Traumatic Brain Injury

Assessment and Treatment

At Montreal Neurotherapy Center, patients with traumatic brain injury receive comprehensive care from neuropsychologists, neurofeedback clinicians, occupational and speech-language therapists.

OUR ASSESSMENT

Assessment & treatment

OUR TECHNOLOGY

The tools we use

IMPROVEMENTS

This is how you will improve

SCHEDULE

A 15 minutes FREE consultation

Teletherapy and Digital Health

In light of the current situation, we are pleased to offer Telehealth services for mental or neurological disorders. We offer an online physical and cognitive rehabilitation program as an alternative treatment option to meet the individual needs of our clients.

HAS A DRAMATIC BRAIN INJURY RESULTED IN LONG-TERM ISSUES SUCH AS…

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DIZZINESS/COORDINATION

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DIFFICULTY WALKING

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TROUBLE CLIMBING STAIRS

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DIFFICULTY COMPLETING EVERYDAY TASKS

If you or your loved one are still experiencing these issues and have reached the limits of current/past treatment, register for a free 15 mins phone call to learn more about our Traumatic Brain Injury Treatment.

Over 500,000 Canadians sustain a traumatic brain injury each year. Let us put our expertise towards better days.

SCHEDULE A FREE CONFERENCE CALL WITH A SENIOR TEAM MEMBER

– We collect a brief history of the problem 

– We discuss your medical records if any

– We explain additional testing/evaluation needed

– We explain the content of the program

– We explain the costs

WHAT IS TRAUMATIC BRAIN INJURY?

what-is-tbi

While most individuals report recovery from mild/moderate TBI within 3 to 12 months after the injury, it is estimated that 15 to 25% of individuals with TBI have persistent post concussive symptoms (PCS), including cognitive problems (e.g., attention, memory), somatic symptoms (e.g., headache and fatigue), affective symptoms (e.g., depression, irritability), sequelae that undermine the ability to carry out daily activities. At present, the primary approach for treating TBI is through physical medicine. We use a systematicand unified aproch that is based on neuroplasticity with specific forms of motor-behavioral interventions.

DIAGNOSIS OF TRAUMATIC BRAIN INJURY AND ASSESSMENT AND TREATMENT OF POST-CONCUSSIVE SYMPTOMS

  • STEP 1

    Computerized Battery for Assessment of Neuropsychological Symptoms

  • STEP 2

    Physiological Stress Test

  • STEP 3

    Measures of eye movement control

  • STEP 4

    QEEG (Quantitative Electroencephalogram)

  • STEP 5

    Quantitative Balance and Gait Assessment for TBI

  • STEP 6

    Report with Diagnosis and treatment plan

ASSESSMENT CONDUCTED BY:

Dr. Alain Ptito, Neuropsychologist

Dr. Simon Tinawi, Physiatrist

Cost of assessment:  $3,500

Duration:  6 hours (average) 

OUR TECHNOLOGY

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Quantitative Electroencephalogram (qEEG)

A QEEG is an assessment tool to evaluate a person’s brainwaves and determine to what extent the brainwave patterns differ from normal. Recent research shows that certain dysfunctions, such as ADHD, Schizophrenia, OCD, Depression, Specific Learning Disabilities, and others are associated with specific patterns in spontaneous and evoked electrical potentials, recorded from the head by multiple surface electrodes, and that these spontaneous potentials and especially the evoked electric potentials provide reliable brain markers of the brain function and dysfunction.

Vision Assessment

Saccade Analytics believes that accurate diagnosis of brain function is key to protecting patients and improving health outcomes. Objective measurements help to inform diagnosis, personalized treatment, and recovery tracking. It starts with a 5-minute set of tests in virtual reality, which measure how the patient’s eyes and head respond to basic tasks. Based on this data, our software generates a report of metrics specific to various key systems in the brain.

Balance Gait Assessment

VSTBalance is a 3D motion analysis system. It is a single infrared camera used to administer evidence-based gait and balance tests. The system provides detailed kinematic data which is compared against norms, and can be used to develop a plan of care. VSTBalance provides biofeedback training and a library of corrective exercises a patient can perform after discharge. Overall the system establishes baseline metrics, tracks progress, and measures outcomes.

Neurofeedback?

EEG Neurofeedback is a form of Biofeedback that uses real-time digital technology to measure electrical activity of the brain (EEG) and present this information in a form that enables the individual to perceive changes in the state of the brain and learn to modify abnormal EEG patterns. Click here for more information.

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rTMS

Transcranial Magnetic stimulation rTMS is a procedure in which cerebral electrical activity is influenced by a pulsed magnetic field. The magnetic field is generated by passing brief current pulses through a figure 8 coil. This coil is encased in plastic and is held close to the scalp so that the magnetic field can be focused onto specific areas of the cortex, or surface, of the brain. Click here for more information.

Transcranial Direct Current Stimulation (tDCS)

Transcranial direct current stimulation (tDCS), is a non-invasive, painless brain stimulation treatment that uses direct electrical currents to stimulate specific parts of the brain. The therapy works by delivering a low intensity electrical current to part of the brain responsible for abnormal pain sensation. This constant, low intensity current is passed through two electrodes placed over the head which modulates neuronal activity. Click here for more information.

Vlight

Photobiology is the study of the effects of non-ionizing radiation on biological systems. The biological effect varies with the wavelength region of the radiation.

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THIS IS HOW YOU WILL IMPROVE

.

1

High-Tech

Modalities


You will get the best therapeutic modality that is available today to treat your chronic pain efficiently. We use the most advanced equipment on the market.

2

Manual Medicine 


You will receive hands-on therapy which includes gentle joint stretching or mobilization to improve joint mobility and muscle dysfunction in the spine, peripheral articulations or adjacent structures.


 

3

Physical Therapy


Physical therapy will help you improve your physical function and 
mobility.
You will have training in activities of daily living to help you b
ecome more independent.

4

Medical

Monitoring



You will have ongoing consultations with a doctor trained in chronic pain care who focuses on the evaluation, treatment, and prevention of pain. We will help you move towards your desired goals and track progress.

OUR TEAM

  • Dr. Alain Ptito
    Dr. Alain Ptito Neuropsychologist
  • Dr. Philippe Estérez
    Dr. Philippe Estérez Family Doctor
  • Marcos Rodrigues
    Marcos Rodrigues Physiotherapist

See How The Montreal Neurotherapy Center Can Help!

STEP 1: Computerized Battery for Assessment of Neuropsychological Symptoms

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.

STEP 2: Physiological Stress Test

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.

STEP 3: Measures of eye movement control

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).

STEP 4: QEEG (Quantitative Electroencephalogram)

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.

STEP 5: Quantitative Balance and Gait Assessment for TBI
  • 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

STEP 6: Report with Diagnosis and treatment plan

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.)