467- The Role of Chiropractic Care in Mild Traumatic Brain Injury Recovery

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode, we are talking all about mild traumatic brain injury tbi. And this is really interesting because it ties directly in to chiropractic. It literally says chiropractic in the title of the study. We're gonna dive into what the study found, how to apply it into your practice and more, all on today's episode. And I wanna kick it off with something that does tie into this and that is the best cervical spine objective ass tool on the market, bar none. Neckcare, neckcare.com, i'll drop that link down below. Reliable assessments and exercises for neuromuscular control, proprioception, range of motion and sensory motor integration. The best hardware and software package on the market. If you have not checked it out and had a conversation with their team, please do so neckcare.com but as I said at the top, today's episode is all about the research. New study that came out, the title is a little heady, but it is a fact of chiropractic intervention on ocular motor and attention attentional visual outcomes in young adults with long term mild traumatic brain injury. A randomized controlled trial in this study. Buckle up. This study is a good one. Let's begin with traumatic brain injury. TBI is a change in the typical brain function. It has effects on neurologic function after an external force to the head most of the time in the chiropractic realm. We're going to classify this two ways. One is with mvis, right? Personal injury cases, motor vehicle accidents. We see a lot of TBI testing tools, companies, et cetera on the market. Some are good, some are not good. Cervical spine assessments, neck care is the best. But TBI is a hot button topic relative to motor vehicle accidents. Personal injury. Also we can see mild traumatic brain injury. Sports, this is the other big one. And if you're a sports chiropractor, I'm hard pressed to believe you're not seeing this somewhat consistently. And if you're not, it's probably just because you're not looking for it. And that's a really key component. So diagnosis of a traumatic brain injury severity is pretty subjective. It's open to a significant amount of bias and predicting the outcome can be challenging. The and we see this, there's no greater example than in the pro sports realm. They're figuring it out as they go along very clearly. So when we look at the pro sports realm that have hundreds of millions, if not in some cases billion dollar plus with an athlete, with their salary, what they bring to the table and marketing expense, et cetera, and they're kind of figuring it out as they go along there, that provides probably when they have all of the tools in unlimited capital for, for us in a smaller practice setting, let's say it's challenging to really assess and it can be really challenging to predict the outcome. But that doesn't mean, and this article will highlight that doesn't mean there aren't things we can do to help that process along and maximize the results for the individuals that come into our practice. So visual symptoms, they can include a variety of different things. Ocular motor dysfunction is one of them. And this manifests often in challenges with convergence and accommodation, poor fixation, slower eye movements, eye pursuit movements being altered, and modifications of the vestibular ocular reflex or vor. Those are really important aspects when we're talking about analysis. To understand and to gain really accurate and objective, sensitive and specific eye gaze behaviors. There's a variety of what they call computerized eye tracker assessments, CEAs. And these have become increasingly common. And what they have discovered is that often the changes with CEAs can be influenced, impacted by proprioceptive changes in disorders, specifically from the cervical spine. Now that should start to take your interest because now we're getting into where this ties into what we do within chiropractic. Mild traumatic brain injury, higher incidence of neck pain, and significantly worse objective measures of cervical spine function compared to a normal population. We also know that when proprioceptive changes have occurred, this becomes a big deal because cognitive performance and specifically relative to mild traumatic brain injury can have influence impact. Again, there's a lot of unknowns with this, but there are tie ins with Alzheimer's, Parkinson's and stroke that are important to highlight. Enhancing proprioception on the other side, through better integration of vestibular and sensory motor functions can improve cognitive performance. So here we're seeing two ends of the spectrum. We see traumatic brain injury and CA performance really leading ultimately and having the potential to lead to some pretty catastrophic disease, chronic disease changes. We also know that improved the proprioception can really make a big impact. I always love to see how the researchers define chiropractic. They define it in a really interesting way. Chiropractic in a really Accurate way manual therapy whose aim is to manage spinal articular dysfunctions and altered neurological components associated with it. I said that a little bit awkwardly, but I think you get the point. Spinal joint dysfunction can result in altered afferent input to the central nervous system and that modifies the way which we process and integrate sensory and proprioceptive input. And once that dysfunction is corrected, sensory motor integration and cognitive function can improve important components there with the research because that is highlighting the core essence of where this study is going to move as we continue to go through it. Mild traumatic brain injury as assessed by these CEAs that were caused or worsened by a spinal injury. It's really important to think about the spinal dysfunction component. Sounds obvious, but for many, many decades and I will go out on a limb and say even today, many people that are suffering with post concussive syndromes, mild traumatic brain injury are not getting the chiropractic care that very likely they need to maximize the benefit over time. This study was a single, blinded, randomized, controlled, single intervention study and it had pre intervention, post intervention patient, basically people that struggled with all the participants, 18 to 35 years old, no known ocular motor deficits prior to their traumatic brain injury and some received chiropractic and some didn't. That's the easiest way to kind of go through the analysis. There were 20 people, approximate age 26 years old in the intervention group that was the chiropractic group. 