A person may appear physically recovered after a concussion while their brain is still processing information more slowly than it did before the injury.
That delay can affect reading, decision-making, athletic performance, and driving. It may take the brain longer to recognize a hazard, decide what to do, and send the signal needed to respond.
During this episode of Mind Matters: Navigating Head Injuries and Concussions, attorney Thomas Ozbolt continued his conversation with Dr. Darcy Dane of Carolina Brain Center. They discussed whiplash-related brain injuries, slowed reaction time, detailed functional testing, and several approaches used in her practice to support concussion rehabilitation.
You Do Not Have to Strike Your Head
A concussion does not always require a direct impact to the skull.
Dr. Dane compared this to blast injuries experienced by military service members. The force from an explosion can disturb the brain even when the person’s head does not strike an object.
A similar principle may apply during a car accident.
Whiplash rapidly moves the head and brain forward and backward. That motion can stretch nerve fibers and disrupt normal neurological function.
Airbags can also create significant force. They save lives and reduce the risk of being ejected or striking the windshield, but their rapid deployment may still contribute to an injury.
Loss of consciousness is not required for a concussion to occur.
Early Symptoms Can Affect Several Systems
Concussion symptoms may begin immediately or become more noticeable as the person attempts to resume normal activities.
Dr. Dane discussed symptoms involving physical, emotional, cognitive, and metabolic functions.
These may include:
- Disorientation
- Shaking or crying
- Light sensitivity
- Noise sensitivity
- Headaches
- Neck pain
- Anxiety
- Symptoms of PTSD
- Depression
- Poor concentration
- Memory problems
- Difficulty finding words
- Sleep disruption
Some people also experience appetite changes. One patient may feel constantly hungry, while another feels too nauseated to eat.
Why Sleep Becomes So Difficult
A person recovering from a concussion may feel exhausted throughout the day but remain unable to sleep at night.
The body is tired, yet the brain continues racing.
Poor sleep can intensify nearly every other symptom, including:
- Headaches
- Irritability
- Anxiety
- Memory difficulty
- Slower thinking
- Pain sensitivity
- Fatigue
Sleep problems should not be dismissed as an inconvenience. They may become an important part of the patient’s overall treatment plan.
What Is Word Blocking?
Dr. Dane described a cognitive problem commonly called word blocking.
The person knows what they want to say but cannot retrieve the correct word.
This can make conversations frustrating and may interfere with work that requires frequent communication.
Someone experiencing word blocking may pause repeatedly, substitute an incorrect word, or lose their train of thought entirely.
These problems can be especially upsetting because the patient may understand that their thinking is different but cannot easily explain why.
Reaction Time Involves Several Steps
Reaction time is not simply how quickly someone moves.
The brain must first notice the information, understand what it means, select an appropriate response, and then activate the body.
For example, a driver must:
- Notice a vehicle entering the lane.
- Recognize that it presents a danger.
- Decide whether to brake, accelerate, or steer.
- Send the signal needed to complete that action.
A delay during any stage reduces the time available to avoid a crash.
Why Driving May Be Riskier After a Concussion
Driving requires constant attention, visual processing, spatial awareness, decision-making, and rapid reactions.
A driver must monitor traffic lights, road signs, nearby vehicles, pedestrians, mirrors, speed, and changing conditions at the same time.
If the brain is processing information more slowly, the person may not respond quickly enough when another driver stops suddenly or drifts into the lane.
A concussion may also cause dizziness, blurred vision, light sensitivity, and fatigue, creating additional challenges.
Patients should discuss driving safety with their healthcare provider rather than assuming that feeling physically capable means they are neurologically ready.
Reaction Time Matters in Sports Too
Athletes rely on rapid processing to avoid impacts and respond to changing play.
A hockey player must recognize an approaching opponent. A football player must react to movement across the field. A swimmer must respond immediately to the starting signal.
Even small delays can affect performance and injury risk.
Dr. Dane explained that reaction time may be one of the last abilities to fully recover.
Returning to play before it normalizes may expose an athlete to another injury because they cannot respond to danger as effectively.
How Saccades Measure Processing Speed
Saccades are fast eye movements that shift focus from one target to another.
During testing, a target may suddenly appear in a different location. The equipment measures how quickly and accurately the patient’s eyes move toward it.
This requires the brain to detect the new target, process the change, and generate the correct eye movement.
Slow or inaccurate saccades may suggest that neurological processing is not functioning efficiently.
The results should be interpreted in context rather than relying on one number alone.
Go/No-Go Testing
Dr. Dane also discussed go/no-go tasks.
The patient may be shown several objects and instructed to respond only when a specific one appears.
For example, they may press a button for an apple but do nothing when shown a banana.
This evaluates more than recognition.
The brain must understand the instruction, identify the image, decide whether a response is permitted, and either act or inhibit the action.
A patient may respond too slowly, press the button for the wrong object, or struggle to stop themselves from reacting.
One Test Does Not Tell the Whole Story
Reaction time depends on multiple neurological pathways.
