Although concussions are often labeled a “minor brain injury,” they can actually lead to major disruption in brain function. Investigators still don’t have a clear picture on the scope and severity of symptoms that concussions pose long term, but a growing awareness has made athletes take head injuries more seriously.
According to a 2014 estimate from the Centers for Disease Control and Prevention, there are between 1.6- and 3.8-million concussions (diagnosed and undiagnosed) each year just in the United States for sports and recreational related injury. This breaks down to about 5,000 concussions day.
Just because you don’t play high impact sports doesn’t mean you’re immune to head injury—concussions can happen with everyday activities that may at first seem like an ordinary bump on the head.
We usually associate concussion with an athlete being knocked unconscious, yet fewer than 10 percent involve loss of consciousness, and many times the condition can be hard to spot. Take, for example, Dr. Clark Elliott, an associate professor of artificial intelligence at DePaul University in Chicago. Driving to teach an evening class in 1999, Elliott was stopped at a red light when he got rear ended. The jolt left him a little shaken, but he still felt well enough to make it to his class.
However, in the following weeks, months, and years, Elliott’s life began to unravel. For nearly a decade he experienced severe symptoms that doctors were unable to address.
“I couldn’t walk at times. I was unable to read. I often couldn’t understand what people were saying to me,” Elliott said. “I had to hold on to the wall if I was going to walk somewhere otherwise I would lose my balance. The tricky thing is that I was fine until I started to think, and then it would leave me so very debilitated for 10 or 15 minutes, that I was completely incapacitated. I couldn’t even get up out of the chair.”
“Depending on how deeply I drained my resources even as little as twenty minutes of the wrong kind of work (like climbing a tree with a chainsaw) could leave me debilitated for more than a week.”
Doctors eventually identified Elliot’s brain injury, but they could offer little help. By 2008, symptoms from Elliott’s concussion threatened to cost him his job, his house, and his children. “I really was on the verge of becoming a ward of the state at that point. I just couldn’t keep going anymore.”
Then Elliott stumbled across the concept of brain plasticity—the notion that our grey matter can change and rewire itself when necessary. This led him to two unique doctors in Chicago who specialized in brain restructuring: psychologist Donalee Marcus, and optometrist Deborah Zelinsky.
“Between the two of them, within the first month of getting treatment they had managed to reroute the visual signals traveling through my brain, using of all things prescription eyeglasses and these paper and pencil puzzles,” he said. “In a month I was about 70 percent recovered.”
Elliott’s 2015 book, “The Ghost in My Brain: How a Concussion Stole My Life and How the New Science of Brain Plasticity Helped Me Get it Back,” documents his experience. His academic focus—artificial intelligence and cognitive science—offers an insightful perspective of what it’s like to live with a damaged brain.
The Epoch Times talked to Elliott about his experience, and what we need to understand about concussions.
Epoch Times: I have to admit, I thought concussions only had to do with football players. I was blown away by how many people suffer this condition, and how serious the damage can be.
Dr. Elliott: Yes, this can happen to anyone, not just football players. There is also the insidious nature of concussion, that it can masquerade as many other maladies that many do not recognize as symptoms. Often times, it’s misdiagnosed or not diagnosed at all.
This is an epidemic. Why don’t we know about it? The truth is that there has been considered no treatment, so there’s just not much interest. If you go see a doctor, and if they’re smart enough to recognize the symptoms, they’ll most often just send you home and say, “Cross your fingers and hope you get better.”
It’s not a knock on doctors. They can often save our lives. But their approach to concussions has traditionally been very limited, and not helpful.
I had sought every kind of traditional help I could get and I was told by virtually every doctor, rehabilitation center, concussion specialist—everyone had said, “You will never get better. No one ever gets better. You have to learn to live with your symptoms.”
ET: Why can it be so tricky to identify a concussion?
