Maria Caligiuri

Curious about concussions?

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Football season has begun, reviving concern and discussion over sports-related concussions.

The American Academy of Pediatrics defines a concussion as a direct hit to the head or jarring blow to the body that gets transmitted to the head, resulting in a rapid onset of short lived impairment of neurological function. However, some controversy surrounds even this definition. So I reached out to Jessica Little, PhD, director of clinical research and operations at the Stanford Concussion and Brain Performance Center, to learn more about concussion research and Stanford’s clinical study of teenage athletes.

What should we know about concussions?

I think it’s important to note that concussions are still not well understood. There are hundreds of different definitions of ‘what is a concussion’ and there is currently no single evidence-based consensus on how to identify and treat concussions.

Research has shown that one of the biggest risk factors for sustaining a concussion is a history of having a prior one. There is a ‘window of vulnerability’ — the concept that a person experiencing symptoms of concussion is more vulnerable to incurring a second concussion during this time, as the brain has not yet fully recovered. If a truly concussed athlete has problems paying attention or is not coordinated, they can then be vulnerable to another injury. Protocols are often used to track signs and symptoms of concussion, and athletes are not allowed to return to play until these have resolved. However, it would be helpful to have more precise ways to measure attention and coordination on the sidelines to keep impaired athletes out of contact sports until those skills recover.

The vast majority of people with a concussion recover fully after the injury, though not all symptoms may improve at the same rate and everyone recovers a little differently.

Describe your clinical study for athletes 12-17 years of age.

Our study just closed recruitment, and we’re prepping all the data for analysis, so this is an exciting time. The study was called EYE-TRAC Advance, short for Eye-Tracking Rapid Attention Computation. Our lab used a specific type of eye-tracking called ‘circular smooth pursuit’ where an athlete follows a dot that moves at predictable speed around a circle. The eye-tracking was in the form of custom-designed portable ‘goggles,’ using built-in cameras and infrared pupil detection.

Our hypothesis is that people without a concussion can ‘sync-up’ with the way the dot is moving pretty easily, while a person with a concussion has a disruption in their ability to focus and pay attention. You often hear people saying that they feel ‘off’ or ‘out of sync’ following a concussion, and we’re trying to quantify that experience. For the study, we baseline tested athletes (before sports participation) with the eye-tracking, as well as other neurocognitive tests that measured things like attention and reaction time. If the athlete later got a concussion, we tested them again as soon as possible and again at 1, 3 and 12 months after the injury. In this way, we’re able to get a clear picture of how their brain recovered over time.

Overall, we reached out to more than 60 different organizations and recruited more than 1,400 people. We had a specially outfitted ‘mobile testing center’ RV. This allowed us to literally drive up to the side of an athletic field and perform the testing on-site at the school or organization, which really reduced common barriers to participating in a research study, such as the costs and time associated with transportation to and from appointments.

Can technology play a significant role in preventing concussions?

A lot of current technologies focus on diagnosing a concussion, but there are far fewer that actually focus on preventing concussions. There are some technologies that measure an athlete’s gait and vestibular-balance ability. If there are impairments, the athletes can be provided skill training to improve any deficits, thus reducing the risk of injury. Other technologies, such as helmet technologies, may be helpful in reducing the instance of skull fractures and other serious injuries, but they haven’t yet proved effective at preventing a concussion — that is caused more by brain rotation, which a helmet can’t fully protect against. One possible preventative solution could come from a neck device that stabilizes the rotational forces while still allowing neck movement at low accelerations, so that athletes can move about freely until it senses a potentially dangerous level of force.

Are there issues with under-reporting concussions?

Historically, there have been some issues with individuals under-reporting symptoms that would lead to a diagnosis of a concussion. This is often motivated by the idea that they should ‘suck it up’ or ‘don’t want to let the team down’ or by the fact that their ability to perform athletically is tied to keeping an athletic scholarship. There is research happening in the field right now trying to figure out the best way to dismantle these types of beliefs and make it more likely that athletes can be properly identified, given the treatment they need, and hopefully continue to safely engage in their sport.

Previously: Building a concussion-proof helmet: A Stanford bioengineer shares his findings at TEDxStanfordStanford bioengineers and clinicians team up to shed light on how concussions affect the brain and Forces at work in concussions more complicated than previously thought, new Stanford study reveals
Photo by Steve – Body Slam

Maria CaligiuriCurious about concussions?
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No Pill to Cure Concussions

In 2007, the Department of Defense spent over 100 million dollars on Traumatic Brain Injury (TBI)  research. A portion of those funds went toward pharmaceutical initiatives to try to find a medical cure for brain trauma. And while over 30 clinical trials and animal studies have been conducted, drug developers have yet to create a pill to treat concussions.

