The Functional Neurology Center’s Comprehensive Approach to Treating Post-Concussion Syndrome

“We’ve seen complete resolution of symptoms in people who had been suffering from PCS for decades.”

If you or someone you love has suffered from post-concussion syndrome (PCS), you know it’s one of the most challenging conditions following a traumatic brain injury (TBI). With persistent symptoms such as headache, fatigue, vision changes, disturbances in balance, confusion, dizziness, insomnia, neuropsychiatric symptoms, and brain fog, PCS can significantly impact quality of life long after the initial injury has healed.

Roughly 1.5 million Americans sustain a head injury each year, according to the CDC. Most recover within a month as neuroinflammation recedes. However, if symptoms persist beyond three months, the individual is considered to have persistent PCS. This happens in at least 15% of mild TBI cases, with lasting effects on cognition, memory, learning, and executive function. Patients who suffer more than one brain injury are at increased risk for PCS.

Traditional approaches often fall short in treating PCS, leaving patients frustrated, with unresolved symptoms and limited options. This is where the Functional Neurology Center (FNC) steps in with a revolutionary approach.

Functional neurology is an interdisciplinary field dedicated to understanding and enhancing brain function through targeted, non-invasive therapies. By combining insights and techniques from manual therapy, visual science, vestibular rehabilitation, autonomic medicine, neuropsychiatry, functional medicine, and nutrition, and designing a personalized approach for each individual patient, functional neurology offers new hope for those suffering from PCS.

Detailed evaluations find what other providers have missed

Under the expert guidance of Dr. Jeremy Schmoe, DC, DACNB, The FNC employs a multifaceted strategy that addresses the root causes of PCS rather than merely managing its symptoms. It begins with a multidisciplinary assessment and detailed patient evaluation to understand the full range of symptoms and identify their root causes.

The FNC uses some of the most advanced diagnostic tools and technology available to identify imbalances, conditions, and causes that conventional testing too often misses.

“This is the story we hear over and over again: Hey, my CT scan was normal, my imaging was normal, and yet I still don’t feel right,” says Schmoe. Using sophisticated diagnostic tools such as complex visual vestibular assessments, videonystagmography, and video oculography, the FNC regularly identifies causes of ongoing symptoms that were missed by other providers.

In addition to a detailed patient history, here are some of the cutting-edge diagnostic tools used at The FNC:

Videonystagmography (VNG):

• Used to evaluate the vestibular system (inner ear and brain), which is responsible for balance and spatial orientation. VNG uses infrared video cameras to record and analyze eye movements. The patient is asked to perform various tasks such as following moving objects with their eyes, positioning maneuvers, and responding to changes in head position.
• VNG can identify issues like benign paroxysmal positional vertigo (BPPV) and other vestibular dysfunctions. It helps in pinpointing whether dizziness and balance problems are due to inner ear disorders or central nervous system dysfunction.

Video oculography (VOG):

• VOG uses high-resolution cameras to precisely track eye movements. It can detect abnormalities in eye tracking, fixation, saccades, and smooth pursuits. Patients may be asked to follow visual targets on a screen, while the device records the eye movements to analyze their accuracy and coordination.
• VOG can identify oculomotor disorders and neurological conditions that affect eye movement and coordination.

RetiTrack

• This technology involves laser-guided ophthalmoscopy to look at the back of the retina and assess eye stability and movement.
• Can help diagnose ocular tremors and other subtle eye movement disorders that less sophisticated tests often miss.

Video head impulse test (vHIT)

• Also known as the head thrust test, EyeSeeCam vHIT is a powerful tool to assess vestibular function and the vestibular-ocular reflex in people with dizziness.
• Can determine if dizziness is related to a vestibular disorder.

Saccadometry

• An advanced protocol that analyzes movements of the eyes as they shift focus from one point to another, providing insight into visual and neurological function.
• Can help diagnose central vestibular injuries including TBI, concussion, and neurodegenerative diseases affecting brain areas that control eye movements.

