After a mild or moderate traumatic brain injury (mTBI), a person may develop long-lasting physical, emotional and cognitive problems which hamper every day and work functioning. This is known as Post Concussion Syndrome (PCS). The problems include headaches, memory and thinking difficulties, dizziness, depression and anxiety, fatigue, and noise and light sensitivity. About 15% of people who have had a concussion continue to have these symptoms for years.
Often, there are no objective measures to validate the original brain injury or the subsequent post-concussion syndrome. In the case of a mild traumatic brain injury, lesions may not be detected by an MRI or CAT scan, despite the ongoing symptoms. When the MRI or CAT scan is “normal”, wage loss benefits and funding for treatment are often delayed or denied.
Over the last 37 years, I have devoted my career to providing injured persons with effective, evidence-based treatment for pain, emotional distress and cognitive complaints. I have found that, in the absence of organic findings, clients suffering from Post Concussion Syndrome often struggle to convince funding sources that their complaints are real. Functional MRI (fMRI) can help solve this problem.
Functional MRI was developed in the 1990s and has been used as a valuable research tool. It is sensitive to multiple variables and, unlike SPECT or PET scans, does not involve injection of radioactive tracers. Recent developments in the application of computerized pattern recognition tools (a form of Artificial Intelligence) have made it possible to interpret the fMRI data with a higher level of accuracy. When compared with an age and gender controlled normal database, one can detect whether brain function is normal or abnormal, with an accuracy exceeding 90% (Hampshire et al, 2013).
What is the difference between MRI and fMRI? Plain MRI is also known as structural MRI. As with a CAT scan, it views anatomical structure whereas fMRI targets cellular metabolic function. By focusing on oxygen levels it measures blood flow to nerve cells. When a particular area of the brain is in use, blood flow to that region also increases and when our brain is challenged to perform we can see if that function is normal or abnormal.
Up until now, there have only been two approaches to assessing Post Concussion Syndrome. One is through an MRI or CAT scan, and these almost never detect mild brain injuries. The other is through neuropsychological testing. A Neuropsychologist uses paper and pencil tests to measure cognitive function, but these tests are usually conducted in quiet, non-stressful environments and may not challenge the patient in the same way that the real world does. And there is a downside for the patient. If he or she fails the validity measures built into the paper and pencil tests, his or her credibility is further called into question.
The patented FANTAB protocol is a unique and innovative way to assess PCS using fMRI after the symptoms have persisted for 6 months or more. In the FANTAB protocol the patient undergoes 5 different neuropsychological tests while he is in the fMRI scanner. The FANTAB tests assess cognitive performance such as memory, spatial abilities, disinhibition and executive function. Therefore they provide measures of the patient’s ability and, more importantly, look at whether brain function during the tests is normal or abnormal. The analysis is done by a machine-learning algorithm that compares the patient to an age and gender matched normal database and provides a statistical measure with an accuracy exceeding 90 per cent. If the scan confirms the presence of abnormal brain function, this will constitute an objective measure of PCS.
Functional MRI offers a more sensitive, objective and direct measure of brain dysfunction (see Hampshire et al, 2013, Mayer et al, 2015) than MRI or neuropsychological tests, allowing for greater certainty that real problems exist. We will scan patients who have suffered from PCS for 6 months or longer following a mild traumatic brain injury. The scan results will be the subject of a medical report prepared by the neurologist who developed the FANTAB protocol. He will review the patient’s medical records and provide an expert opinion.
We expect that objective measures of brain dysfunction will improve understanding and assistance for injured persons. If you are suffering from these symptoms, you will be more likely to get the help that you need.
We are accepting referrals for patients with PCS to be assessed using the FANTAB protocol. Click here for Referral Form. The scans will be conducted in Buffalo, NY. Patients can be referred by their health care provider or lawyer. They can also self-refer.
For more information, contact Dr. David Corey at dcorey@brainscaninc.com or by calling 1-855-822-7226.
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