Eye2Brain Academy

Stephanie Schwartz

How many is too many?

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Concussions happen everywhere. Many athletes sustain multiple concussions in their lifetime and are told by their pediatrician that they have to stop participating in athletic events due to how many head injuries they have reported. This stigma is only hurting the confidence of athletes and individuals, scaring people into the “what ifs” of concussion management and causing athletes to be untruthful with injury reporting.

It’s really not about how many concussions occur, but how each one recovers. Injuries that don’t recover, with or without a secondary impact, wreak havoc on the autonomic nervous system, vision/vestibular systems, and musculoskeletal system. Thus, leading to a very long road to recovery and a lot of pain/dysfunction in an individual’s daily activities. 

This can be prevented by improving and regulating sleep quality, taking the appropriate vitamins and pre/probiotics, and using eye hand coordination to integrate all lobes of the brain together again. Once asymptomatic, or total symptom score less than 5, start implementing interval training with the eye hand coordination exercises. When this goes well, and potentially even decreases symptoms, the athlete is ready to start increasing their heart rate and re-conditioning their system. Concussion recovery is interval training. If there is nothing else you take from this post, that’s it. Integrate heart rate intervals, appropriate rest time, and progress into endurance based activity. It’s important to know and understand various levels of activity so you can work toward an athlete’s goals without diversion. 

In short, there is no number to concussion or refraining from activity. Do we need to be smart? YES. Do we need to give the body time to recover fully? YES. If you’re a healthcare professional and are not sure what to do to assess an individual’s ability to return to sport, work, or daily living then refer to someone that can. Athletic Trainers, Physical Therapists, and Occupational Therapists are great resources to evaluate progress from a concussion management program and give feedback on readiness to return to normal activities.

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Q-Collar Myth Busters

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The below photos are of an athlete’s heart rate variability (HRV) after interval activity without and then with a q-collar. The goal of this research is to determine how the q-collar impacts the autonomic nervous system during physical activity, thus leading to how well an athlete would recover from concussion.

The protocol performed utilized the Dynavision D2 unit for eye hand coordination to measure reaction time in a 60 second time frame. The following exercises were completed between each set:

  • 25 squats
  • 10 pushups
  • 25 jumping jacks
  • 25 situps
  • 10 burpees

The athlete demonstrated the following reaction times without the q-collar with each of these exercises:

  • 25 squats = 0.63 seconds
  • 10 pushups = 0.64 seconds
  • 25 jumping jacks = 0.65 seconds
  • 25 situps = 0.61 seconds
  • 10 burpees = 0.72 seconds

After taking the first HRV, which you’ll see timed at 11:19 am, the athlete demonstrates the appropriate amount of brain wave stimulation for the time of day and sympathetic response after exercise. The blood flow throughout the spine is optimal in its entirety. The athlete also demonstrates an energy pyramid within normal limits and overall optimal performance.

Now, apply the q-collar and repeat the whole process. Here are the reaction time stats:

  • 25 squats = 0.68 seconds
  • 10 pushups = 0.63 seconds
  • 25 jumping jacks = 0.63 seconds
  • 25 situps = 0.61 seconds
  • 10 burpees = 0.72 seconds

See the second HRV, timed at 11:55 am, you will see that his energy resources are much lower than without the collar, that brain waves are more balanced with less beta and alpha stimulation (which are the 2 responsible for focus, concentration, and energy…!), and that he had less balanced blood flow throughout his spine.

Hypothetically, if an athlete were to sustain a concussion while wearing a q-collar, what good would it do given this information? Reply to this post to have the discussion!

qcollarDownload

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Using sound waves to balance the vestibular system

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A common question I ask when someone tells me they are dizzy is, “Do you feel like you are moving, or is the world around you moving?” When the answer is “I am moving” then we get the patient’s subjective response on which way they feel a sway, and then we also perform an assessment to get an objective verification of that sway. THEN, we use an app called Tone Pacer with bone conduction headphones to use sound waves to balance the vestibular system and discontinue the balance dysfunction causing dizziness.