Subjective visual vertical (SVV) testing using virtual reality (VR)

• Measures how accurately one can determine the vertical position of a line or object, using VR to create immersive environments for more accurate measurements. Used to evaluate balance disorders and dizziness.
• Provides insight into the function of the vestibular system. Can help differentiate between central (brain-related) and peripheral (inner ear-related) vestibular disorders.

Platform posturography

• A technology used to graph and analyze a patient’s balance by assessing their ability to maintain stability under various conditions.
• Can help identify the underlying issues contributing to balance disorders and related symptoms.

NeckCare goniometer

• A device that maps out the joint position sense of the neck, assessing range of motion and hypermobility.
• Can identify instability in the neck.

Positional testing and maneuvers

• Physical exams such as the Dix-Hallpike maneuver and the Roll test can provoke symptoms and abnormal eye movements.
• Can indicate the presence of displaced calcium crystals in the inner ear, specifically to diagnose Benign Paroxysmal Positional Vertigo (BPPV).

Genetic testing

• A cheek swab test used to map out metabolic functions, such as B12 absorption, glutathione status, and histamine breakdown.
• Can help identify underlying genetic issues that may affect recovery.

Functional medicine labs

• Tests can include nutritional and micronutrient status, inflammatory markers, gut health and microbiome analysis, hormone panels, mold and mycotoxins, Lyme disease and co-infections, food sensitivities and allergies, heavy metal toxicity, and autoimmunity.
• Can provide insights into a patient’s biochemical and physiological status, which can be crucial for identifying underlying issues that may impact recovery.

“With a lot of people, their imaging looks good, their CT is good, their MRI is good, and their eye movements are pretty good. But if no one has looked at their various systems as a whole and how they’re integrating and working together, a lot can be missed,” says Schmoe.
This includes taking into account things like chronic stress, gut inflammation, and limbic dysfunction that are less likely to show up on conventional neurological tests. “These are the things that can snowball and lead to chronic PCS, because everything loops on top of each other,” says Schmoe. “Our job is to figure out and disrupt those loops.”

Customized treatments restore balance, integration, and function

PCS symptoms span a range of categories, including visual, vestibular, biomechanical, autonomic, emotional, hormonal, and sleep. Many people with PCS have symptoms in multiple categories. “That’s usually where people get stuck. They just had someone work on their neck or they did vision therapy, but really they have a neck problem, a visual integration problem, their vestibular system is off, they’ve developed dysautonomia, they’ve concussed their pituitary gland, and they have hormonal imbalances all at the same time,” says Schmoe.

The FNC approach involves identifying all the underlying issues, then figuring out where to jump in to initiate the greatest therapeutic improvement. It takes into account all the oscillating factors that could affect the stability of the nervous system, and develops a targeted plan to address each of them.

Here are some of the tools The FNC draws on (either in-house or in our referral network) to restore harmonious function in people with PCS:

• Vestibular rehabilitation therapy (VRT): Balance, gaze stabilization, and habituation exercises to improve balance, reduce dizziness, and enhance the integration of sensory information from the vestibular system.
• Visual and oculomotor therapy: Eye movement exercises, convergence training, and visual-vestibular integration exercises to improve eye tracking, coordination, and visual processing.
• GyroStim multi-axis rotational chair: Provides precise vestibular stimulation through controlled rotations and movements to improve vestibular function, balance, and spatial orientation.
• Hyperbaric oxygen therapy (HBOT): Breathing pure oxygen in a pressurized environment to enhance oxygen delivery to brain tissues, promote healing, and reduce inflammation.
• Manual therapy and chiropractic adjustments: Spinal adjustments, soft tissue manipulation, and cranial therapy to address musculoskeletal issues, improve spinal alignment, and reduce pain.
• Pulsed electromagnetic field therapy (PEMF) and ARPwave: Uses electromagnetic fields or direct current electrical stimulation to stimulate cellular repair, reduce pain and inflammation, and promote healing in damaged tissues.
• Functional medicine and nutritional therapy: Dietary changes, supplementation, and personalized nutrition plans to reduce inflammation, address nutrient deficiencies, and support overall brain health.
• Autonomic regulation therapy: Includes heart rate variability training, biofeedback, and tilt table therapy to improve autonomic nervous system function and reduce symptoms like dizziness, fatigue, and cognitive fog.
• Vibroacoustic Feedback: Retrains brainwave patterns and enhances neuroplasticity to improve cognitive function, reduce anxiety, and enhance emotional regulation.
• Virtual reality (VR) motion platforms: Uses immersive environments to challenge and improve balance, coordination, proprioception, and gait stability through simulated real-world scenarios.
• Dynamic vision training and reaction time training: DynaVision machine and other reaction-time training devices help improve peripheral awareness, hand-eye coordination, and reaction times.
• Specialized exercises and physical therapy: Personalized exercise programs tailored to the patient’s specific needs help improve strength, flexibility, coordination, and overall physical function.
• Behavioral and psychological support: Collaboration with mental health professionals for comprehensive care to address the psychological impacts of PCS, such as depression, anxiety, and PTSD.
• Home exercise programs: Tailored exercises that patients can perform at home to ensure continuity of care and reinforce the gains made during in-clinic therapy.

When combined and tailored to the individual needs of each patient, these modalities can be transformative in restoring function and improving quality of life. We’ve seen complete resolution of symptoms in people who had been suffering from PCS for decades.

Many clients visit us for a week-long immersive program that can lead to rapid improvements and lay the foundation for long-term healing. This is augmented by take-home exercises that build on the progress made at the center. Those who live nearby have the option of designing a personalized schedule that fits their needs, allowing for ongoing, flexible access to our comprehensive care and support.

Cristabelle’s story: The FNC approach in action

In 2007, Cristabelle experienced a traumatic brain injury (TBI). She underwent rehabilitation and treatment immediately following her injury but was eventually discharged due to insurance limitations. She continued to struggle with persistent symptoms.

Fast forward to 2019. Eleven years after the initial injury, Cristabelle came to The FNC. During her visit, Dr. Schmoe diagnosed her with an inactive reflex in her right knee. He also identified issues including dysautonomia and vision problems that had contributed to Cristabelle’s previous vestibular therapy being ineffective.

Dr. Schmoe and his team examined her gait and balance, using platform posturography to graph her balance. They conducted a video oculography, having Cristabelle wear goggles that allowed them to graph her eye movements.

“It was crucial to observe what her eyes were doing in the dark. Her eyes were drifting and moving, and she had a vertical nystagmus pattern, which explained why she felt like she was rocking on a boat,” Schmoe says. “Certain areas of her brain were not firing appropriately to keep her eyes steady. As a result, despite vision therapy and physical therapy, she continued to feel unstable even while sitting still.”

Therapies such as GyroStim therapy, soft chamber hyperbaric oxygen therapy (HBOT), and nerve stimulation helped to resolve Cristabelle’s PCS and dysautonomia. Dr. Schmoe also recommended a gluten-free diet, which significantly alleviated her migraine symptoms.

Cristabelle’s journey wasn’t simple. She had to return for additional intensive treatments after a secondary concussion from a fall down the stairs. On these subsequent visits, Dr. Schmoe used newly available technologies, such as advanced eye tracking, VR motion platforms, genetic testing for metabolic function, and wearable technology for tracking eye movements in everyday life.

The results were remarkable. “I don’t need migraine medication anymore. I can now go on an escalator, I can go on an elevator. I would always get triggered by the vertical scrolling motion on my phone, and I can scroll on my phone now (for better or for worse) without symptoms,” Cristabelle says.

She offers words of hope for others who are suffering as she once was: “Whether you’re one day, one month, a year, or 10 years, 20 years, 30 years, even 40 years out from your brain injury, there’s always hope to improve. Don’t ever feel like you have reached the end and you’re never going to get better, because it’s not true.”

To schedule a free phone consultation with the expert team at The FNC, click here.