Imagine you are driving in a parking lot looking for a space to pull in. You see something off to your right side, and all of a sudden there is a jarring, and you hear a crunch when you realize someone has just backed into your car.
It is a horrible feeling just thinking of the hassle that is involved. What if later in the day you feel a little funny, and you brush it off due to the stress of the accident? What if four to eight weeks later, your frustration level is slowly increasing, and it seems like you are having a harder time concentrating? What if your ability to comprehend and read seems to become more difficult? You think, “Am I getting old? Is it my glasses that are off? It might be stress.” You notice that your loved one is annoying you more, and you just like to be left alone. Then you think, “I wonder if I’m depressed.” You go see your family physician who listens to this and writes a prescription for an antidepressant.
Slowly, gradually, your life is changed. Could it have been from that fenderbender in the parking lot several months before?
There is story upon story of examples of patients I have seen who have had changes in their lives from traumatic brain injury which influenced the visual system’s ability to process information. It can be an extremely subtle condition. Those with traumatic brain injury are known as the “walking wounded” because from outward appearance, they look totally fine. Even looking at them with a number of diagnostic instruments, from CAT scans to MRI, everything looks completely fine. “It must be in their head,” doctors often say.
Traumatic brain injuries can be related to difficulties in the individual system and often therapies can be done that can make a profound impact in regaining improved quality of life so you can enjoy life again. Depending on the severity of the trauma, things may not go back to the way they used to be. However, before resigning oneself to a much lower quality of life, a person should have their visual system evaluated in a way that looks at the function and more than just whether the pathway from the eyeball to the brain is intact and healthy.
The visual system has five times the sensory input to the brain of any other sense in our body. Approximately 25 percent of our total energy consumption daily is used by the visual system. This has very little to do with our ability to see clearly but more with how our eyes coordinate. In particular, how do we process the information coming in through the eyes? This is the area that can be significantly impacted by head trauma.
Let’s go back to the parking lot fender-bender. It was subtle. It did not cause the airbags to deploy. There was minimal damage to the bumper. Could something little like that cause a problem?
Think of the anatomy of our body. Our head weighs approximately eleven to twelve pounds. It is on our neck, so depending on the length of our neck, the robustness of the muscles that support our neck, and our body structure, different impacts can have different amounts of damage. A ninety-five-pound person will not be able to sustain the same amount of impact that a three-hundred-pound linebacker would be able to sustain.
Imagine a bullwhip. As you take the handle into your hand and make that snap movement, the speed of the end of the whip is going so fast that it breaks the sound barrier. It is that amount of whipping motion that can cause difficulties. A five-mile-an-hour parking lot fender-bender can put five thousand pounds of force on a person’s brain stem. A thirty-mile-an-hour accident can easily put over thirty thousand pounds of force on the brain stem.
We have all hit our funny bone and noted that unpleasant feeling when it is hit. We start shaking it off because of that pain. That is a sudden impact on a nerve in the elbow. Imagine our brain stem getting a sudden jolt or impact from the whipping motion caused by the impact.
You can have a similar type of physiological reaction as hitting your funny bone, but have it happening to your brain stem, and it is not so funny. I do not want to dive too deeply into the physiology, but know that there are neurotransmitters involved. Those are the chemicals that help run our brain and nervous system. Calcium and potassium are part of the nerve signaling. If there is a sudden impact, just like when you hit your funny bone, those nerves are now activated, and that “uses” up a molecule.
Along with this sudden impact or depolarization of the nerve, there is a void. Nature abhors a vacuum, so calcium, which is part of every cell, will rush in to balance out this polarization. However, the unfortunate part of it is that too much calcium can be toxic to nerves. This “calcium cascade” can lead to issues surfacing weeks, even months, after the initial injury. Feel free to google “calcium cascade related to traumatic brain injury” or “neurometabolic cascade of concussion.” The consequences of this calcium cascade can be incredibly detrimental.
Clark Elliott, a DePaul University professor in artificial intelligence, wrote a book in 2015 called The Ghost in my Brain. It is a wonderful book by a person with firsthand experience to traumatic brain injury and the years it took for him to deal with it and ultimately receive some incredible therapy to help him regain his life. He is most grateful to Deborah Zelinsky, a doctor of optometry, in the Chicago area for being of such tremendous assistance to him.
Along with the physiological changes that go along with a traumatic brain injury, how a person experiences it in their day-to-day life is what is most important to them. A common theme throughout this book is looking at different parts of the nervous system related to the visual system under duress or stress, whether it is a traumatic brain injury, stroke, or a child who had a traumatic birth, or even while in utero the mother was under severe trauma. All these varied amounts of physical or emotional stress have similar impact on our body’s nervous system.
Side effects can include photophobia or light sensitivity, increased sensitivity to other inputs, whether it is sound or texture, or movement can be particularly bothersome. It is not uncommon for a person to start having digestive difficulties following a traumatic brain injury due to the decrease in stomach acid caused by the sympathetic dominant nervous system. Balance or ease with walking can be affected by the traumatic brain injury. Short-term memory and sleep issues are also not uncommon. The symptoms go on and on as to how injury to the head or neck can have quite a significant impact on a person’s life.
Whether it is with traumatic brain injury, suffering from anxiety, or others with vision-related learning disabilities, you will see a common theme of visual symptoms as well as other day-to-day life experiences that are negatively impacted from poor coordination or an inefficiently operating visual system. The good news is that in the vast majority of cases, things can be done to help ease the effort spent and assist with improving performance. We certainly cannot guarantee anything for any patient, but the brain is amazingly pliable and retrainable. It is always worthwhile to look into the different options for helping patients gain improved quality of life.
Learn more about therapies that may help with traumatic brain injuries: