Level 1 of the Carrick Institute’s Functional Neurology Management of Concussion was dedicated to understanding, identifying, and managing the acute phase of concussion. Level 2 picks up where Level 1 leaves off and builds a comprehensive understanding of concussion’s sub-acute and persisting phases. Under the guidance and leadership of our lead instructor, Dr. Matthew Antonucci, our medical advisory board of expert multidiscipline providers has developed a curriculum including over 500 Entrustable Professional Activities (EPAs) in 10 chapters necessary to understand, disentangle and correct the complex neurological remodeling that occurs with persisting concussion dysfunction. 

Chapter 1: The Entanglement of Neurological Hubs and Edges after Concussion This chapter dives deeper into the pathophysiology of concussion leading to alterations of neurological networks that manifest as the morbidity after a concussion. Particular attention is given to mitochondrial, neurophysiological, neuroanatomical, vascular, immune, inflammatory, oxidative stress mechanisms, disruptive equipotentiality, and their effects on functional remodeling. The goal of this chapter is to establish a basis for special testing and a rehabilitation construct for concussion rehabilitation. 

• Recapitulation and expansion on the dynamics of the pathophysiology, feedback loops, and persistence of concussion symptoms, with correlation to patient presentations and complaints 
• Applying the Lashley’s principle of equipotentiality and sensory reorganization to understanding the protraction of concussion signs and symptoms 
• Identifying and understanding cortical processing networks and their relationship to concussion 
• Understanding the cyclical influences of sensory-cognitive-motor processing and neural plasticity 
• Fundamentals of functional imaging and entry-level interpretation 
• The Function-Neurology Matrix: Function vs Anatomy 
• Kleim’s 10 Principles of Experience-Dependent Neuroplasticity and Brain Injury
• Applying Kleim’s Principles in Concussion Rehabilitation 
• Review literature surrounding neuromodulation technologies and their appropriateness for the treatment of concussion 
• Discuss the research on uni-modal vs. multi-modal rehabilitation programs
• Applying concepts in neuro-ontology in the creation of concussion treatment programs
•  The transition from concussion screening and examination to special testing.

Chapter 2: Autonomic/Physiologic Dysfunction After Concussion 

Research supports that more than 85% of all concussions have varying degrees of autonomic dysfunction. Autonomic function may be primary or secondary to other sensory processing abnormalities. Understanding how to critically evaluate autonomic function and compare outcomes to other sensory aberrancies allows a clinician to be more effective and efficient. This chapter will review autonomic function and dysfunction secondary to concussion. It will also delve into the downstream effects of autonomic dysfunction. 

• • Autonomic anatomy and physiology 
  • Primary autonomic disorders 
  • Common autonomic syndromes secondary to other dysfunctions 
  • Neurological control of the autonomic nervous system 
  • Neuro-cardiovascular influences on cerebral blood flow 
  • Evaluating autonomic/physiologic function 
  • Consequences to dysautonomia

Chapter 3: Implications of Peripheral and Central Vestibular Dysfunction in Concussion In human development, the vestibular system is the most precocious sensory system. It is the foundation upon which the human brain is built. Due to its early development, humans do not have a vestibular cortex; rather, it is omnipresent in the brain. When vestibular transduction or integration is impaired, pervasive dysfunction can manifest. This chapter aims to understand the vestibular system and its influence on human function. 

• Explore the anatomy and physiology of the vestibular system from peripheral to central, including more common vestibular presentations/pathologies that are connected to or comorbid with a concussion
• Review and comprehend all vestibular reflexes, their normal and abnormal presentations ● Implications of common and special diagnostic procedures and their results on localization of vestibular decompensation: 

1. 1.  Computerized Posturography 
   2. Rotary Chair Testing 
   3. Video Head Impulse Testing 
   4. Videonystagmography (VNG) 
   5. Caloric Irrigation 
   6. VEMPs 

• Understanding the interplay between the vestibular system and the concussion subtypes and associated conditions 
• Vestibular rehabilitation procedures and treatment programs 

Chapter 4: Proprioception, Somatosensation, Spatial Processing and Concussion The sense of one’s self is second to manifest during fetal development. Proprioception is vital to proper human biomechanics and embodiment. Proprioception is also the second of three human spatial awareness components. Alterations in proprioception can impair the sense of one’s self, muscle contraction, coordination, tactile processing, and relationship with the extracorporeal world. This chapter will allow the scholar to comprehend the neurology of proprioception and its relationship to concussion. 

