Concussion Rehabilitation & Baseline Testing
At Zone Performance, we use the most advanced and cutting-edge technology to accurately assess and more importantly rehabilitate your brain. Our program is designed to systematically improve your brain function and reduce the concussion symptoms that are often experienced after sustaining a concussion.
What is a Concussion?
A concussion is a traumatic brain injury. Concussions can be caused by a blow to the head or body. In fact, most whiplash motions have the potential to become a concussion. Although there may be no signs of injury this doesn’t mean a concussion hasn’t occurred.
Following a suspected concussion, a player should be immediately removed from play.
Concussion Symptoms May Include:
- Slurred speech
- Delayed response to questions
- Appearing dazed
- Headache or a feeling of pressure in the head
- Temporary loss of consciousness
- Confusion or feeling as if in a fog
- Amnesia surrounding the traumatic event
- Dizziness or “seeing stars”
- Ringing in the ears
- “When in doubt, sit them out!”
- If you feel dizzy, nauseous, have a headache, blurred vision or just feeling “not right”, remove yourself from the game.
- See your family physician.
- See a chiropractor to determine if your headaches are from any neck damage or pinched nerves.
- Set up a recovery program.
Our Concussion Rehabilitation and Baseline Testing Program Begins with a Comprehensive set of Tests
Our concussion rehabilitation and baseline testing protocol consists of a series of tests examining memory, concentration, visual tracking speed, processing abilities, balance, and reaction timing. These tests are used to assess the overall current functioning of the brain. If a concussion is later suspected, the results established from the baseline can be measured against a post test and used to determine impairment in brain functioning. In addition, they are used as an effective measure to determine when the brain has fully recovered and the athlete is safe to return to play or the client is ready to return back to work. For most accurate measuring, a baseline test for athletes should be done prior to the start of each season.
Following a concussion, the “sitting in a dark room” approach is only effective for so long. Concussions, like other injuries, should be properly managed and rehabilitated. At Zone Performance Psychology we understand that each client is affected differently and therefore a customized rehabilitation program will be designed to meet the specific needs of each client. Management strategies are used to limit the amount of impairment as well as expedite recovery as much as possible. The following procedures will be utilized to assess and rehabilitate your concussion so that you can recover as quickly and safely as possible:Concussion Rehabilitation and Baseline Testing
A series of Cognitive Performance Tests (CPT’s):
- Sustained Attention
- Short-Term Memory (Visual and Auditory)
- Working Memory (Visual and Auditory)
- Sequential Memory
- Episodic Memory
- List Retention
- Stroop Test
- Wisconsin Card Sorting Test
- Spatial Sorting
A 19 channel Quantitative Electroencephalogram (qEEG)
The TOVA Test (Test of Variable Attention)
The IVA-2 (Integrated Visual & Auditory -2 Continuous Performance Test
A Cognitive-Perceptual Assessment
Remember, most concussions will not show up on CT scans or other neuroimaging processes. There is also no set time for recovery, as everyone is different.
“Concussions aren’t just from a “blow” to the head – any body blow can cause the whiplash effect that injures the brain.”
“The degree of severity is determined over time by symptoms and relief of symptoms.”
Quantitative Electroencephalography (qEEG) & Neurofeedback
Quantitative Electroencephalography (qEEG) is a brain imaging technique that provides a wealth of information regarding brain function that allows us to better understand an individual’s experienced symptoms and behavior. Creating a map of the brain’s electrical activity is actually fairly straightforward and takes only a couple of hours. It is also completely non-invasive and pain-free. This procedure allows us with pinpoint accuracy to identify what parts of the brain aren’t “firing” correctly, and why.)
Our Lead Psychologist will conduct a thorough post-injury evaluation in order to gain a complete picture of your injury and how it’s impacted you. This includes a detailed interview in order to obtain information on:
- How the injury occurred
- How you felt immediately after
- How you’re feeling currently
- History of previous concussions
- Current and past medical conditions
- Previous trauma/injury
Neurofeedback, also called EEG feedback also known as Electroencephalography (EEG) Biofeedback is a learning strategy that enables a person to alter their own brain waves.
For over four decades, EEG has been used in research and medical settings to help train individuals to change brain wave patterns. Only recently, have advances in computer technology made it widely available for the general public and athletic populations.
Thus, Neurofeedback can be referred to as brain exercise or mental training. Neurofeedback is training in self-regulation. Good self-regulation is necessary for optimal brain function and performance optimization. Self-regulation training enhances the function of the central nervous system and thereby improves mental performance, emotional control, and physiological self-regulation.
During a 50-minute Neurofeedback session, sensors are attached to the scalp at preselected locations with EEG paste, which detects the brain waves. It is a painless procedure and does not involve the application of any voltage or current to the brain. It is entirely non-invasive.
The Neurofeedback Performance Psychology Consultant observes the brain in action on the computer screen from moment to moment by monitoring brain waves and rewards shifts towards more optimal and stable brain states.
As the client engages in a training screen or video game that responds to the client’s brain waves that represent well-regulated attention focus and arousal levels the graphics appear uninterrupted.
Conversely, when the brain waves are not meeting the parameters set by the intervention, the training screen or video game is temporally stopped. Specifically, Neurofeedback (auditory and visual) allows the client’s brain to detect and release un-useful or sub-optimal patterns, which can be a source of distraction-such as negative self-talk and self-regulate them and convert them into a positive attentional focus.
