SLEEP

This may seem obvious, but sleep quality is of the utmost of importance when recovering from a concussion. After a traumatic brain injury (TBI) occurs, a build up of reactive biological substances are formed in the brain tissue via a cyclical neuro-inflammation process.  These substances might include reactive oxygen species, tau tangles, amyloid beta plaques and proinflammatory cytokines. While we sleep, the build up of these substances that contribute to neuro-degenerative processes is flushed out via the glymphatic system.  Sleep initiates the glymphatic system to do it's janitorial job of cleaning out the waste substances in our brain and central nervous system.  Sleep is a key element to TBI recuperation and, therefore it is first on this list strategies for optimal recovery.  Best sleep practices are outlined below: 

• establish a sleep regimen of 8 continuous hours

• maintain a 2 to 3 hour fast from eating near bedtime

• time sleep where it is more closely associated with waking at sunrise

• eliminate (or minimize) screentime as bedtime approaches

• keep consistent bedtime rituals and timing from day to day

• turn off wireless sources at night by putting mobile devices in airplane mode and disabling wifi routers

• if tolerated, regular reading of "physical" books or magazines as part of the bedtime ritual may be a helpful for stimulating the body's circadian rhythm.

• consistent mealtimes have been shown to establish and maintain a consistent circadian rhythm. This supports the natural melatonin release for sleepiness at bedtime.

• avoid stimulants like nicotine, caffeine and alcohol due to their ability to disturb the natural sleep mechanisms

• naps are not necessarily a substitute for continuous sleep at night; though they may be necessary to account for accumulated sleep deficits that may occur during recovery.

SUPPLEMENTS

Supplements can assist the natural recovery mechanisms of the human body.  Consult your physician prior to starting any new supplement regimen for any interactions that may be unique to you. Below you will find a list specific to traumatic brain injury and general brain health:

• N-acetyl Cysteine induces the synthesis of glutathione - a potent antioxidant of the brain by helping to prevent reactive oxygen species to occur. One brand is Pharmanac that has been recommended by physicians.

• Glutathione - get it intravenously (IV), otherwise take N-Acetyl Cysteine (see above) due to human digestion rendering it impotent when taken orally.

• Turmeric has two compounds that assist with recovery from traumatic brain injury. One compound is curcurmin which is a natural anti-inflammatory. For this compound to be absorbed into the system, it needs to be taken with an additional compound called piperine. This suppresses the liver’s filtration of curcurmin that would not occur without the addition of piperine. The second compound is tumerone which also inhibits inflammation, but, more significantly, it induces neural stem cell proliferation. This is critical for neuronal growth and regeneration.

• Vitamin D regulates serotonin synthesis. Seritonin is tangentially related to concussion recovery whereas it is significantly influential to mood (depression vs happiness), appetite and sleep quality. Aim for blood serum levels of ~ 50. If levels are below 30, it takes a few months daily to get level to an optimum value.

• Omega 3 fatty acids (DHA & EPA) - DHA is part of the cell membrane of the brain and has been shown to be helpful for cognitive decline. DHA & EPA are naturally anti-inflammatory and have been used to also help with depression. Nordic Naturals brand takes great measures to help prevent rancidity.

• Melatonin is created by the body for it’s own use, though supplementation may be warranted. This is due to the multiple roles for aiding traumatic brain injury recovery (TBI). Firstly, melatonin is a regulator of the circadian rhythm where the natural sleep cycle is induced. Implications to sleep quality should be obvious. Melatonin is also a free-radical scavenger promoting the specific antioxidant enzymes related to glutathione production (see above). Lastly, it has been show to have interactions with the immune system and anti-inflammatory processes that are occurring in the brain while recovering from TBI. Redisorb is one brand, but Tart Cherry Juice is a wonderful source of melatonin (*see this page for more information & considerations).

• Lion’s Mane Mushroom - scientific research is in it’s infancy for this food product/supplement. Research has shown it to stimulate nerve growth factor (NGF) production, NGF is a neuropeptide that helps maintain neurons - the cells responsible for helping your brain process and transmit information. More information available here. Unfortunately, due diligence is required to sort through the products that work best for outcome.

DIET

With chronic inflammatory processes in play, the finite resources of the body are spread thinly across other much needed areas.  In the case of traumatic brain injury, it is advisable to remedy any chronic inflammation and concurrent metabolic disorders that may be occurring during the concussion recovery process. Addressing these conditions allows for the freeing up of resources for maximal benefit to the body’s natural defense system. It is outside the scope of this article to dig into this subject, though we recommend the work of Valter Longo for further reading into how to engage in a dietary intervention that is useful for this endeavor.  

SENSORY OVERLOAD

This also may seem obvious, however, the busyness of our modern culture can be antagonistic to the process of repair and recovery from concussion symptoms.  Things like loud music, quick moving visuals, overbearing odors and crowded shopping malls can complicate recovery, as well as distress the afflicted.  Here are some considerations for minimizing sensory overload:

• generally, avoid chaotic places and situations.

• perform errands at less busy times of the day (e.g. mid-morning)

• meet friends at your home or their home rather than at a public place

• when meeting with more than one friend, ask them to speak one at a time rather than overlap conversation.

• investigate ideal locations for eating out (or order take-out/delivery)

• when attendance to an event or meeting is required, choose a seated location near an exit. This allows for emergent escape, if needed.

• titrate sensory exposure as symptoms improve while working with your healthcare practitioner for sensible reintegration strategies.

OSTEOPATHIC MANUAL THERAPY

Certain osteopathic protocols have been shown to aid and facilitate recovery from traumatic brain injury.  See this page for more information about concussion help and Kathleen Brannan Brown’s practice in Santa Rosa,CA.