Cognition is the process of thinking and awareness. It includes basic thought processes such as orientation (who you are, where you are, what time it is, and how you are). Attention, concentration, memory, intellectual functioning, speech processes, reasoning, judgment, insight, problem-solving, and many other mental functions are part of what we call cognition. Many conditions can affect one or more of these cognitive processes such as psychiatric conditions, neurological diseases, medical conditions, and head injuries. Head injuries are one of the most common causes of death in the United States. Over 500,000 new cases a year of head injuries are reported. Half of these cases arise from motor vehicle accidents (MVA's). Many more milder forms of head injury are undiagnosed or treated in out-patient settings. It is not uncommon for milder cases with no obvious presenting symptoms or external signs of head injury to go undiagnosed in emergency rooms and end up as a "walk and drop" case where the patient leaves the hospital only to collapse later from subdural hematomas or other conditions common to head injuries. Sometimes CT scans taken immediately after a head injury do not detect any signs of brain injury but, weeks later follow-up MRI's find aneurysms or subdural hematomas. It is important to follow-up after any head injury if headache or cognitive problems persist several days after onset or injury and if symptoms worsen. Serious cognitive problems and brain injury can result from minor "fender bender" accidents. A 5 mph rear-end impact to your car produces nearly the same blackout G-force on your brain as sometimes experienced by fighter pilots going into a full dive! The brain is thrown forward and then slammed back inside the skull with tremendous force which can cause bruising, contusions, and tearing of the brain tissues. This is also why many "whiplash" injuries also have hidden brain injuries. This traumatic brain injury, despite no outward physical signs of injury, is what causes the cognitive problems associated with head injuries.
How do you fix brain injuries?
When you injure another part of your body you go through rehabilitation designed to promote proper healing and normal function. There are physical-based therapies like physical therapy and occupational therapy designed to restore normal function but these physical approaches have little value in rehabilitating the brain. The brain is not a bone or muscle so, you can't lift weights with your brain or do the same kind of exercises as you would for an injured leg or back. The first phase of brain rehabilitation involves assessment. This involves assessing overall medical condition and neurological function to determine if peripheral nerve damage is present that may affect results of brain function. Brain function is assessed by specific cognitive processes. For example, attention, memory, executive function, intellectual function, expressive speech, receptive speech, reasoning, and numerous other cognitive processes are evaluated. From the results of this assessment, functional lesions can be located. This is very important information to have in additional to identifying structural lesions through MRI. For instance, knowing the type of damagedone to a wall in your home does not tell you if the electrical wiring and plumbing is functional. You still have to test the wiring and plumbing to fully assess the extent of injury to your wall. Thus, it takes both functional and structural testing of the brain to properly assess brain injury. Additional tests may include standard EEG, evoked potentials to assess peripheral nerve injury and cognitive processing of the brain, or quantitative EEG analysis.
The second phase of brain rehabilitation involves treatment which consists of three components:
1. Neuronutritional Therapy - Just as physical rehabilitation or fitness training requires supplying the proper nutrients for maximum fitness, the brain needs all the nutrients necessary for recovery from brain injury and maximum performance. This may be accomplished by the use of nutrients and orthomolecular medicines to facilitate maximum speed and extent of recovery.
2. Brain Fitness - Through the use of cognitive exercises, stimulation of the injured areas of the brain facilitates the recovery of injured nerve pathways thus restoring normal brain and cognitive function. Cognitive exercises are taught to patients who are then instructed to follow exercise handouts at home or in the hospital. Periodic followup sessions help guide progress and ensure that optimal cognitive recovery is achieved.
3. Neurofeedback - From the initial assessment findings, various forms of neurological biofeedback may be used to aid in the recovery of normal EEG activity. As normal EEG activity is restored so is normal brain and cognitive function.