“There’s no pill to stop neurons from dying. No treatment to prevent inflammation in the brain. Nothing to pull patients more quickly out of the fog that can descend after a concussion,” Cassandra Willyard writes in her article for STATnews.com. Not even the highly anticipated progesterone studies from 2014 have revealed any promising leads.

Why Can’t Concussions be Cured by Medication?

The brain is a vast mystery among scientists; the functionality of cells and molecules are being studied and discovered everyday. Therefore, having a grasp on brain recovery is still very new category of research. As Willyard’s article states, a patient with a traumatic brain injury might be prescribed drugs to reduce brain swelling, but these drugs seemingly have no effect on regaining cognitive or motor skills.

The problem lies in the fact that the intricacies of the brain are so delicately balanced, that when a trauma knocks them out of place, it takes more than the function of a pill to restore the balance. In other words, the labs have not come up with a pill that can shift and realign the components of organs.

Concussion Complications on the Brain

Another consideration is that concussion injuries are often spread throughout the brain, not just in one area. Bruising, tearing, and stretching can occur as well as inner bones jolting out of place. Drug studies typically don’t focus on these individualized situations. They group study participants together and treat all brain injuries the same.

Trials and Tribulations

As stated on STATnews.com, These drug trials have no real way to measure results, so they rely on patients to fill out a questionnaire. Patients then grade their responses to the best of their ability. Questions like “Is the patient able to work?” is graded on an eight-point scale with no option to explain their answers further.

This results in skewed data because patients have no way of describing their situation. A patient might not be working at that time period due to another bodily injury obtained at the same time as the concussion. However, on the questionnaire it appears that the patient is not working because of the concussion itself.

Alternative Concussion Treatments

For patients battling the lasting symptoms of a TBI, a pill might not be the answer in this lifetime. But there is a treatment alternative that works to restore brain functionality after an injury– It’s called cranial movement therapy. Simkovich Concussion Institute uses this treatment method to maneuver the cranial bones back to their original positions.
This correction restores the natural rhythm of bone movement within the skull, which reinstates the normal cerebrospinal fluid flow and circulation. Concussion victims that don’t receive cranial movement therapy are susceptible to “second concussion syndrome.” Their symptoms will continue to worsen overtime.

For more information on cranial movement therapy and how it can help your concussion, schedule a free phone consultation, today!

Maria CaligiuriNo Pill to Cure Concussions
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Parents of Concussion Victims Speak Out

Last year, The Total Learning Center in Wexford, PA hosted a seminar for parents to learn about concussions. I was joined by local pediatrician, Dr. Anthony Kovatch, and Dr. Carol Utay, director of the center. The presentation focused on what symptoms occur when a child suffers from a concussion and what warning signs need immediate emergency room care. These seminars typically revolve around parent education. But I can honestly say that what I learned that day from the listening to the parents was certainly eye-opening for me, as a practitioner.

I spoke to the group about the dynamics that occur during a concussion and the damage they cause. I explained the anatomy of the cranium, how all of the cranial bones move in a rhythmic motion, and that this motion has a direct affect on brain function. I described the role of the cerebrospinal fluid and how a concussion decreases the cranial bone movement, which decreases cerebrospinal fluid flow.

 

Central Nervous System Waste

I further stated that this decrease in cerebrospinal fluid flow inhibits the removal of the waste products produced in the central nervous system. This flow is critical, because the waste that remains in the cranial vault longer than normal will begin to kill brain cells. Dead brain cells leads to decreased brain function in both cognitive and motor function.

The damage to the brain cells and the decreased function is the reason so many of the retired NFL players have the severe issues that worsen with age. There has even been talk that ALS is caused by concussion. While this hasn’t been confirmed, it is, theoretically, very plausible.

I’m a bottom line kind of doctor. I attempt to reach the quickest, least invasive solution to my patient’s problems. The bottom line in treating a concussion is reestablishing the normal cranial bone movement. Without this, the brain simply can not, and will not, heal or return to pre-accident status.

 

Rest is Not a Treatment

‘Rest,’ which is the most commonly prescribed ‘treatment’ by doctors, simply does not ‘fix’ the problems caused by concussions. Resting will help the acute issues of the concussion go away (such as swelling, etc.), but rest does not return the cranial bones to their normal intrinsic movement. This needs to be done by a practitioner who practices that specialty.

