The Dorsolateral prefrontal cortex (dlPFC) is responsible for executive functions including working memory, cognitive flexibility, planning, inhibition and abstract reasoning. There has been extensive research of studies on glutamate receptor mechanisms underlying classic neuroplasticity, but few on NMDA receptors mediating the recurrent excitatory circuits underlying working memory in the dlPFC. This is significant to aging and Alzheimer’s because of the decline in expression of NMDA receptors in the dlPFC could be related to impaired cognition. To reach further see article.
Family history of migraines is a precursor to headaches in children and as per studies cited bellow, head trauma and concussions may increase the length of headaches and complicate treatment. The question is: are Traumatic-Triggered Migraines (TTM’s) different than headaches as a concussive characteristic? and should they be treated differently? The case study referenced by Lords, Q reported in Sports Health Multidisciplinary App.(Traumatic Migraine Versus Concussion: A Case Report.) presented a different look at their diagnosis and treatment approach. This report instead of actually separating them apart it may be pointing out how related they are or that one is part of the other. Headaches post injury may be more or less severe, longer lasting and have a genetic component but should be dealt with in the contest of brain injury. The word “Concussion” can at this time, after it became a popular word in sports, complicate how we deal with it. Because concussions have the sports connotation is easy to fall into the trap of making us follow the light path others have taken and skip important steps toward treatment. In the brain injury world, per say, I can relate to the stance of wanting to distance ourselves from what the word “concussion” is becoming and try to separate its components, such as headaches, and give it another name as it clearly happens in the cited article. For example in this study the author seem to attempt to separate the diagnosis between what a concussion is and what traumatic related headaches or migraines are. Headaches and migraines most times are components of a concussion were its nature, historic and genetic component challenges current diagnosis and treatment methods.
Have you dealt with headaches and/or migraines pre and post injury? Can you separate them and what approaches have you tried with or without success?
Younger children are more resilient! Or are they? As I read more and experience different recovery rates in youth, the notion that children are more resilient, or that they heal faster, may apply more to anatomical injuries of an orthopedic background. I see my own children healing in record time and young clients with sport related injuries that barely need rehabilitation post injury. But when it comes to brain injury, it appears as if it was the opposite. Keith Yeates, a neuropsychologist at Nationwide Children’s Hospital and professor of pediatrics at the Ohio State University, says there are many reasons why children may be more susceptible to long-term effects after TBI or concussion.
“The pathophysiology of the injury tends to be a little bit different in kids because there are differences in the composition of the brain and there are differences in the size of children’s heads relative to the size of their body,” he says. “Their necks are less strong so they are subjected to different deceleration forces. And from a psychological perspective, young kids still have a lot to learn. They don’t have the stored knowledge and acquired skills like adults to fall back on.”
As emergency medicine evolves in the area of traumatic brain injury there is an opportunity to change the pathophysiology that takes place post injury. After head injury there is a storm of neurotransmitters that overwhelms, stresses, and challenges the developing brain. If it can be attenuated, all involved providers as a team, may see a better future of concussion treatment. In the meantime even with the limitations in imaging and evaluative methods, we may be looking at a possible “scaring” effect that may explain the traceable behavior changes and deficits that tend to reappear later on in some of our young patients. Let’s not rely on their resiliency when there are so many unknowns.
“Children who sustained a severe TBI at a younger age are more likely to have a range of deficits that include deficits in their thinking skills, deficits in their academic skills, and also social problems,” says Yeates in a recent study published in Rehabilitation Psychology. “They tend to have trouble making or keeping friends. And they’re at greater risk for certain types of emotional and behavioral problems.”
Mayer and colleagues examined the brains of 15 children who had recently experienced a concussion using DTI. They administered cognitive testing four months later and repeated the scanning. They found that structural changes in the children’s white matter remained months after the injury—even after cognitive and other symptoms had disappeared.
I continue in the quest for better understanding about the subtle changes these young athletes present after concussions. As I hope that imaging evolves at a faster pace, I realize how much more conservative I need to get. Designing and formulating rehabilitation strategies mostly concentrated on limitation of stressing mechanisms needs to be customized.
What is the biggest challenge to concussion management? Improving awareness about what the new evidence is showing to parents and members of the potential management team. They only realize they are part of the team when a youngster gets hurt but if information flows well before an injury, we may be looking at better odds. Pediatricians, neurologists, physical therapists, trainers, coaches, parents and their own teammates are that team. Let me underscore the value of their teammates. Their peer pressure can cause the athlete to prematurely return to sport or avoid reporting the injury altogether.
There is plenty of research funding now by the NFL, NCAA and other organizations to improve the efficacy of the rehabilitation process but until then rehabilitation professionals should lead the way before young athletes are further exposed to catastrophic injury. As a parent, I’m not taking any risks and that is how I see every case, and so should every one in their care. Click here to access the Dr. Yeates’ study published in Rehabilitation Psychology 2012
There is no “magic bullet” when it comes to treating concussions with anti-inflammatory medication. Medications are not the first line of treatment for concussions. Even though a good option when complications expected or in the case of protracted recovery, not all cases respond well and like with any other injury, every patient responds differently. Rather, it seems that a tailored array of pro- and anti-inflammatory compounds given at particular temporal intervals will likely be implemented given the complexity of the inflammatory response to concussion. Treatments will likely differ based on severity of brain injury, age of the patient, and previous history of brain injury. Read the full article published on Frontiers in Cellular Neuroscience. Understanding the neuroinflammatory response following concussion to develop treatment strategies