Understanding Vision Post-Concussion with Dr. Bryce Appelbaum
Show Notes:
You may have 20/20 eye sight but how is your vision post-concussion?
Today's guest Dr. Bryce Appelbaum keeps it straightforward:
Eye Sight = Glasses
Vision = Brain
Dr. Bryce Appelbaum is a board certified fellow of the College of Optometrists in Vision Development and an Adjunct Clinical Professor at the Southern College of Optometry. He joins us today to discuss the importance of addressing your vision after experiencing a brain injury. We also go onto discuss the constant use of screens today and different aspects of nutrition that may affect your recovery. Don't miss out on this insightful episode!
Key Points From This Episode:
[00:02:15] Dr. Bryce shares what led to his interest in vision and concussion recovery
[00:07:24] Bella share's the difficulty of taking a step back as an athlete
[00:08:31] Dr. Bryce walks us through vision therapy
[00:11:52] Dr. Bryce shares visions relatimBon to returning to play
[00:15:29] Bella shares overstimulation challenges at the grocery store
[00:18:31] Dr. Bryce shares nutrition and supplements role in concussion recovery
[00:24:49] Dr. Bryce shares his final message
Learn more about Appelbaum Vision: https://www.appelbaumvision.com/
Concussion Clear: https://concussionclear.com/
Join Concussion Connect Today!
We understand the need for a safe place to go separate from your regular social world, less overwhelming and more personal. Join Concussion Connect to have a place to share and get support along your survivor journey!
Though a place for survivors, we also welcome all loved ones and professionals who are out to learn more about this invisible injury.
Follow Post Concussion Inc on Social Media to stay up to date on the podcast
-
Podcast Introduction
[00:00:00] Bella: Hi everyone. I'm your host Bella Page, and after suffering from post-concussion syndrome for years, it was time to do something about it. So welcome to the Post-concussion podcast where we dig deep into life When it doesn't go back to normal, be sure to share the podcast and join our support network.
Concussion connect. Let's make this invisible injury become visible. The Post-concussion podcast is strictly an information podcast about concussions and post-concussion syndrome. It does not provide nor substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast. The opinions expressed in this podcast are simply intended to spark discussion about concussions and post-concussion syndrome.
Episode Introduction
[00:01:06] Bella: Welcome to episode number 98 of The Post Concussion Podcast with my myself, Bella Paige, and today's guest, Dr. Bryce Appelbaum. Dr. Appelbaum is on a mission to change the way the world views vision. He believes there is more division than just 2020 eyesight and has developed programs to retrain the brain, to revise the eyes.
Dr. Appelbaum is a pioneer in neuro optometry. He is passionate about unlocking life's potential through vision. His expertise includes reorganizing the visual brain post-concussion to return to learn, and return to life. He is the owner and managing doctor at Appelbaum Vision pc, a private practice specializing in vision therapy, rehabilitation with offices in Bethesda and Annapolis Maryland. He is the founder and CEO of Screen Fit. The Premier Eye Doctor created online vision training program designed to transform your tired, strained, and blurry computer eyes into HD clear vision. Dr. Appelbaum is a board certified fellow of the College of Optometrists in Vision Development and an adjunct clinical professor at the Southern College of Optometry.
Welcome to the show, Dr. Bryce.
[00:02:11] Dr. Bryce: Thank you so much for having me honored to be here.
Dr. Bryce shares what led to his interest in vision and concussion recovery
[00:02:15] Bella: So to start, do you wanna talk a little bit about what created your interest in helping concussion survivors?
[00:02:21] Dr. Bryce: Absolutely. And I would, I would love to start just by thanking you for sharing your story, and hosting this and inspiring so many others to know that they're not alone.
Because it can be a scary world when, as you know, all too well, when you're trying to recover from a head injury. So I mean, I've always had a pretty keen interest in, brain injury recovery but it really started after suffering a pretty severe concussion myself, back in middle school. I was on the path training pretty intensely as a soccer goalie until one particular game during, I think it was the finals of a travel tournament where there was this corner kick and I dove and made a ridiculous save, and I was in all this traffic and my head was unfortunately mistaken as the ball and I was kicked point blank right in the forehead, knocked unconscious for a short period of time.
