The autonomic nervous system (ANS) is a network of neural pathways that controls various organ systems in the body in order to maintain homeostasis. These functions are involuntary, meaning the ANS functions without conscious control. You can think of autonomic like “automatic.”
The autonomic nervous system is comprised of two systems: the sympathetic nervous system (fight-or-flight) and the parasympathetic nervous system (rest-and-digest).
These two systems control different bodily functions, utilize different neurotransmitters (chemicals used to communicate), and follow different paths through the body. The sympathetic nervous system carries signals that put your body’s systems on high alert, while the parasympathetic nervous system carries signals to relax those systems. The balance here is crucial, as we will explore below.
When recovering from a concussion, traumatic brain injury (TBI), or stroke, it is important to understand the balance between these two systems, as an imbalance can seriously inhibit recovery.
The sympathetic nervous system[1] is a network of nerves that is activated during stressful or dangerous situations, as well as during physical exercise. When you are in a stressful or dangerous situation, your sympathetic nervous system activates and causes a “fight-or-flight” response, which means your heart rate and blood pressure rise, your pupils dilate (enlarge), your gut stops digesting food to divert energy elsewhere, and you feel hyper alert.
While this is certainly beneficial and necessary in some circumstances when we need to act quickly, it should not be our baseline throughout the majority of the day, as we will discuss later in this article.
A key area of the sympathetic nervous system that is particularly relevant to concussion, TBI, PTSD, and stroke patients is the hypothalamic-pituitary-adrenal (HPA) Axis. The HPA Axis, as its name suggests, is a complex feedback system involving the hypothalamus and the pituitary gland in the brain, and the adrenal glands on top of the kidneys.
Simply put, stress[2] causes the body to release stress hormones into the bloodstream. First, the hypothalamus receives a message from the amygdala (fear center in the brain) that stress is present. The hypothalamus releases corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP), which then tell the pituitary gland to produce adrenocorticotropic hormone (ACTH) and release it into the bloodstream. When this ACTH reaches the adrenal glands, this signals the adrenal glands to produce cortisol[3], commonly known as the “stress hormone.”
Feedback is sent upstream to the hypothalamus when sufficient corticosteroids are detected in the blood, signaling that the hypothalamus can stop producing CRH and AVP to then slow the production of cortisol. However, when living in chronic psychological stress or after a brain injury, this feedback loop can be disrupted, leading to a consistently elevated amount of cortisol in the blood.
It is important to note here that stress can mean physical stress such as extreme cold or extreme heat, as well as psychological stress. We have included a section below describing different types of stress, and how some forms are actually beneficial for the nervous system and body.
The nervous system is the central organizing system within the body, and brain injuries have the potential to drastically impact the feedback system in the HPA Axis due to damage to the frontal lobe and an overactive amygdala.
The amygdala is the fear center of the brain, responsible for processing fear, arousal, and emotional stimuli to determine the appropriate response. The amygdala is typically kept in check by the frontal lobe, which is known as the inhibitory lobe, as it can “apply the brakes” on other parts of the brain. One of the frontal lobe’s jobs is to process the information from the amygdala and determine whether a stimulus is a threat or not.
The frontal lobe is often affected by brain injuries and concussions, so its ability to calm the amygdala is severely impaired. This leads to an inaccurate perception of environmental threats, perpetuating the release of stress hormones and essentially being stuck in “fight-or-flight” mode.
Research[4] shows a strong correlation between an overly active HPA Axis (sympathetic overdrive) and suicidal ideation, as the stress diminishes the frontal lobe’s executive function ability.
Cortisol, while labeled as the “stress hormone”, certainly does have important functions in the body. Cortisol levels are meant to fluctuate throughout the day, following our body’s natural rhythms. For example, cortisol levels are meant to be higher in the morning upon waking, and lower at night when going to sleep.
However, as mentioned above, many people struggle with a constant state of low-level stress, leading to an unhealthily high level of cortisol in their blood for sustained periods.
