Carrick Institute

Functional Neurology Management of Concussion (FN-MOC) Level 2

Carrick Institute is proud to bring you one of the most comprehensive concussion and mTBI management programs in the world! 

 Functional Neurology Management of Concussion presented by Dr. Matthew Antonucci.

FN-MOC LEVEL 2 OBJECTIVES

Each chapter of Level 2 will dive into the deepest depths of its content, with a consistent theme of “assess to treat”. In Level 2 we are not concerned with a diagnosis. Every assessment that is performed should provide meaningful therapeutic implications for solving the complex puzzle of protracted and persisting symptoms.

Chapter 1: Understanding Persisting Concussion Symptoms (“Post-Concussion Syndrome”) (via online self-paced learning)

  •  To solve persisting concussion symptoms, scholars must understand why they are persisting, to begin with. The mechanisms of PCS are related-to but are different than the mechanisms of acute concussion. Therefore, they need to be managed differently. Scholars will find these answers and more in this carefully curated flipped classroom assignment.

Chapter 2: Concussion-Related Metabolic, Autonomic, and Sleep Pathophysiology (via online self-paced learning)

  • After weeks, months, and sometimes years of neuroplastic remodeling, the brain and its environment is often in a downward spiral. Chronic inflammation, hormonal disruption, autonomic dysfunction, insomnia, and other challenges perpetuate pain, suffering, injury, and poor quality of life. In this chapter, we will discuss common metabolic, autonomic and sleep disturbances caused by hypothalamic and pituitary dysfunction, as well as remodeled central autonomic networks.

Chapter 3: Vestibular Dysfunction and Central Syndromes (via online self-paced learning)

  • In Level 1, we learned that vestibular processing is the most precocious sensory modality, upon which all other senses are tangentially built. In this chapter, we discuss the advanced vestibular testing, interpretation, and multi-sensory training that can augment central and peripheral vestibular processing.

Chapter 4: Cervical and Somatic Dysfunction and Treatment Strategies (via online self-paced learning)

Chapter 5: Oculomotor and Visual Assessment and Rehabilitation (via online self-paced learning)

Chapter 6: Assessing and Rehabilitating Changes in Cognition and Affect (via online self-paced learning)

Chapter 7: Clinical Workflows, Patient Management, and Treatment Plan Creation (via online self-paced learning)

Chapter 8: Therapeutic Procedures Workshop (3 days of on-site training)

FULL LIST OF TOPICS FOR LEVEL 2:

  1. Understand the biomechanical deformations of neurons and glial structures in concussion
  2. What we know about the loss of consciousness
  3. Astrocyte and microglial activation, cytokine responses, kinases, neuroinflammation, tau deposition, glymphatic, BDNF expression
  4. Nonspecific depolarization involving glutamate, NMDA, and Na/K Pump activity, calcium dysregulation, mitochondrial dysfunction, axonal transport defects, axonal injury, hub dysfunction, and rerouting
  5. Impaired vasoreactivity in mTBI and cerebral blood flow/perfusion dysregulation
  6. Impaired neurotransmission and pain networks, sleep networks, cognitive networks, limbic networks, sensorimotor integration, vestibular function, and predictive brain state.
  7. Predictive brain state’s role in sensory cues, balance, gait, error signaling, perception, confusion/disorientation, executive function, social interaction, and coping.
  8. Sleep’s role in restoration, autonomic function, physical fatigue, headache/migraine, and cognitive fatigue
  9. The role of balancing and reinforcing feedback loops
  10. Explore the depths of the metabolic consequences of concussion (measurable changes laboratory testing)
  11. Critically analyze and understand fuel sources in the presence of concussion
  12. Discuss the mechanisms and findings associated with pituitary injury and dysfunction
  13. Differentiate pituitary dysfunction and hypothalamic decompensation
  14. Become familiar with the immunological consequences of concussion, including cytokine pathways
  15. Identify if concussion may contribute to the development of autoimmunity
  16. Comprehend the role of tau protein and its hyperphosphorylation
  17. Understand alpha-synuclein and its accumulation
  18. Compare and contrast alpha-synuclein, beta-amyloid, and tau
  19. Understand the anatomical locations and connectivity of autonomic structures
  20. Comprehend the function associated with the autonomic structures
  21. Describe the interplay between, and the effects of cognitive, psychological, sensory, and motor pathways on autonomic function
  22. Identify when autonomic dysfunction is functional or anatomical
  23. Comprehend the hemodynamics and physiological implications of cerebral blood flow
  24. Intrinsic vs. extrinsic cerebral blood flow regulation
  25. Head-up tilt testing vs. Head-down tilt testing
  26. Identify when cerebral blood flow may be compromised
  27. Know when and how to order testing for cerebral blood flow
  28. Concussion and the brainstem
  29. Functional neuroanatomy of the brain stem
  30. The mesencephalon, its subnuclei and their functions
  31. The pons, its subdivisions, and their functions
  32. The medulla, its subdivisions, and their functions
  33. Brainstem decompensation: focal or diffuse
  34. Clinical connecotmics of the brainstem
  35. The brain stem and autonomics
  36. The brain stem and sleep
  37. The brainstem in vision and oculomotor function
  38. The brainstem in somatic dysfunction
  39. The brainstem and cognition
  40. The brainstem and affect
  41. Clinica interventions to target brainstem dysfunction
  42. Understand the autonomic regulation of organ systems and how concussion may hypothetically cause alteration in organ function
  43. Describe how dysautonomia can manifest systemically
  44. Discuss commonly observed autonomic findings associated with concussion
  45. Review and identify the three most common autonomic syndromes associated with concussion
  46. Compare and contrast the etiology of post-traumatic headache and migraine 
  47. Identify, compare, and contrast central/autonomic vs cervicogenic headache
  48. Review the autonomic reflexes associated with concussion
  49. Describe the pupillary light reflex, along with its autonomic components
  50. Understand the physiology of static pupil diameter and how concussion may affect it
  51. Describe the neurophysiology of the latency component of the pupil light reflex
  52. Describe the constriction velocity component of pupil light reflex
  53. Describe the return to baseline diameter component of pupil light reflex
  54. Understand the impact of brightness and luminance on pupil response
  55. Explain the asymmetrical function of pupil responses that are supposed to be consensual 
  56. Common neuro-opthalmologic conditions associated with concussion
  57. Performing a fundoscopic examination
  58. Signs and symptoms of cataracts that may mimic concussion, and the mechanism
  59. Signs and symptoms of glaucoma that may mimic concussion, and mechanism of glaucoma
  60. Signs and symptoms of retinal detachment that may mimic concussion, and mechanism 