And, and let's just say that, ended my playing career as a goalie. But afterwards I had terrible headaches and motion sensitivity and trouble sleeping and was irritable and especially on school days where, you know, the visual demands were that much greater. Having to focus my eyes and process that immense amount of visual information that's, presented in a classroom setting.
So thank goodness that back in the nineties, it wasn't like today's world where there's screens and computers and phones everywhere, and I didn't have to deal with all the digital devices and the stress that comes with that, that kids today are having to engage with all day. But I was also extremely fortunate at the time, to have access to the ideal care and collaborative rehab team where vision therapy was, the critical path to my return to learn in the classroom and for my return back to life and so with time I've transitioned from patient to a clinician where, for decades I've been studying this work, but professionally it was, 2016 where I truly went all in with vision therapy and rehabilitation for the TBI community. There was a particular evening in early June, where I was out west working with an NBA team and then helping evaluate potential draft picks, looking at vision development, neurocognitive development, seeing how in line these were with the player's performance to help determine risk and reward and whether the team should invest in that particular player.
And there was a night where we were watching the NBA finals and those were the few of the front office execs and a particular star player clearly got concussed mid-game, with the whole world watching and he got up from the ground was visibly wobbling and dazed and stumbling around, and I remember saying out loud, now the series is likely gonna take a turn with this guy outta commission.
And was immediately corrected by one of the front office guys saying, oh no, he'll, he'll go back in the game. He's too valuable to be sitting on the bench. And my jaw dropped. I mean, I remember thinking he couldn't possibly be serious. This is crazy. No chance to go back in and nor should the medical staff allow him to.
And then sure enough, after a couple TV timeouts, he was back in the game playing. And you know, this was wrong on so many levels. And the complete opposite message that we should be putting out there and teaching our youth and I recognize this was all too common in the lay of the land at the time and even now, our system was so broken and, the priority needs to be placed in the right places is not the wrong places. And you know, I made it my, one of my missions to dramatically shift the stigma and perception around head injuries or else things would continue down this terrible downward spirals with so many people struggling unnecessarily.
And I knew that I had suffered from my concussion years prior so that others wouldn't have to. And this was kind of the complete how to guide of what not to do from so many levels. I think the big thing I see is it's not just athletes who become concussed. You know, every, every day in my office, I'm seeing a person who hits their head on a cabinet or a countertop in the kitchen or in a car accident who has concussion at a younger age and was never treated properly.
And they all have these similar symptoms that I'm sure will get into about, dizziness and nausea and vertigo, and motion sensitivity, and light sensitivity and blurry vision, brain fog, fatigue, sensory overload, and crowded environments. I mean, all the symptoms, you know, too well and it's not just my mission to spread awareness so that others don't have to live like this.
And that's why I'm really all in dedicated to evolving vision therapy in terms of innovations and practices and protocols and to what vision therapy is today but also, to what it will continue to evolve to in the future. And so often vision is the missing piece to, getting your life back.
[00:06:48] Bella: I love that you. Talked about like the visual demanding of screens and everything, especially nowadays, it's everywhere. My sister's kids are young and there's screens everywhere all the time, and they are part of their schooling.
[00:07:03] Dr. Bryce: Completely everywhere.
[00:07:04] Bella: Yeah. I have three screens in front of me right now.
[00:07:08] Dr. Bryce: If you think about children's environments, that they're living in now are so different than they were generations ago and introduced at earlier ages before the kids are ready and for adults. I mean, we're not meant to be staring. No one is to be staring at screens all day long, so it's kind of the new pandemic.
Bella share's the difficulty of taking a step back as an athlete
[00:07:24] Bella: And that athlete component, how you mentioned about that player going back in, it's hard. I know as an athlete myself, the only person who was gonna take myself out was probably someone else. Cuz it's really hard as an athlete to take a step back. We're learning a lot about it, but I remember like if you're at the top of your game and you get hurt. You just kind of don't care. Like you're like, it's fine. Like I'll just suck it up. We know now that that sucking it up is not a good plan, especially when it comes to head injuries. But it is really important that we have all these other people related to the sport watching out for people like their parents, coaches, doctors, depending on the level of league that you're in. Have to watch out for these athletes cuz they're not exactly watching out for themselves in the way that they should be. Cuz that competitive mindset gets set in.
