Traumatic Brain Injuries

"The severity of brain injury typically dictates initial symptoms."
Signs and Symptoms

Symptoms of TBI range from mild to severe and are the result of shear forces and blunt trauma to the brain. The severity of brain injury typically dictates initial symptoms. Commonly reported symptoms include cognitive impairment, post-traumatic seizures, dis-coordination of movement, balance disorders, loss of speech, loss of swallowing, and visual changes, to name a few. Other symptoms include fatigue, nausea, vomiting, ringing in the ears, irritability, anxiety, impulsivity, depression, and sensitivities to light, sound, and smell.
What is TBI

Traumatic brain injuries (TBIs) are injuries that cause damage to brain tissue. The severity ranges from a concussion to brain bleeds and axonal injuries. More mild forms of TBI result in minor cell changes in the brain at often are not visible on imaging. More severe TBI may show changes in blood flow, swelling, and noticeable cell death on MRI and/or CT. These injuries often result in cognitive, physical, neurological, and metabolic symptoms. There are different grades of TBI, from mild - which includes concussions - to severe, and they are usually defined by how severe the deficits and damage are from an isolated event.
TBI severity can be described using several different tools. The Glasgow Coma Scale (GCS), a clinical tool designed to assess coma and impaired consciousness, is one of the most commonly used severity scoring systems. Persons with GCS scores of 3 to 8 are classified with a severe TBI, those with scores of 9 to 12 are classified with a moderate TBI, and those with scores of 13 to 15 are classified with a mild TBI. We require that a patient has minimum GCS of 9 and be off of all life-sustaining devices before booking treatment at Revive.

Our Approach to Diagnostics and Testing
Revive utilizes research-based diagnostics to evaluate function in specific areas of the brain. Looking at eye movements, motor function, sensory function, cranial nerves, cognitive function, balance, and gait. This information allows us to better understand what areas are affected so we can develop a treatment plan that targets those regions and networks to make them stronger and more efficient. These tests include eye movements, motor function analysis, physical exam, cognitive ability and balance.  

  • The VGN or testing of eye movement gives us a representation of the function of eye muscles, cranial nerves, brainstem nuclei, cerebellum and cortical regions. By measuring things like gaze stabilization,  smooth pursuits, saccades, and optogenetics it helps us to differentiate the areas of weakness.

  • Motor function analysis enables us to see the strength, tone, and coordination of the movement of muscle groups so we can better understand the regions and networks of involvement. Networks that are utilized in a movement are the coordination of movement involve the frontal lobes, parietal lobes, and the cerebellum.

  • In our office, the physical examination is focused on not only finding definitive signs of functional deficits but also catching the subtle changes which give us greater insight into the physiology and function (these findings are often considered irrelevant or ‘within normal limits’ in most conventional clinical settings).

  • Cognitive testing is utilized as a baseline marker to measure and monitor patient outcomes. These quantifiable tests validate results in many different avenues. Our testing encompasses depression screening, anxiety screening, verbal memory, psychomotor speed, processing speed, simple attention, and motor speed.

  • Balance test or vestibular testing gives us an insight into the function of networks that are needed for standing, walking, even riding in a car. We look at the three main factors of balance (Vestibular, proprioception, and vision) both together and individually to isolate the areas of involvement.  
TBI presents a unique set of challenges for the individual and caregiver. At Revive we have a team that not only understands your symptoms but identifies with the role of both patient and caregiver. Our goal is to create a strategic and comprehensive treatment plan to help you live better and love life more. We realize that when we improve the quality of life for the patient, this will improve the quality of life for the caregiver as well.
Our Approach to Care

At Revive we specialize in providing treatment to the neurological regions affected by TBI. Your treatment can include balance, gait, and eye training; as well as hand-eye coordination, repetitive transcranial magnetic stimulation (rTMS), hyperbaric oxygen, diet, and supplements.

We offer a unique process that is built to maximize time and results. To reach your personal healthcare goals, it is imperative that your physicians and care providers precisely know your individual story and desires. Your individual goals are the focal point of the comprehensive treatment plan which is based off your exam, diagnostics, and lab results.  

Beyond the neurological system, there are many factors that can impact the presentation of TBI: the immune system, diet, sleep, and stress (to list a few). By integrating knowledge of the brain and influence of these factors, we are able to be very specific with targeted therapies which create lasting neurological changes. Your treatment plan is designed specifically for you and is not a protocol.

This plan is executed over 5-10 days. Patients see measurable improvement during their time in our office and continue to make gains once they leave. To help ensure success on your journey of healing, we create and define a plan for you when you go home. This plan may include sourcing local specialist for a safe and effective continuum of care. Our goal is to see each patient continue to build upon the initial results they achieved in our office. 

Research on our treatments

Rapid Transcranial Magnetic Stimulation (rTMS) sends a magnetic waveform through the skull that depolarizes the brain cells.  rTMS can be directed at specific regions of the cortex to cause activation of the neurons in the area.  
rTMS as a treatment for mild traumatic brain injury

Hyperbaric Oxygen therapy has shown to increase oxygen saturation to tissues and increase the amount of stem cell production and circulation. This allows for the greatest potential for healing in the brain.

Function Movement exercises and Whole body vibration have shown tremendous results in increasing strength and self-awareness while decreasing spasticity.

The word of virtual reality has grown rapidly in recent years. Currently, research is looking at the affect of VR on gait and movement. We may incorporate different types of VR to help patients with their perception of space and self.

We utilize E-stim in many different waveforms to increase strength, increase self-awareness, decrease spasticity. The following studies are studies of individual waveforms and how they can affect strength, spasticity, and awareness.

Sensory Motor Integration (SMI) can help increase reaction time and motor skills. SMI is strongly researched in the world of developmental delays and can be adapted to affect many different disorders.

Cold Laser Therapy has shown increases mitochondria production in cells, helping to decrease inflammation and increase healthy cellular activity. When the cold laser is utilized as a transcranial (through the skull) therapy we see an increase in brain activation to the targeted areas.

Vestibular therapy is a very powerful tool in the world of neurological rehabilitation. When we look at brain development we see that movement drive brain growth and one of the most important areas for sensing movement is the vestibular system. When we utilize rotational therapy to active the vestibular system we see an increase in activation in several cortical regions.

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