  61. Using an Amsler grid to evaluate retinal integrity
  62. Evaluating the optic nerve
  63. Changes in optic nerve that may be associated with concussion
  64. Evaluate and interpret the integrity of the Valsalva reflex
  65. Understand how atherosclerosis can affect autonomic baroreflexes
  66. Perform and interpret the oculocardiac reflex
  67. Comprehend how a concussion can affect cardiac function
  68. Comprehend how a concussion can alter vascular tone
  69. Review orthostatic autonomic tests
  70. Compare and contrast tilt table testing with isometric handgrip (IHG) exercises in the identification of sympathetic tone.
  71. Understand common and evidence-supported Graded Exercise Testing procedures for concussion and dysautonomia, in the clinical laboratory,
  72. The Levine and CHOP/Dallas Exercise programs
  73. Recite from memory the contraindications for Graded Exercise Testing procedures
  74. Review commonly utilized rating scales of perceived exertion
  75. Prescribe and administer graded exercise rehabilitation plans when warranted 
  76. Understand the mechanisms and how to identify a TURC Murmur
  77. Apply vascular assessments to Graded Exercise Testing Procedures
  78. Explore the brain-liver connection in concussion
  79. Assess liver function
  80. Explore the brain-kidney connection in concussion
  81. Assess kidney function
  82. Understand the role of the brain in pancreatic function in the presence of a concussion
  83. Assess pancreatic function
  84. Identify the respiratory dynamics that can occur with a concussion 
  85. Understand the potential for digestive alterations after a concussion
  86. Review the implications of sexual health and reproduction on concussed individuals
  87. Comprehend the influence of commonly prescribed medications on autonomic function
  88. Describe the influence the cervical spine and musculoskeletal systems have on autonomic function
  89. Discuss the influence of the vestibular system on autonomic function
  90. Confidently identify whether autonomic dysfunction is primary or comorbid 
  91. Administer and interpret a research-supported, patient-completed survey to identify dysautonomia
  92. Properly perform and interpret pupillary reflexes
  93. Measure neuro-cardiac integrity at the bedside
  94. Perform the Isometric Handgrip Test and interpret findings
  95. Perform and interpret forced breathing tests, such as the Wieling and Karemaker Tests
  96. Assess and interpret heart rate variability, at rest and during exercise
  97. Evaluate and interpret arterial pulse waves
  98. Perform and interpret a Head-Upright Tilt (HUT) Study
  99. Perform and interpret the Buffalo Concussion Treadmill Test (BCTT)
  100. Perform and interpret the Buffalo Concussion Bike Test (BCBT)
  101. Assess vascular tone and perfusion at the bedside and in the clinical laboratory
  102. Understand the role of neuromodulation in treating dysautonomia
  103. Comprehend the research and applications of vagal nerve stimulation
  104. Explore peripheral nerve stimulation in autonomic modulation
  105. Understand how and when to implement reflexes as a therapy to restore autonomic function  
  106. Communicate autonomic function, testing, and relativity to patient presentation to a lay audience
  107. Review the prevalence of vestibular dysfunction that accompanies a concussion
  108. Identify patient complaints that may indicate vestibular insult after concussion
  109. Compare and contrast the symptoms of concussion with those of vestibular injury
  110. Be able to identify sopite syndrome as a consequence of concussion
  111. Elicit from a patient the difference between symptoms of vestibular hypofunction including the many interpretations of dizziness
  112. Discriminate the differences between lightheadedness, disequilibrium, oscillopsia, egocentric/allocentric vertigo, angular/linear vertigo, and floating
  113. Recap the correlation between vestibular symptoms, motion intolerance, and concussion duration
  114. Explore the mechanism of vestibular injury in concussion
  115. Identify the signs and symptoms of traumatic peripheral vestibular insult 
  116. Compare and contrast signs and symptoms of central and peripheral vestibular insults
  117. Differentiate vestibular trauma from pharmacological insult in vestibular syndromes
  118. Correlate history, vestibular (and other) symptoms, and findings to its yellow/red flags that warrant imaging. 
  119. Referring/Managing patients with anatomical pathology in vestibular function
  120. Order appropriate imaging and/or specialty testing based on patient presentation
  121. Understand specialty testing, including Caloric irrigation, VEMP, BAER, and more
