Caleb and Clay Moyle
By Clay Moyle
Special to the Sports Paper
This past September, I passed the three-year anniversary of falling off a ladder and suffering a mild-traumatic brain injury (TBI). I wrote a series of articles along the way chronicling my ensuing miseries, efforts to recover, milestones I passed along the way back, and what I learned from the experiences.
Just prior to leaving the hospital the morning after the accident the nurse told me that it was probably going to take six months to recover. While I was suffering from blurred and doubled vision at the time, I know I was convinced I’d be back to normal sooner than that.
But over the coming weeks and months, I not only continued to suffer from blurred and doubled vision in specific gazes, but experienced various combinations of post concussive symptoms including all of the following: sensitivity to bright light, fatigue, irritability, memory problems, dizziness, fogginess, depression and anxiety.
I came to learn that while most people who suffer a mild TBI realize a full recovery within 3-6 months, it can take those of us over age 40 up to a year or longer. Well, wouldn’t you know it I fell into the latter category.
I remember approximately three months after the accident coming across a blog in which a party wrote about suddenly realizing that he’d come out the other end of the tunnel five years after his own head injury. At the time, I was walking around in what felt like a thick fog 24/7 and my immediate reaction was “Five years, you’ve got to be kidding me.” I couldn’t imagine enduring what I was dealing with for that long.
But three years later, I understand how it can take that long for some parties. The good news is that I believe I now know some ways to speed up the process in many cases.
A while back, I came across a very good on-line video presentation by a woman named Natalie Kelly, a.k.a. “Brain Recovery Coach.” She suffered a severe head injury and in this presentation she shared the following which she called the six top treatments your doctor doesn’t know about:
Behavioral optometry
Reduce inflammation
Citicholine
Neurofeedback (Brainwave optimization)
Pulsed electro-magnetic field (PEMF)
Chiropractic Neurology (Functional Neurology)
Based upon my own experience, I believe there’s a good chance your doctor or any neurologist you see won’t tell you about most, if any, of these treatments.
In my case, I had my balance evaluated immediately after my accident, and I was extremely fortunate to be referred to a neural optometrist (Dr. Curtis Baxstrom) that did volunteer work at the hospital. I wrote another article that described in detail the services he provided that enabled me to rid myself of almost all the blurred and doubled vision issues over the first year.
But the neurologist I saw on a number of occasions at a respected local university neurology clinic mentioned nothing about any of these treatments. In fact he told me there was really nothing I could do other than rest, eat a healthy diet, and give myself time to get better.
He also prescribed medication for the anxiety I was suffering from. By the way, he was quick to point out that many people find the medication so helpful they decide to stay on it the rest of their life.
He also suggested I meet with another party who said they could provide me with some tools to help me come to grips with my new reality during our one and only meeting. I was much more interested in reshaping my new reality, than learning to accept the current one.
Of course, the services and input I received from service providers like that, as well as the ophthalmologist I quit seeing who told me I’d never be able to wear multi-focal contact lenses again and suggested I try prism glasses, were all covered by insurance.
I would come to learn that other than the services received from the neural optometrist and vestibular physical therapist, the other treatments that ended up being most helpful weren’t covered by insurance.
A year after my head injury, I was fully functional and capable of doing anything I could pre-injury. But I continued to fatigue easily and suffered from other ongoing issues.
For example, I continued to struggle with complex visual environments such as malls, airports, and grocery stores where I quickly began to feel a little disoriented. And while I’d resumed playing basketball around that time, I found that as the games went on my vision would begin to blur a bit and I’d have to sit out a game to recover before I could give it another go.
The bottom line was that while I looked completely normal, and almost everyone viewed me as 100 percent recovered, I just still didn’t feel like myself. Only a couple of people closest to me, including my wife, could identify times when I was in distress. But, in general, I was completely functional and could typically just push through those times to accomplish whatever task was at hand.
Two-years post- injury, I learned about brainwave optimization and decided to investigate it further by reading a book titled Limitless You. The Infinite Possibilities of a Balance Brain.
Essentially, brainwave optimization enables the brain see itself and adjusts itself to an optimized state. I know that sounds a bit out there and I was skeptical at first, but what I learned about it made sense to me, and I and others I know who gave it a whirl were very satisfied with the experience and results.
