The Neuro-Optometric Rehabilitation Association International is an interdisciplinary group of professionals dedicated to providing patients who have physical or cognitive disabilities as a result of an acquired brain injury with a complete ocular health evaluation and optimum visual rehabilitation education and services to improve their quality of life.

BLOG: Brain injury may affect sleep, fertility, digestion

Paul Hrkal
Paul Hrkal

by Paul Hrkal, ND

Concussion is typically managed by a family doctor who recommends rest and limited screen time for a few days.

If symptoms don’t resolve, the patient may be sent to see a specialist, such as a physical therapist, chiropractor or a neuro-optometric rehabilitation or vision specialist, to address lingering issues from the traumatic brain injury (TBI).

TBI patients often have vague symptoms that even they struggle to articulate — and what’s going on at the cellular level may help provide an explanation. The latest research confirms that a TBI stimulates a cascade of glutamate and calcium release, which leads to neuroinflammation, excitotoxin production, mitochondrial dysfunction and immune activation.

A TBI, for example, can turn on the microglia cells in the brain. These immune cells are responsible for producing inflammation to protect the brain from infections and invaders. But if they don’t get turned off, the inflammatory signaling mechanisms continue, impeding normal mitochondrial function and energy production.

Mitochondria produce adenosine triphosphate (ATP) molecules that power the cellular functions of every system in the body, including the visual and vestibular systems. In fact, the brain and visual systems are metabolically intense regions of the body. Little wonder then, that TBI patients are easily fatigued.

Depending on which part of the brain is injured, the hormonal center of the brain in the hypothalamus may also be affected. The hypothalamus coordinates the pituitary and autonomic nervous systems, which play a major role in regulating organ function and sleep, among other things. More than 50% of people who suffer a TBI have difficulty sleeping afterwards, sometimes for months or years. Changes (usually reductions) in the release of melatonin, growth hormone, thyroid-stimulating hormone, adrenal-stimulating hormone, prolactin and reproductive hormones are all possible after concussion, according to the latest research.

Additionally, a TBI may unmask pre-existing problems or underlying metabolic weaknesses for which the patient was previously able to compensate but no longer can after an acute injury.

Optometrists who see post-concussion patients who are presenting with persistent symptoms, such as nausea, fatigue, sleep or mood disturbances, should consider a referral to someone with naturopathic or functional medicine expertise so that metabolic and hormonal systems can be addressed, in addition to vision or vestibular therapy, occupational therapy and other services provided by other members of the care team.

In working with TBI patients, I often order advanced bloodwork panels to evaluate hormonal and digestive function. Based on test results and the patient’s symptoms, I will design a highly personalized treatment regimen that may include an anti-inflammatory diet, nutrient supplementation, hormone therapy, acupuncture and/or sleep counseling. There are some simple nutritional supports that any clinician can consider to optimize metabolic function. For example, curcumin, green tea, essential fatty acids, resveratrol and vitamin E are some of the compounds with potential therapeutic benefit in the treatment of TBI (Blaylock et al.).

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