  122. Review the embryological development of the vestibular system and its significance to human function.
  123. Understand the anatomical/structural components of the vestibular apparatuses
  124. Discuss how humans’ vestibular gain must be continuously adjusted in the first years of life to compensate for significant changes in head circumference 
  125. Review the effects of aging on vestibular integrity and how that may affect concussion presentation
  126. Contemplate why we don’t normally “feel” vestibular sensations, and why we do when neurological integrity is impaired
  127. Review the anatomy and clinical relevance of the vestibular pathways
  128. Develop fluency in the central vestibular integration and structures
  129. Recognize the anatomical proximity of the vestibular nuclei and the nucleus of CN V and how that can affect the patient presentation
  130. Describe how ​​the nervous system differentiates between vestibular signals imposed by the external world and those that result from our own actions
  131. Discuss the three major groups of vestibular sensorimotor functions: reflexive control of gaze, head, and body in three spatial planes; perception of self-motion and control of voluntary movement and balance; and spatial memory and navigation.
  132. Discuss the cortical area(s) of vestibular perception, and ultimate integration
  133. Understand the implications of vestibular hypofunction in perception, oculomotor function, postural control, and autonomic function
  134. Understand the importance of graviception in mammalian physiology
  135. Review the dichotomy and overlap in the linear and angular receptor systems
  136. Explore the convergence of otolith and canal signals and its relationship to patient presentation and rehabilitation.
  137. Describe the speed of vestibular reflexes compared to other reflexes and their relevance to patient presentation
  138. Discuss the vestibular sub-nuclei with their various inputs and projections
  139. Review the vestibular nucleus’s integration to the paraventricular nucleus of the hypothalamus and the relevance to patient autonomic and metabolic presentation
  140. Review the role of the medial and lateral vestibulospinal tracts in the assessment and rehabilitation of concussion
  141. Discuss the relationship between the vestibular nuclei and the sternocleidomastoid muscle
  142. Understand the effect of diminished vestibular function on the cervicocollic responses
  143. Discuss the role of the vestibular commissure, type I, and type II cells in vestibular physiology and in rehabilitation
  144. Describe the neurophysiology and clinical relativity of Y-group neurons
  145. Explore the relationships between the juxtarestiform body, regions of the vestibulocerebellum (including the flocculus, nodulus, uvula, fastigium, and interposed nucleus) and their contribution to vestibular function
  146. Identify the role of floccular target neurons (FTNs) in modifying the VOR gain
  147. Understand the function of the flocculus and the nodulus and their contribution to the movement, and vestibular adaptation (short-term and long-term)
  148. Explain the mechanism behind sensitization of vestibular canals after cerebellar injury
  149. Discuss other inputs to the flocculus and their relevance to creating clinical applications
  150. Be able to identify red flags associated with vestibulo-cerebellar compromise
  151. Know how to order appropriate imagining when necessary
  152. Fluently describe the course and terminality of the medial longitudinal fasciculus
  153. Elaborate on the vestibular system’s influence on oculomotor function through the ascending medial longitudinal fasciculus, including static eye position, as well as dynamic horizontal and vertical gaze holding/tracking 
  154. Obtain fluency in the various vestibular reflexes, including but not limited to the various angular VORs, linear VORs, vestibulospinal reflexes, and the vestibulo-collic reflexes
  155. Understand the degrees of nystagmus, their etiology, and clinical correlates
  156. Relate vestibular function to muscle tone and muscle spindle sensitivity
  157. Correlate vestibular function with volitional activities, and their clinical relevance 
  158. Develop mastery in the understanding and interpretation of the head impulse test (HIT)
  159. Understand the difference and significance between redress saccades and covert saccades due to poor VOR gain
  160. Realize the effect that the magnification of corrective lenses for common visual conditions may have on vestibular gain.
  161. Discuss the utilization of validated technology to measure vestibular function
