Study for veterans with insomnia, new Concussion Alliance resources created by our interns (8/12/21 newsletter)
Last week our Summer 2021 Concussion Education & Advocacy Internship Program ended on a high note with three days of End-of-Internship Showcases. Because the interns did such valuable work creating new resources for ConcussionAlliance.org, we wanted to take this newsletter to inform you of our latest pages, courtesy of our Summer 2021 intern cohort. As the projects do not fall cleanly into our usual categories, we’ll be keeping our ‘Opportunities’ section and then announcing the new resources alphabetically.
We would like to acknowledge the interns who wrote synopses on their project for this newsletter:
Writers: Han Nguyen, Bethany Lazo, Christine Hau, and Conor Gormally.
Editors: Conor Gormally and Malayka Gormally.
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Opportunities
Are you a U.S. service member or veteran who finds it hard to fall or stay asleep?
A clinical trial is enrolling service members and veterans to test the efficacy of an online Cognitive Behavioral Therapy app for insomnia (SHUTi) that has been customized to be specific to military members. Research has found that Cognitive Behavioral Therapy is an effective treatment for insomnia; read more about this therapy on our website.
“This study can be completed 100% online, anywhere in the U.S.! Active duty service members and veterans between the ages of 18-64 who are experiencing insomnia and have had a head injury might be eligible to participate.”
Contact the study via email at cnrm-ecbti@usuhs.edu, or call or text (301) 456-5474. The researchers are closing enrollment at the end of September. The clinical trial is being run by The Center for Neuroscience and Regenerative Medicine at the Uniformed Services University.
August 13, 12:00 pm PST: A free, virtual class on Post-traumatic Headache (Headache after Brain Injury) will be presented by the physicians at the University of Washington Headache Clinic. The class is hosted by the Brain Injury Alliance of WA State (BIAWA); register in advance.
August 18, 10:30 am PST: A free, virtual class Changing Your Mind: Regain Control Over Your Life will be presented by Certified Life Coach Anita Chin. The class is hosted by BIAWA; register in advance.
Acupuncture
In recent years, there has been an increased interest in alternative medicines, such as acupuncture. This holistic approach may be used to treat many symptoms associated with concussions. While research on acupuncture as a treatment for concussion is still relatively new, there is some evidence that points to this alternative treatment option being a successful treatment. Following a concussion, patients typically report many symptoms such as headaches, nausea, neck and shoulder pain, and mental health struggles. These symptoms are treated by needle penetration at acupuncture points to relieve stress, pain, or discomfort.
The U.S. Department of Defense and the U.S. Department of Veterans Affairs use acupuncture with active-duty soldiers and veterans to treat concussion symptoms. The acupuncture page, found on our ‘Treatments’ index, goes into more depth on the theories and mechanisms of how acupuncture works, the use of acupuncture in different populations, and accessing acupuncture care.
Interns Christine Hau and Alyssa Schaechinger created this page with assistance from Iris Cutler, DAHM, EAMP, and Concussion Alliance Staff.
Automatic Nervous System (ANS) Dysfunction
One of the many potential factors contributing to persistent post-concussion symptoms is autonomic nervous system (ANS) dysfunction. Unfortunately, most people who experience ANS dysfunction do not recognize its symptoms, such as anxiety/depression, irregular heart rate, exercise intolerance, and sweating abnormalities.
The ANS is the part of our nervous system that acts unconsciously and regulates involuntary bodily processes such as heart rate, blood pressure, breathing, and body temperature. The ANS comprises the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). The SNS regulates our “flight or fight” response, while the PNS regulates our “rest and digest” response. The ANS requires a balance of these systems, and if one system, such as the SNS, is in overdrive, this results in ANS dysfunction. The ANS Dysfunction page can be found under ‘About Concussions’ and addresses the ANS structure, ANS dysfunction symptoms, potential diagnostic tools and treatment options, and how ANS dysfunction presents in the brain on a cellular level.
This page was created by interns Lori Mae Yvette Calibuso Acob and Meena Shanmugam, with assistance from M Nadir Haider, MD, PhD, Leah Talbert, MS, and Concussion Alliance staff. Dr. Haider also reviewed the page for accuracy.
Cognitive Rehabilitation
For people who have suffered concussions, persistent post-concussion symptoms (PPCS) may include a range of cognitive deficiencies which can impair everyday life. Types of cognitive deficits have a wide range and differ from person to person, but they all tend to diminish the individual’s capacity to process information. Cognitive rehabilitation therapy (CRT) aims to help concussion patients overcome cognitive deficits through restorative or compensatory training.
Cognitive Rehabilitation can be found on our ‘Treatments’ index page. The resource dives into what CRT is, when and why patients may want to look into CRT, what the therapy can look like with different practitioners, how to access it, and how it compares to Cognitive Behavioral Therapy (CBT).