Consequently, the brain responds to the challenge of the feedback and moves towards a more adaptive and flexible functioning. During the course of the training, program settings are continuously adjusted on the feedback program to define greater challenges for the client until the client achieves mastery. In some cases, this can be done in 15-20 sessions, in others it could take quite a bit longer (80-100).
Contact us for more information on concussion rehabilitation and baseline testing.
Audio Visual Entrainment / Photic-Biomodulation
This is a technique that utilizes pulses of light and sound at specific frequencies to gently and safely guide the brain into various brain wave patterns. By altering your brain wave frequencies, you have the ability to boost your mood, improve sleep patterns, sharpen your mind and increase your level of relaxation, all with the simple push of a button! AVE also increases brain health by increasing cerebral blood flow and stimulating beneficial neurotransmitters, such as serotonin, norepinephrine, and endorphins.
Cognitive-Perceptual Assessment and Training for Concussion Rehabilitation and Baseline Testing
NeuroTracker emerged out of 20 years of neuroscience research to enhance cognitive performance and endurance. It challenges you to track multiple targets moving dynamically in 3D space. Training sessions are continually adapting for speed and complexity to ensure your brain is being challenged at a threshold that promotes the most change.
NeuroTracker isolates, trains and tests the high-level mental resources that are necessary for the perception of complex movement in a dynamic sports environment. These perceptual-cognitive resources are known be sensitive to concussion-related damage, particularly during late recovery stages when impairments are measurable but the patient is otherwise symptom free and feeling normal. For this reason, combined with the reality that NeuroTracker is a direct objective measurement of brain function and processing speed, NeuroTracker is an ideal baseline measurement in any concussion program. A baseline session lasts approximately 30-40 minutes.
Zone Performance Psychology has partnered with NeuroTracker to assist our patients in both their concussion rehabilitation, and sports performance. The systems and cognitive functioning that are impaired following a concussion are the same as what athletes need to perform at their best during competition. This is what makes NeuroTracker such a valuable tool for both concussion patients, and athletes striving to give themselves an edge to perform at their best.
Brain scans reveal that NeuroTracker training sustainably increases brainwave speeds, associated with heightened alertness and learning capacity. This is also associated with increased neuroplasticity, meaning that the brain has an increased ability to adapt and change to better respond to the demands of functioning in day to day life. Research has shown that the use of NeuroTracker enhances attention, alertness, working memory and processing speed. What does this mean? The use of this tool will allow you to use your visual system more efficiently in a way that allows you to better attend to multiple sources of information in your environment, pay attention for longer with sustained focus, and maintain enhanced awareness.
Often times following a concussion, we hear patients describe forgetfulness, word finding challenges, difficulty with multi-tasking, and challenges engaging in group discussions. When used in combination with an appropriate assessment and treatment program, NeuroTracker can help improve brain function by reteaching patients how to simultaneously integrate the systems that are necessary for recovery and can otherwise be difficult to train.
At Zone Performance Psychology, we will incorporate NeuroTracker training into your post-concussion rehabilitation program to allow for enhanced recovery of cognitive and visual processing systems.
Heart Rate Variability Training
Heart Rate Variability (HRV) is a technique that measures your physiological functions under stress and peak performance like breathing (respiration rate RR), heart rate (HR), and blood pressure (BP). This technique teaches clients how to self-regulate these functions through diaphragmatic breathing techniques taught at an optimal pace to ensure coherence between heart rate and respiration.
More specifically, heart rate is coordinated with your breathing patterns and vice versa. The client will receive feedback on the monitors how these physiological functions change (HRV) under situations of stress and optimal functioning in both performance and life situations. The aim of the process is to teach clients how to control or self-regulate HRV for optimal functioning under pressure on demand.
The biggest concern surrounding concussions comes from the energy deficit that occurs in the brain following injury. When the brain is in this low energy state, it has been well established that the brain is extremely vulnerable to additional trauma, where even smaller impacts can lead to another concussion; and these second concussions can cause severe brain injuries with potentially permanent or fatal outcomes.
The problem is that symptoms (meaning how someone feels) do not coincide with brain recovery. The only way to know when the brain has fully recovered and out of this “vulnerable period” is to compare current brain function to when the individual was healthy; this is what is known as a “baseline test”.
A baseline test is a battery of tests that measure every area of brain function that could potentially become affected following a concussion (you need more than computer tests!!). The reason that the test is termed a “baseline” is that it is done BEFORE the athlete gets injured. In order to know when an athlete has fully
recovered, we first have to know where they were when they were healthy. Without having this information, there is no way to truly know when an athlete has fully recovered and is safe to return to their sport.
Baseline testing is the most important thing to get done prior to beginning your sports season on a yearly basis. Comprehensive baseline testing helps us help you and your coach know when you’re ready to get back in the game if you experience a concussion during the season. Your concussion experience, like yourself, is unique.
Our concussion baseline testing keeps you safe on the field.
“We want you to avoid the bench this season. Our concussion baseline testing can make all the difference.”
We believe every athlete playing a contact sport (hockey, soccer, football, lacrosse) should have baseline testing completed before the beginning of each season.
Comprehensive baseline testing helps you and your coach know when you’re ready to get back in the game if you experience a concussion during the season. Your concussion experience, like yourself, is unique.
6 Steps to Return To Play and Academics with Concussion Rehabilitation and Baseline Testing
A typical return to play or activity protocol is as follows.
Please note that each level is a step, not a day, so it may take more than one day to proceed with each step. However, each step should take a minimum of one day.