Mild Traumatic Brain Injury In The News

Mild Traumatic Brain Injury in the News

Everywhere you look these days the top of concussions and/or mild traumatic brain injuries (MTBIs) is being discussed. The issue came to the national forefront over the summer when famed football player Junior Seau tragically took his own life. An autopsy revealed that Seau’s brain had signs of damage consistent with multiple concussions over his long playing career. Those who knew him well said that he was depressed, isolated, and generally just “not himself” prior to his death.

In addition to seeing signs of MTBI in football players and athletes, we are starting to see signs of MTBI and concussions in veterans. In yesterday’s 60 Minutes there was a news story entitled “Invisible Wounds of War” where the broadcasters looked into the “silent epidemic” of MTBI in our veterans. They determined that it was a severely underdiagnosed condition in our veterans. Just like how athletes are expected to rest and take time away following a concussion, so to are soldiers expected to take a break. Unfortunately they are not given the same opportunity to rest as professional athletes are often given. Concussions and PTSD are frequent conditions seen in our veterans returning from combat.

As a Baltimore Chiropractor that focuses on treating acutely injured clients with whiplash, concussions, mild traumatic brain injuries, along with headaches, neck pain, and back pain, I routinely see patients involved in auto accidents that results in concussions. In most cases the Emergency Room staff have not diagnosed these patients with these injuries. It is important to remember that ER staff are doing their job correctly in the majority of cases- they are ruling out life threatening conditions and releasing these patients when it is safe to do so. Chiropractors such as myself are some of the best resources to be able to diagnose and monitor concussions and MTBI since we see patients frequently following the onset of their symptoms. We are able to pick up on subtle differences day to day in behavior, emotion, cognition, and sleep differences that can be crucial in making an accurate diagnosis. Often the patients themselves do not realize that they are behaving differently and it is with the help of friends, family, and loved ones that help me make an accurate diagnosis.

The good news about concussions is that they are often self limiting and resolve in up to 12 weeks. Research has shown that repeat concussions, such as often seen in patients involved in multiple crashes in a short period of time, can lead to a worsening of symptoms, and in some cases, a problem that never completely resolves. At our office we routinely refer these patients to neurologists for appropriate diagnosis and testing. Don’t be afraid of your concussion- get the help you need!

Low Property Damage Crashes Can Cause Injury to Occupants 

One of my pet peeve’s in clinical practice is when claims adjustors arbitrarily decide not to pay the medical/chiropractic bills of their insureds involved in auto accidents in Baltimore. They like to make the claims that their bumpers “only had a scratch” and that as such, there is no way the occupants of the vehicle could be injured. I typically remark that I am not a mechanic- that is, I don’t care how much property damage a car has sustained…I don’t treat the car, I treat the occupants of the car. They sometimes go on to imply that any individual treating with less than $1,000 in property damage to their vehicle (so called M.I.S.T. “minor impact soft tissue” cases) must be committing fraud and/or embellishing on their complaints.

The idea that a vehicle’s property damage necessarily correlates with a patient’s injury likelihood/severity has not ever been found to exist scientifically. Yet despite this, everyone from claims adjustors to lay people to patients always seem to “know” that there is a relationship. In my nearly 5 years as a Chiropractor I have seen several hundred patients that have sustained injuries in an auto accident. These run the gamut from no/low property damage to complex roll overs with brain trauma where occupants had to be extricated by the jaws of life. I use my experience clinically and my post graduate education to examine and grade an individual’s injury. I do not pay much attention to property damage of a vehicle when assessing an individual’s complaints.

Dr. Arthur Croft in this month’s “Dynamic Chiropractic” wrote an article where he succinctly describes the paradox between occupant injury and property damage in an article entitled “Reimbursement for Treating Crash Victims: Deconstructing the Objections”. If you have about 5-10 minutes give it a read, it is really interesting.  It explains why it is possible to sustain significant injury even in cases of no/low property damage to a bumper. In the article he explains the paradox:

“A general understanding of collision mechanics goes a long way to explain this seeming paradox involving speed and injury. Without delving into too much depth here, the vehicle is relatively stiff in lower-speed ranges: it does not undergo crush or mechanical deformation here. Much of the kinetic energy of the collision is used to accelerate the vehicle and its occupant.

When the speed of the crash is high enough that the bumper energy absorber, bumper reinforcing bar, struts, or even frame elements are damaged, two things happen: (1) the kinetic energy used to deform these structures is no longer available to accelerate the vehicle; and (2) the duration of the collision is increased. And, since acceleration is equal to the change in velocity (delta V) divided by the time of the change in velocity (delta T), a relatively long collision pulse translates into less acceleration.”

