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
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