Interns Melissa Brown and Nate Campbell created this page with assistance from Speech-Language Pathologist Kam Gardner, MS, CCC-SLP, and Concussion Alliance staff.
Concussion and Rehabilitation Clinics
After experiencing a concussion, it is often overwhelming to decipher what treatment options are out there and which ones would be the most beneficial to pursue. This piece is taken out of the equation at a concussion clinic through a multidisciplinary team of healthcare providers who create a personalized recovery plan.
Our new page on Concussion Clinics breaks down the basics of these care centers, including what a concussion clinic is, the initial intake process, treatment timelines, the science behind multidisciplinary care, Concussion Clinics versus Rehabilitation Centers, what to look for in a multidisciplinary center, and how to find a Concussion Clinic.
Intern Julia Brzac created this page with assistance from Steve Flanagan, MD, and Concussion Alliance Staff. Dr. Flanagan and Dr. Elizabeth Sandel reviewed the page for accuracy.
History of concussion as a public health issue – patient experiences: a brief history
Stigma is a defining aspect of the concussion patient’s experience. This page provides a historical perspective on social and political factors that have provided challenges to concussion patients. Topics covered include the NFL, boxing, intimate partner violence, and employment compensation laws.
Interns Clovis Wong and Aamy Woldesenbet created this page with assistance from Elizabeth Sandel, MD, Stephen Casper, PhD, and Concussion Alliance staff. Drs. Sandel and Casper are two of the preeminent authors on the history of concussions and concussion care. The page authors and mentors are currently finalizing the resource for publication later this year.
Hormone Therapy
Hormone dysfunction can result from concussions due to disruptions to the endocrine system. Generally, patients suffering from dysregulation of hormones experience symptoms like changes in weight, muscle aches, excessive thirst, anemia, headaches, and dizziness. Some women might experience disruptions to their menstrual cycle, and some men might experience erectile dysfunction. Hormone treatment has worked for some individuals suffering from hormone dysfunction following a concussion.
The Concussion Alliance Hormone Therapy page can be found in the ‘Treatment’ index page and covers practical treatment-related questions such as: ‘What is an endocrinologist?’, ‘Should I get tested?’, ‘How can I seek out help?’, and ‘What is hormone testing?’. The resource also includes a subsection on hormone dysfunction from TBI in male veterans and a comprehensive educational section on the neuroendocrine system for those who want a better understanding.
This page was created by interns Karina Suwal and Calder Stenn, with assistance from Tamara Wexler, MD, PhD, and Concussion Alliance staff, including Leadership Team Member Julian Szieff.
Massage Therapy
Massage therapy includes a range of modalities that may be beneficial for those experiencing concussion or post-concussion syndrome symptoms. Doctors may recommend it for a variety of reasons: to help alleviate tension patterns in the neck and shoulders, to regulate mood disorders, and to improve lymphatic fluid circulation.
Our newly-updated Massage Therapy resource is also on our ‘Treatments’ index page and covers massage for muscle tension and alignment, cupping therapy, manual lymphatic drainage, and how to find a massage therapist with experience working with concussions.
This page was created by intern Wyatt Hill with assistance from Concussion Alliance staff.
Sleep & Sleep Problems
Sleep disturbance is frequently under-recognized in concussion treatment plans despite its detrimental consequences for recovery. Reduced sleep quality could result in mood swings, increased risk of heart disease, and high blood pressure. Moreover, disrupted sleep tends to negatively affect immune health and executive function skills. Concussions can sometimes cause biochemical changes that give rise to sleep disorders. For example, changes in neurotransmitter levels like dopamine and serotonin post-concussion may impact sleep modulation.
Concussion patients often report experiencing sleep apnea, insomnia, or hypersomnia after their injury. These sleep disorders could make it challenging to get a sufficient night’s rest. Studies have found that lower sleep quality correlates with longer concussion recovery time. As such, seeking care from a sleep specialist and practicing sleep hygiene may be necessary for those with concussion history.
The new sleep and sleep problems webpage on the Concussion Alliance site provides information on sleep-related issues following concussion and tips for promoting quality sleep. Check out our sleep hygiene and provider recommendations and resources!
Interns Bethany Lazo and Han Nguyen created this page, which can be found under ‘About Concussions’, with assistance from Concussion Alliance staff.
Vision Therapy
Intern Chelsea Ryan updated and expanded Concussion Alliance’s existing Vision Therapy page, adding diagrams, gifs, & videos to make the resource more accessible and easily understood. Chelsea also created new sections on identifying types of visual issues, common types of visual problems, visual motion sensitivity, photophobia and concussions, Visual Midline Shift Syndrome, and specialized treatments and assistive devices.
Chelsea worked with neuro-optometrist Jacqueline Theis OD, FAAO, and Concussion Alliance staff for feedback on her updates.