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

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