Dr. Elliott: Well, keep in mind: I’m not an expert in the physiology of concussions. I’m a guy who had one and I wrote 1,200 pages of notes on the experience. I understand the cognitive aspects, but I’m not an MD.
It’s very typical in concussions that the damage takes place inside the sheathing of the nerve, and we can’t see this with most modern brain scanning techniques. So if you go for an MRI or a CT scan, it can come back normal even though you may be profoundly damaged. More recently we have these SPECT scans that can show damage that MRI and CT scans sometimes won’t pick up. We have a more sophisticated EEG that shows more too, but someone who has been profoundly affected may still pass these tests.
Another very troubling aspect of concussion is that it often affects those parts of the brain that we need to understand that something has gone missing.
This is kind of an extreme example, but in my case under times of stress I would lose the right hand side of my world. I could read and understand the numbers on the left hand side of a number line, but the right hand side would disappear, sort of off into a fog. And I couldn’t turn right. If I was at a doorway and it was on my right, I had to spin around to the left to go through the doorway, because I couldn’t make sense of the right hand side of my world.
But in my notes, I never once wrote down “the right hand side of my world is missing.” So why would that be? The reason is that I had no ability to recognize that it was gone, because to understand it I would have to know what that meant. Mine is an extreme case, but it is so common in concussion to know that something is wrong but we can’t figure it out. People ask us what’s wrong, and we say, “I don’t know. I feel strange.”
On one of my trips to the emergency room a nurse said, “Why are you here?” And I said, “I don’t know.” She got mad at me and said, “Well, we’re busy. If you’re not going to helpful, could you go away?” But I didn’t know why I was there, I just knew that my life had fallen apart and I just couldn’t put my finger on what was wrong.
When someone says, “I don’t feel human,” that’s a hallmark of concussion. It makes you feel alienated from the human race. So doctors may send you to a psychiatrist to talk about your childhood. Or they may give you drugs to treat depression, when the problem is really a brain injury. That was my experience, and that’s what I hear so often from readers. So I know it’s still happening, even though we’re raising awareness.
Since my book has come out I have gotten many passionate letters from readers around the world saying, “Thank you, Dr. Elliott, you have captured my experience. You’re the first person in eight years who believes me.” We have many people living with this, and they’re living in a dark world where nobody gets it.
ET: So if a concussion can be hard to diagnose, conventional treatment has little to offer, and the sufferer can’t even articulate what’s going on, I can see why it’s such a puzzle.
Dr. Elliott: It gets worse. Look at all these kids who are being treated for attention disorder and people who are suffering from depression. How many of those might be stemming from a brain injury that took place two years ago, or even 30 years ago? It was something they didn’t think much of back then. They fell off the swing set when they were a kid and they felt sick for a week. Now they’re having trouble studying and they’re being treated with Ritalin for attention disorder.
How many of these people identified with other maladies over the course of their lifetime actually have head injuries that were never diagnosed?
One doctor wrote to me after reading the book and said, “I’ve had nightmares thinking how many cases over the years I misdiagnosed because I thought they were mental cases or drug problems. I think back to the symptoms they reported and I realize it was a head injury. The string of people I misdiagnosed runs down the block and around the corner.”
ET: How does your work with Artificial Intelligence (AI) inform your understanding of brain damage and recovery?
Dr. Elliott: I work with a lot of the cognitive function of the brain in AI models. I find that even the simplest thought—what seems to most of us to be trivial—may actually involve dozens of layers of thinking.
We have an unbelievable computational device in our heads. The computing power of the human brain is roughly the equivalent to 50 million desktop computers. This says nothing about the complexity of the software, memory capabilities, and so on.
Much of that computing power (somewhere between 50 and 80 percent) is involved in visual processing. It may sound strange but our visual processing lies at the root of our ability to think. It’s at the core of what makes us human. So when we’re working out a math problem or deciding on the grammar and structure of a sentence, we use all of the same hardware of our visual/spatial relationships to keep things in our brain separate. This is why just thinking will often completely end the concussive’s day.