  162. Discuss how the anterior and posterior spinocerebellar pathways may influence vestibular responses and testing
  163. Understand the value of balance testing as a proxy for vestibular testing
  164. Review the visual, proprioceptive, vestibular, and central perceptual components of balance (testing)
  165. Review the literature and discuss the strengths and weaknesses of various balance testing methods
  166. Understand the mCTSIB
  167. Explain the biomechanical and neuromuscular control mechanisms of quiet stance, along with its measurements
  168. Describe the kinematic strategies of quiet stance
  169. Discuss the similarities and differences of force plate technology compared to accelerometry technology
  170. Identify normal and pathological sway parameters
  171. Think critically about alterations in balance and sway parameters in relationship to incidental or purposeful circumstantial nuances
  172. Develop fluency in the explanation of results from BESS and COBALT tests
  173. Discuss technology for assessing balance
  174. Perform and interpret balance testing, both as a sideline test and a quantified clinical/laboratory test
  175. Interpret findings of balance testing in relationship to both diagnostic and treatment relevance
  176. Elaborate on the processing of proprioception
  177. Conscious vs. Subconscious proprioception
  178. Concussion and the Cerebellum
  179. Functional Neuroanatomy of the cerebellum
  180. Generalized role of the cerebellum
  181. Clinical Connectonomics of the cerebellum
  182. Cerebellum and autonomic function
  183. Cerebellum and vestibular function
  184. Cerebellum and ocolomotor function
  185. Cerebellum and cognition
  186. Cerebellum and affect
  187. Examining cerebellar function
  188. Biasing the cerebellum with treatment modalities
  189. Parietal lobe and Concussion
  190. Functional Neuroanatomy of the parietal lobe
  191. Generalized role of the parietal lobe
  192. Clinical Connectonomics of the parietal lobe
  193. Parietal lobe in physical space
  194. Parietal lobe in non-physical (abstract) space
  195. Parietal lobe and vision
  196. Sujective visual vertical
  197. Subjective visual horizontal
  198. Parietal lobe and cognition/memory
  199. Parietal lobe syndromes
  200. Examining the parietal lobe
  201. Treatments with a parietal lobe bias
  202. Concussion and the Temporal Lobe
  203. Functional Neuroanatomy of the Temporal Lobe
  204. Generalized role of the Temporal Lobe
  205. Clinical Connectonomics of the Temporal
  206. Temporal lobe and vision
  207. Temporal lobe and auditory processing
  208. Temporal lobe and spatial processing
  209. Temporal lobe and limbic function
  210. Temporal lobe and memory
  211. Temporal lobe and olfaction
  212. Treatments that may bias the temporal lobe 
  213. Concussion and the Occipital lobe
  214. Functional Neuroanatomy of the occipital lobe
  215. Generalized role of the occipital lobe
  216. Connectonomics of the occipital lobe
  217. Occipital lobe and vision
  218. Occipital lobe and memory
  219. Occipital lobe and balance
  220. Occipital lobe and vestibular function
  221. Occipital lobe and spatial processing
  222. Treatments tha may bias the occipital lobe
  223. Functional neuroanatomy of the frontal lobe
  224. Generalized function of the frontal lobe
  225. Clinical connectomincs of the frontal lobe
  226. Afferent projections to the frontal lobe
  227. Frontal lobe integration into the basal ganglia
  228. Frontal lobe integration to the cerebellum 
  229. Frontal lobe and somatic movement
  230. Frontal lobe and oculomotor funciton
  231. Frontal lobe and cognitive function
  232. Frontal lobe and limbic function
  233. Thalamic interplay of the frontal lobe
  234. Frontal lobe and reality manifestation
  235. Understand gait mechanics and neurological control mechanisms
  236. Discuss common alterations of gait associated with concussion and their neurological origins
  237. Understand Pusher Syndrome as decompensation of the central vestibular system
  238. Explore the relationship between graviception, ocular cyclotorsion, and skew
  239. Differentiate between otolith-driven skew and muscle weakness
  240. Understand subjective visual vertical, how to test it, and its clinical relevance
  241. Understand the Room Tilt Illusion as decompensation of the central vestibular system
  242. Identify the connection between vestibular ocular function and pursuit mechanisms
  243. Compare and contrast optokinetic responses, vestibular function, and their effects on patient presentation
  244. Describe optic flow and its relationship to vestibular function