But as strongly as I will endorse working with a neural optometrist, vestibular physical therapist and someone trained in brainwave optimization, my number one recommendation for anyone suffering any consequences from a head injury is that they see a well-qualified functional neurologist as quickly as possible.
Maybe if somebody had suggested to me that I see a functional neurologist, I would spent some time researching what it is they do and seen one sooner. But in my case, my chiropractor suggested I go see a chiropractic neurologist in Oregon, another name for this type of service provider, a number of months after my injury. At the time, I knew nothing about chiropractic neurology. I just remember thinking I have a head injury, what on earth can a chiropractor do for me?
But as I’ve come to learn, a chiropractic neurologist is a different animal. Personally, I prefer the term functional neurologist, and would like to think I may have been more inclined to investigate their services much sooner had it been presented to me in that manner.
The functional neurologist that I was referred to was Dr. Glen Zielinski of Northwest Functional Neurology in Lake Oswego, Oregon. His practice focuses on rehabilitation of traumatic brain injuries, as well as vestibular disorders, neurodevelopmental challenges and movement disorders. He was an Assistant Professor of Clinical Neurology with the Carrick Institute in 2004. Dr. Ted Carrick and the Carrick Institute have been the leading authority in the training of physicians and therapists in the field of postgraduate clinical neurology over the past 39 years. Dr. Zielinski was honored as the Neurologist of the year for 2014 by the International Association of Functional Neurology and Rehabilitation.
So what does Dr. Zielinski do?
Well as he explained in an on-line presentation, one of the most important things our brains do is help us determine where we are in space. And to do that the brain uses several different sensory systems including the following:
Proprioception: Stretch receptors in muscles and joints that tell the brain where the body parts are in relation to gravity.
Vestibular system: Receptors in the inner ear tell the brain where the head is in relation to gravity, and how it’s moving.
Visual system: The eyes tell the brain where the body is in relation to the world.
All of the inputs we receive from these systems need to work together so the brain can make sense of the body’s location in relation to the environment. The sensory integration that takes place from these inputs initially takes place in the brainstem.
Unfortunately, the forces involved in suffering a traumatic brain injury can result in shearing of the long thin fibers that enable these systems to communicate and work together. As Dr. Zielinski explains, in essence the symptoms of TBI, i.e., dizziness, headaches, visual and balance issues, etc. is result of a failure of these systems to properly integrate. And I personally suffered from all of those issues.
A traumatic brain injury can result in a failure of these systems to properly work together and inform the brain of where the body is in space. And the harder the brain has to work to localize itself in the environment, the faster it fatigues, and the more likely that higher brain functions will fail.
When these inputs create a sensory mismatch, dizziness and vertigo is a typical result. 50 percent of TBI patients experience it as some point in their recovery.
In order for the visual system to correctly map the world, our gaze must be stable. To give us accurate information about where the world is, the eyes need to be able to hold still. But almost all TBI patients have some kind of gaze stability issues.
The systems that integrate in the brainstem that promotes gaze stability come from the inner ear, the cerebellum, the basal ganglia, the frontal lobe, the parietal lobe. Almost the entire brain is involved in providing gaze stability.
When the eyes drift around a target more than five degrees, Dr. Zielinski explains the result is dizziness and vertigo. And it’s why dealing with complex visual environments like supermarkets, malls, playing basketball, etc. are so challenging. When the eyes drift less than that, the result is brain fog with visual tasks.
Keep in mind that early on after my own head injury I suffered through a number of months during which I described as feeling as though I were in a thick fog 24/7. The first thing the brain does to try to stabilize gaze is engage upper neck muscles as reflexes. This is most often the driving force behind persistent post-TBI headaches. I can’t tell you how many individuals I’ve spoken to who suffered month after month of debilitating headaches after their head injury.
The lack of gaze stability as it turns out is also the source of the problem dealing with complex visual environments such as grocery stores. When one isn’t able to sufficiently fix their gaze on a target, all that additional movement taking place in the background just melts them down. The best way I was able to describe it myself was that it made me feel a bit loopy. In cases like that, I couldn’t wait to get the heck out of there, sit down, and close my eyes for a bit.
Dr. Zielinski further explains that fixing gaze stability isn’t just about the eyes. It’s about identifying and fixing the parts of the brain that are creating the problem. It’s about stimulating the deficient parts of the brain, and engaging them with gaze stabilization exercises.
