How We Help
Concussion evaluation and treatment guidelines
The clinic offers sophisticated technology for neurological diagnosis of concussion and other forms of traumatic brain injury. Through collaborative arrangements with St Michael's Neurology and other facilities, patients who suffered persistent concussion symptoms will receive compasionate neurological diagnosis and care, leading to the best possible recovery. We offer cutting-edge diagnostic techniques, and treatment for adults, adolescents, and children. We collaborate with neurologists, neuropsychologists, neurosurgeons, pain management experts, orthopedic surgeons, and physical therapists trained in traumatic brain injury. Patients will be offered cutting-edge knowledge and expertise to treat concussion related headaches and migraines, and other complications of traumatic brain injuries. We use sophisticated methods for testing cognition (memory, problem-solving skills, attention, language, visual functions) and improving performance. Our aim is to make certain that patients receive a precise diagnosis, and correct treatment, and are ready to resume a fully active state.
Most patients with persistent concussion symptoms are poorly diagnosed and treated, leading to profound frustration, and unresolved disabilities.
Our concussion experts are ready to help evaluate your situation and provide customized therapy guidelines.
DIAGNOSTICS
We offer cutting edge diagnostic techniques to identify
the areas of the brain damaged and thus target more effective rehabilitation protocols . This include cortical mapping, videonystagnmography, neuropsychological testing, dynamic posturography, autonomic nervous system testing, and advanced imaging (collaboration with other facilities). Importantly, we will correlate the findings of various studies with symptoms and produce an easy to understand clinical report.
Do I have a concussion?
Diagnosing a post concussion syndrome correctly and identifying objective brain pathology behind subjective complaints are the most critical steps in diagnosing and managing disabling concussion symptoms
CLINICAL CORRELATIONS
It is essential to recognize that no single technique can be taken in isolation to show or prove a brain injury. All techniques complement each other.
After, obtaining the appropriate evidence supporting brain damage, the neurologist will correlate the findings with the clinical presentation and the neurological examination. Nothing can replace objective findings for planning therapy. Also, for patients involved in litigation, nothing can replace easy-to-understand medical reports with clear demonstratives.
The Power of Objective Evidence Behind Subjective Symptoms
Expert care for brain injuries
We specialize in the diagnosis of traumatic brain injuries, and other neurological conditions. Experienced board certified neurologists use the latest techniques to identify and help patients recover from their injuries and regain their quality of life.
Please scroll to the end and read the CONCUSSION CRASH COURSE to learn about mild traumatic brain injuries and post concussion syndrome. We explain how the tests we perform can help diagnose mild traumatic brain injuries and enhance treatment options.
SOME OF THE METHODS WE USE TO DIAGNOSE A CONCUSSION OR MILD TRAUMATIC BRAIN INJURY INCLUDE:
Quantitative EEG and Cortical Mapping of the Injuries
Brain Cortical Mapping ( qEEG brain mapping). Using quantitative electroencephalography techniques, significant abnormalities can be identified in patients with persistent symptoms (these lesions are not visible in standard MRIs).demonstration of pathology provides important therapeutic guidance and objective evidence for treatment planning or litigation settings. At the concussion TBI Neurodiagnostic Laboratory we work with board certified TBI neurologists. Our sophisticated techniques help us identify brain injuries that are invisible to standard MRIs and correlate the results of the tests with the symptoms.
Quantitative EEG and Cortical Mapping of the Injuries
Brain Cortical Mapping ( qEEG brain mapping). Abnormal areas in the brain cortex and abnormal connections between different brain areas are identified and elocuently demonstrated. At the concussion TBI Neurodiagnostic Laboratory we work ONLY with board certified TBI neurologists and correlate the OBJECTIVE results of the tests with the patient's complaints (TBI subjective symptoms).
Quantitative EEG and Cortical Mapping of the Injuries
Example of abnormal activity in cortical brain areas are identified by qEEG, not visible by MRI methods.
Videonystagmography
Abnormal Eye Movements. In persistent post-concussion syndrome, there are often typical eye movement abnormalities, which can cause abnormal gait and balance, visual and spatial disorientation, coordination problems, and other deficits impacting the patient’s daily functioning. These abnormalities can be captured with sophisticated computer-assisted measurements of eye motion (VIDEONYSTAGMOGRAPHY). Importantly the results can not be modified voluntarily by the patient (symptom amplification or malingering) or the examiner.
Cognitive Assessments with validity indicators
High quality neuropsychological assessments, including validity indicators that can rule out malingering or symptom amplification. Contemporary computer-based neuropsychological assessments include sophisticated algorithms which can flag the presence of malingering or symptom amplification. Experienced neuropsychologists can also obtain similar outcomes using traditional “pen and paper” testing. These techniques provide additional layers of evidence to support the organic nature of the symptoms.
Dynamic Posturography
The method of posturography is used to measure postural control in an upright posture under static or dynamic situations. Ten different test protocols are performed including a Sensory Organization Test (SOT), Limits of Stability Test (LOS), a Motor Control Test (MCT) and an Adaptation Test (ADT). A special computer software integrates all this and produces detailed graphics which can then be compared with normal ranges. The pattern of results can not be voluntarily modified due to the complex interactions among sensory, motor, and central processes. In brain injuries, abnormal results are often present.
Evoked Potentials
This is a simple layperson description of the evoked potentials.
The brain's immediate reaction to a particular visual, mental, or physical event is measured by event-related potentials (ERP), also known as evoked potentials (EP). To understand that simply, when hear a noise, the stimulus travels all the way to the brain through different pathways. Cells in various parts of the brain produce electrical activity captured by electrodes as an electrical wave. The size of the wave (called amplitude) and the time it takes to be formed and detected (called latency) can be accurately measured. Injuries cause delays in the time the brain responds to a stimulus and also cause the wave (electrical response) to be too small (size of the decreased amplitude).