And you kind of brought up vision and so do you wanna talk to us a little bit about vision therapy and what vision therapy looks like today? Because it's definitely changed a lot since when I started vision therapy 10 years ago was pencil pushups, so it's definitely come a long way.
Dr. Bryce walks us through vision therapy
[00:08:31] Dr. Bryce: Absolutely. Well, the pencil pushups are still around but I'd like to say we, we are hopefully evolving as a profession with technology and with, changes that are on the forefront, but also for the future. I like to explain vision therapy as it's like physical therapy for the brain through the eyes with the intention of, teaching somebody how to use their eyes to essentially retrain their brain. And I think one of the biggest, distinctions that I always like to just preach as, as often as I can is the difference between our eyesight and our vision. Because I feel like if you can understand that difference then so much of, the world I'm in and the vision therapy world makes a lot more sense. And really healthcare kind of has it all wrong about the eyes where so many doctors are solely focused just on the pursuit of the 20/20 eyesight and eye health, which are important.
But eyesight, and vision are separate entities and eyesight refers to how well we can see, whether that's letters on our chart or street sign or with the teacher writes on the board in the classroom. And that's important. But vision is so much more complex. Vision is how our eyes move together and converge and track and focus and process information, and really how we derive meaning from the world around us, and then direct the appropriate. I like to simplify and say eyesight is glasses. Vision is brain. Vision problems for the majority of them are brain problems, especially the functional problems and the ones that emerge after a head injury. And in so many cases, there is a fix for the brain problems with vision therapy, designed to rewire the software of somebody's brain to change how they take in the world around them. Process information. It should be life changing if that is the treatment that is recommended and there are lots of other treatments, especially through vision that should be first lines of defense with lenses and prism and filters and performance glasses and syntonics and all the stuff that's out there.
But I think vision therapy usually has the highest ceiling allows somebody to operate at a potential that's very different when we can retrain the brain rather than just kind of being dependent on something, but obviously dependence can help with comfort, which, you know, it's a journey. It's not just a quick fix in most cases.
[00:10:50] Bella: And I think that's a huge part of all of this. It's not overnight if you get these fancy glasses or filters. It might make a difference, but it's not gonna fix you, so that's why a lot of those therapies are important and doing them for a while. I always like to encourage people, you know, we do it for a month and we're like, oh, I don't see anything yet and it's like, keep going. That's not long enough. Takes time. And a lot of these exercises, are very physically demanding, even though you don't think it would be . Just doing eye therapy. You're like, oh, I could do eye therapy and be good, but eye therapy is a workout for your brain, and so then you are usually exhausted afterwards.
At least I always was. And so it's really important to think about those things and when it comes to sport, vision is so important because your vision is related to everything that you're doing, especially depending on your sport. Things are fast, things are flying at you, you are running. Whatever is happening, your vision matters because you have to process so much information as you are performing.
Dr. Bryce shares visions relatimBon to returning to play
[00:11:52] Bella: So do you wanna talk a little bit about returning to play and how that relates to vision?
[00:11:57] Dr. Bryce: Absolutely. And, and you're so right. I mean, vision is our first contact with the world, but especially with sport and lets us know how to react and how to use what we have to be able to respond appropriately. And you know, I think vision in general, I mean there's, more areas of our brain dedicated to processing vision than all of our other senses combined. And about two thirds of our neurons entering our brain actually originate from our eyes. So it's kind of impossible to have a brain injury, minor or major and not have vision be impacted. It's just kind of okay at what level this and so often the, suddenly kind of previously normal activities of life, like going to the mall or grocery store, navigating the halls of a classroom or of a school can become so visually overwhelming because the brain can't process all of that sensory input and reading and screens can cause dizziness and nausea and blurred vision. And you know, we can literally rewire the brain to change how somebody uses vision to establish order from all that disorder and really with, like you shared the right motivation, compliance, but the right team around you, the majority of, concussions at least, can return to a previous level of function and return to learn and return to life.
