We have access to computer-assisted tests that can be administered in 2 hours. The test battery consists of alternate forms by randomly varying the stimulus array for each administration and minimizing practice effects. The system allows presentation of French and/or English auditory as well as visual material and responding is carried out orally, on a touch screen, or with the use of a joystick. Neuropsychological assessments can be used in many different contexts: – to determine current cognitive and affective states; – to obtain objective information about disabilities and any resulting social and professional handicaps; – to evaluate rehabilitation options and the possibility of reintegration into work; – to plan rehabilitation treatments; – to identify changes in cognitive and affective functions over the course of a disease, or to assess the effects of therapy; – to describe the results in medical reports or expert opinions; – to assess motivation, maximum effort, amplification, simulation or malingering (e.g. TOMM, Dot counting test, Rey 15-item); – to measure cognitive processes of memory, attention, language and visuospatial skills; – Measures of ATTENTION: Alertness, Sustained attention, Focused attention, Divided attention, Selective attention, Vigilance. – Measures of memory: Working memory, Short-term memory, Long-term memory. – Measures of executive functions: Interference, Cognitive flexibility, Planning ability, Response Inhibition, Reasoning clinical, Task switching. – Measures of language: Language comprehension, Number comprehension. The following tests will be administered, if necessary, according to the recommendations of Dr. Simon Tinawi, physiatrist and Dr. Alain Ptito, neuropsychologist. Both are recognized experts in the assessment and treatment of traumatic brain injury.

V.C. Psychophysiological Assessment Psychophysiological assessment involves recording and quantifying various physiological responses in controlled conditions using electromechanical equipment (e.g., electromyography, electroencephalography, electrodermal activity, respiratory activity, electrocardiography). Which response or response system is measured depends on the purpose of the assessment. Psychophysiological measurement has been used to assess autonomic balance (e.g., heart rate, diastolic blood pressure, salivation), habituation to environmental stimuli, reactivity to traumatic imagery, orientation response, and other physiological systems. The psychophysiological assessment provides the possibility to estimate physiological functions under different conditions: at rest, under stress and during recuperation. Having exaggerated reactions to stressors as well as requiring a prolonged period to return to baseline level could be related to physical and/or psychological symptoms as well as to difficulties with ADL and AVQ’s. Under stress conditions, the body is programmed to fight, fly or freeze. There is increased cardiac activity along with increased blood flow to bodily organs in order to mobilize the necessary energy for movement.

A simple 20-minute set of tests in virtual reality (VR) to measure the patient’s eyes and head movements as they perform simple tasks. Each test is designed to target specific neurological functions. The intent is to create a mobile, light and precise package that would function without an expert medical clinician for early triage of mTBI, dizziness, or visual-vestibular disorders. Being light and automated, the package also allows home (or special clinic) monitoring of rehabilitation. The main benefits of finding a significant correlation between oculomotor dysfunction and mTBIs are: 1. quantitative metrics for diagnosis; 2. reduction of unnecessary MRIs; 3. personalised rehabilitation programs based on specific dysfunction; 4. patient progress tracking; 5. accelerated recovery due to proper diagnosis and rehab resulting in lower costs to society. NeuroFlex® by Saccade Analytics™ evaluates eye and head movements in response to visual and vestibular stimuli, or their lack thereof (e.g., to evaluate spontaneous nystagmus) to detect deviations from the ‘normal’ eye and head responses of healthy subjects. Instrumentation consists of off-­‐the-­‐shelf virtual reality goggles (e.g. FOVE) equipped with binocular recordings in 3D (horizontal, vertical & pupil size) and head recordings in 6D (3D angular and 3D linear accelerations). By choosing a head-­‐mounted system, we will be able to evaluate oculomotor integrity in mobile situations with totally automated analysis even in the field. With the Saccade Analytics approach, we will detect pro-­‐saccades with a gap effect, anti-­‐saccades, 2D smooth pursuit, visually guided saccades, visual-­‐vestibular interactions with and without a free head, Optokinetic Reflex (OKR) and Vestibular Ocular Reflex (VOR).

Mild traumatic brain injury (TBI) may be associated with dysfunctional frontal, temporal and parietal lobes, often despite a lack of evidence of brain abnormalities on conventional MRI and CT scans. In contrast, quantitative EEG has been shown to be highly sensitive (96%) to post‐concussion syndrome. The obtained EEG severity index may be of value in establishing whether or not there is a neurological basis for the patient’s complaints. It may be used as an adjunctive diagnostic test or as one more measure of the origin of a patient’s complaints. The EEG severity index also provides an objective measure that can be used for prognostic purposes in devising and evaluating presently used treatment methods as well as new methods for treating patients who have suffered a traumatic brain injury.

– mCTSIB (modified Clinical Test for Sensory Inputs on Balance) ‐ measures a person’s three sensory inputs on balance in a four‐part assessment. – Functional Reach – a special test used as an outcome measure in physical therapy. It is used to assess your balance and functional motion after an injury or illness or when you may have limited mobility. – Sitting Reach – similar to Functional Reach but performed from a seated position. – Gait Analysis – Gait analysis is a method for identifying biomechanical abnormalities in the gait cycle ‐ in other words, it’s a way of assessing the way in which you walk and run. – TUG (Timed Up and Go) – a simple test used to assess a person’s mobility and requires both static and dynamic balance. It uses the time that a person takes to rise from a chair, walk three meters, turn around, walk back to the chair, and sit down. – Tinetti Test – The Tinetti Test, or Performance Oriented Mobility Assessment (POMA) is a common clinical test for assessing a person’s static and dynamic balance abilities. – Berg Balance Scale – The Berg Balance Scale is a widely used clinical test of a person’s static and dynamic balance abilities. – 5x Sit to Stand – Assesses functional lower extremity strength, transitional movements, balance, and fall risk. – Questionnaires – Neurobehavioral Symptom Inventory (NSI) – Subjective inventory of TBI symptoms – Pittsburgh Sleep Quality Index (PSQI) – Headache Disability Index (HDI) – Assesses frequency & severity of headaches – Neuro-QOL – Beck Depression Inventory (BDI) – Beck Anxiety Inventory (BAI) – Fatigue questionnaire – Alcohol and drug consumption questionnaire – PCL-S for assessment of post-traumatic stress disorder (PTSD) – Rivermead post concussive questionnaire

The diagnosis of co-morbidities or MTBI will be confirmed or denied by the physiatrist on the basis of a complete review of the medical chart, the answers to the questionnaires and the neurological examination. In addition, the physiatrist will take into consideration all the potential contributing factors which may prolong the rehabilitation period or alter the outcome (e.g. Migraines, previous TBI, depression, ADHD, alcohol and drug use, etc.)