How concussion recovery is like solving an algebraic equation
Working backward from the solution while we wait for advances in brain imaging
There are many ways to solve a problem. In the early stages of our education, we learn how to solve the problems that are presented to us.
As we grow older, we learn how to identify problems and arrive at novel answers by figuring out what the real underlying problem is—the problem under the problem. Many inventors and entrepreneurs have succeeded by identifying a problem that everyone else failed to see.
Now, if a person who’s used to identifying underling problems gets a brain injury, what are they likely to want? How about a brain scan or some form of imaging that can reveal the true nature of the problem? Where is the injury exactly?
The current state of brain imaging
Immediately after concussive injury, imaging may be done to see if there’s any large scale structural or vascular damage to the brain.
This imaging lacks detail. As of this writing, the ability to see microscopic neuronal damage with imaging is still emerging (rapidly emerging, with promising devices on the horizon such as the Kernel Flow).
The fact that an Alzheimer’s patient, retired combat veteran, or NFL player’s widespread neurodegenerative disease can only be identified in an autopsy under a microscope speaks volumes about the inadequacy of brain imaging technology at present.
At this time, it is possible to get an fMRI, a form of magnetic resonance imaging that allows a practitioner to watch your brain activity (and bloodflow) in real-time as you perform different kinds of cognitive tasks. An fMRI machine is huge and expensive. Such tests cost patients upwards of $10,000 at private clinics like Cognitive FX. And, you guessed it, an insurer is unlikely to pay for such a test.
If you got this test, what would happen? The fMRI would show the functional impact of your injury. This could allow you (and the practitioners helping you, such as physical and occupational therapists) to form a more targeted approach to your rehabilitation. That might save you some time.
But here’s the thing: the rehabilitative exercises themselves are going to be identical to those being done by people who did not get an fMRI. The only difference is the potential for accelerating the timeline of your recovery with a more targeted approach, but shortening the timeline isn’t a certainty.
Working backward from the solution while we wait for advances in brain imaging
In the absence of brain imaging, what do the physical and occupational therapists base their recommendations on? Your symptoms. What movements provoke them? What tasks are you’re struggling with?
They also do functional tests, such as vision and balance assessments, to inform your treatment plan. In general, they’re working from the outside in, and this makes sense when you view the brain as the centerpiece of your nervous system, which is distributed throughout your body.
In the absence of brain imaging that reveals the precise nature of the injury, we have to work backward from the solution.
Rehabilitating your brain injury is a bit like solving an algebra problem where you know the value of X already. Dizziness. Vision problems. Inability to focus. Inability to calm down. Sensory overload. Collectively, your symptoms equal X, or the resolution of your symptoms equals X.
From your symptoms, you can work backward to figure out which activities will help you reacquire lost abilities. The unknowns in your equation might include such things as: behavior tools and modifications, diet, exercise, supplementation, medication, medical devices, etc.
Part of my motivation in writing posts like this is to help you survey such options so you can solve your own equation.
Sure, in an ideal world, we would enter a clinic and get a quick and easy scan revealing the precise location and nature of our injury, which would then allow us to do a whole range of targeted non-invasive treatments including neurofeedback, transcranial magnetic stimulation, transcranial laser therapy, etc. It would be like a Star Trek scene where Bones moves a device the size of a lipstick over your head and you sit up going, “Wow, how can I ever repay you?” And he’d say it was nothing and smile with that glint in his eye.
I believe we’ll get there within this century. But in the meantime, what do we do?
Well, I’ve done all the non-invasive treatments I just mentioned above, along with other therapies and treatments, and I’ve made improvements, despite the absence of detailed imaging showing my injury at a microscopic level.
If you stop to think about it, there are a wide range of medical treatments, and certainly medications, given to patients because they’re known to work, even when there’s no scientific consensus about why they work. The exact mechanisms may be unknown, especially if those mechanisms involve neurotransmitters or neuromodulators.
Meanwhile, we can work backward from the solution and use the body to influence the mind. At this time, it’s the most useful approach available. It has the added benefit of moving the locus of control within us.
Brainwave is an informational resource for people whose symptoms haven’t resolved after a concussion or mTBI. I endeavor to present this information in a clear and concise way, spelling out what’s backed by science and what remains unknown. Nothing here is meant as a substitute for professional medical advice, diagnosis, or treatment. I am not a physician or a healthcare practitioner of any kind; I’ve simply had a lot of sports-related concussions and had to learn this stuff the hard way. If you found this information helpful or know someone who might benefit from it, please share and subscribe to Brainwave.