Symptoms of high cortisol levels:
The parasympathetic nervous system is a network of nerves that relaxes your body and allows life-sustaining processes, like digestion, during times when you feel safe and relaxed. The vagus nerve makes up about 75% of the parasympathetic nervous system overall, connecting to your heart, lungs, and other vital organs all the way down to your bladder and bowels.
BALANCE IS KEY
Autonomic nervous system imbalances and disorders can arise for many reasons and present in different ways. People with too much sympathetic activation and too little parasympathetic activation experience tense, stressed, anxious states of mind with little to no ability to relax. On the other hand, those with too little sympathetic activation and too much parasympathetic present as apathetic and depressed with little to no motivation.
The connection between autonomic nervous system imbalance and cognitive decline is currently being explored[5]by researchers, suggesting that even middle aged adults can experience significant cognitive decline from an overactive sympathetic nervous system.
SYMPATHETIC OVERDRIVE AND PARASYMPATHETIC DYSREGULATION
Much of the signaling for the parasympathetic system originates in the brain stem and is therefore highly susceptible to disruption resulting from an impact such as a motor vehicle accident or blast injury. This causes many of our patients to experience an underactive parasympathetic nervous system[3], meaning their overall ANS balance is skewed significantly toward sympathetic and are essentially stuck in fight-or-flight.
Sympathetic overdrive, as it is often called, presents as a range of symptoms including heightened anxiety, chronic stress, constipation, indigestion, emotional instability, tachycardia (increased heart rate), and hypertension (high blood pressure).
“GOOD STRESS” AND “BAD STRESS”
“Good stress”, known as hormetic stress, actually creates resilience in the brain and body and serves a very important role throughout the course of one’s life. Exercise is the most common hormetic stressor, so here we will use the example of lifting weights. The exercise of lifting weights creates stress on the muscles involved, which ultimately strengthens them. You may feel heightened energy and alertness (fight-or-flight) when pushed to your limit physically, but eventually should settle back down into parasympathetic where recovery takes place.
Within the last few decades, researchers have been interested in exploring the correlations between overall health and the regular practice of hormetic stress practices that involve deliberately putting the body into extreme conditions, such as cold plunging and sauna, for short periods. The research is promising, though please consult your doctor before beginning any of these practices. We mainly bring these practices up to demonstrate the concept of a hormetic stressor: a controlled, deliberate practice that puts stress on the body, with a clear ending to the stress.
The “bad stress” is the chronic, constant feeling of stress that many people feel as their baseline throughout their lives.
The challenge lies with our cultural acceptance of feeling stressed all the time, believing that being chronically stressed is simply the norm. Long, stressful workdays, empty consumption, and fruitless pursuits keep many of us living in a constant state of fear and stress. This kind of stress, chronic stress, is quite detrimental to overall health and puts people at risk for a number of diseases and disorders.
THE BRAIN NEEDS PARASYMPATHETIC FOR RECOVERY
We explained the detrimental effects that high cortisol levels have on the body, and these tend to be intensified by the body’s inability to switch into parasympathetic “rest-and-digest” mode.
When the brain is stuck in fight-or-flight, it is difficult for any recovery to take place, as the nervous system is unable to fully relax and allow the body’s energy to be used for healing and recovery. Therefore, a major component of many TBI and concussion recovery protocols is parasympathetic activation, i.e. improving one’s parasympathetic tone, through the vagus nerve.
DYSAUTONOMIA
Dysautonomia is the umbrella term for when one’s autonomic nervous system does not function properly, several examples of which we have mentioned throughout this article. Aside from traumatic brain injuries and concussions, many people (about 70 million worldwide) suffer from dysautonomia. Dysautonomia can stem from many causes, not only brain injuries:
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Research:
2 Stress-induced activation of the sympathetic nervous system
3 Neuroanatomy, Parasympathetic Nervous System
5 Parasympathetic and sympathetic nervous systems interactively predict change in cognitive functioning in midlife adults
6 Physiology, Cortisol
Repetitive transcranial magnetic stimulation (rTMS) has taken the world of neurological rehabilitation by storm the last few decades, offering a safe, effective, non-invasive treatment for a range of neurologic and psychiatric conditions. rTMS is proven to be particularly effective when used in conjunction with other neurorehabilitation therapies and treatments.