Frequencies specific to vestibular canals are 100 Hz for the anterior canals and 500 Hz for the posterior canals. At Vision In Motion, we use an app called Tone Pacer to customize the frequencies used because we can customize it per ear. For example, if a patient demonstrates an anterior sway when the head is positioned up and to the right (left anterior canal and right posterior canal) then we will put 500 Hz on the left ear and 100 Hz on the right ear to activate the opposites of what we just saw. We always perform a dual task when using sound waves for vestibular balance, such as eye hand coordination activities, VOR exercises, and peripheral vision coordination exercises. We may do this anywhere between 5 and 20 minutes per session depending on how the patient tolerates this type of treatment.

Breakdown:

If there is an anterior sway, that means the side the anterior canal activated is overactive. This is why we would apply posterior frequencies to this canal; balance. The same concept is taken if there is a posterior sway and we need to apply anterior frequencies.

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Visual Snow Trajectories

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With the visual snow patients that we have encountered this year and the different treatment outcomes they have individually reported, we have noticed that there may be varying trajectories of why the visual snow occurs. 

  1. Biochemical
    1. Lifestyle
    2. Illness 
  2. Physiological
    1. Injury (i.e. concussion/TBI)

Treatments that have reported the most consistent positive outcomes include combinations of light and sound wave frequencies to increase energy reserves and the energy balance of the autonomic nervous system. Patients that are naturally a calmer demeanor, are not involved in regular exercise, and suffer from a biochemical trajectory seem to take much longer for treatment to have an effect than patients whose visual snow was onset by a concussion. To have more positive outcomes with these patients we discuss:

  1. Regular exercise that does not worsen the intensity of the visual snow. This may be something they have to trial and error.
  2. Nutrition. Are they getting the recommended daily amounts of fruits, vegetables, and protein? What kind of inflammatory foods are currently part of their diet and potentially inhibiting recovery?
  3. Sleep quality and consistency.
  4. Smoking cessation and avoiding alcohol consumption. This naturally increases the stress and sympathetic response of the autonomic nervous system, causing symptoms to worsen and be stuck. 

There is a website that you can ask the patient to use so you can see what they are seeing in their visual snow: https://visionsimulations.com/visual-snow.htm

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Retinal Detachment

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Importance of visual rehabilitation following eye and brain injuries:

The addition of vision rehab early in the recovery process following a TBI or eye injury can significantly impact the short term and long term outcomes and success of safely returning to play and work. 

A recent example: Female high school soccer athlete came in with a history of a retinal detachment (including 3 surgeries). Main symptomatology – decreased reaction time and visual field deficits in the affected eye and the opposite eye due to fast onset of cataract. 

Goals include:

  1. Implementing and being comfortable with protective equipment
  2. Improving reaction time in both central and peripheral fields of available vision
  3. Safe return to ADLs
  4. Preventing further injury/loss of vision 

Within 5 weeks of this athlete performing sports vision training exercises 2x a week in our clinic she has improved her overall reaction time by 2.5 seconds! She no longer has to completely search for a target; she just sees it and responds. For a 15 year old girl with a full life ahead of her this could have been tragic, but because of her attitude and family support she was able to be proactive and take hold of her future. She has not missed a high school soccer game yet.

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Cerebellar Ataxia: What can we do to help?

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We have had multiple patients come in recently presenting with Cerebellar Ataxia. Some of their main symptoms have included balance and swaying with weight bearing activities, double vision, and a lack of spatial awareness. We have experienced good results utilizing full body vibration at varying frequencies, plantar surface vibration with oculomotor tasks, VOR (seated then standing), EHC with proprioceptive stances, prism usage, and crossbody movements with oculomotor tasks. 

Our patients demonstrate improved confidence with walking and less reliance on walking aids within just a couple of sessions utilizing these treatments along with others. We have seen improvements in double vision with using prisms and seeing results last after taking the prisms off.

