ON Chiropractic Fall 2014 | Page 21

ON Chiropractic like Cognitive-Behavioural Therapy can help patients recover. “Chiropractors are encouraged to look beyond symptoms to embrace the biopsychosocial model, and understand the implications of the social determinants of health.” Dr. Cassidy is facilitating further research studies both in Canada and in Denmark, and continues to strive for a more complete understanding of this complex issue. Dr. John Crawford T hrough continued education and clinical practice, Dr. John Crawford has extensive experience managing patients who present with concussions. After completing a Ph.D. in pathology from the University of Toronto in 1983 and graduating from the Canadian Memorial Chiropractic College (CMCC) in 1986, Dr. Crawford taught pathology and a variety of other subjects for several years at CMCC, served as Chair of Continuing Education for five years and built a chiropractic practice. Dr. Crawford has undertaken additional training specific to concussion management with Shift Concussion Management, through the University of Pittsburgh Medical Centre. Using the ImPACT test, a computerbased test of neurocognitive function, as an adjunct in his clinical practice, he is able to monitor concussion patients’ progress, while re-training vestibular function and monitoring progress through three phases of physical exertional testing. Dr. Crawford is all too familiar with the difficult scenario of mild traumatic brain injuries sustained by kids who play sports like hockey. When tournaments are looming, getting the kids back on the ice becomes the number one priority. It can be difficult to communicate the severity of an injury and manage the return to play expectations of parents and coaches. Dr. Crawford stresses a proper understanding of helmets. Helmets protect against fractures but not against concussions, and this needs to be communicated to parents and coaches who assume that protective gear will diminish the severity of a concussion. Patient education is pivotal in keeping patients from overexerting themselves in recovery when structured rest is crucial to healing. Convincing patients and athletes of the need for rest is especially challenging when a concussion does not include visual signs of trauma. Dr. Crawford recalls one instance where re-educating a patient on what “proper rest” entailed was essential to recovery. The patient, a school teacher, was on yard duty when she fell on a patch of black ice and struck the posterior aspect of her skull on the pavement. Although she was unable to continue working, she followed her regular routine of waking early and walking her dogs. Following her return home, she would spend an hour working at the computer to prepare her lesson plan for the teacher who was taking over her class. She commented that after doing so, she would feel exhausted. After lying down for a few hours she would awaken and watch TV. Again this would leave her feeling exhausted. This is a perfect example of how visual stimulation by electronic means drains energy from the brain. Dr. Crawford informed her that her fatigue was largely the result of using electronic devices, such as the computer, which subsequently drained her of energy. He educated her about the importance of not napping throughout the day and emphasized that returning to normal sleeping patterns and wakening times were crucial for recovery. He explained the necessity of avoiding over-stimulating environments, limiting the use of electronics and wearing sunglasses when outside or in bright lights. With a new understanding of 'rest', the patient was able to understand that her perception of ‘resting,’ which was filled with using electronics and oversleeping between her normal working hours, was actually hindering her recovery. The patient followed Dr. Crawford’s advice, and two weeks later had a greater amount of energy and felt completely different. Within three Concussion in Review An mTBI can occur anytime there is an external force that causes a dramatic acceleration, deceleration or rotation of the head and neck.s The external force does not necessarily need to impact the head directly for a concussion to occur. An mTBI can be induced by traumatic forces being transmitted indirectly to the brain. For example, injury to the cervical spine in a whiplash incidence has a significant role to play in causing mTBIs. The involvement of the cervical spine goes against conventional knowledge that concussions are strictly related to head injuries, and gives further insight into the intricate physiology that causes concussions and concussion symptoms. When working with patients with a concussion, the OCA encourages members to be highly cognizant of their individual capacities as practitioners, such as training in the management of the MSK sequelae of a concussion. www.chiropractic.on.ca 21