  245. Explain why full-field motion on the retina not only provides an observer with an indication of how fast, and in what direction, the visual world is moving, but leads to the sensation of self-rotation
  246. Know when to use linear and/or torsional optokinetic in treatment
  247. Differentiate and Identify different types and etiologies of vertigo, including subclavian steal syndrome
  248. Compare and contrast spatial (pseudo)hemineglect of concussion from stroke
  249. Learn to assess for spatial memory deficit
  250. Discuss the strengths and weaknesses of vestibular rehabilitation in its current state
  251. Compare and contrast “peripheral vestibular treatment” vs. “central vestibular treatment”
  252. Explore how the strong multisensory and multimodal central integration, at the first stage of vestibular processing, allows for a diversity of treatments
  253. Compare and contrast eye-head neurons, vestibular only neurons, and position-vestibular-pause neurons and their utility in clinical practice
  254. Comprehend the effect of focal distance on PVP neurons and vestibular gain
  255. Understand the concept of velocity storage and how it contributes to function and concussion symptoms
  256. Measure velocity storage
  257. Discuss plausible mechanisms to alter velocity storage mechanisms
  258. Discuss an evidence-supported framework for motion intolerance
  259. Compare and contrast the neurological activity of passive versus active vestibular stimulation
  260. Compare and contrast movement and non-movement (electrical, thermal, mechanical) strategies of vestibular stimulation
  261. Understand the neurophysiology of vestibular plasticity
  262. Clarify compensation, habituation, and rehabilitation
  263. Understand and prescribe vestibular training exercises to accomplish a certain goal
  264. Develop an effective strategy to increase vestibular gain
  265. Have the ability to decrease vestibular gain and know when that is applicable
  266. Prescribe VOR cancellation exercises when appropriate for the patient and their occupation
  267. Differentiate when head-on-body, whole-body, or head-fixed/body-moving therapies are warranted in treating concussion
  268. Utilize the visual system’s integration to the VN as a vestibular modality in treating concussion
  269. Utilize the oculomotor system as a vestibular modality in treating concussion
  270. Utilize the somatosensory system’s integration to the VN as a vestibular modality in treating concussion
  271. Utilize a feed-forward mechanism as a vestibular modality in treating concussion
  272. Utilize electromodulation as a vestibular modality in treating concussion
  273. Utilize caloric irrigation as a vestibular modality in treating concussion
  274. Identify and describe the parameters of vestibular training exercises
  275. Comprehend the influence of patient gaze parameters on VOR training
  276. Creating patient at-home vestibular rehabilitation exercises
  277. Create an individualized vestibular rehabilitation program for a concussed patient based on clinical findings and their priorities
  278. Identify the common VOM symptoms associated with concussion
  279. Discuss the prevalence VOM symptoms after sustaining a concussion
  280. Compare and contrast the symptoms of autonomic dysfunction, vestibular injury, and VOM insult
  281. Understand how VOM injuries can masquerade as other syndromes
  282. Review the visual pathways beginning at the cornea through its integration into the prefrontal cortex
  283. Understand the ipRGC pathway and its affect on brain function
  284. Discuss the differences between central vision and peripheral vision and its relationship to concussion (symptoms/presentations)
  285. Discuss how VOM injuries can cause pervasive dysfunction and morbidity
  286. Review the synergy between vision and oculomotor function
  287. Optometric terminology
  288. Basic trigonometry in relationship to eye positions
  289. Blur: Refraction or Position?
  290. Review the autonomic contribution to focus
  291. Review the degrees of freedom of the eyes and their limitations
  292. Explore the concept of gaze
  293. Understand the 2 basic types of oculomotor function: gaze holding and gaze shifting
  294. Static position
  295. Displacement of neutral gaze in the horizontal, vertical and torsional positions
  296. Oculomotor-related cranial nerve lesion vs functional decompensation
  297. Innervation of extraocular muscles
  298. Vestibular contributions to static eye position
  299. The role of the cerebellum in static eye position
  300. Measuring ocular alignment and disparity
  301. Stereoacuity and binocular vision
