In this episode of Ask Concussion Doc, Dr. Cameron Marshall, DC, discusses whether or not it’s okay to ride rollercoasters or travel on an airplane following a concussion; ways that people are impacted by screens (e.g., computer screens, phone screens, etc.) and constant brain stimulation following injury; and exercise therapy and concussion treatment.
There’s limited research in this area. The only study we are aware of looked at professional hockey players within 6 hours after injury. The researchers looked through the literature and injury reporting history across the league, and analyzed players that suffered a concussion who travelled by air within 6 hours after their injury. What they found was that about 33% more games were missed when athletes traveled by air immediately following an injury.1
Therefore, in the very acute phase of a concussion, this study showed that air travel could potentially prolong recovery. Of note, this is a retrospective study, which would need to be replicated with different sample sizes and time periods following injury.
In the immediate post-acute phase there may be some implications for air travel; however, we’re unsure whether or not it makes a difference 2-3 weeks following the injury. My assumption would be likely not.
The answer to the question about riding rollercoasters is a little bit tricky. I think that the implication – or what you’re trying to ask is – whether or not the jostling around and movements while on a rollercoaster could re-injure the brain. If you are symptomatic going over those bumps and jostling side-to-side, this could create some vestibular symptoms for a concussion patient.
Data shows that a concussion injury requires about 70 to 120 G’s (force of gravity) – with increased likelihood for injury happening around 98 G’s. To put that into perspective, if you are in a motor vehicle accident – airbags deploy at a change of velocity of 48 km/hr (or approximately 30 mi/hr). If you’re in a car accident and come to a dead stop from 50 km/hr, your airbags will deploy, and then what that translate to is a 60 G’s acceleration or deceleration through the seatbelt. This is a tremendous amount of force.
Returning to the rollercoaster example, we need to ask if there is enough acceleration going through the head as someone rides a rollercoaster to re-injure your brain. If it takes 70 to 120 G’s to cause a concussion, it’s unlikely to happen on a rollercoaster. That said, whether or not you advise your patients to avoid a rollercoaster altogether should be a clinical decision.
Sensitivity to light and screens, and computer intolerance, are very common following a concussion, especially if you are looking at a computer screen with an LCD light. When you’re looking at a screen, what you don’t notice is how often it refreshes; it flickers at about 60 Hz – or about 60 times per second. Most people don’t even notice it.
This causes your brain to create a lot of stimulation, and patients that have issues with stimulation or have difficulty looking at computer screens may caused by the refresh rate. The computer is constantly flashing in your eyes.
There is a group in Canada called Iris Technologies that developed a “patent-pending, research-backed” solution to this problem. Their assistive technology (or adjunct) computer monitor is based off the concept of ePaper – picture what a Kindle looks like. It’s a different way of presenting an image on a screen that refreshes only when the content of the screen changes and not at 60 Hz like a standard screen. Click here for more information about Iris Tecnologies’ ePaper Screen.
Simply, exercise is not a bad idea; however, it needs to be appropriate. If someone experiences symptom onset or exacerbation with exercise, it likely means that there’s an autonomic nervous system dysfunction, particularly in how the brain blood vessels regulate blood flow.
Following a concussion in the acute phase, animal studies show that there’s about a 50% reduction in blood flow to your brain, and in certain patients, particularly those with lingering and latent symptoms, those blood flow issues can linger.
If you’re having issues with exercise, it means that you’re likely suffering from a blood flow dysfunction, and exercise is actually the treatment. However, it’s important that it’s done in the appropriate manner. If this is the case, you should find out what you can and cannot tolerate through a Buffalo Concussion Treadmill Test. You can find a trained clinician or therapist in your area by visit the Complete Concussion Management website.
How does it work? It is a walking test that is graded. A gradual increase in speed and incline results in the patient’s heart rate gradually increasing. The clinicians job is determine any type of threshold for symptom exacerbation. Once confirmed, then they can encourage a patient to exercise at a certain percentage of effort as to not cause symptoms to increase.
Click here for more information about evidence-based approaches to concussion treatment and rehabilitation. To find a clinic near you, click here.
Ask Concussion Doc is a live Facebook show where Dr. Cameron Marshall, DC answers questions submitted by viewers about concussion and concussion management.
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