Concussion symptoms and Post Concussion Syndrome have a significant number of audiovestibular symptoms (in addition to visual disturbances, pain, reduced functioning and range of motion, poor cognitive skills including memory, and other cognitive and psychological changes that ensue).
These symptoms include: Tinnitus, Vertigo, Dizziness, Imbalance, Hyperacusis, Misophonia and Recruitment, as well as Hearing Loss and Auditory Perceptual Deficits or Auditory Processing Dysfunctions following Head Injury. Some of these symptoms may present right at the scene of an accident, whether it is due to a Motor Vehicle Accident (MVA), a sports injury causing concussion (whether hockey, football, soccer or even minor childhood accidents like those which occur during skiing accidents, snowboarding, tobogganing, or bike riding, etc.), or it can develop over the next number of weeks.
Often times, these audiovestibular symptoms do not get properly evaluated, and most times an audiologist is not considered in patient examination. Further, basic ‘hearing tests’ do not reveal the scope of the functional deficits that these patients experience, and they must be thoroughly examined for each patients particular complaint to investigate the causes and exacerbating factors to their complex set or sequalae of symptoms. Because of lack of examination or non-assessment, these patients do not get properly diagnosed and managed by the appropriate healthcare provider.
In our team, for which we affectionately refer to as our ‘Sandbox’, our approach with the Collaborative Care Model involves a group of doctors how are not what classic medicine even considers for referring these patients to see for care. Crucial first examinations are most often seen following ambulance attendance and taken to the Emergency Department of a hospital and receive a neurology work-up and often head imaging with C.T. or M.R.I. scans (but not always, because patients are often not symptomatic within the first few hours, so are seen days following the concussion) and seen by their family physician. Unfortunately, because this is not an illness, medicine cannot provide the full support for the patient, so referrals are generated to physiotherapy for various post accident conditions, and treatment is undertaken without advanced diagnostic work-up to determine the many causes of these symptoms. This also critically includes visual complaints that classic Optometry fails to identify, all the while the patient reporting visual changes and triggers to symptoms because a classic monocular vision test does not reveal the oculomotor dysfunctions, eye convergence and ‘teaming’ dysfunctions, depth perception complaints, among other complaints, so the patient leaves after being told their vision is fine. This is the same as when they get a ‘hearing test’ if hearing loss is not present. However, a basic ‘hearing test’ can fail to uncover more subtle changes like those seen in Otoacoustic Emission testing to reveal the cause of the tinnitus, change in perceptual hearing (which is more thoroughly evaluated with an auditory processing exam), and does not at all address any of the ‘dizzy’ complaints which are well examined using the American Institute of Balance CD-VAT exam to properly assess a vestibulo-ocular reflex problem (and diagnose the plane(s) affected), as this test is used in all branches of the U.S. Military and U.S. Department of Defence by Dr. Richard Gans, in addition to more functional dizziness, vertigo, imbalance and disequilibrium testing by the Gans SOP test (test of Sensory Organizational Performance Test). Our team includes a Doctor of Audiology, a Doctor of Optometry, a Doctor of Dental Surgery, a Psychologist, and a Neurophysiologist.
Diagnostic Examination for the Concussion, P.C.S. and TBI patient is more complex and because often times, structural testing is negative the awareness of the impact of the true pain and functional changes to that person is not well captured. Dual Deficit Disorder is well documented in the literature, which demonstrates that 34.6% of patients that suffer a head injury will demonstrate functional vision and audiovestibular symptoms. Further, a whiplash injury is known to contribute to ligament and neurophysiologic changes to the temporo-mandibular joint due to the acceleration / deceleration injury. The obvious, seemingly most impactful area of damage that contributes to so many of the patients conditions is the primary region of the neck during the whiplash injury (that must occur even when there is a blunt head injury), as the neck is the only moving portion of the body in a direct head blow. Last but not least, is the psychological impact that these injuries can have when they develop chronic pain, symptoms that are not revealed on an MRI (so classic medicine cannot truly report on why the symptoms exist due to the fact that they are neurocognitive changes) that actually fall within the scope of Psychology, Neuropsychology. Fortunately these patients receive care by physiotherapy and occupational therapy and speech-language pathology whose support they cannot live without. However our team has found over the last few years that the chronic patients have underlying conditions that can be treated or well managed, that reduce the patient’s pain and suffering. We have a group of colleagues in these professions as well who are critical care team players in the ongoing management of these people.
Interested on learning more about concussions and PCS? Register and join us for for the 1st COVD Canada Annual Symposium!
Hosted by: Academy of Ophthalmic Education (AOE)
Saturday, May 28th & Sunday, May 29th
Lakeridge Health and Education & Research Network Centre
(LHEARN Center), 1 Hospital Court, Oshawa, ON, LIG 2B9
Day One Theme: Visual Dysfunction and Learning Difficulties
Day Two Theme: Concussion / mTBI: Importance of the TEAM!
See Dr. Brenda Berge
Sunday, May 29th – 10am-11am
Topic: Why the “Eyes are the Liars”!