The Power of Objective Evidence Behind Subjective Symptoms
What is a concussion and what is post concussion syndrome?
THIS IS A CONCUSSION CRUSH COURSE PROVIDED BY A BOARD CERTIFIED NEUROLOGIST (DR. PAPPOLLA) WHO IS ALSO A PROFESSOR OF NEUROLOGY.
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 two 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 at least brief loss of consciousness. However, it is now recognized and agree 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.
A new frontier has opened up. Right now, 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 nature of the subjective complaints. The objective testing includes the following evaluations:
SCROLL BELOW FOR A DESCRIPTION OF EACH TYPE OF STUDY.
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 in the litigation setting. At the concussion TBI Neurodiagnostic Laboratory we work with board certified TBI neurologists 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).
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.
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).
How We Help
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 managing or litigating disabling symptoms in most patients
DIAGNOSTICS
We offer advanced diagnostic techniques to identify
the areas of the brain damaged and thus target more effective rehabilitation protocols . This include cortical mapping, videonystagnmography, advanced imaging, neuropsychological testing, computer posturography, and advanced imaging. Importantly, we will correlate the findings of various studies with symptoms and produce an easy to understand clinical report.
CLINICAL CORRELATIONS
It is essential to recognize that no single technique or methodology can be taken in isolation to show brain injuries. All these techniques complement each other.
After, obtaining the appropriate evidence supporting brain damage, the neurologist will correlate the findings with the clinical presentation. Nothing can replace objective findings for planning therapy and easy-to-understand demonstratives for educating a jury in the litigation setting.
Concussion evaluation and treatment guidelines
For those who have had a concussion, the clinic offers collaborative arrangements with St Michael's Neurology for medical care and advice on recovery. We are part of a Concussion Network, a multispecialty network that offers cutting-edge diagnostic techniques, and treatment to adults, adolescents, and children. Its members include neurologists, neuropsychologists, neurosurgeons, pain management experts, orthopedic surgeons, and physical therapists. Patients will be offered cutting-edge knowledge and expertise to treat concussion related headaches and migraines, and equipment and testing methods for diagnosing and treating concussions. We use advanced computerized methods for testing cognition (memory, problem-solving skills, attention, language, visual functions) and 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.
Our concussion experts are ready to help you to evaluate your situation and provide customized therapy guidelines.
For those who have had a concussion, the clinic offers evaluation, medical care, and advice on recovery.