In recent years, research and some high-profile cases of athletes developing Chronic Traumatic Encephalopathy (thought to be related to repeated head injuries) have advanced our understanding of just how serious concussions can be. No longer is it a case of “take a painkiller and sleep it off under observation. We are now aware of the various post-concussion syndromes and symptoms that can stretch for weeks or months.
As our understanding of the condition grows, so too should the chiropractic understanding – how we care for people with concussion, how we create conversations with other caregivers, and how we can ensure our care for people with concussion is comprehensive during a pivotal time post-injury. It is this issue that a recent paper in the Asia Pacific Chiropractic Journal has taken aim at. In it, Dr. Charles Blum centres two vital aspects: the interdisciplinary relationships (and the complexities raised in that most healthcare practitioners don’t understand the chiropractic paradigm) and salivary biomarker assessments [1].
In the paper (which focuses on athletic scenarios), Blum also brings three levels of testing to the fore: Immediate on-field assessment, off-field assessment and use of saliva testing to understand five microRNA biomarkers to help identify who might experience prolonged concussion symptoms.
For the immediate testing, the paper determined that athletes are “currently best evaluated with the Immediate Post Concussion Assessment and Cognitive Testing” or ImPACT testing, followed by the Sports Concussion Assessment Tool (SCAT) outcome assessments. As with prior research, chiropractic care for the assessment and treatment of the cervical spine may also be vital in treating or preventing post-concussion syndrome.
The rationale behind this? Cervicogenic symptoms have been found to be prevalent in “the acute and chronic stages following concussion, which, if not diagnosed appropriately, increase the likelihood of [persistent post-concussive symptoms]. [2]
When it comes to the vital interdisciplinary communication between chiropractors and other caregivers, Blum suggests the objective tests could be key. Use of the ImPACT and SCAT tests are the starting point for developing mutually understood language from which chiropractors can build. But adding salivary testing for microRNA biomarkers adds extra insights that could prove extremely valuable.
What’s the benefit of saliva testing? According to Blum, it’s a non-invasive, biological measure that can “aid objective and accurate diagnosis of head trauma [1].” The test, which is analysed by biocomputational analysis, is said to be able to predict the involvement of certain microRNAs in “biological processes that might be related to trauma, such as response to hypoxia, cell death, neurogenesis, axonal repair and myelination.” [3]
We know that sport is a part of a healthy, active lifestyle for millions of people across the globe. Thus, we know that concussion isn’t a problem that is going away. It’s on us to make sure we are well-equipped to care for people in its wake. That includes knowing how to have conversations with other healthcare providers and how to utilise state-of-the-art, non-invasive testing to expand our understanding of the level of care our practice members may need. Check out the full article at the reference below.
REFERENCES:
- Blum, CL. Building interdisciplinary relationships with chiropractic care of post-concussion syndrome patients: Incorporating salivary biomarker assessment. URL Asia-Pac Chiropr. J. 2023;4.1 apcj.net/papers-issues-4-1/#BlumSalivaryBiomarkers
- Cheever K., McDevitt J., Phillips, J., Kawata, K., The Role o Cervical Symptoms in Post-concussion management: A systematic review. Sports Med. 2021 Sep;51(9):1875-1891
- DiPietro V., Porto E., Ragusa M., Barbagallo C., Davies D., Forcione M., Logan A., DiPietro C., Purrello, M., Grey, M., Hammond D., Sawlani V., Barbey, AK., Belli, A., Salivary MicroRNAs: Diagnostic Markers of Mild Traumatic Brain Injury in Contact-Sport. Front. Mol. Neurosci. 2018 Aug 20:11:290