  302. Ocular dominance/preference
  303. Ocular suppression
  304. Conjugate vs disjunctive eye positions
  305. Location and depth estimation
  306. The formation of extrapersonal space
  307. Three-dimensionality of gaze holding and transitions 
  308. Central structures associated with gaze holding
  309. Neural integrators for central and eccentric gaze holding
  310. Input to neural integrators for therapeutic applications
  311. Gaze holding with the head moving on the body
  312. Gaze holding with the head still on moving body
  313. Normal vs Pathology of gaze holding
  314. End gaze nystagmus
  315. Cerebellum’s role in gaze holding – Purkinje fibers
  316. Three distinct cerebellar syndromes of gaze holding
  317. Microsaccades vs saccadic oscillations vs. square wave jerks
  318. Gaze shifting
  319. Fundamentals of Saccades
  320. Neurology of a saccade
  321. Horizontal vs. Vertical vs. Diagonal vs. Vergence
  322. The superior and inferior colliculi
  323. Collicular mapping
  324. Assessing collicular maps
  325. Changing collicular maps
  326. Collicular maps and spatial maps
  327. Omnipause cells
  328. Reading saccadometry reports
  329. Measurements and characteristics of a saccade
  330. Reflexive vs Voluntary (Command) saccades
  331. Express saccades
  332. Delayed Saccades vs Anti-Saccades
  333. Latency of saccades
  334. Gap Effect
  335. Influence of elastic elements on velocity 
  336. Saccade phase
  337. Saccade Velocity
  338. Pulse-Step Relationship
  339. Compare and contrast horizontal saccades vs vertical saccades
  340. Saccades and the basal ganglia
  341. Pathology of saccades and their relationship to brain function and presentation in concussion
  342. Effects of cerebellar decompensation on saccades
  343. Effects of brainstem decompensation on saccades
  344. Effects of frontal lobe decompensation on saccades
  345. Effects of prefrontal cortex decompensation on saccades
  346. Saccades in relationship to posturography
  347. Saccades in relationship to muscle tone
  348. Saccades in relationship to vestibular function
  349. Effects of stimulus on saccade properties (luminance, size, contrast, complexity, position, task, stimulus, amplitude, predictability, orbital position, instructions, age, etc)
  350. Saccades to egocentric vs allocentric targets
  351. Affecting the characteristics of saccades with interventions
  352. Strategies to effect latencies
  353. Strategies to effect velocities
  354. Strategies to effect amplitude
  355. Strategies to effect phase
  356. Pursuits
  357. Overlap and differences between saccades and pursuits
  358. An understanding gain in pursuits
  359. Types of pursuit pathologies seen in concussion
  360. Neural pathways of pursuits
  361. Involvement of neural integrators on pursuits
  362. Compare and contrast horizontal vs vertical pursuits
  363. Pursuits and VOR
  364. Retinal slip neurons
  365. Direction sensitive neurons
  366. Velocity-sensitive neurons
  367. Phases of a pursuit
  368. Three-dimensionality of gaze holding and transitions
  369. Factors that influence pursuit quality  (luminance, size, contrast, background, complexity, position, task, stimulus, amplitude, predictability, orbital position, instructions, age, etc)
  370. Influence of moving background, on pursuits
  371. Influence of moving head, on pursuits
  372. Egocentric pursuits vs allocentric pursuits
  373. Feedforward mechanisms vs feedback mechanisms and their effect on pursuits
  374. Effect of cervico-ocular responses on pursuits
  375. Utilizing saccades to influence pursuits
  376. Modifying cerebellar input/function and it’s influence on pursuits
  377. OKR and its purpose
  378. Symptoms associated with faulty OKR
  379. Assessment of OKN
  380. Localization of faulty OKN
  381. Linear vs Rotational OKR
  382. Full-field vs Partial-Field OKR
  383. OKN as an indicator of Neural Integrator and Velocity Storage integrity
  384. Neurology of Vergence Eye Movements
  385. Assessment of Vergence Eye Movements
  386. Voluntary vs Reflex Vergence Eye Movements
  387. Neurological Mechanisms of Accommodation
  388. Pathologies of Accommodation
  389. Assessment of Accommodation
  390. Factors Influencing Accommodation 
  391. Accommodation Effect Gaze, Vergence, as well as Tracking
  392. Visual Pathway Injuries associated with concussion
  393. Testing visual pathways
  394. Visual evoked potentials and concussion
  395. Electroretinography and concussion
  396. Vision
  397. Contrast sensitivity
  398. Refraction
  399. Field of vision (L/R, U/D)
  400. Depth perception
  401. Color Vision
  402. Perkinje fibers are responsible for gaze holding