 

Parental Feedback

So, why was I surprised by what some of the parents said that day? One woman, a nurse, explained that her daughter had a concussion. It interested her enough that she was invested herself into the concussion field through one of the local facilities. She acted as a self-appointed advocate, telling the other mothers that “it will get better,” and that her daughter had “fully recovered.”

She spoke about how they had a terrible road, and that her daughter suffered for a long time with the issues from her concussion. I listened and wondered how it was possible for her daughter to have a full recovery if she hadn’t been treated? Because of the knowledge of the physiology and mechanics of cranial bone movement and concussion, I knew it was impossible for her daughter to be fully recovered. To clarify, if the normal cranial bone movement hasn’t been restored, a patient will not recover.

I began to ask her questions about her daughter. Slowly, she admitted that her daughter was still experiencing difficulty in school and working slower than she did pre-accident. Her daughter even needed special consideration from her college to get through her course work. It was clear that this woman didn’t understand what actions were needed to recover from a concussion. I consider it a tragedy that her daughter will have to deal with special accommodations in college when her problems can easily be corrected.

Another eye-opening parent was a mother of a high school student who was more concerned about that fact that the school wasn’t paying attention to the legislated accommodations from the state. While these accommodations are a good thing and assist in the early stages of healing, she also missed the point. The problems her child was dealing with are treatable. The bottom line here is that the suffering from concussions is needless when there is a solution for the problems caused by them.

If you or someone you know suffers from a concussion, please sign up for a free phone consultation so we can get them on the road to a true recovery.

 

Maria CaligiuriParents of Concussion Victims Speak Out
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NFL Tackled By Concussion Movie Message

A former Steeler, currently being treated by me for the concussions he sustained while a player, came into the office last week after viewing the premier of the movie, “Concussion.”  What he had seen in the movie made him visibly emotional. He spoke at length about the damage retired players experience and how they need to know that there is help for them- in this office. He was exasperated that the movie made no mention that there is a solution (cranial movement therapy) for the impairments sustained by the head traumas, and that the existing “treatment” of “rest” or “physical therapy” simply has limited results.

Concussions are the most frequent injury in the NFL, but (as quoted by Forbes) in the medical world a concussion does not currently have an agreed upon medical definition. Many believe the actual diagnosis criteria is a grey area for the sake of the NFL’s decision makers.

In an article from the Tribune Review, Freelance Columnist and Sports Radio Host Joe Starklyinterviewed Steelers’ Quarterback Ben Roethlisberger about his recent concussion diagnosis. The issue was that Roethlisberger wasn’t sure if he even had a concussion because no one would tell him the results of his computer concussion test (ImPACT). His coach and doctors were the ones who determined whether Roethlisberger was clear to go to practice, but wouldn’t give any hard diagnosis. Arguably, they could have been withholding this information to allow him to continue playing– a subject that hits close to the Concussion movie message.

My patient shared how he had gone through the “prescribed” concussion protocols the NFL and UPMC recommended only to realize that he was continuing to deteriorate over the first year of his retirement.  It was then that he sought care here for his injuries. He mentioned several times that he didn’t want to imagine where he would be if he hadn’t come here. That opened a long discussion about the physiology of the cranial bones and the role cranial bone movement has on brain health.

In short, the only way a person can recover from a head injury is to have the normal cranial bone movement restored. This allows the brain to reinstate the normal cerebro-spinal fluid flow and circulation compromised after a concussion.  It is critical in the rehabilitation of the brain after a concussion, and there is no way a person can recover fully from a concussion if this isn’t accomplished.

That statement is worth repeating:  It is not possible for the brain to return to pre-concussion status if the cranial bone movement isn’t restored! People who have had concussions and don’t receive cranial movement therapy are susceptible to “second concussion syndrome.” Second concussion syndrome wouldn’t exist if the person had received cranial bone movement restoration.

For example, take a look at Sidney Crosby. He never received proper treatment after his major concussion.  His acute symptoms are better, which allowed him to return to play, but the real problem was never dealt with and remains compromised. His performance proves this. Talk is abundant about how his level of play just isn’t the same as it was pre-concussion.

Some people think he’s holding back, because he’s afraid of another injury.  But
people who have never been around hockey players know that can’t be true, because hockey players are fearless. The reality is that he is struggling because his brain is continuing to slowly deteriorate due to the fact that his normal cranial bone movement was never reestablished.

Why is this critical? The movement of the cranial bones pumps cerebro-spinal fluid around the brain, facilitating the removal of metabolic waste products out of the central nervous system. After a head injury, the cranial bone movement is altered, slowing down the cerebro-spinal fluid movement, and making it impossible to efficiently remove the waste products that are produced. The net result? Thebrain tissue starts to die.