HOW DOES IT WORK?
rTMS utilizes electromagnetic pulses to directly stimulate areas of the brain that have been damaged or are not fully functioning. We know that neurons, or brain cells, use electrical charges to communicate with one another. However, after a brain injury or with psychiatric disorders, these neurons struggle to fire correctly due to an electrical imbalance.
By sending a rapid series of painless electromagnetic pulses into these neurons, the rTMS can effectively reset the electrical charge of the neurons so that they can fire appropriately. This improved function is sustained long after receiving the treatment, as the neurons have essentially been given a gentle jumpstart that shifts them back into harmony.
THE HISTORY OF rTMS
The history of rTMS actually dates back to discoveries made in the 1800s, when scientists first learned that neurons, or brain cells, carry an electrical charge. With further discoveries in the 1800s around using magnetic waves to generate electrical charges, it became clear that magnetism would have a significant role to play in neurologic and psychiatric conditions.
The first rTMS device was invented in 1985 and was initially utilized to positively affect and upregulate the frontal lobe of depression and PTSD patients with a high degree of success. Researchers and clinicians quickly realized that the benefits of rTMS could likely reach a much larger audience, particularly in the arena of traumatic brain injury (TBI), concussion, and stroke recovery, so the research began to expand rapidly.
Initial studies showed very promising results for brain injury patients, particularly in the area of neuroprotection and recovery after a TBI. Over the course of the last 35 years, the data has continued to pour in from all over the world, adding to the excitement surrounding the potential for rTMS as a cornerstone of neurologic and psychiatric care. rTMS is FDA-approved for a range of conditions, and that list continues to grow as the research discovers more uses for this therapy, such as rehabilitating the motor areas, speech areas, and more.
WHEN IS rTMS USED?
rTMS is used for many of our patients at Resiliency, though it must first be deemed appropriate by the doctor who performs the examinations and evaluations. Since every patient and every brain is unique, this is decided on a case-by-case basis.
We are using it to help many of our TBI and concussion patients suffering from symptoms of insomnia, chronic pain, memory loss, anxiety, stroke, and many more due to its widespread applications.
HOW IS rTMS ADMINISTERED?
Once rTMS has been prescribed to a patient, the patient sits in a chair that we recline back according to the patient’s preferences for maximum comfort. One of our doctors will then place a locator cap over the patient’s head, which essentially maps out the regions of the brain and ensures that the pulses are delivered in the precise targeted area.
Using this cap, the doctor will bring the rTMS magnet to the patient’s head, so it is gently touching the precise area that needs to be stimulated. Next, the doctor will begin the treatment, which sends a series of pulses through the scalp and skull, into the targeted area of the brain.
This lasts for about 7 minutes, since it is rapid TMS, remarkably condensing a traditionally lengthy treatment into a short, relaxing experience. It is recommended to allow the body and mind to relax by breathing slowly and settling into a meditative state while receiving the therapy.
After the treatment has been completed, the doctor will assist the patient in removing the cap and getting out of the chair.
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Research:
When it comes to providing optimal support for the brain, particularly following a brain injury or stroke, vitamin D and omega-3 fatty acids (fish oil) are at the top of the must-have list.
Vitamin D certainly offers a tremendous range of benefits for the brain and body, as it is involved in many different systems and functions. Here we will detail a few benefits that are particularly relevant to brain injury recovery.
In recent years, low vitamin D levels have been strongly associated with depression and poor overall mood, as well as emotional dysregulation. Introducing vitamin D to depression patients has been clinically shown to improve their mood as effectively as antidepressants.