Evoked Potentials
The level of focus on a stimuli and the subsequent encoding of information for storage and retrieval are fundamental components of memory. Two ERP components that may be used to gauge these features of memory are P300a and P300b. When it comes to conditions that cause memory loss, such Alzheimer's disease or TBIs, the P300b component has undergone extensive research. Individuals with AD reported lower amplitudes and longer P300b delay measurements when compared to age-matched controls. It has been shown that P300b amplitude and delay may predict how mild cognitive impairment would develop. Additionally, P300b measurements show greater sensitivity in identifying early preclinical memory decline than traditional tests like the MMSE or other neuropsychological tests.
TESTS FOR AUTONOMIC NERVOUS SYSTEM FUNCTION AND AUTONOMIC DYSREGULATION
What is autonomic dysregulation?
In the complex world of Post-Concussion Syndrome (PCS), dizziness presents a particularly significant problem. This disorienting sensation isn't just a symptom but a sign of deeper disruptions within the body's internal regulating system. Many who suffer from PCS experience a condition called autonomic dysregulation. In essence, autonomic dysregulation is a disruption of the body's ability to manage its automatic functions like heart rate, blood pressure, and respiratory rate. If abnormal, these automatic bodily functions can cause dizziness (for example, when standing up rapidly, the heart and blood vessels cannot adapt and the blood will not reach the brain at the normal rate).
While this phenomenon might seem intangible, autonomic dysregulation isn't beyond the reach of science. In fact, there are objective tests that can highlight its presence. In the field of neurophysiology, certain examinations like Quantitative Sudomotor Axon Reflex Test (QSART), or Heart Rate Variability (HRV), and others test are used. These sophisticated measurements assess how the autonomic nervous system responds to changes like posture shifts or stress, revealing whether it's properly controlling the body's functions such as blood pressure, or heart rate. These essential examinations not only help diagnose autonomic dysregulation in PCS patients, but also paves the way for targeted treatment options.
Some of the tests to demonstrate problems with the autonomic nervous system include:
✔ Sudomotor Function Markers.
✔ Heart rate variability Analysis (HRV).
✔ Cardiac Autonomic Reflex Tests:
- Valsalva Ratio,
- E/I Ratio ,
- K30/15 Ratio and
- Systolic and diastolic Pressure Response to Standing.
Contact us for more information on these tests.
Advanced Imaging
We work with various facilities to incorporate advanced imaging studies (DTI, SPECT, DWI, others) for additional and powerful clinical correlations with our cognitive, oculomotor, qEEG and posturography data. A board certified neurologist with a track record in cognitive neurology and TBI will analyze all the data, including the neurological examination's findings, and prepare a powerful and easy to understand report (importantly, we ONLY work with experienced and established neuroradiologists who are financially independently of our neurological clinics for added transparency and credibility of all the data).
Compassionate and Advanced Neurological Care
WHAT IS A CONCUSSION? A 5 MINUTE FAST TAKE
A concussion is a blow to the head or body shaking causing acceleration/deceleration or violent rotation. Symptoms developing immediately after a concussion are grouped under the definition of post-concussion syndrome. Symptoms may include vertigo, fatigue, problems with balance, coordination, unsteadiness, blurred vision, memory problems, anxiety, depression, and personality changes. When symptoms last for longer than three months, and do not promptly resolve, the condition is called persistent post-concussion syndrome, which can often lead to various degrees of disability.
Concussions were required for a long time to have had a brief loss of consciousness. However, it is now recognized and agreed by most experts that loss of consciousness in not necessary for the diagnosis. Often, patients do not show signs of structural damage in MRIs or CT scans. Even though these tests don't assess brain functions or cognition, they can help identify stroke, bleeding, tumors and vascular damage, or seizures. Therefore, physicians were left to rely only on subjective reports from the patient. Thus, appropriate objective tests to determine the location and extent of the brain damage are critical for treatment and medicolegal purposes.
What is Persistent Post-Concussion Syndrome (PPCS)?
Persistent Post-Concussion Syndrome (PPCS) refers to a condition where an individual continues to experience symptoms long after suffering a concussion, typically beyond the usual recovery period of 3 months. These symptoms may include headaches, dizziness, problems with concentration and memory, and changes in mood. Unlike a typical concussion, where symptoms gradually disappear, those suffering from PPCS face prolonged challenges. The exact cause is not fully understood, but factors like the severity of the initial injury, age, and history of mental health issues may influence its development. It's important to consult a healthcare professional if these symptoms persist, as managing PPCS often requires a multidisciplinary approach, combining physical therapy, cognitive behavioral therapy, and sometimes medication.
A new frontier has opened up. Plexus Diagnostics provides tests for objectively assessing a TBI. Several of the tests we offer, allow visualization of the injury and assist neurologists, other physicians and therapists in diagnosing organic brain damage and identifying performance impairments. It also allows attorneys and disability rating experts to determine the organic (legitimate) nature of the patient's subjective complaints.
Expert Diagnosis and Treatment
Our team of board-certified neurologists has years of experience in diagnosing and treating neurological conditions. We use the latest technology and techniques to provide the best possible care for our patients.
Headache and Migraine
We understand the impact that chronic headaches, migraines and post-traumatic headaches (e.g., headaches that develop after a concussion) can have on your quality of life. Our team specializes in the diagnosis and treatment of these conditions and provides individualized care to help you find relief.