatment Involved Team of Specialists

Because her daughter Heidi was experiencing post-concussion syndrome (PCS), and because her concussion made several pre-existing conditions worse, says Dorothy Bedford, a large team of different specialists - both traditional and alternative - helped to manage her care.

1. A pediatrician/primary care physician;
2. The staff of the Health Center at Heidi's boarding school;
3. A sports physician: in Heidi's case, a physician with specialized training in both sports musculoskelatal injuries and other medical conditions affecting athletes, but not an orthopedist or orthopedic surgeon;
4. Craniosacral therapists (CST): while considered somewhat outside the mainstream, the impressive results achieved by CSTs has led some leading sports physicians treating concussion to now refer patients to for craniosacral therapy, the goal of which is to improve cranial flexibility and restore normal brain function.  In Heidi's case, CST was helpful.
5. A chiropractic neurologist (CN): A CN practices a sub-specialty of chiropractic medicine focusing specifically on brain function; the aim is to restore normal brain function by locating the injured (target) area in the brain via non-invasive, stimulative techniques - such as very simple, non-strenuous, visual exercises, the use of specific colors and pattern of target lights - which reveal sensory or musculo-skelatal responses indicating either normalcy or dysfunction, and then perform therapy according to the observed responses to the targeted environmental stimuli.  The CN view of concussion suggests that symptoms linger due to the swelling of the neurons in the damaged area of the brain.  One specific brain area which may be damaged in a concussion is the vestibular system, which may cause dizziness and/or dysfunction of the brain's vascular (blood flow) system, among other symptoms.  CN is designed to promote the formation of new connections in damaged areas of the brain (neuroplasticity), the consequence of which is to improve brain function.  Heidi had been working with a CN since infancy.  Among the therapies her CN suggested after her concussion was the use of Epsom salts.  Whenever she was having a bad day, a warm (not hot) bath with Epsom salts always helped.  
6. A neuropsychologist for computerized neurocognitive testing (ImPACT) and academic accommodations.  Heidi's neuropsychologist was Dr. Rosemarie Scolaro Moser, MomsTeam's expert sports concussion neuropsychologist.
7. An optometrist/neuro-opthomalogist Heidi's concussion resulted in increased sensitivity to light (a common concussion symptom), discrepancies in her visual convergance (ability to coordinate her eyes at certain ranges), a narrowed field of vision which enlarged her blind spot, which Dorothy found worrisome, but more so because Heidi is a teenage driver.  She is still sensitive to light, but, with her field of vision issue much improved, Dorothy allowed her back behind the wheel of the family Jeep in November 2010;
8. An audiologist/neuro-otalogist .  Heidi has been hearing impaired since birth; the concussion worsened her disability, resulting in a permanent incremental loss of hearing, although not enough to keep her from returning to playing the concert (pedal) harp.  With her dream of playing college hockey shattered, Heidi will be applying to colleges with harp schools and practicing for a harp competition in July 2012
9. A vestibular rehabilitation therapist.  Heidi had a balance problem prior to her hockey concussion, and had experienced an extended bout of vertigo in 2008. At fifty weeks post-concussion, Heidi began vestibular rehabilitation therapy (VRT); six weeks later, all of her balance metrics were well within normal range; and
10.  A neurologist, who performed periodic neurological exams, diagnostic testing (EEG and MRI) and when Heidi began experiencing what she could only describe as a "buzzy" feeling, like an electrical current, taking over her brain for up to 60 seconds at a time, during which she could register input, but not respond in her head which left her unable to move.  Not surprisngly, as is usuallly the case with mild traumatic brain injuries such as concussion, neither the EEG (resting and 24-hour "walkabout") nor MRI found any clinical evidence to support Heidi's subjective symptomolgy.  Fortunately, her buzzy feeling eventually cleared.

Coordination a challenge

Because specialists are not, in her experience, very good at talking with each other about a particular patient,  Bedford says it is often up to the parents to coordinate their child's concussion treatment, prompting a recommendation that parents use a notebook to keep track of their child's care by various specialists.  

Posted December 13, 2011