• The anatomy of proprioception from peripheral to central 
• Assessments of proprioception and their interpretation 
• The integration between proprioception and vestibuloception 
• Common proprioceptive deficits in concussion 
• Somatic syndromes associated with concussion 
• Proprioceptive, somatostethtic, and spatial processing rehabilitation procedures and techniques 
• Utilizing proprioceptive strategies to enhance or substitute for vestibular function 

Chapter 5: Olfaction, Gustation, and Auditory Processing Disorders Associated with Concussion 

Audition is a complex function of soundwave transduction, neurological relays, computation, and interpretation that can be compromised during a brain injury. Common presentations after concussions range from tinnitus, phonophobia, and misophonia, to more generalized auditory processing disorders. This chapter will elaborate on the neurology of auditory processing and pathological processes associated with concussion. 

• The anatomy of audition from peripheral to central 
• Assessing hearing and sound localization 
• Common auditory pathologies that may manifest after concussion 
• Therapeutic interventions to augment or manipulate olfaction, gustation, and auditory processing 
• Utilizing olfaction, gustation, and auditory processing to augment the function of vestibular and other spatial senses

Chapter 6: Visual and Oculomotor Dysfunction in Concussion 

The human visual system is often considered the most dominant sense because it provides the majority of sensory input for our perception of the world. About 80% of our brain’s information about the environment comes from the visual system. The brain controls its visual input through a symphonic coordination of 3 intra-ocular muscles, 6 extra-ocular muscles, 4 facial muscles, and our neck muscles. This chapter details the various visual and oculomotor processes affected by concussion, their assessment, and their effect on human functioning. 

• The anatomy and physiology of the visual and oculomotor system from peripheral to central 
• Basics of visual refraction 
• Special testing of the visual system 

1. 1. ○ Visual Evoked Potentials 
   2. ○ Electroretinography 
   3. ○ Pupillometry 

• Oculomotor Functions and Pathologies: 

1. 1. ○ Accommodation 
   2. ○ Ocular alignment 
   3. ○ Ocular reflexes 
   4. ○ Gaze Maintenace 
   5. ○ Saccades 
   6. ○ Pursuits 
   7. ○ Vergence 

• Rehabilitation strategies for visual and oculomotor pathologies commonly associated with concussion 

Chapter 7: Level 2 NeuroSkill Laboratory A: Diagnostic Skill Acquisition Implementation and practice of diagnostic skills introduced in Chapters 1-5 (3 Days of Onsite Training)

Chapter 8: Cognitive and Affective Dysfunction Associated with Concussion Cognition and Emotion are mammalian evolutions out of a necessity to more efficiently and effectively interact with our environment through action or inaction. Disruption of sensory processing alters cognitive framework, disrupting cognitive processes. Additionally, cortical and sub-cortical injury associated with the biomechanical forces may disrupt or alter cognitive and/or emotional processing. 

• Review and understand the neurological constructs of intelligence 
• Become familiar with the neurophysiological implications of learning 
• Discuss the neuroanatomy and functional networks associated with primary domains of cognitive function. 

Chapter 9: Clinical Concept Integration and Implementation Strategies This course underscores the concept that humans learn by association. The information presented in this course can be overwhelmingly abundant and complex when viewed in solidarity. In this chapter, Dr. Antonucci will break down the course into hierarchical concepts and decision trees in an attempt to make the information easily accessible and implemented. Patient cases will be presented, reviewed, and discussed in the context of the information presented in the course to solidify learning objectives. 

Chapter 10: Level 2 NeuroSkill Laboratory B: Therapeutic Skill Acquisition Implementation of therapeutic strategies and techniques introduced in Chapters 1-9 – (3 Days of Onsite Training)