20 people in the control group, average age 26 years old. So pretty similar in terms of that. And the key findings were as such. The results of this study showed that chiropractic intervention improved gaze stability both with a stable head fixation and during dynamic head movement. VOR chiropractic also reduced eye movement latency and improved the performance in the Stroop test. Stroop test goes into detail in the study. We'll drop of course a link down in the show notes if you want to check that out. It's a test specific to traumatic brain injury and how we are moving proprioceptively. So these findings do support the idea that vision based TBI symptoms involve some abnormal spinal issues, proprioceptive input, abnormal spinal issues, and that interventions aimed at reducing that dysfunction. Ding ding ding AKA chiropractic adjustments, spinal adjustments may have some benefit in the management of mild traumatic brain injury. The chiropractic group in this study showed improvement in gaze stability again during the fixation, meaning head still and during the VOR head moving test. And there has been previous research I did not know this showing brain injured people have poorer fixation than healthy controls, suggesting that a chronic injury can affect gaze stability. And this is important because a lot of times I look at some of the research like this, there's some more to go into in this study, but sometimes it can become pretty scientific pretty quickly and almost get detached from quality of life issues. You know, are you moving your head this way or that way? How is your eye moving this way or that way? And are we able to impart any inference on whether or not that's impacting or resulting in a mild traumatic brain injury? These are important things to keep in mind. But what's really important to keep in mind beyond all of that is people that have mild traumatic brain injuries. When you have a concussion, you're more likely to get a second concussion. We all know this. And then there's the cascade of these that can really impact quality of life. And I'm going to go take a step to the side here because athletes are easy to look at. When we've seen post concussive syndromes in athletes, people that have repetitive concussions, repetitive mild traumatic brain injuries, this can result in real big changes to their life. And I'm talking quality of life issues that go far outside the scope of what we consider spinal issues. Personality changes. We have seen violence ultimately as a result of some of these consistent concussions over a long period of time. Personality changes that get to the heart of the who the person were. And there's still a lot of gray area in terms of cause versus correlative, versus what was there versus not what. That's not for today's episode. What's for today's episode is for you to understand that what you do with your hands, what you do with the chiropractic adjustment, a spinal adjustment in your practice can make a really positive impact on the dysfunction of that individual's spine. And when you make a positive impact on the dysfunction of that individual's spine, you're helping them recover from that traumatic brain injury in the best manner possible. That is a really, really big deal. So during their Stroops test, they found people with post concussive syndrome had higher error rates and the time to complete the test was much longer than those in the normative data. So this is really important. And when we think about chiropractic, there's the proprioceptive aspect, can't be overstated. How we view and interpret our life, how we're living, how we know we are in space, all comes down to our brain's ability to process information. And the spine provides the largest amount of that proprioceptive information to the brain. So critical to remember that injury that causes spinal dysfunction could alter and does alter how we interpret all of this visual information. And when we provide chiropractic care, it can activate musculature, it can activate spindles in the spinal joints by firing 1A afferent to the brain, which this directly impacts processing. Chiropractic can, as we've seen in all of our mechanisms of action, we can change motor evoked potentials and their generation time, suggesting that we can impact and influence sensory drive to the brain and also the motor outputs. So both up and down, in and out to the brain. Very impactful. Especially tying this back to when somebody has alterations of brain capacity, alterations of brain function, specifically related to their ability to track in space, specifically related to their ability to know where they are in space. And while that may seem far detached from personality changes, it's probably a lot closer than we've given credit for in the past. The results of this study indicate that chiropractic can impact sensory motor function and influence a range of outcomes. And it should be considered for those suffering with post concussive syndromes. Practical applications they have two bullet points. I'm going to read them verbatim because they're great. This single blind, randomized controlled trial used chiropractic intervention to assess the difference in eye tracking outcomes for an intervention and control group. Chiropractic care resulted in significant, significant differences between the chiropractic and control groups for many eye tracking outcomes, indicating that improving spinal dysfunction aids in recovery from visual symptoms after mild traumatic brain injury. So couple take home messages there. This study got a little complicated. It can get really complicated really quickly. And I tried to keep it high level. But let's recap on some of the most important points. 1. Mild traumatic brain injury is a big deal. And for any individual that has a concussion, you need to understand that that can fall within the umbrella of mild traumatic brain injury. And you need to take the assessment of that really seriously for a variety of reasons. One is that you can make a really big impact in it. So being able to assess whether somebody has a mild traumatic brain injury and then deliver the appropriate care can help them in a way that's probably difficult for you to appreciate today. Two, for those individuals that are struggling with a traumatic brain injury, they can have a cascade of effects that could take effect over time. So you being able to help them get better quicker is really meaningful, especially when you think of the fact that one concussion dramatically increases the likelihood of the second concussion, which dramatically so the time and the velocity of this time really matters. If you're able to shorten the recovery period then, or at least influence the shortening of that recovery period, you are by definition going to be decreasing the likelihood that they're going to have a subsequent concussion. That advances into traumatic brain injury territory. That is really, really important. And another component is I can nearly guarantee you that almost nobody in your community knows that what you do within your four walls of your practice, probably very few of you out there listening, maybe you have a concussion based practice, but 99% of you listening, 99.999% of your community has no idea that when their child or themselves have a concussion or are diagnosed with a mild traumatic brain injury, they should be in your practice, borrowing a red flag unequivocally, bar none. So hopefully this research study started to tease out some of those concepts for you. Hopefully provide a little bit of inspiration to get out there and have some of these conversations. And of course I'm going to drop a link to the study down in the show notes if you'd love to dig deeper at the source. Now, before we wrap up today's episode, I want to say a few words about turncloud. Turncloud ehr. They're a supporter of this show. I'll ask you to click over to them, have a conversation with their team and see if turncloud can help you run a more efficient practice. Why wouldn't you do that? They strip away everything that's non essential, they make everyday function simpler, and they create an intuitive application where no one needs a user manual. If that sounds interesting to you, head over to turncloud.com, schedule a quick call with their team. Other than that, I hope you have a fantastic week in practice and I will talk to you soon.

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Sam.