Thank you so very much for asking me to talk about our newly published paper in Frontiers Neurology; it’s in the Neurotrauma section. That journal has an impact factor of 3.552 and are really over the moon happy about that. The title of the paper isHead–Eye Vestibular Motion Therapy Affects the Mental and Physical Health of Severe Chronic Post-Concussion Patients.
It’s a passionate article because we’ve identified that 1.8 to 3.6 million annual traumatic brain injuries are occurring in the United States alone and that an evidence-based treatment for concussions hasn’t been available, so we wanted to contribute. We’ve had a lot of press over the last 40 years specific to our work, and we had some pretty spectacular outcomes. We did a retrospective clinical chart review and reported the things that we found using an objective validated measurement of the physical and mental health characteristics of our patients, and we were able to demonstrate both statistical and substantially significant outcomes in our patients.
Traumatic brain injuries are the buzz presently in the lay and academic press. We know that they can because by extra-cranial mechanical forces. We have treated just a plethora of injuries over the last four decades and have developed an expertise in treating people that have had injuries that haven’t responded to other types of treatment. The interesting concomitant that we realize is that the mental health of patients that suffer brain injuries is significantly affected and this can confound different interventions that could be very helpful. Many patients describe only physical symptoms, but in fact, their greatest suffering may be specific to depression, anger, control issues or cognitive problems as well as increases in suicide in a variety of other types of things.
We know that imaging such as with MRI and CT is not as definitive diagnostically as are predictors of suffering as such as mental health issues, and very interestingly we found that the mental health issues predict the physical incapacitating symptoms of a post-concussion syndrome. So we were really concerned with the global health of our patients. We had an international group of authors that are involved in this study and review. People that are using the techniques that we develop throughout the world and we were very excited to have them come aboard. What we did find is that we were able to show a symptom severity scores, which would validate what your symptoms are, or your suffering if you would, and we were able to change this, were statistically significant with very high P values. We used different regression models to identify individual predictors of this suffering. Not only did we show that the outcomes of our treatment were good for the things you’d expect like headache, head pressure, neck pain, dizziness, blurred vision, sensitivity to light and all of the concomitants that are usually reported, but we also showed changes in the mental health status of the patient as well.
The paper is well delineated with a lot of box plots that allow the reader to look very simply at some complex statistical evaluations by looking at very simplified graphs that are easy to interpret. You can see which of the types of symptoms and suffering best respond to the treatment that we did. So we had a large number of patients, we took 620 of them and then looked at the ones that had debilitating symptoms that lasted over six months. When we say debilitating, we are talking about people that can’t work, they can’t go outside and be in crowds, they can’t walk very well, they can’t think well, they have pain, they have blurriness of vision, they are light-sensitive, they are sound sensitive and all of the things that are associated with these concussions. We do that there is a statistical relationship between symptom severity and the set of predictors that were able to identify. So doctors can read this paper and look at the individual predictors, signs or symptoms that patients will have and if you have certain numbers of these predictors it will allow you to say “well if you got this then there is a good probability that you’re going to improve, or you’re not going to improve if do this.” So we describe the individual therapy which was used to stimulate muscles, the vestibular system, the visual system, and basically we moved the head and body in certain frequencies and directions associated with the stimulation of structures that we delineate. I think we do fairly well in our methodology so that if you read this paper you’ll be able to understand the types of techniques that we utilized and most importantly you should be able to incorporate these individual therapies specifically designed to address the physical concomitants that we have identified.
All of our patients had visual and neurological impairment similar to what you’d expect with deficits of vestibular function. We used a variety of the techniques and then we compared our techniques to other findings of colleagues that have reported similar activation in the literature and were able to develop a probability of the structures that we would affect. So as you go through the paper you’ll see a variety of figures, you’ll see tables with the statistical significance of the outcomes of our therapy as well as the effect size or the Cohens D that we reported. A Cohen’s D that is .8 or over is is really over the top, and specific to effect sizes and rather high for a majority of them. We had some very interesting concomitants, as the mental health issues were the greatest predictors, especially things like irritability and anxiety, and we also found that physical signs such as problem sleeping were very significant as predictors in these individual cases. We talked about the autonomic system that system that regulates your heart and your gut, and we spoke of the activation of particular reticulospinal fibers and all of the intrinsic neurological structures that appear to be affected by the type of therapy that we utilized in this paper.
I think is a good one for people to review the anatomical basis of the types of therapies that we do and also for the types of therapies that might be done in the treatment of human suffering. It is fascinating because even though these patients were treated for five days only the outcomes are outstanding and very humbling in regards to the fact that they have gone, all of these patients, through a variety of good treatments with other facilities, which referred them to us. So that even though people can suffer for greater than six months the treatment time is not that great, just one week out of their life and then they can get back in the game. The outcomes are statistically significant; it’s work that has put us on the map and has made us a favorite stop for the people that have head injuries, whether they be professional athletes or Olympians or the people next-door. So it’s not the length of time but the quality of the treatment of this Head Eye Vestibular motion therapy that should have applications in other mental health scenarios. We are very excited about that, especially my group at the Bedfordshire Center for mental health research in association with the University of Cambridge. The predictability of total severity scores, the identification of mental health activities and outcomes are super exciting. We hope that you’ll read the paper and then if you have any questions just contact us or contact me directly and will do our best to explain things to you. I think it’ll be a good read for you and it’s going to be an excellent study, a good reference material. There’s much more to come and were are honored to have it published in such a marvelous prestigious journal, indeed the largest read journal in the field of neurology that has open access.
If you would like to learn how to perform such powerful therapies for you patients, consider registering for Prof. Carrick Clinical Applications of Eye Movements Seminar on November 10-12, 2017 in Cape Canaveral and via internet live-stream.