But it just, it, takes a lot. So I, I always like to say upfront, you know, anytime there is a hit to the head, you know, first step is consult with a sports medicine physician. Make sure that you know the appropriate tests are being done and we're evaluated the right way but concussion is, the silent diagnosis and that so many of the tests that are done in an emergency room setting are to rule out something catastrophic. Which is important. You gotta make sure that there's no pooling of blood or, you know, scary things occurring. But what occurs is at a functional level and the damage to the really small, intricate neuronal networks in our brain, that's what impacts function and reading and learning and, going through life.
So, there's interesting study that shared that a year after a concussion up to a third of kids still have symptoms like headaches and irritability that, of course can impact school performance. And while many concussions do resolve spontaneously, so many, a large percentage are with older adolescents and with adults where, you know, it, can be take a lot longer to get back to previous level of function, maybe not even ever. And younger individuals we know take a lot longer, to get back to where they need to be. So, you know, I, think with one head injury, we know we're more likely to have an additional one. And I'm a big believer that with something like vision therapy, you can actually rely on vision to guide and lead and prepare yourself more appropriately and accurately for what's coming at you. If you can really access periphery and side vision and you know what's in front of you and what's around you simultaneously.
And of course many head injuries are, not, avoidable and they're not in response to you, it's to people around you. But I do strongly believe that many head injuries, especially after, an initial one, can be improved or decreased in terms of frequency or have a different impact if we can let our eyes, brain and body work as efficiently together as a unit as possible, because that lets you get outta harm's way when that is possible.
[00:15:13] Bella: You know, sometimes head injuries happen and if you are like me, they happen a lot because you kind of put yourself in situations where it's more likely. I still put myself in situations where I definitely am increasing my risk of getting a head injury, and you have to either decide if that's for you or not.
Bella shares overstimulation challenges at the grocery store
[00:15:29] Bella: But also, as you mentioned at the beginning concussions happen anywhere. Most people in Concussion Connect were hurt, falling, slipping, car accidents, all these types of things. It's not always athletes like the news likes to portray. And you mentioned that over stimulation of going into stores, and I find grocery stores is probably the biggest one that I get messages about. I don't know how to grocery shop. It's so loud. It's so bright. And so that is definitely something where vision therapy will hopefully help you
[00:16:03] Dr. Bryce: Grocery stores, that's the perfect recipe for disaster. You've got fluorescent lights, you've got crowded, busy periphery. You've gotta integrate what's in front of you and what's around you. And then you're trying to find can of beans, let's say in an aisle with a million cans around. And you have to look at the detail and open up periphery. And that's always compromised after a head injury is the brain's ability to process what's in front of you and around you at the same time.
[00:16:28] Bella: Yeah. It's something that sounds so simple, like before you get a head injury, you're like, how is grocery shopping hard? Everyone grocery shops. And then you get a concussion and you're like, wow. But actually my one grocery store here locally does sensory friendly hours every week for like two hours. So they turn off all the beeping of the machines. I don't know why they just don't turn them off permanently cuz they don't need to be on. But beepings off lights are dimmed, music is off. So it's like a quiet, store. And the first time I went in during this, I didn't know and I thought the store was closed.
I was like, am I supposed to be here? Cause like, you know, it wasn't super bright and super loud and but it was wonderful to go at that time. So I always recommend for people to look into that. We are gonna talk a little bit about nutrition and supplements but before that, we're gonna take a quick break.
Cognitive FX is a research-driven clinic that has successfully treated thousands of patients who have long-lasting symptoms from concussions or other brain-related injuries. Cognitive FX has an innovative approach to recovery that uses in advanced F M R I scan to map the function in your brain.
Treatment at Cognitive FX takes five days to complete and uses your F M R I scan as a guide and baseline to ensure that your treatment is personalized and effective. This means that you won't need to schedule and keep track of multiple specialist locations, dates, times, or therapies because it will all be prepared for you when you arrive.
Once you've completed their treatment, you receive a personalized at-home plan to continue your recovery and gain access to their online patient portal that has instructional videos and resources for your continued recovery. Conveniently, cognitive effects also offers free consultation so both you and the doctors can ensure that treatment is a good choice for you and your injury.
