What the Duke Study on fMRI Brain Scans Means for Post-Concussion Syndrome Detection
The Hariri lab at Duke University recently published a review that questions the reliability of task-based fMRI as used to examine individual patients.
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Dr. Mark D. Allen holds a Ph.D. in Cognitive Science from Johns Hopkins University and received post-doctoral training in Cognitive Neuroscience and Functional Neuroimaging at the University of Washington. As a co-founder of Cognitive Fx, he played a pivotal role in establishing the unique and exceptional treatment approach. Dr. Allen is renowned for his pioneering work in adapting fMRI for clinical use. His contributions encompass neuroimaging biomarkers development for post-concussion diagnosis and innovative research into the pathophysiology of chronic post-concussion symptoms. He's conducted over 10,000 individualized fMRI patient assessments and crafted a high-intensity interval training program for neuronal and cerebrovascular recovery. Dr. Allen has also co-engineered a machine learning-based neuroanatomical discovery tool and advanced fMRI analysis techniques, ensuring more reliable analysis for concussion patients.
The Hariri lab at Duke University recently published a review that questions the reliability of task-based fMRI as used to examine individual patients.
If you’re struggling to recover after a brain injury, dealing with healthcare providers is often a frustrating process. Unless you have a clear, severe injury, they might be dismissive of your symptoms or just may not have enough treatment options to help you. Oftentimes, they’ll order an MRI or a CT scan.
If you’ve been reading about concussion diagnosis and symptoms and feel confused, that’s pretty normal. Most advice about concussions feels vague. It’s hard to know what applies to you. And if you’re like most patients, you may be second-guessing yourself and unsure whether to see a doctor after your injury.
It’s not uncommon for people in today’s society to be tired. The demands on our time seem to be never ending. However, there’s a difference between being tired from being on the go all of the time and the feeling of extreme fatigue.
If you’ve recently suffered a concussion, you might be confused about when and how to return to exercise. Maybe you were told to avoid all physical activity until you feel better. But what if that time never comes?
Are you still experiencing post-concussion syndrome symptoms even after resting like your doctor recommended? If you’re frustrated, tired, and in pain because your concussion symptoms won’t go away, you’re not alone.
A regular MRI (magnetic resonance imaging) looks at brain structure and integrity. While it is helpful for diagnosing structural brain damage, it can’t often be used to detect post-concussion syndrome (PCS). However, a specialized form of MRI called functional neurocognitive imaging (fNCI) can detect PCS.
If you notice symptoms after a concussion, it’s best not to wait to seek treatment. If you’re the type to “wait it out” and see if things get better, then we recommend waiting no longer than three months. After that, it is very unlikely your symptoms will improve, so it makes sense to pursue active rehabilitation of concussion and post-concussion syndrome (especially if those symptoms interfere with your everyday life).
The medical community can be painfully slow to adopt best practices, and concussion care is no exception. Many doctors and clinics recommend “cocooning” — i.e., rest and inactivity in a dark room until symptoms disappear — even though research shows that is not the best way to treat a concussion.
If you’re like the majority of people who have had a concussion, then you likely recovered a few weeks afterward and have felt fine ever since then. Concussive symptoms typically resolve in 7 to 10 days (sports-related concussions) or within 3 months (non-athletes). But not everyone is that fortunate: up to 30% of post-concussion patients have lingering symptoms that don’t go away with time and rest.
And even if you do recover and walk away with no long-term symptoms, it isn’t without consequence: You will always be more susceptible to another concussion than someone who hasn’t had one, particularly during the first year after your concussion. It takes less force to sustain a repeat concussion within a year of the previous concussion and it’s likely to take more time to resolve. Repeated subconcussive jarring or shaking to the head can contribute to this situation as well.
If you visit a doctor for a concussion, you might be told to lie down in a dark room until all your symptoms go away. Many doctors learned that rest was the best way for patients to heal safely from a concussion, but that is no longer best practice. In fact, research shows that active management of concussion has better outcomes. And in our experience treating thousands of patients, many of whom had symptoms that lasted for months or years, we know that “rest until you feel better” can be frustratingly ineffective.
Concussion symptoms can be confusing. They don’t always show up immediately, they can come and go, and they don’t always go away without treatment. We treat concussion patients every day and answer these questions for our patients regularly. That’s why we’ve put together a guide to concussion symptoms, including:
Past patient, Anna Empey shares her experiences in a series of blog posts including "Perspective After a Brain Injury" and here in this post.
I sustained my first concussion in July of 2011, playing broom hockey. My roller skates slipped out from under my feet, and I hit the back of my head on the right side on cement.
I didn’t know how severe my concussion was until I went to the doctor a week later with symptoms such as:
At the time, it was diagnosed as a "grade 3" concussion, which means I also had lost consciousness for more than 30 minutes. I was told to rest for a few months, and slowly I got back into my life over the next six months.
I came to Cognitive FX in 2015 about 9 months after I sustained another concussion on the front right side of my head in a car accident. It has taken me time to be grateful for both of my injuries, but most importantly I am thankful for who and where I am now. I wanted to share 10 things I wish I would have known before I had a brain injury.
About a year ago I did an interview over the phone with a sports-talk radio show in Texas. The topic was concussion in high school football (Texas is all about high school football). I talked about treatment for long-term concussion effects and how new therapies are available that can be extremely effective. I also mentioned research that shows treatment effectiveness even when the concussion (or concussions) happened years earlier.
“Eat right and exercise” – this advice is nothing new, you’re tired of hearing it and you’re tempted to tune it out right now – but it’s not going away. In fact, when it comes to brain health, this worn cliché is gaining more traction than ever. Here I’ll focus just on exercise and leave nutrition to another post.
By Mark Allen, Director of Research
The Enhanced Performance in Cognition - EPIC concussion treatment provided at Cognitive FX is a highly effective approach to concussion rehabilitation. We have developed an optimal program for recovery that typically lasts about 1 week, with intensive daily therapy. Each day includes a cycle through specific therapies for each patient guided by her/his brain activation images (fNCI).