The Clinic Q&A Five: Shift Concussion Management

Your clinic is called Shift Concussion Management. What is your philosophy behind your name?

Shift Concussion Management

Many moons ago, Shift started as an athletic training facility. The idea was athletes would arrive ready to make a change in emphasis, direction, or focus. As our owner, Scott Haller, was emerging as a leader in concussion management, Shift naturally transitioned to ‘Shifting’ the way we think about concussion management and treatment.

At Shift we proudly offer a strong interdisciplinary model of health care, which is particularly important in the management of concussion and post-concussion syndrome. Sometimes it truly does take a “team” — which in our case includes various health care disciplines both on site and within the community to ensure our patients receive the best possible care. We are dedicated to providing a high standard of evidence-based care to all individuals to get our patients back to work, school, and daily activity safely.

Shireen

Objective testing best reveals the injury, unhampered by either the tester’s or client’s subjective assumptions. You provide a number of diagnostic tests, including Vestibular Ocular Motor Screening (VOMS), gait assessment, exercise tolerance testing, orthopedic assessment, neurological screen, and more. Which one objective test do you believe is key to giving people with brain injury the answer they’ve been seeking as to their most troubling part of their injury, and why?

Shift Concussion Management

At Shift, we believe the best approach is a comprehensive approach – including a variety of objective examinations that best suit our patient’s injury and circumstances. It is important to point out that there is no clear “gold standard” diagnostic test for concussion. It’s important for a trained professional to use a variety of objective testing methods to thoroughly evaluate different areas of potential functional impairment and put together the “puzzle pieces” if you will. Concussions, and post-concussion syndrome in particular, can present in a variety of ways ranging from fairly straight-forward (from the practitioner’s field of view) to extremely complex. In saying this, if we were to have to choose one objective test that is key to giving people with brain injury the answer they’ve been seeking it would have to be the Vestibular Ocular Motor Screen (VOMS).

VOMS is a great tool we use in conjunction with other evaluation methods to identify how a patient’s symptoms are manifesting. For example, dizziness, nausea, blurred vision, diplopia, impaired eye movements, difficulty with reading, headaches, ocular pain, and poor cognitive performance commonly coincide with deficits found on VOMS. By conducting the VOMS, we are able to create a treatment plan around the primary functional impairments specific to each case.

Watch the video below to check out how a VOMS is completed!

Shireen

Your clinic offers a number of treatments to heal brain injury and restore the person, with a focus on cervical, vestibular-ocular, autonomic, and cognitive regulation. Which one solution do you believe every client would benefit from and why? How does this solution work, both as the client experiences it in the short and long term and the science behind it?

Shift Concussion Management

This is a tough question to answer because the solution that every client would benefit from would be an integrated approach to care. While concussions may follow generalized clinical trajectories, to truly recover from a concussion, an integrated approach of the impaired systems is essential. This means integrating vestibular-ocular exercises with rehabilitation for the autonomic nervous system along with cervicogenic treatment and other components as well. It’s also important to note that every concussion is different so an integrated approach to care for one patient may not look the same for another.

Shift Concussion Management
(continued)

Another component of the care we provide that every patient could benefit from would be education and normalization of their symptoms and experiences to date. We at Shift Concussion Management find that through education and explanation of the “Why?” behind symptoms and rehabilitative exercises, patients feel more empowered and encouraged regarding their recovery. We also try to normalize their experiences because while each concussion is different, a lot of what patients are experiencing (while frustrating) is also normal after a concussion and we try to minimize the associated anxiety and mental health components of the injury.

However, something that should be addressed is that sitting in a dark room without any stimulation is no longer recommended for concussion recovery!

After an initial rest period of 48 to 72 hours, we at Shift Concussion Management try to encourage earlier return to activities of daily living as long as they do not provoke symptoms. A big part of our care for most people who come to our clinic is initiation of daily aerobic exercise. Daily aerobic exercise helps to address issues with the Autonomic Nervous System, which is commonly impaired after a concussion. We will work to individualize and track intensity levels and associated symptom responses to encourage an active recovery in our patients.

Initially we will prescribe slow walks for 20 minutes outside at a level that does not provoke symptoms, and as the patient begins to feel better, there are different routes we can take depending on their rehabilitation goals (functional vs athletic, etc.). What we are trying to address is an overactive / stimulated sympathetic nervous system (fight or flight).

Commonly after a concussion, our parasympathetic nervous system (rest and digest) will lose its ability to help in the regulation of our heart rate response. This is partly why concussion patients may experience increasing symptoms such as dizziness, headaches, and feeling lightheaded to name a few with increased activity levels and postural changes (from seated to standing).

Shireen

Collaboration and teamwork provide people with brain injury the foundation from which they can best benefit from treatments. How do you promote collaboration between all the client’s treatment providers and/or between you, them, and their support network?

Shift Concussion Management

We could not agree more. Collaboration and communication are the foundation to our treatment model. Our multidisciplinary team consists of Physiotherapists, Chiropractors, Osteopathatic Manual Practitioners, Registered Massage Therapists, Occupational Therapists, and Kinesiologists on site. Additionally, we have community affiliates that include Family Physicians, Optometrists, Psychotherapists, Community Support Groups, Yoga Instructors for Brain Injury, and more. We recognize that a harmonized approach to concussion care is the best approach. Allowing open and honest communication between everyone involved in a patient’s care ensures that the patient is always put first.

Shireen

Neuroplasticity, the ability of the brain to change itself in real time, was first noted in the late 1700s and proposed by William James in 1890. The 20th century saw much research demonstrating this concept. And in the 1960s and 1970s, researcher-clinicians began to research and clinically apply ways to stimulate the brain’s ability to heal itself. In the last three decades, a number of solutions using neurostimulation have blossomed into reality that heal various aspects of brain injury. Which neurostimulatory solution excites you the most in terms of what it can achieve, and which one is your clinic working towards to incorporate into your offerings and why?

Shift Concussion Management

While to date we have not considered neurostimulatory solutions, we are dedicated to providing evidence-based care. We recognize that there has been growing research to support neurostimulation especially as it pertains to headache management, gait deficits, and many other facets of brain injury. The foundational principle of neuroplasticity is at the core to all of our rehabilitation methods. Knowing that our beautiful brain is able to undergo biological changes and remap neural pathways pushes us to ensure the best possible outcomes for our patients.

In the future, you will see us continue to push boundaries and offer the most up to date cutting edge care. Whether that be neurostimulation, computerized eye tracking*, or perceptual cognitive training* we are always on the lookout for ways to improve our standard of care.

Shireen

What kind of virtual assessments and/or services do you provide, if any?

Shift Concussion Management

Due to the current global pandemic, we have introduced virtual care as a means of staying connected and helping our patients and our vulnerable populations move forward with their recoveries. We know that locally, clinics may not be available to some patients or individuals may not have the means to travel to see us. Virtual Rehab is our way of meeting patients where they are at! Whether we meet virtually, in person, or both, our trusted providers are ready to help you take the first step in your recovery. Click here to learn more!