So take a moment and let that sink in. Imagine that you’ve suffered a head injury and the next thing you know you awake and over the course of many months you suffer from a variety of symptoms such as extreme sensitivity to bright lights, dizziness, headaches, extreme fatigue, balance issues, blurred and doubled vision and fogginess. You have no idea as to how long it’s going to continue, or whether or not any of it might be permanent. Can you see how it might become a source of anxiety?
Now imagine you see a traditional neurologist, get an MRI, and they tell you they don’t see anything to indicate there will be any long-term damage. They go on to tell you there’s nothing they can do to help. All you can do is get rest and be patient. Oh, “and here’s a prescription for some anti-anxiety medication, some people decide to take it the rest of their life.”
Is it any wonder so many folks who experience a head injury and month after month of symptoms as described here subsequently suffer from anxiety and/or bouts of depression?
The job of the functional neurologist as described by Dr. Zielinski is to evaluate the functionality of all of these systems, proprioceptive, vestibular, and visual. More importantly they evaluate how all of these systems are working together, as they’re all interrelated.
They find out what doesn’t work, what does, and design a customized rehabilitation program that will facilitate the creation of neural pathways to get all of these systems working in conjunction with one another again.
In my own case I underwent an extensive three-hour evaluation in Oregon. It included some balance testing and a videonystagmography (VNG) test. The latter is a series of tests while wearing googles hooked up to a computer to track one’s eye movements and determine their ability to follow visual objects and how well their eyes respond to information from their vestibular system.
A VNG test also addresses the functionality of each ear and if a vestibular deficit may be the cause of a dizziness or balance problem. The fluid-filled semicircular canals of our inner ear send information on balance and head positions to the brain, and therefore help us know where our head is in space. One quickly comes to realize just how important this is when things aren’t working as they should.
I won’t bore you with all the details of my own evaluation in December of 2017. The bottom line is that I was told all major pathways looked fine and my brain was in great shape.
But, I was told I was still dealing with some issues integrating my right vestibular system and had a sensory mismatch as a result. I learned that while my right posterior ear canal was functioning properly by all indications, the way my brainstem and cerebellum was responding to the input was “a little sketchy.”
In terms of gaze stability, I was showing a lot of what is called square wave jerks, i.e., inappropriate saccades that take the eye off the target, followed by corrections to bring the eye back to the target.
In summary, my brain was having to work harder to compensate for the fact that I still wasn’t integrating sensory inputs as well as I should because my brain wasn’t making good sense of the input from the right posterior ear canal, and the more I challenged that, the worse my gaze stability became, and the more I challenged vestibular input, the harder it got and the more my brain fatigued. His theory was that I most likely “smoked” the right posterior ear canal, contused it as a result of my accident and reintegrating that input would resolve the bulk of my remaining issues.
So again, gaining an understanding of this helped explain a number of ongoing issues, for example, why my vision would blur as games went on and my brain fatigued while trying to play basketball, or why I had problems walking around in a crowded complex visual environment. It suddenly made sense to me.
Dr. Zielinski went on to tell me that had I come to him sooner he believed he could have cut my recovery time in half. I believe it.
This past January I spent a full week in his facility doing various exercises to begin recreating the necessary neural pathways to resolve my issues. Thank God for the gift of neuroplasticity. By the end of the week, I’d made significant progress and left with a series of exercises to continue performing at home on a daily basis to continue the work.
I feel great these days, the best since prior to my accident over three years ago. I’d like to go out and really put that to the test by playing some full-court basketball, because that would provide me with what I believe would be the best measure of success. Unfortunately, that’s not possible until at least this coming April because I’m presently recovering from a reconstructed PCL knee surgery.
So I’ll have to wait until then to confirm I’ve completely rid myself of any on court blurred vision playing basketball.
That said, I’m comfortable saying that I’ve experienced wonderful results as a result of my experience with functional neurology. I won’t hesitate to recommend it as the strongest course of action to take to anyone suffering from any long term head injury issues.
If you know of anyone who suffered a significant head injury, and is suffering from ongoing symptoms as I’ve described here, whether it is from a blow to the head, or a stroke, I urge you to investigate functional neurology as a possible solution. At a minimum, I strongly recommend receiving an evaluation to hear what they have to say.