Visit their website@cognitivefxusa.com. Don't delay your recovery any longer. Find solutions at Cognitive FX today.
[00:18:24] Bella: Welcome back to the Post-Concussion podcast with my myself, Bella Paige and today's guest, Dr. Bryce Appelbaum.
Dr. Bryce shares nutrition and supplements role in concussion recovery
[00:18:31] Bella: So I really wanna talk about nutrition and supplements because I think it's something that people are always asking me about, and I am not a doctor. I know what I've tried and I've tried the entire spectrum of diets to, different supplements. But I'll let you take it from there. And what do you think, are good ideas and what do you think should be avoided?
[00:18:54] Dr. Bryce: Absolutely. So, you know, for so many people on the recovery process from a concussion, One of the most common triggers of symptoms can be sensitivities to food and what we put in our bodies. For pretty much every head injury patient I work with, we always offer working with one of our health coaches. But I get people to think about the ingredients that are giving their bodies so that we can give the right instructions for our body to function as, as best as possible. And, you know, it's very often that the endpoint is not the same, in terms of recovery journey unless a lot of the neuroinflammation that occurs after a head injury, unless that's addressed or improved, and thinking about visual components, those are kind of symptoms of the underlying systemic problems and they're more efficiently resolved when we can address things systemically. So some of the most kind of common, sensitivities that I see with my patients would be gluten, dairy, sugar, processed foods and alcohol.
I think when we're relying on, glucose or sugar as our primary fuel source, a lot of symptoms, even without a head injury, can come from that, like fatigue and, highs and lows and kind of, decreased cognition and, mental clarity depending on what you eat at times of the day.
I always recommend, you know, decreasing as, much of those as possible, but, very often experimenting with a ketogenic diet or a diet that has at least higher quality fats and, more fats rather than, carbohydrates, can be really effective for the brain.
To me the number one, the one seed for supplements after a concussion would be omega-3 fatty acids. And definitely talk to a primary care doctor before doing anything and adding supplements to the diet, but, the DHA in particular in omega threes, is really, really helpful from a healing standpoint, from a, neurocognition standpoint. And there's definitely different doses that are important there to make sure you get over the threshold. I know I see one of the biggest, mistakes I see is, whether it's from reading or being recommended, from a practitioner that, you know, we should also be taking something like magnesium, let's say, when we're recovering from a head injury.
Magnesium is a wonderful supplement and it can have wonderful, positive effects on the body, but in particular, magnesium theronate is a specific type of magnesium that can actually cross our blood brain barrier and actually get to the areas that it needs to, versus other types of magnesium are important for sleep or for bowel movements.
And so we gotta make sure we dial in to get the right supplements to really help us get to a good place. but along with, nutrition and supplements, which are hugely important from a, recovery standpoint, so two is, managing our stress, whether that's with meditation working out, yoga, walking, lifestyle modifications where we can really prioritize ourselves and, sleep and the recovery that's needed. And, the mental health component you touched on is a huge problem with concussion recovery and, often, I see, individuals labeled with things like depression and anxiety and P T S D and, when, this was not the concern, before the head injury. But now so much in life is so much harder and oftentimes it's because certain PR doctors or practitioners, don't really know what to do or what to recommend or don't understand head injury.
I think as a medical community, we have so much more to learn about head injury, but we also have learned a lot in the last handful of years, and that should continue, indefinitely as we learn from our patients and we have the research to support what we're doing and we can raise the bar for people to get back to, better places in life so they're not struggling as much as they are.
[00:22:51] Bella: Absolutely. And I like that you mentioned gluten, dairy free. I have done gluten and dairy free I actually have, all of my past in my house is gluten free just to lower the amount of gluten intake I get. We actually have The Post Concussion Cookbook, as everyone knows, that has a ton of gluten and dairy free recipes in it because I find a lot of people do better when they're reducing those in their diet with concussions. And also, as you mentioned, talking to your doctor. A really important thing, I always like to throw it in there before you start taking supplements, is actually getting your blood checked.