That is why Dr. Dane described using several tests rather than reaching a conclusion from one result.
A patient may perform normally on one task and struggle on another that requires more visual processing, impulse control, or coordination.
When several tests consistently show slowed processing, the results provide a stronger picture of the patient’s functional limitations.
Those findings may also help guide recommendations about driving, work, school, and athletic activity.
Balance Problems Drain Mental Energy
The brain constantly combines information from the eyes, inner ears, muscles, and joints to keep the body upright.
When balance is disrupted, the brain must devote more energy to basic orientation.
The patient may feel as though their mental battery drains quickly because the brain is working harder to determine where the body is in space.
A simple walk through a grocery store can become exhausting.
The patient must process bright lights, patterned aisles, moving people, head turns, and changing visual information while maintaining balance.
Eye-Movement Problems Also Increase Fatigue
The visual system is active almost every moment a person is awake.
If the eyes do not move accurately from one target to another, the brain may need to make repeated corrections.
Reading a sentence or working on a computer can therefore require far more effort than it did before the injury.
The patient may develop headaches, eye strain, dizziness, or concentration problems after only a short period.
This does not necessarily mean the person lacks motivation. The task may genuinely require more neurological energy.
What Happens During a Detailed Evaluation?
Dr. Dane described an initial evaluation lasting approximately two hours.
Testing may include:
- Video eye-movement analysis
- Computerized balance testing
- Reading and visual processing tasks
- Reaction-time testing
- Go/no-go tasks
- Rhythm and coordination testing
- Gait observation
- Neurocognitive testing
- A standard neurological examination
The goal is to see how the person functions during activities that challenge specific brain systems.
A patient may pass a brief neurological examination while showing significant problems during more detailed functional testing.
Testing Balance Under Different Conditions
Computerized posturography may evaluate balance with the eyes open and closed on firm and soft surfaces.
Each condition changes the information available to the brain.
When the eyes are closed, the patient must rely more heavily on the vestibular system and body-position signals.
A soft surface makes information from the feet and joints less reliable.
Comparing performance across these conditions may help reveal which system is contributing most to the instability.
The Glasgow Coma Scale Has a Specific Purpose
The Glasgow Coma Scale measures eye opening, verbal responses, and motor responses.
It is most useful near the time of the injury, particularly when administered by emergency personnel or hospital staff.
Dr. Dane noted that its usefulness may decrease when it is administered much later because alertness can improve rapidly.
A normal Glasgow Coma Scale score does not rule out ongoing problems with balance, memory, eye movements, reaction time, or emotional regulation.
It should be treated as one part of the acute evaluation rather than a complete concussion assessment.
Hyperbaric Oxygen and Ketones
Dr. Dane discussed combining hyperbaric oxygen with exogenous ketones in her practice.
Hyperbaric therapy places the patient in a pressurized chamber. Under pressure, additional oxygen can dissolve into blood plasma.
Ketones provide an alternative fuel source that the body can use for energy.
Dr. Dane reported using the combination to help selected patients tolerate longer rehabilitation sessions and address what she described as the energy crisis associated with concussion.
She also acknowledged that research directly studying the combined approach remains limited.
These therapies should therefore be considered developing treatment strategies rather than established solutions for every brain injury.
Medical Lasers and Consumer Red-Light Devices
The discussion also covered medical-grade cold laser therapy.
Dr. Dane distinguished targeted clinical laser systems from consumer red-light products sold online or used in wellness centers.
Her clinic uses selected wavelengths as part of its approach to pain and cellular function.
The transcript reflects her clinical experience and opinions. It does not establish that laser therapy is proven for every concussion patient.
Anyone considering these treatments should ask about the medical evidence, provider qualifications, possible risks, and realistic expectations.
Baseline Testing Before an Injury
Detailed brain-function testing may also be useful before an injury occurs.
Athletes often undergo baseline testing so later results can be compared with their normal performance.
A baseline may include:
- Reaction time
- Balance
- Eye movements
- Cognitive processing
- Coordination
Without a baseline, providers compare the patient to population averages and reported pre-injury abilities.
Baseline testing cannot prevent a concussion, but it may provide useful information when determining whether someone has returned to their previous level of function.
Movement Supports Brain Health
Dr. Dane emphasized movement as an important source of stimulation for the brain.
Exercise challenges coordination, balance, cardiovascular function, and reaction time.
The right activity depends on the person’s health and neurological status. Someone recovering from a concussion may need a carefully controlled return-to-exercise plan rather than immediately resuming intense workouts.
For healthy individuals, regular physical activity can support long-term brain and body function.
Recovery Is About Real-World Function
A normal scan or brief examination does not always mean a person is ready to drive, return to sports, or resume a demanding job.
Those activities require the brain to process information accurately and respond quickly under pressure.
Functional testing may help identify slowed reaction time, visual problems, poor balance, and cognitive limitations that routine evaluations miss.
The ultimate goal is not simply to produce a normal test result. It is to help the patient safely return to the activities that matter in daily life.
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