This phenomenon explains why the NFL has to deal with the fallout from head injuries. It explains the reason for the problems of the Mike Webster’s and Junior Seau’s of the world.  Yet the technology and treatment exists, so this shouldn’t be happening to these men.

It has become a common scene: former athletes come into my office, shut the door, and break down emotionally because they are scared to death over what is happening to them. One former NFL lineman got my attention when he said the he wanted to be able to see his “grandchildren grow up and be able to remember their names.”  Concussion, the movie, was riveting, emotional and hard-hitting, as is the real-life epidemic. However, it is long past time to tackle the truth.

 

Photo Credit: Sony Pictures

Maria CaligiuriNFL Tackled By Concussion Movie Message
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What Cranial Bone Movement Restoration Can Do For You

What Cranial Bone Movement Restoration Can Do For You

Simkovich Concussion Institute is putting themselves on the map by providing contemporary therapy options for patients battling concussions, autism, and learning disabilities. Dr. Charles A. Simkovich’s private practice procedures have been used for the past 30 years, on over 30,000 patients, and have achieved overwhelmingly positive results.

Why are Simkovich Concussion Institute’s Revolutionary Treatments So Effective?

Well, the majority of the success stems from Dr. Simkovich’s knowledge of the cranial functions. His early involvement in cranial research challenged the traditional medical theories. For instance, it was thought that our cranial bones were fused into place early in life, which we now know is not the case.

Michigan State University School of Medicine (Department of Physiology) proved that cranial bones continue to move by measuring the movement of the parietal suture, which is the skull’s least movable suture. This, as well as other landmark studies, (from Russian Space Program to NASA’s research), was the basis for Dr. Simkovich’s work.

Proving that cranial bones move opened a whole box of new questions. Each movement of the cranial bones needed to be identified. He had to then study how the bones interact with each other, and the effect these movements have on brain functions. This was accomplished through the technology that he currently uses for his treatment.

Why Do We Have Cranial Bones?

We have bones within our body to hold organs in place. Our cranial bones hold and protect glands within our brain. The pituitary gland is the vitally important, master gland that sits right in the middle of the brain on the Sella Turcica bone cavity. This gland releases hormones that control the growth, blood pressure, thyroid gland, metabolism, and other bodily functions. Also present is the pineal gland. This gland controls serotonin levels, critical in the cases of PTSD (post traumatic stress disorders).

What Does Cranial Bone Movement Have to Do With Brain Health?

Just like other systems of the body, like a heart beating or the lungs breathing, the cranial bones all move in a very specific manner. Unlike the heart, which beats for the naked eye to see, cranial bone movement is more like a rhythmic “pulsing.”

An individual can develop poor brain-functioning symptoms when the normal cranial bone movement is altered. What causes these normal cranial bone movement to change? Physical trauma (such as a concussion) or chemical trauma (being exposed to chemical or toxic substances).

An extremely critical function of cranial bone movement is pumping Cerebrospinal Fluid (CSF) throughout the brain and spinal cord. The main job here is to remove metabolic waste from the central nervous system.

After an incident where the cranial bone movement is decreased (from physical or chemical trauma), the CSF flow slows down. The metabolic waste products remain in the central nervous system longer than they should, slowly killing brain cells. Once normal CSF flow is restored, the brain can regenerate cells and heal. This is all accomplished through the treatments Dr. Simkovich practices.

What is Cranial Injury Complex?

When the patient is never treated and normal cranial bone movement is not restored, it can manifest itself into Cranial Injury Complex. Cranial injury complex can cause a variety of weakened brain functions, like eye-tracking, short term memory, diminished left brain function (logical brain), and over stimulated right brain function (emotional brain).

People with cranial injury complex commonly start struggle in school, have emotional breakdowns, angry outbursts, fall into a depression, and begin having memory issues. All of these have a devastating effect on the victim, both academically and socially.
While learning disorders might only affect patients academically, autism presents both brain-related and organic issues, (such as gut issues, allergies, immune issues, etc.) Daily routines are challenging for autistic individuals and often extend to their entire family.

Simkovich Concussion Institute Treatments

With the technology utilized with through Simkovich Concussion Institute treatments, the autistic patient is physically rehabilitated. The restoration of their cranial bone movements allows maximum healing of the brain and related organic systems. This helps other autistic interventions to be more effective since the body is most stable to utilize the various vitamins, dietary changes, and other methods currently being used to treat autism.

Maria CaligiuriWhat Cranial Bone Movement Restoration Can Do For You
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