Complementary and alternative medicine in the treatment of TBI.
It is estimated that approximately 2 million people experience a traumatic brain injury (TBI) each year. The traditional recovery protocol for TBI includes reduction of physical activity to prevent secondary injury, and reduction of mental activity and sensory stimulation to promote mental rest. Except in cases of severe TBI (for example, penetrating head wounds that require hospital care), TBI recovery typically does not benefit from conventional medical intervention. In recent years, the practice of complementary and alternative medicine (CAM) has become an popular way to increase the likelihood of TBI recovery and to reduce the risk of post-concussive symptoms. Because TBI-related symptoms and their underlying physiological changes are complex, CAM provides potential for a broad treatment approach.
CAM is defined as a form of healthcare that falls outside of conventional medicine. It is often rooted in philosophical beliefs, but recent evidence suggests that certain CAM modalities elicit distinct neurological effects by acting on the autonomic nervous system, or the division of the nervous system that adjusts functions like heart and respiration rate during times of stress and calm. Popular CAM modalities include massage therapy, mediation, acupuncture, the use of herbal medicine, and the use of nutritional aids, vitamins, and supplements. CAM has been used to treat chronic diseases such as high blood pressure, heart disease, musculoskeletal pain, and psychological health conditions like anxiety, depression, and PTSD.
In the case of TBI, CAM is most effective in targeting psychological and cognitive deficits. Acupressure, a practice which involves the use of pressure applied to the site of illness in an attempt to “un-block” energetic pathways that are thought to be involved in injury, is commonly used in brain injured patients, including those with a history of TBI and stroke. Acupressure has been shown to reduce perceived stress in brain-injured patients. Research further suggests that acupressure has improves cognitive function in patients with TBI. In a study that compared performance on neurocognitive assessments in patients who were randomly assigned to acupressure or placebo treatment, the patients who received acupressure showed greater improvement in performance pre-and post-treatment than did the placebo group.
Mindfulness-based stress reduction (MSBR) is an inpatient (residential) treatment program that incorporates CAM modalities that include meditation and a general increased awareness of body and self. MSBR has been shown to reduce mental fatigue, a post concussive symptom for which there has been little progress in developing effective treatments, and improve improve cognitive performance in patients with a history of TBI. Importantly, studies that show a reduction of post-concussive symptoms with the use of CAM also report improvement in functional goals, such as the ability to return to work.
CAM has been shown to effectively treat psychological health conditions such as PTSD and depression, which are often associated with TBI. In a study of service members who were diagnosed with TBI and PTSD and/or depression, those who completed a CAM inpatient treatment program experienced significant reductions in their psychological and post-concussive symptoms. These findings support the idea that CAM is most effective when used in conjunction with conventional medicine.
CAM promotes patient self-care and independent administration, which is strongly associated with improved patient outcomes. This can be partially attributed to the “portability” of CAM modalities – for example, activities like meditation and yoga can be practiced anywhere. Furthermore, CAM encourages patients to take active roles in their recovery, which is also associated with better outcomes.
Studies have indicated that patients often withhold information about their use of CAM from their doctors, and experts caution against this practice. Though evidence indicates that many patients find improvement in their symptoms as a result of CAM, not all practices are safe for all patients. While most CAM modalities are non-invasive (and may be encouraged even in the absence of TBI-related symptoms), treatments such as the use of medicinal herbs and nutritional supplements can have negative interactions with conventional medicine. It is therefore best to keep your doctor informed about the full treatment plan to ensure the best outcomes.
Hernández, Theresa D., et al. "Complementary and alternative medicine (CAM) following traumatic brain injury (TBI): Opportunities and challenges." Brain Research 1640 (2016): 139-151.
McFadden, Kristina L., et al. "Acupressure as a non-pharmacological intervention for traumatic brain injury (TBI)." Journal of Neurotrauma 28.1 (2011): 21-34.