Evolving the Way We Manage Concussions

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By Scott Haller & Frances MacInnes

These days most people are aware that concussions can be serious, and even that they can have health consequences decades after recovery.However, few people actually realize just how debilitating the symptoms of post-concussion syndrome can be.  For some patients, effects like headaches, eye strain, dizziness, nausea, confusion, and depression can make meeting the demands of daily life impossible.

It’s not uncommon for activities like work, school, sports or driving to have to be put on hold for months on end.  What’s more, when post-concussion symptoms make these activities intolerable, it makes recovery all the more difficult. This is because the brain is being cut-off from the types of stimulation it needs to regain and rebuild lost cognitive functions.

The Challenge of Managing Concussions

Concussions can happen to anyone, and at any time in life. Clinical practitioners who treat concussions, know just how important it is to be able to manage the recovery process in order to minimize the impacts on people’s lives.  Unfortunately, the challenge can be huge.  Here are some reasons why.

  • Every concussion can be different – traumatic injury forces to the head can occur in different ways, and in different areas of the brain, with a vast range of consequences for the most complex organ of the body.
  • Every brain is different – the same type of injury can have different effects from one person to another. This is due to individual variation in brain physiology, such as neural structures, topography, or connectivity, or personal characteristics such as age, sex, genetics, pre-injuries or other health issues.
  • Symptoms are diverse – problems can vary widely across physical complaints, cognitive impairments, or emotional issues. These can also change in severity and type over time.
  • Recovery is unpredictable – the severity and duration of symptoms vary in ways that are often inconsistent with the types of injury. Sudden regression of symptoms also makes it notoriously difficult to diagnose readiness for full return to activity.

The Goals for Shift Concussion Management

These challenges are the reason why Shift Concussion Management exists. Shift Concussion Management was started as an education platform, providing training on the assessment and management of concussion and post-concussion syndromes to a network of international health-care providers. The aim is to offer accessible, individualized and effective concussion management strategies to individuals of all ages suffering from mild traumatic brain injuries, while also educating the public on the nature of concussion injuries.

At Shift, we believe that concussion management requires a team approach, encouraging open communication and collaboration across all health providers involved in a patients care. We teach our practitioners to assess and manage each patient as a whole and to tailor rehabilitative strategies to the individual needs of the patient.

Perhaps the most important role we play is by developing and providing an on-going education platform through our Level 1 and Level 2 courses, as well as training seminars. It is our continual goal to establish the most current, evidence-based concussion assessment and rehabilitation protocols that can be delivered to our network of providers.  This is the reason we collaborated with NeuroTracker and the Faubert Applied Research Centre.

Making Strides with NeuroTracker

After reviewing the science in detail and seeing the potential, we have been using NeuroTracker extensively in order to understand how it can be applied best from a clinical practitioner’s perspective. We can honestly say that the results have been phenomenal, and the implementation of NeuroTracker has been pivotal in the progress of some of our most complex and chronic patients.

We’ve been able to improve many aspects of post-concussion syndrome by targeting the integration of the incoming sensory information. In fact, the results we found led us to re-evaluate our practices to be able figure out which area of concern was best being addressed by the implementation of NeuroTracker protocols at various points in the recovery.

Therapy for Real-World Needs

One of the key challenges we had was that patients would go through a course of vision therapy, and a course of vestibular therapy, both implemented at a high standard.  We would see objective information showing improvement through the therapy results.  However, when the patients were back out in real-world situations, they were not reporting functional changes to their daily life. We were not always seeing transfer into real-life scenarios.

We’re doing vision therapy on one stream, and vestibular therapy on another stream, but rehabilitating systems individually for such a complex injury is not enough.  For the reality of the functional world, we have to combine the visual & vestibular systems efficiently and effectively on a constant basis. We realized this means going the extra mile – to recover the patient’s ability to integrate and interpret multiple and simultaneous streams of sensory information.

This is where we saw that NeuroTracker played a complementary role in the rehabilitation of our concussion patients. NeuroTracker training retaught patients to use these multiple systems – to integrate vision, vestibular and cognition process – all those things in real-time and real-space. What is so unique about it, is that it can achieve this in a controlled environment that really isolates the appropriate training threshold of each patient, so that it can best promote and stimulate neuroplasticity. This can otherwise be very challenging to do in complex patients. It really helped to bring the pieces of the puzzle together clinically.

Upwards and Onwards

Once we started developing more rehabilitation exercises that focused on first the stabilization of the individual systems, followed by integration and loading of the systems, the results for our patients are so much better. We have been able to achieve this through tailored exercises that meet the functional demands of the patient’s lives, as well as the use of NeuroTracker to help ensure all systems are working as efficiently and effectively as possible – to ensure transfer into real life function. And that’s great news for the prospects of improving people’s lives across Canada.

We now educate our health care providers on these new protocols, which add in the reintegration of sensory systems. We’re really excited to continue evolving the science and practice of concussion management through our partnership with NeuroTracker.

About Scott Haller

https://www.shiftconcussion.ca/

Scott is President and Lead Instructor of the Shift Concussion Management Program. He is a Credentialed ImPACT (Immediate post-concussion assessment and cognitive testing) Consultant (CIC). His role at Shift includes the development of an advanced protocol for the assessment and management of concussions – The SHIFT Concussion Management Program. Scott has worked on the medical rehabilitation staff of the NHL’s Edmonton Oilers and the Hamilton Bulldogs.  As a result of diverse training, Scott’s specialties span from generalized osteopathic treatment, craniosacral therapy, acupuncture, vestibular therapy, to concussion management.

About Frances MacInnes

Frances holds a Bachelor of Science Degree in Kinesiology and a Master of Science in Physical Therapy. She is trained in vestibular and oculomotor rehabilitation, acupuncture and dry needling, ImPACT (Immediate post-concussion assessment and cognitive testing), and soft tissue modalities. Frances plays an active role in updating and integrating Shift’s concussion protocols, and serves as an instructor alongside Scott Haller, also assisting in the creation and development of our course content.  Frances has held Head Athletic Training positions for varsity soccer, and Junior hockey.

About Shift Concussion Management

Shift Concussion Management and its Canada-wide network of Health Providers offers accessible, individualized and effective concussion management strategies to individuals of all ages suffering from concussion and mild traumatic brain injury. Shift also serves as a training platform for Health Professionals, offering education on current, evidence-based concussion assessment and rehabilitation techniques to ensure an informed and high standard-of-care for those seeking support in their recovery.

https://www.shiftconcussion.ca/

 

If you are interested in reading more about NeuroTracker’s role in concussion management, here are some related blogs.

Study Finds NeuroTracker Promising for Concussion Management

Evolving the Treatment of Concussions

Assessing Concussion with Dual-Tasks

4 Leading Practitioners on Using NeuroTracker for Rehabilitation

NeuroTracker: A Technology Worth Shouting About!

Dr. Matter on Neuro-stimulation with NeuroTracker

 

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The NeuroTracker Team