For example, two weeks ago I got all my blood work done. As everyone knows, I was at Mayo before we were recording this, and I had low B12 first time in my entire life as I get my blood checked like every few months for everything but then, you know, instead of just kind of winging it and filling your containers of weeks with all of the supplements you can think of, get your blood checked a lot of the time, it'll tell you what you are missing and makes it a little easier to know where to go first.
[00:23:55] Dr. Bryce: Test don't guess, right? Absolutely. I love that, you're bringing up how important it is to just, look inside before we figure out what we need to do.
[00:24:05] Bella: Yeah, because you know how social media works. We hear all these things, but it's good to make sure we are checking before we try things. And I also love that you touched on the mental health component cuz it is true your life changes. You go from maybe a highly functioning individual to sometimes the opposite and you know, that's not permanent, but it definitely can take a lot of time to get out of that, lots of people are no longer working, athletes can't even get on the field without getting dizzy. School is really a big struggle with a lot of students and so it's really important to, realize that this is temporary and that's why there's all these therapies and all these people out there to help you. It's just finding the right health is really important.
Dr. Bryce shares his final message
[00:24:49] Bella: And so you have given us lots of great insights today is there anything else you would like to add before ending today's episode?
[00:24:56] Dr. Bryce: How much time do we have here? So I would say just, to touch on what you just shared, having mental health be impacted, shows that you're not establishing status quo and not giving up, and I think that is so huge for so many people is just knowing that there is hope.
And if you haven't gotten the right answers from the medical world, that means you haven't seen the right people yet. So much can be done to make life easier down the road, but definitely, don't let labels act as end points and those are just points in time. And then so many labels can be eliminated with the right treatment when those behaviors no longer are options.
While you mentioned, gluten and dairy and, what can trigger us, , I would love to just talk a little bit more about screens if possible.
[00:25:40] Bella: For sure.
[00:25:41] Dr. Bryce: Because that is, you know, one of the, biggest challenges I see with my patients is returning to work or even just texting and emails and everything that's needed from, you know, to engage with where the world is these days. And, definitely screen engagement, and screen time is, severely impacting our, kids' eyes and brains and visual development, cognitive development, emotional development, and our personal communication. I mean, so many different areas, but also screens aren't going anywhere. It's important that to recognize that we can have the right foundation in place with the right type of, vision learning, whether that's visual skills and abilities or visual processing that's needed.
There are certain glasses that can be fantastic in terms of, allowing the brain to engage with that two-dimensional plane that's blasting light at you. Blue light has been a big hot topic post covid, where we all know that it's this short wavelength, high energy light. But blue light in general is not bad for us.
We actually need blue light to promote alertness and regulate our circadian rhythms and help with mood. And blue light is light from the sunlight and that's needed, but artificial blue light that's blasted through our eyes to our brains for 8, 10, 12 hours a day. That can significantly impact our circadian rhythms.
And we can actually develop the right visual foundation in place to become screen fit, to become, productive and efficient so that we can stare at screens, even though breaks are really important and we should be taking breaks at least every 20 minutes for at least 20 seconds, looking something 20 feet away and can give a lot of tips there.
But we can thrive in an environment, where there is all this screen engagement if we have the right foundation in place. And that's something that, is not really known in, so many different circles of the medical world.
[00:27:40] Bella: Yeah. Thank you so much for sharing about that and I just wanted to thank you so much for joining us today and sharing so many of your insights.
[00:27:48] Dr. Bryce: Thank you so much for having me. And, honestly, what you do here with this podcast and you sharing your story has, helped so many people, and I hope we'll, light a fire under so many more to, really help one another to get to a place where, you know, vision is, important, but more importantly, concussion is not limiting us.
It allows us to open up our door and live a better quality life when we can empower ourselves with the right tools.
[00:28:13] Bella: Need more than just this podcast. Be sure to check out our website, post-concussion inc.com to see how we can help you in your post-concussion life. From a support network to one-on-one coaching, I believe life can get better because I've lived through it. Make sure you take it one day at a time.
The Post Concussion Cookbook is here!
Make sure you don’t miss out!
OTHER CONTENT YOU MAY LIKE