Often times, concussive people may have trouble hearing. If two people are speaking at once it’s a nightmare. I would run from the room holding my ears just from being overwhelmed by the processing. That’s because most of the processing for our hearing is also visual/spatial in nature. When our 3D spatial hearing is thrown off kilter with what we’re seeing, the brain gets very, very tired trying to put those two views of the world back together again.
With concussion, we often suffer damage to that visual processing, including our ability to think. This is why these neuro-optometric and brain puzzle treatments that take advantage of the brain plasticity have been so successful.
The most common outcome with concussions is that you feel sick for a little while and then you feel better. But the truth is the damage to the brain is most often permanent, it’s just that our brains learn to work around it.
The brain will take advantage of other neural real estate that can be used for similar functioning. In many ways the brain is a very general purpose device. So if a part of the brain is damaged, it will find healthy tissue and reroute the signal processing through it so that we get our functioning back. That doesn’t mean the brain hasn’t been damaged. It’s just that it starts working around the damage.
ET: So the brain has to carve new pathways to get back to proper functioning.
Dr. Elliott: Exactly. It’s common knowledge that when we have a concussion we’re at a greater risk of having another concussion. How I would prefer to say it is that we’re at greater risk of suffering a greater loss of functioning from that second or third concussion.
When I went to see Dr. Zelinsky, the optometrist who emphasizes the neuro-optometric techniques, she used a series of tests over the course of about two hours.
She found not only which parts of my brain were damaged, but also found pathways through my brain that she could use to channel the input signals through my retinas to my visual cortex in the back of my brain. She gave me special glasses—in my case they had prisms built into them, but they will use other techniques in other cases—and in the course of that three weeks I was like a three-month-old baby rediscovering the world. I woke up again into my body and into my ability to fully think.
So we can think of Zelinsky carving dirt roads into the healthy tissue in my brain. And using Donlee Marcus’s brain puzzles we turned those dirt roads into super highways that once again let me be a professor of AI.
ET: As you know, there is a push to raise awareness of concussions in the sports world. How can neuro-optometric ideas contribute?
Dr. Elliott: There was a rugby study that was done over the course of two seasons, using just under 60 rugby players. They used these simple, neuro-optometric tests, one is called the King-Devick test—it’s just a timed reading test on a single sheet of paper with numbers and lines printed on both sides. It takes about a minute. These are very inexpensive tests.
What they did differently in this study is evaluate all the athletes at the beginning of the season for baseline testing. During the season they tested all of the athletes again, whether there was a concussion or not, even if they said they were fine. What they found comparing these tests was six times as many concussions then they originally identified using the traditional protocols. They verified this by sending them in for more tests. Then they went back to the game tapes and were able to identify when the injuries occurred.
Concussion is potentially a horrendous injury. People kill themselves because they can’t live with what life is like with concussion. But I think regulation and rules are going to be very difficult when it comes to addressing concussions in sports. Americans like choice. They want to make their own choices about their future. Sometimes they’re willing to take risks because there are financial rewards and scholarships available, and I think we need to respect that.
So how do we make a solution where there isn’t any incentive to hide the fact of a concussion? If we do this through regulation and prohibit them from participating, we will always have many athletes that are going to hide it.
The key is testing all the athletes both before the season and then all athletes again during the season. We can give this data to high schools and colleges, parents and students. We can give this information to our professional athletes. Let them make their own choices, but at least give them this crucial data. Along with that should be some education on the horrors your life might become if you suffer a brain injury. Because it’s pretty clear right now that we’re sending an awful lot of athletes back on the field when they’ve already had a brain injury.
Many will argue that the physical and social benefits of sports have a positive value for communities and students. My solution respects that, but the key is you have to give people the data. You have to let them know what the choice is they’re making.
Answers have been edited for clarity and brevity.