Just like muscles and soft tissues, the cerebellum needs to move and be challenged so it does not shrink. Regardless of age, hobbies, limitations…

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Nutrition Part 3: Protein Timing

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Everyone in healthcare stresses protein intake, and if they don’t they should! What most don’t tell you is that the timing of protein consumption is also crucial to performance. Case example:

Athlete walks in for concussion rehab at 345 pm AFTER a full day of work. When she was unable to perform word association as well as she has previously, we asked how much protein she has eaten today. Her response sounded mildly defensive, but she did respond with a smile on her face when she said, “I just ate a protein bar on the way here, and had muscle milk for breakfast”. We estimated that this was about 1/4 of what her daily protein intake needed to be for her body weight.

The clinicians had a great discussion with the athlete about the timing of protein consumption. It is most important to start the day off with natural sources of protein and then consuming it evenly throughout the day so that there is no drop in energy level. It is also important to consider how much protein is consumed of an evening, because this increases sleep quality. 

If you are unsure what the definition of a “good” source of protein is, you can always ask us and work collaboratively for positive patient outcomes. 

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Patient Engagement

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Keeping patients engaged in their care can help with patient compliance, leading to better outcomes of care. So what are ways that we can keep them engaged during treatments and when not in our direct care?

Some ways that are successful include: 1) finding out what they are passionate about and helping them to stay active with that activity during recovery. Even if it’s only in small increments. 2) doing our best to keep the atmosphere in the clinic light and welcoming; doing this through fun activities. 3) different conversational techniques, including humor with the appropriate patient population. 4) making the treatment sessions as competitive as the patient is (i.e. If the patient is super competitive in nature then we focus on the scores and how the scores they achieve compare to other scores we’ve seen on the same activities. And if the patient isn’t very competitive, we keep it about how they are feeling with the activities and not the scores as their standard for progress.) Patient engagement is important in keeping them compliant with their care, and giving them the steering wheel in their recovery process. 
These are just a few examples. What are ways that you utilize to keep your patients engaged?

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Golf Master’s 2023

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Did anyone watch the Master’s this weekend? (April 6-9, 2023)

We did. And wow, what a show. It reminds me that even professional athletes are human, in reference to Jon Rahm pulling out a ham sandwich in the middle of the tournament. I will attest, I am not a huge golfer. In fact I have a hard time watching it because I don’t understand when an athlete has good form, bad form, or what a “good” shot looks like. Regardless of that, each professional (and amateur in this year’s tournament) golfer spend countless hours training physically with trainers, mentally, and actually on the golf course. Some also do sports vision training in order to get their eyes to sink the putt, or to use the appropriate force in their swing. Which takes depth perception and eye hand coordination. Sports vision training also strongly utilizes cervical positioning. What kind of sports vision exercises could you do in various cervical positions that are golf specific? 

While you think about that, let me give you some ideas: 

  1. Ball toss with cervical rotation
  2. Chart exercises in side plank. You could also have them do thread the needle with this to really work gaze stabilization after changing direction.
  3. Pursuits with eye hand coordination in cervical rotation at various distances and eye levels.

Although golf seems like a slower paced sport, it’s really not. It takes a significant amount of concentration, technique, and visual endurance to be above average at the sport. Next time you spectate golf, or participate yourself, think about what kind of visual requirements the sport takes and how you as a healthcare professional can improve those skills. Until next time…

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Massive Results

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20 yo college student/club volleyball coach presented to the clinic last week with a symptom score in the upper 20s, with the history of 7 concussions in her last 2 years of high school then went a year and half without 1. A month ago was hit in the face with a volleyball during a practice and got another concussion. Pt family member expressed observed symptoms of migraines and “spacing out” during conversations. The Pt was seen in the clinic 4x this week and received treatments including but not limited to: syntonics (AlphaOmega/MuUpsilon), PEMF mat with Huso sound waves, cervical and facial dry needling, EHC activities, saccadic exercises, and neuro entrainment/meditative therapy with intermittent compression. 

After roughly 4 years of struggling with symptoms from multiple concussions and receiving no formal treatment, the Pt left her appointment today with a symptom score of 1 (headache) and stated that she is feeling better than she has in a few years.
The plan is to continue to treat her concussion and graduate to a return to play protocol so she can continue to exercise and coach volleyball without any worries of symptom provocation.

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