Vitamin D deficiency is also linked to poor cognitive function, particularly in people over 50. Vitamin D exhibits neuroprotective qualities, meaning that it promotes the health of the brain through its ability to clear out free radicals and amyloid beta, which over time accumulate in the brain and lead to Alzheimer’s, dementia, and chronic traumatic encephalopathy (CTE) for those with repeated head injuries.
Research also shows that low vitamin D levels increase one’s risk for a stroke, as well as the severity of stroke. Thankfully, research is demonstrating that stroke survivors who take vitamin D show improved recovery outcomes.
Vitamin D contributes greatly to bone strength and bone health in general, as well as reducing fall risks by strengthening muscle contractions. This is very important for stroke and TBI patients rehabilitating motor function. It also plays a major role in immune system function, protecting against respiratory infections and viruses through its role in signaling T-cells (killer cells) that seek out and eliminate pathogens in the body.
AN EPIDEMIC OF VITAMIN D DEFICIENCY
Recent studies found that over 42% of the world’s population is deficient in vitamin D, with that number doubling to about 80% for the BIPOC population. These numbers are staggering, especially when one understands how absolutely vital vitamin D is for a healthy brain and immune system.
WHY ARE SO MANY PEOPLE DEFICIENT IN VITAMIN D?
The simple answer points to lifestyle and work conditions. We are spending more time indoors instead of working outside like our ancestors, and we are eating foods that are nutrient-depleted, as well as not eating a healthy balance of foods.
Vitamin D is found in salmon, sardines, and egg yolks, to name a few, and can also be synthesized by our skin through sunlight exposure. Since it is only found in a few foods and most people don’t get the recommended amount of time in the sun every day, it can often be beneficial to consume vitamin D in supplement form.
While it is true that vitamin D can be synthesized from sunlight, certain populations and ethnicities convert sunlight into vitamin D more efficiently than others. Those with darker skin tend to synthesize less vitamin D from the sun, while causasians with fair skin tend to be more efficient in vitamin D conversion. We recommend spending time in the sun every day for a range of benefits, including vitamin D intake, circadian rhythm refinement (morning/evening), mood, and more.
OMEGA-3 FATTY ACIDS / FISH OIL BENEFITS
Fish oil is a highly recommended supplement for our many patients, and it primarily contains two types of omega-3 fatty acids — eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are well known for their benefits for the brain, heart, liver, skin, and more.
OMEGA-3s HELP RECOVERING BRAINS
These two fatty acids, EPA and DHA, have powerful anti-inflammatory qualities which significantly help reduce inflammation in the brain after a stroke, TBI, or concussion, as well as helping to keep the cardiovascular system functioning smoothly.
In addition to reducing inflammation, omega-3s also play a major role in the health and function of neurons, or brain cells, as they help strengthen the cell membranes and improve communication between neurons. Therefore, omega-3s are extremely important for neurological rehabilitation after an injury, as well as for those suffering from psychiatric disorders such as depression and PTSD.
Similarly to vitamin D, the research is showing that omega-3s can help the brain significantly as it ages, helping to preserve memory, learning, and cognitive function and reducing the risk of developing Alzheimer’s or other neurodegenerative disease.
WHERE DO OMEGA-3s IN FISH OIL COME FROM?
Fish get EPA and DHA from eating ocean plankton and algae, which led to the common belief that wild caught fish had more omega-3s than farm fed fish (which are often raised on corn). However, recent studies show that the omega-3 content of farm-raised and wild fish is roughly equivalent because fish oil is added to many farmed fish diets and farmed fish are generally fattier than wild fish.
Since many Americans do not eat the recommended amount of fish, it can be helpful to take a fish oil supplement containing these two omega-3 fatty acids, EPA and DHA. We will help you choose a fish oil supplement of the highest quality, as not all supplements are made equally.
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