  403. Discuss the lack of knowledge and clinical experience limited the use of a cervical differential diagnosis by clinicians following a concussion
  404. Discuss and  understand the prevalence of concussed patients with cervical symptoms, potential causes, and effectiveness of preventive and treatment measures
  405. Compare and contrast the symptoms of autonomic dysfunction, vestibular injury, visual dysfunction, and cervical-spinal insult
  406. Understand how cervical injuries can masquerade as other syndromes and vice versa
  407. Differentiate spinal injury from other concussion syndromes
  408. Differential diagnosis of cervogenic symptoms and a cervical clinical profile after concussion
  409. Implementing PROMs to measure level of cervical dysfunction
  410. Neck Disability Index
  411. Dizziness Handicap Index
  412. Rivermead Post-Concussion Questionnaire
  413. Identify the mechanisms which can cause cervical and spinal injury during and after a concussion
  414. Comprehend how spinal injury can affect brain function
  415. Understand the motor pathways of spinal control
  416. Discuss the feedback mechanisms of spinal movement
  417. Articulate the concept of signal-to-noise ratio in relationship to spinal afferents
  418. Explore the effects of chronic, un-treated spinal trauma in relation to concussion symptoms and recurrence
  419. The effect cervicogenic symptoms have on the resolution of concussion symptoms.
  420. Discuss the risk factor of neck pain on developing persistent post-concussive symptoms
  421. Understand the three-phased approach to treating comorbid cervical pathology after concussion: exam and ID red flags; graded cervical manual therapy; graded aerobic exercise
  422. Red flags of cervicogenic pathology: fracture, instability, dislocation
  423. Purser test
  424. Alar ligament stress test
  425. Manual palpation
  426. altered cervical sensorimotor function such as decreases in cervical flexor endurance and strength as well as decreased cervical kinesthesia 
  427. Understand range of motion, cervical strength testing, neck palpation, cervical joint position error test, cervical flexion-rotation test, head and neck differentiation test, and smooth pursuit neck torsion test
  428. Cranio-cervical flexion test
  429. Smooth pursuit neck torsion test
  430.  Stretching, manual traction, cervical and/or vestibular physical therapy, cervical manipulation, and subthreshold aerobic exercise, have been proposed to improve symptom resolution in both the acute and chronic stages after a concussion
  431. When are therapeutic modalities such as massage, cervical spine proprioception retraining, vibration, manual manipulations, stretching, and traction appropriate
  432. When should providers begin conservatively and progress to more aggressive treatment techniques
  433. What are conservative therapies (gentle stretching, position release therapy, vibration, light manual traction, and cervical joint position error training have been shown to be effective starting points)
  434. What are aggressive therapies?
  435. Specialized and targeted intervention techniques such as cervical manual manipulations and mobilizations significant reduction in PPCS symptoms
  436. Vestibular rehab vs cervical training in Cervicogenic dizziness (cervical treatment group was 30 times more likely to report improvement in dizziness severity compared to a vestibular treatment group)
  437. Neurology of the Cervico-collic reflexes and how concussion can affect them
  438. Presentation of altered cervico-collic dysfunction
  439. Utilizing cervico-collic reflexes in rehabilitation
  440. Neurology of the Cervico-ocular reflexes and how concussion can affect them
  441. Presentation of altered cervico-ocular dysfunction
  442. Utilizing cervico-ocular reflexes in rehabilitationCervico-ocular reflexes
  443. Neurology of the Tecto-spinal reflexes and how concussion can affect them
  444. Presentation of altered tecto-spinal dysfunction
  445. Utilizing tecto-spinal reflexes in rehabilitationTectospinal reflexes
  446. Neurology of the oculo-cervical reflexes and how concussion can affect them
  447. Presentation of altered oculo-cervical dysfunction
  448. Utilizing oculo-cervical reflexes in rehabilitation

The Functional Neurology Management of Concussion (FN-MOC) has been meticulously crafted for all healthcare providers with a passion for helping patients with concussions, regardless of their educational background.

THIS PROJECT HAS BEEN YEARS IN THE MAKING. ARE YOU READY TO LEARN HOW TO DELIVER UNPRECEDENTED CONCUSSION OUTCOMES? IT’S TIME!

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