Etiological factors may vary from a minor blow to the head, often combined with a whiplash-type injury of the cervical spine resulting in a symptom complex that may be minimal in degree. However, when the trauma is more severe, it may render the patient comatose for prolonged periods of time and even result in death. In most instances, symptoms are brief in duration and last for a matter of days to several months.
The Center for Disease Control and Prevention defines concussion as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces, secondary to direct or indirect forces applied to the cranium.”
Symptoms can last from minutes to days and in some instances become chronic or permanent. Early symptoms include headaches, pain in the cervical spine, nausea, dizziness, an inability to focus or concentrate, memory loss, visual disturbances and in a small number of cases induce loss of consciousness or even coma.
The Glasgow Coma Scale classifies concussion based upon the level of consciousness of the patient. Mild concussion typically allows complete neurological recovery. Moderate concussion can result in stupor and lethargy. In cases of severe concussion, patients may experience a comatose state, a heightened risk of hypotension, hypoxemia and edema of the brain. Invariably, all forms of concussion result in varying degrees of inflammation of neurological tissue, accompanied by pain and neurological impairment.
It has been determined that MRI, PET scans, EEG studies, etc., generally do not reveal any significant abnormalities in the early phases of the disease. Macroscopic changes of cellular tissues may not accompany the symptoms that exist until a significant period of time has elapsed.
Usually, traumatic episodes that result in concussion include a collision with an opposing player when engaged in sports activities, falls and other incidents sustained in the home, motor vehicle accidents and the numerous traumatic episodes related to military activities. The majority of episodes cause only minor symptoms, which usually disappear over a finite period of time, in most cases without any specific therapy being applied.
It has been calculated that somewhere in the vicinity of 10 to 20% of all cerebral concussions that have been formally diagnosed result in symptoms, which if they persist over a period of time may become chronic. In all of these cases, appropriate therapy should be applied and continued until the patient has been asymptomatic for a period of at least 2 months while engaged in relatively normal activities.
The symptoms most frequently reported consist of headaches which may take many forms. Generally, they are fronto-occipital in location accompanied by pressure sensations, stabbing, aching, throbbing, etc. They may be intermittent or exist on a 24/7 basis. The majority of these patients also complain of pain in the cervical spine with or without radiation to the upper extremities. Insomnia, irregular sleep patterns and cognitive impediments may be minimal to extreme. These include difficulty in finding words, the normal comprehension of reading material, TV content, an inability to focus and concentrate and in essence, mentation is impaired in varying degrees. Memory loss may be short or long term and in some instances both. Often this relates to the duration of the period of loss of consciousness, which however in the majority of cases does not occur. As previously indicated, the injury may induce a prolonged state of coma or even death.
Symptoms may also include a loss of sense of taste, reduced auditory acuity, tinnitus and visual disturbances including blurring, double vision, etc. Both light and sound sensitivity are frequent and may persist. The patient may be unable to attend school, work, lose the ability to socialize and be unable to engage in normal relationships. Irritability with periods of labile mood disorders may be accompanied by loss of anger control. Fatigue, anxiety and depression may be present in both the early and late phase of cerebral concussion. With the development of chronicity however, they may become the most dominant long-term problems.
An increasing number of neuroscientists believe that many years later, neurological diseases such as Parkinson’s disease and the dementias may result from a traumatic episode of the brain experienced much earlier in life and long forgotten.
All patients who have sustained cerebral concussion with persistent symptoms should be monitored until asymptomatic and in most cases based on clinical findings and progress, should be subjected to curative Laser Therapy and in some instances preventative treatment.
Certainly, in patients who remain symptomatic even for a week without improvement, a course of Laser Therapy based on thorough clinical evaluation is advisable. A standardized or individual customized course of treatment for each patient should be administered as clinically indicated.
In conclusion, all patients who have sustained a cerebral concussion should undergo an ongoing course of Laser Therapy, unless symptoms improve rapidly post-trauma spontaneously. The purpose for this is not only to relieve symptoms but to prevent chronic damage to the intracranial tissues. Therapy can be standardized or customized and ideally should be applied every 2 days initially.
• Depending on clinical change, the protocols are changed according to the progression or resolution of the severity of the symptoms.
• This applies particularly for patients who are severely affected and present for an assessment relatively early after the injury.
• In chronic cases where symptoms persist regardless of the time period elapsed since the trauma, curative therapy should continue for at least 2 months subsequent to the resolution of all symptoms. Depending on the nature and duration of the injury and unless symptoms are improving rapidly spontaneously, treatment should be applied as early as possible and continued for a minimum of 8 weeks during which the patient is able to engage in normal activities.
• Each case must be assessed on its own merits and treated accordingly.
• In our experience, Laser Therapy should be considered the treatment of choice and be continued until the patient is asymptomatic, fully active and does not require any other therapy, including medications.
Conclusion: All patients who have sustained a cerebral concussion and continue to demonstrate symptoms receive a course of Laser Therapy tailored to their individual situation. Ideally therapy should be continued every second day until the patient has become asymptomatic for at least 2 months.
Generally, protocol settings are initiated at lower levels and increased in accordance with clinical change. As symptoms diminish in the degree of severity, the frequency of treatment can be gradually reduced, but not during the first 2 to 4 weeks.
All patients require periodic clinical assessment incorporating appropriate measurements to determine improvement as the course of treatment progresses. Symptoms should diminish rapidly in most instances when all appropriate parameters are observed.
The entire process should result in a significant improvement/cure rate in all categories of cases treated. This should be accompanied by the restoration of the patient’s quality of life, normal activity levels, and a total absence of symptoms.