Traumatic Brain Injury and Concussion Evaluations

Did you ever wonder how it is determined that a football player with a concussion and wobbly legs from being knocked almost unconscious and being helped to the sideline is ruled to return to the game in a short time? Did you ever ponder how a boxer lying on the canvas after a devastating shot to the chin, obviously sustaining a concussion, staggers to his feet only to be deemed fit to continue? Does it concern you that men and women who have been shell-shocked by an explosive weapon or device, having sustained a mild to moderate traumatic brain injury, stumble to their feet, weapon in hand, to make life and death decisions on the battlefield and then return to a normal civilian life? You are not alone.

In 1999 there were as many as 14 different concussion-grading scales. Many of these involve terminology such as loss of consciousness (LOC), amnesia, symptom time frame, confusion and mental status. We now know, however, that LOC is not a predictor for concussion or traumatic brain injury severity, and only ten percent of all concussions involve LOC. The recovery is left to the subjective judgment of the evaluator. In other words using some cognitive testing such as orientation to time and space or some performance tasks, the evaluator gives an opinion on whether the individual is competent to continue. This is roughly the equivalent of even a competent cardiologist pronouncing someone ready to resume a normal life without having done an echocardiogram, cardiac ultrasound, stress test, or blood work. It would be an opinion based on observation. How comfortable would you be if the patient were you or someone close to you? The brain is arguably the most important organ in the body, but we do the least amount of evaluation of the brain before arriving at a conclusion about a path on which to proceed when treating it. There are good technologies available to objectively evaluate the brain.

Thornton and Carmody (Traumatic Brain Injury Rehabilitation; Applied Psychophysiological Biofeedback, 2009, 34:59-68), discussed the benefits of using a Quantified Electroencephalogram (QEEG) to assess concussions and traumatic brain injury. However, their conclusion was that more work needs to be done to delineate proper treatment. A digital electroencephalogram and spectral analysis, or DESA for short, is a noninvasive, non-painful, non-sedative technology that anyone can undergo. Not only does it consist of a baseline QEEG, but it also measures visual and auditory processing in real time. These neuroelectrical measures give objective information with which to make decisions about the levels of proper brain functioning.

Truth be told, without all of this information not even an excellent neurologist can tell how badly the brain’s electrical circuits have been damaged by a concussion, other traumatic brain injury or exactly when and to what extent recovery takes place. The National Football League is concerned enough about traumatic brain injury and concussions to have mandated all teams send representatives to a conference regarding the topic. Helmet manufacturers’ number one goal is to reduce trauma to the brain.

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