Hi, I’m Dr Eric Cobb from Z-Health performance and today we’re continuing on discussing brain injury. In the United States, March is brain injury awareness month and we talked last time about something called post-concussion syndrome. If you are new to Z-Health we are a brain-based education company we specialize in working with doctors therapists and coaches around the world so discussing brain issues and brain injury awareness month is a big deal for us. So last time I went through the four kind of basic buckets of problems that we will see in people who develop post-concussion syndrome and that basically means that people have symptoms that last longer than three months after their head injury and they’ve gone through some basic Rehabilitation.

Those four buckets are:

Cognitive

Physical

Emotional

Sleep

So we’ll see issues that may arise in only one of those buckets or in all four depending on the individual and depending on the severity.

Now if we are dealing with someone who has post-concussion syndrome it is generally getting better right they’re they’re functional, one of the things that we always need to focus on is aerobic exercise. Whenever I get asked about this and I get asked with some regularity people say “well I thought after a head injury concussion I was just supposed to rest and take it easy” and I need you to understand that that is kind of old school thinking.

What we now know is that a part of the issue that occurs after a sports injury or a sports concussion is a change in the cerebral blood flow, in other words blood flow to the brain.

Depending on the type of injury and where it occurred there will be focal areas of the brain that will receive less blood flow and we will also see particularly cases of post-concussion even years later that generalized blood flow to the brain may also be degraded or decreased compared to healthy control groups.

So what that then means is that if someone is trying to heal from a brain injury heal from a concussion we need to begin incorporating aerobic exercise quite early in the rehabilitation program.

So how do we do that?

Well, this is one of the challenging parts because it needs to be monitored at some level because the main thing is we need to push people hard enough to get their heart rate up to drive blood flow to the brain but we need to balance that with making them feel worse.

So this has been discussed now probably for the last 10 or 15 years and so again there are multiple protocols out there but I like to start off just by saying look it needs to happen we need to do some aerobic exercise in the vast majority of cases.

Now the way that we prefer to do this is let’s say I have someone who has a variety of issues in the physical symptoms bucket meaning they have some vision problems maybe they have difficulty converging their eyes which makes reading really difficult maybe they’re getting some vertigo or dizziness symptoms or some nausea or they’re light sensitive whatever that may be.

Depending on what I’m going to be doing with them after, I like to begin their training sessions with somewhere between 25 and 40 minutes of cardiovascular exercise.

Now for most people this means that we need the cardiovascular exercise to be safe to feel comfortable. So obviously if someone has balance issues, telling them to go out and take a walk or try and run it doesn’t make a lot of sense.

So in most cases what we will do is we’ll use an exercise bike or some other form of cardiovascular training equipment so that we can do this in a safe controlled way.

Normally we say that the intensity of the exercise meaning how high their heart rate will go is going to be governed by their tolerance.

So if let’s say we’re watching someone they have a heart rate monitor they’re on and we get their heart rate up to 125 beats a minute and all of a sudden they start getting a headache well we know that we’ve now pushed them too high. And 120 beats per minute isn’t that high isn’t that intense but for that particular individual it may mean that the next time we see them we need to work around 115 to 120 beats per minute for 25 to 40 minutes and then we would progress the intensity of the aerobic exercise over time.

Now I’m again all of that is done before we do other training. And I think this is one of the big mistakes I see people make with regularity is they know that someone has Vision issues after a concussion and so they come in for a training session and they start doing that right away. That may work in some cases but in many cases the first thing that we need to do is support the ability of the brain to change by providing it with increased amounts of blood because that’s going to carry oxygen which will help the neurons in the brain do what they need to do make rehabilitation possible.

So again what I’m talking about here brain injury awareness month I think that a lot of people still carry this kind of old-school mentality about brain injury and we just need rest in dark rooms and things will immediately get better or eventually get better on their own. We now know that in most cases that’s not the ideal pattern to follow.

So if you have experienced a head injury you have someone a kid or whatever that’s had a concussion speak to some concussion training specialist to get them started on a program right away because in many cases even in an acute situation, often we can start aerobic work early on to help prevent the development of these other issues going forward.

So aerobic exercise in the brain go hand in hand so that’s your next big takeaway for brain injury awareness month. Let us know if you have any questions otherwise we’ll see you soon.