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Novel Approaches to Traumatic Brain Injury by Dan Engle, MD

Watch our short video as Dr. Dan Engle shows us the pathophysiology of Traumatic Brain Injury (TBI).


These are going to be novel approaches to TBI only because the standard care doesn’t really utilize a lot of these methodologies, even though they have really good data. Part of what happens in neurology, that can be consistent with psychiatry too, is we have excellent diagnostics and fairly lousy therapeutics.

I’ve learned from a variety of different therapeutic models and other integrative approaches, and we really take a transdisciplinary approach to TBI.

Pathophysiology of TBI

The pathophysiology of TBI, traumatic brain injury, what happens is you typically have this acceleration deceleration injury. The force that happens isn’t necessarily like the tofu brain bouncing around a really sharp, hard skull, as much as it is the force that includes the brain moving in a particular trajectory, and then all of a sudden stopping really fast.

You actually don’t have to have a contact injury to have a whiplash injury or a concussion or traumatic brain injury. It seems to be, and we’re still learning a lot about this kind of science, it seems to be that the acceleration deceleration shears the meninges and leads to axonal and pituitary injury.

PCS Symptoms

When these symptoms, being three or more, that are necessary over a period longer than three months post injury that does not have to include loss of consciousness. That’s a really important one, these symptoms that are related to concussion for sure, but what we’re talking about here is post-concussive syndrome. These symptoms lasting for longer than three months: problems with concentration, memory (those are more cognitive performance measures), mood dysregulation, sleep challenges, chronic headaches, light noise sensitivity. This is super common. And it’s almost pathognomonic for post concussive issues.


You just should know that sometimes the brain is not healing from a head trauma because it’s got toxicity. And what are those toxicities? I use the acronym O.P.E.N. Essentially, we’re trying to open up the channels for detoxification. That can really look like opportunistic infections, the big one being viruses, EBV and CMV. And it doesn’t have to be somebody who lives in a high, humid environment. Sometimes it’s a person who got traumatized when they were in a mold exposed environment. And there’s residue still there. There’s not a whole lot of mold there because it tends to be an arid, low humidity environment. But if you start unpacking the history, then it could have been somebody who got injured or exposed when they were living somewhere else.

Lifestyle Support

And then lastly, D.R.E.A.M.S.

This is the acronym for diet, rhythm, energetics, attitude, movement, and sleep. This is everything in the umbrella of lifestyle support. I like this acronym too, because we’re trying to do two things. We’re trying to help people get into restorative sleep, which oftentimes includes more dream recall because oftentimes post concussive syndrome is one of those just very annoying things that a lot of people don’t get, many practitioners don’t even know to look for. And it is like walking around in a fog. That is really hard to be in the seat of your own soul here to do the work that you here to do.