I’ve said it before and I’ll say it again. If you have been involved in an auto accident in Baltimore City or Baltimore County and you are injured- get the care you need. A delay in care will only potentially lead to a chronic condition that will lead to the need for more care in the future.  Don’t let an insurance company dictate your care. You know your body. You know when you don’t feel right, and only you know what “normal” is for you.

At Mid-Atlantic Spinal Rehab & Chiropractic Dr. Gulitz, a Baltimore Chiropractor, routinely treats individuals involved in auto accidents with little to no property damage. Many times these clients do not have huge injuries that require a lot of care and that is great. But when they do require a lot of care and coordination with other providers, Dr. Gulitz is happy to help as well.

Regardless of property damage to your vehicle, if you are in pain from an auto accident in Baltimore, call Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500 or email us. We would be glad to help!

Whiplash in Baltimore

 Here are some sobering words from Dr. Arthur Croft in his book “Whiplash and Mild Traumatic Brain Injuries: A guide for Patients and Practitioners” (page 28):

“Whiplash injuries are quite real and potentially disabling. In the U.S. there are approximately 3 million whiplash injuries each year, at a comprehensive cost of about $43 billion. They account for 25% of all claims paid by auto insurers. They can and often do occur in low velocity collisions-usually from the rear-in which little or no damage occurs to the car. About one third of those involved in low velocity rear impact collisions are injured to one degree or another. Nearly half of the people injured in this way will develop long-term pain varying from very minor to severe. About 10-12% will become disabled.”

It is interesting to point out that the amount of property damage to a vehicle is in NO WAY a predictive indicator of the forces that occupants are subjected to nor is it a predictive indicator of the injury that the occupants may or may not have sustained. All too often I hear insurance companies say “your client can’t be injured there’s only a scratch on the bumper.” They choose to ignore science in order to tow the company line and save money for their employers (insurance companies).

As the saying goes “accidents happen.” Statistically most of the time you will walk away without an injury. But for those of you who aren’t so lucky you owe it to yourself to get evaluated by a trained Chiropractor who sees these injuries every day. According to Dr. Croft nearly half the people that sustain injuries develop long term pain. It can be avoided with appropriate low-tech rehab and Chiropractic care.

If you, or anyone you know, is in need of a Baltimore Chiropractor for whiplash in Baltimore following an auto accident in Baltimore, contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500 or email us. We would be glad to help!

Clinically mild traumatic brain injuries (MTBIs) and concussions are not the same thing- that is concussions are a type of mild traumatic brain injury. For the sake of this post they will be considered the same thing. MTBIs and whiplash can often co-exist. Interestingly, they are often under reported and under diagnosed by physicians and providers (Chiropractors included) that are likely to treat patients involved in auto accidents in Baltimore and the rest of the country.

According to Dr. Arthur Croft in his book “Whiplash and Mild Traumatic Brain Injuries: A Guide for Patients and Practitioners” he states (p.28-29) “…the mortality from head injury in the last 12 years has exceed the cumulative number of Americans killed in all wars since the founding of this country. The number of non-fatal injuries is conservatively estimated to be more than 2 million each year (potentially up to 7 million each year) with an overall economic cost to society of about $25 billion per year.” This equates to an incidence of approximately one mild traumatic brain injury for every 40 citizens per year.  This is why mild traumatic brain injuries and concussions are considered the “silent epidemic.”

The clinical signs and symptoms of mild traumatic brain injuries vary.  Not every patient with an MTBI or concussion will display all of these complaints. Symptoms include: nausea, vomiting, confusion, memory loss, dizziness, tinnitus (ringing in ears), blurred vision, problems focusing, changes in sleep patterns, etc. In some more serious cases other patterns of behavior, emotion, or cognition can be impaired. It is often difficult for the injured patient to notice these changes in their own lives. Instead it is not uncommon for their friends, coworkers, or loved ones to notice these changes and report them to their providers.

Dr. Croft goes on to report that “As for outcome, 25-35% of persons suffering an acute MTBI will report unrelenting complaints 3-6 months later. In many cases, these complaints will persist indefinitely. Many have reported, and it is also my clinical experience, that 6 months is an important watershed point. If symptoms are persistent at that point, they are likely to be permanent. From a medical perspective this one of the most under-diagnosed problems of all time.”

These assertions by Dr. Croft can not be understated. As a Baltimore Chiropractor that treats patients with whiplash and mild traumatic injuries/concussions in Baltimore I routinely see patients with these complaints. They are promptly referred for co-treatment with Baltimore Neurologists who can monitor their conditions, order appropriate diagnostic tests, and medicate patients as necessary.

If you or anyone you know is suffering from a concussion or mild traumatic brain injury as a result of a Baltimore auto accident please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500 or email us. We would be glad to help!