ADD Centre Concussion Intervention

 

ADD Centre Concussion Intervention

Medical specialists diagnose concussion but often have little to offer in the way of interventions to the approximately 30% of people who do not make a full recovery. Medical imaging using MRI and CT scans are helpful for detecting structural problems, like a brain bleed or skull fracture, that require medical intervention. They do not detect concussion, so a normal scan does not rule out a concussion. Concussions cause functional problems due to disrupted communication between different areas of the brain, referred to as diffuse axonal injury (DAI). DAI involves  the stretching and twisting of the axonal connections. It causes disruption of communication of electrical signals from one neuron to another. Gradual return to work and play after concussion meets the conservative criteria of “do no harm” but does not offer guidance when symptoms involving memory, attention, headaches, light and sound sensitivities and mood swings/irritability cause daily frustration months after the traumatic brain injury.

 At the ADD Centre there is hope for functional recovery for those with postconcussion syndrome because we offer active intervention – brain exercise and heart rate variability training – based on a comprehensive assessment. Assessment measures include the following:

19 Channel QEEG and Evoked Potentials (ERP). This type of assessment can reveal the effects of damage elicited by stretching and twisting of axons, called diffuse axonal injury (DAI). The evoked potentials are particularly important for reflecting brain speed. Mild traumatic brain injury (mTBI/concussion) will often have a negative impact on the right and/or left insula which, in turn, relates to changes in heart rate variability. At the ADD Centre we use Evoke Neuroscience and Neuroguide to analyze brainwave patterns (EEG). Then we know how to train for healthier patterns.

Heart rate variability (HRV) is a measure of the changes in heart rate. The higher the variability, the healthier the cardiac pumping system. After a concussion, HRV is often reduced.  Training to increase heart rate variability is helpful for stress management and, additionally, to improve cognitive function.

Continuous Performance Tests measure attention, impulse control, variability of response time (drifting attention), and response time (speed of response). Doing these tests as a baseline and then again after a series of training sessions provides an objective measure of improvement. 

Neurocognitive Testing – CNS Vital Signs Neurocognitive Testing is used at the ADD Centre. It is done on-line and includes tests of visual and verbal memory, simple and complex attention, executive function, social acuity, processing speed and reaction time.

 Balance Testing – Meditech Balance Board and accompanying software, a system developed in Germany, is used at the ADD Centre to assess balance and risk of tumbling before and after training.

Clinical Interview – A clinical interview that includes an explanation of the findings and discussion of a treatment plan is completed with a professional registered with the College of Psychologists of Ontario. 

 Following Assessment, a individualized training program is created. Components may include any of the following modalities: single channel neurofeedback training, heart rate variability training, LORETA neurofeedback training, balance training. 

 Comprehensive testing is completed before and after training to gauge progress.  Here is an example Before and After brain maps showing decreased over-activation (red and orange areas) following an ADD Centre training program for Concussion. Note that every concussion is different: some people will show area of under activation.  

Before Training:                                                                 After Training: