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1. What type of services does NeuroHealth providE?
NeuroHealth is a functional neurology-based clinic that utilizes vestibular oculomotor rehab, reaction time training and other modalities specifically designed to remediate the symptoms associated with post-concussion syndrome, migraines, dizziness and other neurological issues. Our office utilizes a protocol that provides intense treatment in short duration in order to eliminate the underlying brain dysfunctions responsible for the symptoms that keep these patients symptomatic for much too long. Many of our patients have seen other doctors such as neurologists, psychiatrists and family medicine doctors where they have not found anything medically wrong with the patient; however, in many instances there is nothing medically wrong. The patient more has a functional neurological issue that has to do with the way certain parts of their brain are functioning and communicating with other parts of the brain.
2. What does treatment look like at NeuroHealth Services?
Our office utilizes an intense short duration protocol. Patients will be treated intensively for anywhere from one week to two months with one hour sessions of specifically designed exercises to maximize the function of the brain and nervous system. We have designed this protocol based upon current research into functional neurological problems like concussion, migraines and dizziness. Our treatments are evidence based and done in a way to individually customize treatments for each individual patient's needs. We do the therapy sessions with increasing intensity as to not overstimulate and fatigue the patient; however, many of our patients initially will feel tired, fatigued and may have some symptoms after each session. We like to do multiple sessions per day, up to three to four sessions a day and can get through on average 20 to 40 sessions in a 2 month period depending on each individual case.
3. How often will I be seeing the doctor?
We will strive to work with each patient individually as much as possible and will be reexamining the patient often throughout the care plan. Dr. Ralston will check in with the patient each day of therapy, specifically if he is providing any one-on-one care with the patient such as manipulation, soft tissue therapy or very specific neurological exercises. Patients will be reassessed after every five to seven therapy sessions and changes to their protocol will be made only after reassessments are done.
4. What is involved with the examination?
In order to maximize our time together, we regard our preparation and first examination as the most important time together. Upon scheduling your appointment, you will be asked to bring any pertinent records and any recent lab results, MRIs, EEGs, etc., to your first visit. You will be asked to fill out some very specific questionnaires that are going to be asking about your brain function and metabolic function. Please have those done by the time you arrive at the office so we can review them upon arrival. The examination will be a detailed head to toe neurological exam focusing on the specific goals and symptoms that the patient presents with. The goal of the examination is to localize the underlying dysfunctioning areas in the brain, brainstem, cerebellum, basal ganglia, spinal cord, peripheral nerves, etc. We will look at autonomic function such as blood pressures, pulses and pulse ox in different positions. We will do a oculomotor examination, cranial nerve examination and a complete orthopedic and neurological physical exam. Following that, we use specific diagnostic testing. The first test will be the CAPS which is the Computerized Assessment of Postural Sway. This is referred to as dynamic post urography. You will stand on a force platform with a solid platform at first and then perturbation foam which is essentially a foam cushion that will be more challenging to keep your balance on. We will assess your balance with your eyes open/eyes closed to determine if you have stability that is in a normal range for your age, height and weight. This will give us a good idea of how well your vestibular and proprioceptive symptoms are compensating. Next, we will do a VNG which is video nystagmography. This is a test typically used by ENTs to diagnose central and peripheral vestibular problems. We use it as an objective tool to measure and evaluate extraocular eye function so you will be looking at a light bar with a light moving in various speeds and directions and we will be tracking your eye movements, making some specific measurements and looking to see if you have any extraocular dysfunction and smooth pursuit tracking, saccade speed, vergence eye movements, autonomic stress, etc. After the examination, if we deem that we can help your case, we will set you up to begin therapy. Prior to starting therapy, we will perform a diagnostic test called C3 Logix. This is software from the Cleveland Clinic that is designed to give some objectives data. It is similar to the Impact test used in concussion protocols but with a little bit more objectivity. We will do the C3 Logix prior to the start of your therapy and we will do it post therapy and compare the results. This will give us some objective markers on how well your brain and nervous system is performing as a result of your treatment at our office.
4. How often will I be coming to the office?
Ideal treatment plans are short duration, high intensity so the ideal way to work with these problems is if you can give us specific days at a time to work with you. If you can give us five days in a row, that would be ideal. If you can give us two or three days at the end of one week and two days at the beginning of a next, that will work too. We can work around you to find the best plan for you. The intent is that it is intense so that we make a change and we get your nervous system to adapt and to habituate as quickly as possible. Spacing out the treatments too long would be the same type of thinking as spacing your workouts too far. You are probably not going to see a lot of gains if they are spaced out too far so the quicker they are and the more intense they are the more it is going to change your nervous system for the better in a quicker order.
5. What is habituation?
Habituation is a term referred to as your brain and nervous system adapting to the environment where the normal sensory environment becomes more tolerable with repeated exposure. Often times what happens in functional neurological conditions that involve aberrant eye movements and balance is it alters perception and awareness of where you are in space so that you have trouble dealing with the sensory environment. You may have trouble reading or looking at screens or watching sports or riding in a car and these are all changes that are happening in central neurological mechanisms. Our therapy is designed to remediate those problems by giving your nervous system specific stimulations in a graduated way so that you become better at them and you get used to doing them. As we do that, your nervous system habituates to the stimulation and it becomes less taxing on you to use your eyes in everyday activities.
6. Is this covered by insurance?
In our office, we do our best to work with your insurance company to maximize any coverage we can get; however, specific neurological therapies often fall in categories that are un-billable due to the nature of the therapies provided. Because we are providing multiple services in a day, sometimes this is regarded as overuse. Because we are providing multiple examinations often times every day, that is considered overuse but our protocol is not designed to fit into an insurance model. It is designed to get you back to functioning as quickly as possible. Services that can be billed and are covered are things that would naturally be covered under your chiropractic insurance, chiropractic manipulations, in some cases therapeutic activities, massage, ultrasound, e-stim, things that are typically coded under chiropractic. Our front desk will gladly verify your benefits and explain to you what would be covered and not covered in regards to the costs.
7. When should I expect to feel better?
In working with patients over the past 15 years, it has been our experience that initially the exercises are going to provoke some of your symptoms, in some cases more than others depending on your individual situation. We will try to do our best to minimize this and give you exercises that attenuate your symptoms but we expect that patients will be tired, fatigued and possibly symptomatic initially which is why we set up a one week protocol that is high intense and have you concentrate on nothing else but your recovery so that after your exercises you can go home and rest. Generally, as subsequent days of rehab happen, the patients feel less and less symptomatic as they habituate and towards the end of their treatment are feeling improvement in symptoms like dizziness, headaches, migraines, nausea, etc., so our goal is to get you feeling better as quickly as possible. The longer the treatment goes, the less symptomatic you should be as your nervous system should habituate to the therapy.
8. What should I expect when this is over?
After our treatment plan, we essentially repeat all the tests we did on the first examination and have a pre and post comparison. At that time, we will decide whether we want to (a) continue with therapy for a specific time longer, (b) continue having you do therapy at home, home exercises or (c) make a referral to another provider if we were not able to eliminate your problem. Initially, as we start you on supplementation or if we have any dietary strategies we are implementing, we will re-visit those. I will repeat lab work after 60 days of initial lab work being done. The majority of our patients continue doing home exercises and their metabolic plan upon release and have followup appointments to make changes to the metabolic plan moving forward so that we can discontinue supplements that are no longer needed as physiology normalizes into an appropriate range.