BLOG: Five key elements for healing the brain
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by Michael Steiner, PT, DPT
A concussion or other type of brain injury can damage neuronal connections that serve as the communication pathways in the brain. This can produce common symptoms like headache and nausea and affect cognition and visual processing.
It can also make many of the automatic functions controlled by the brain — like your heart beating faster during exercise or your pupils constricting in bright sunlight — much less automatic.
In this setting, we want to do everything we can to get the brain back to its normal level of functioning as quickly as possible. And that requires neuroplasticity, or the ability of the brain to repair itself by forming new neuronal connections. Neuroplasticity allows undamaged axons to grow new nerve endings to reconnect links that were injured or, in some cases, form entirely new pathways in the brain.
To create an ideal healing environment, one that encourages and supports neuroplasticity, patients need five things: sleep, exercise, nutrition, stress management and cognitive challenge.
The fact that sleep and good nutrition are needed is probably not surprising, but many of the other elements on this list get short shrift in typical concussion care. Conventionally, patients have been told to rest and avoid physical activity after a brain injury. But research in the last few years strongly suggests that patients who are active early in the recovery process recover faster.
To be clear, I am not suggesting a quick return to contact sports. However, light aerobic exercise such as riding a stationary bike promotes the release of brain-derived neurotrophic factor, which is essential for neuroplasticity. For many people — and especially athletes — exercise is also an important stress management tool. Stress ramps up release of the hormone cortisol, which hampers neuroplasticity.
One of the first things I do with concussion patients is give them an exertion test. Many people may not pass the test on the first attempt due to an increase in their symptoms (eg, headache, nausea, dizziness), which would require a prescription heart rate to be established and used for therapy. But often the symptoms aren’t truly a physiological response to the activity itself. Rather, many times the symptoms are due to ocular or vestibular problems that leave the patient unable to process environmental stimuli. If they try riding the stationary bike and they close their eyes and the symptoms go away, then there is likely not exertion intolerance, and this patient is going to respond well to exertion therapy. Modifications will likely need to be made during exertion therapy until the vestibular and ocular deficits improve.
Another area that often gets neglected in the recovery process is exposing the concussion patient to cognitive tasks. For example, patients are often advised to avoid or cut back on school and TV or reading. However, if you remove too much sensory input, it is really hard for the brain to be challenged to build new neuronal connections and get back to normal functioning. It is important that patients be counseled that sensory exposure may provoke symptoms that feel uncomfortable, but that we want to keep exposing them, little by little, until it isn’t uncomfortable anymore.
I have found that when sleep, exercise, stress, nutrition and cognitive challenge are all managed appropriately, it creates an environment that is conducive to neuroplasticity and promotes concussion recovery. Address any of these missing links and the patient will often start to make progress — or more rapid progress — in other areas of their rehabilitation program, such as vision therapy or physical therapy.
References:
Grool AM, et al. JAMA. 2016;doi:10.1001/jama.2016.17396.
Leddy JJ, et al. JAMA Pediatr. 2019;doi:10.1001/jamapediatrics.2018.4397.
For more information:
Michael Steiner, PT, DPT, is a certified concussion and vestibular rehabilitation specialist with Twin Cities Orthopedic, in Burnsville, Minn. He believes in an active treatment approach with focus on injury prevention and lifelong health and wellness. He will be speaking on “How to create a healing environment for the concussion patient” at the NORA annual conference, Sept. 11-13, 2020, in Columbus, Ohio.
Disclosure: Steiner reports no relevant financial disclosures.
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