Motor Vehicle Collision and Concussion
Popular media has really elevated awareness about concussion and the potential long-term accumulative effects of concussion.
Even with all the attention concussion has received, it remains under-diagnosed and misunderstood. A hospital doctor will often not diagnose a concussion after a motor vehicle collision because concussion is not a life-threatening injury. If suspected head trauma has occurred, an MRI or CT may be ordered. This does not aid in the diagnoses of concussion. There is no commercially available imaging that can detect concussion. An MRI or CT is helpful when bleeding in or on the brain is occurring. A concussion, however, is a functional disturbance to the nervous system and is found by a competent and thorough exam.
Victims of motor vehicle collisions often suffer from concussions. 89% of these patients have objective (and subjective) signs of concussion. This was not a comprehensive audit of this patient population, but it does demonstrate that the chances of receiving a concussion from a motor vehicle collision are higher than previously thought.
Additionally, most of these patients did not hit their head. As stated in the American Chiropractic Board of Sports Physicians’ position paper on concussion, “Concussion may be caused by a direct blow to the head or elsewhere on the body.”
So, what does the exam for a concussion include?
Vitals
A thorough history
Do you have sensitivity to light or sound?
Do you have a headache?
Do you feel clumsy or have you lost your balance?
The two most common sequalae following a concussion is headache and dizziness.
Have you experienced memory problems (immediately following the accident, recalling something before the collision or recalling something after the collision)?
Have you experienced changes in sleep, digestion, or mood?
Sensory, motor and reflexes
The cranial nerves (nerves of your head and face)
Balance (we at Agape Health use motion capture software to detect subtle balance errors resulting from concussion. I will discuss balance in-depth in future articles.
Memory
This list of history questions and areas of examination is not extensive, but it does represent the basics.
It is only appropriate to assess for a concussion once other life- threatening conditions have been ruled out. We have found that concussion symptoms respond favorably to our interventions. Cranial (head bones) and cervical (neck) manipulations have proven to be helpful in our patient base. Interestingly, if you look at the symptoms of concussion and compare those symptoms with symptoms of an upper cervical dysfunction (the type of dysfunction we adjust in Chiropractic) you’ll see a lot of overlap. Soft tissue treatment to some of the deep muscles in the cervical spine may aid in recovery as well. Rehabilitation of the injured structures once they’ve been treated is also a must. Additionally, if the concussed individual is an athlete, then the athlete must follow a graded (gradual stepwise protocol) return to play. I will write more on treatment and recovery of concussion shortly.
Dr. Krugly is a Board-Certified Chiropractic Sports Physician by the American Chiropractic Board of Sports Physicians. He is also a Diplomate (highest level of education available) of the American Chiropractic Board of Sports Physicians. As a doctor of sports medicine, Dr. Krugly is a specialist in the assessment and management of head traumas including concussion.
A copy of the position paper on Concussion from the American Chiropractic Board of Sports Physicians can be found here https://secureservercdn.net/166.62.110.213/rvu.6e5.myftpupload.com/wp-content/uploads/2018/11/CONCUSSION-STATEMENT.pdf