Concussion / mild traumatic brain injury changes the way the brain functions; however, these injuries are invisible even with using advanced imaging such as MRI and CT scans.
Comprehensive Multi-System Physical Exam
In many cases diagnosing abnormalities of the brain due to trauma or disease can be difficult and unclear. However, we utilize a comprehensive examination procedure as well as leading-edge diagnostic technology to help locate where in the brain and associated areas, the problem(s) lie.
The physical examination we employ is focussed on identifying the deficits in the function of the peripheral and/or central nervous system and help us arrive at a better understanding of your condition. The testing procedures we use include but are not limited to the following:
• Gait analysis: Arm swing, stride length, and lateropulsion (sideways shifting) are important determinants in nervous system function
• Ocular alignment: using a testing method with a special prism can help us evaluate misalignment of your eyes.
• Bilateral temperature, oxygen concentration (SpO2), reflexes, sensation testing, muscle strength, cranial nerve and cerebellar tests help to define alteration in output of the left versus right side of the brain, as well as the peripheral nervous system.
• Semicircular canal testing (inner ear): specific positioning manoeuvres aid in the diagnosis of various causes of disequilibrium.
• Vestibulo-ocular reflex testing to determine the accuracy of the reflex that helps keep your eyes steady while in motion or with head movement.
Each person’s concussion is unique; therefore, we don’t recommend a “cookbook” approach. We pride ourselves on working as a team with your healthcare practitioner, lawyer or support administrators to help facilitate your care.
You should also know…
Videonystagmography and Saccadometry
When it comes to brain trauma the scientific literature emphasizes the importance of examining the visual system as it is most often affected by brain trauma.
Videonystagmography and saccadometry are advanced diagnostic tools that evaluate the function of eye movements we use in everyday life. Some examples are:
• smooth pursuit eye movement which is used for scanning moving objects both vertically and horizontally
• gaze holding is critical for concentration and focus
• saccadic or fast eye movements, which we use between 100,000 and 178,000 times per day, is a type of eye movement that is used to quickly look from target to target as is done when scrolling on a computer screen
• optokinetics which test our ability to perceive movement like one would be exposed to when driving in a car or surrounded by moving people
Computerized Dynamic Posturography
A key component of vestibulo-ocular testing is of course evaluating the function of the vestibular system. We test an individual’s balance with bedside tests as well as advanced testing with computerized posturography. The advantage of computerized testing is that it can produce objective data that can be compared to norms. There are numerous subtleties with this form of testing that cannot be seen by the naked eye. It is the data that can prove to be most useful in arriving at a diagnosis as well as developing a customized treatment plan.
Our goal is to provide you with objective evidence that helps indicate what parts of the brain are involved and then use this information to design a treatment program that is as individual as your injury.
Results from your comprehensive examination help us tailor a treatment program for you that is as unique as you are. Some of the treatment modalities we may use include:
• Vision Therapy that is guided by real time data from videonystagmography and saccadometry. In fact, we make it a point to show you first hand the results of your tests so you will have an idea of what the issue is and what needs to be done.
• Vestibular rehabilitation guided by our advanced diagnostics, an example might be standing on a perturbed surface while performing a visual, sound or head therapy.
• Transcranial vagus nerve stimulation beneficial for headaches, irritable bowel syndrome, depression and memory loss
• Tongue stimulation with somatosensory evoked potential to promote brain plasticity
• Tablet based eye exercises using Focus Builder
• Ear insufflation for headache management
• Non-surgical decompression therapy for neck pain
• Nutritional recommendations to support cellular repair
• Exercise recommendations to aid recovery
• Mirror Therapy to aid in motor control
• Auditory therapy for balance and gait improvement (remove pain attenuation…)
• Laser guided proprioceptive feedback
• Photobiomodulation (laser therapy)
1. Tyler C.W. et al Consequence of traumatic brain injury for human vergence dynamics. Frontiers in Neurology, Feb. 2015, Vol. 5, Article 282.
2. Carrick F.R. et al Evaluation of the effectiveness of a novel brain and vestibular rehabilitation treatment modality in PTSD patients who have suffered combat-related traumatic brain injuries. Frontiers in Public Health, Feb. 2015 Vol. 3 Article 15.
3. Ventura R.E. et al Diagnostic tests for concussion: is vision part of the puzzle? Journal of Neuro-Opthalmology 2015; 35:73-81.
4. Mullen S.J. et al Saccadic eye movements in mild traumatic brain injury. A pilot study. Can J Neurol Sci 2014; 41:58-65
5. Pearson, B.C. Saccadometry: the possible application of latency distribution measurement for monitoring concussion. Br J Sports Med 2007; 41:610-612
6. Lynall, R.C. et al Concussion research: new horizons. The Lancet vol 14 January 2015.
Computerized Dynamic Posturography