Neurological Evaluation of TBI
General Neurological Evaluation.
Neuro-Vestibular Evaluation: VNG, RotaryChair, VEMP, Posturography
EEG with Quantitative Analysis.
Neurocognitive and Behavioral Evaluation
Cognitive assessment has the following components.
While all psychological and neuro-cognitive domains are evaluated (Attention and concentration, Language and language-related skills, Spatial and constructional skills, Sensory perceptual skills, Memory, Motor and visual-motor skills, Executive function, intelligence), we devote particular attention to the areas of cognition most affected in traumatic injuries, namely executive function, information processing speed, attention, and concentration.
Psychologically there is a pattern of dis-inhibition which leads to a significantly higher occurrence of Alcohol and substance abuse, criminality, divorce, and unemployment. Studies of inmates with a history of TBI, published in peer-reviewed medical journals have revealed significantly worse anger and aggression scores, poorer cognitive test results, and a higher prevalence of psychiatric disorders than the group without TBI in the prior year. This provides a powerful argument for the necessity of ongoing medical and psychological care in order to prevent such tragic outcomes for the affected individual and society.
Gait and Balance Disorder
Determination of stability index and future risk of fall
One of the most common and debilitating complications of TBI is chronic dizziness and disequilibrium. Neurovestibular & balance evaluation allows us to quantify the degree of balance disorder, monitor the patient’s progress with balance therapy, and estimate the risk of future falls and additional injuries.
Rotational Vestibular Assessments: The purpose of rotational testing is to determine whether or not dizziness may be due to a disorder of inner ear or brain, and particularly to determine if both inner ears are impaired at the same time.
Computerized Dynamic Posturography
quantifies the degree of disequilibrium, and, permits to follow the evolution of the patient during the gait and balance retraining therapy.
Videonystagmography & Vestibular Evoked Myogenic Potential:
Assess the integrity of the neuro-vestibular system. These tests provide objective proof of peripheral and/or central vestibular system dysfunction.
Electroencephalography (EEG) and
Quantitative EEG analysis (Q-EEG)
EEG reveals multiple types of brain abnormalities following TBI (e.g. focal slowing, post-traumatic paroxysmal activity leading to seizure disorder). Quantitative EEG produces a topographical map of the brain's electrical activity which frequently corroborates the imaging abnormalities discovered on MRI, volumetric analysis, and Diffusion Tensor Imaging studies.
Neuro-Optometric Evaluation of TBI:
The study of eye movements is a reliable indicator of the severity of brain dysfunction resulting from a TBI. In particular, several studies of adults after TBI have shown a direct correlation between the alteration of eye movements and the presence of neuropsychological deficits. There is a proven correlation between ocular motor dysfunctions and neuropsychological deficits even after mTBI. In the early stages of recovery after TBI, when attention capacities are still compromised and standardized tests hardly provide reliable data, measurement of eye movements is an important screening tool to identify patients at a high risk of neuropsychological deficits.
We use FDA-approved infrared goggles to record and analyze all types of oculomotor abnormalities.
Neuro Endocrine Evaluation of TBI
Marked changes of the hypothalamo-pituitary axis have been documented in the acute phase of TBI, with as many as 80% of patients showing evidence of gonadotropin deficiency, 18% of growth hormone deficiency, 16% of corticotrophin deficiency and 40% of patients demonstrating vasopressin abnormalities leading to diabetes insipidus or the syndrome of inappropriate anti-diuresis.
There remains a high frequency of hypothalamic-pituitary hormone deficiencies among long-term survivors of TBI, with approximately 25% of patients showing one or more pituitary hormone deficiencies
Brain MRI with (D.T.I.) Fractional anisotropy (FA) is the primary measure of white matter integrity.
Brain MR Spectroscopy.
Volumetric Brain MRI with FDA-approved Neuroquant® reveals the pace of brain atrophy and cerebral tissue loss following TBI.
Brain MR Venogram.
Neuro-Psychiatric Evaluation of TBI
The neuropsychiatric sequelae of TBI are long-term and include depression, mania, obsessive-compulsive disorder, psychotic disorders, anxiety, insomnia, irritability, post-traumatic stress disorder, etc.
Diagnostic studies may demonstrate the anatomical correlate of these abnormalities by revealing the Orbitofrontal cortex, caudate nucleus, and anterior cingulate cortex lesions.
Evaluation of TBI related sleep-disorders
As compared to the general population, traumatic brain injury survivors in both the acute and chronic phases, have a significantly higher ratio of Sleep-wake disturbances, resulting in excessive daytime sleepiness, increased sleep need, insomnia, apnea, and sleep fragmentation. A pattern of progressive worsening occurs due to weight gain following a TBI caused by hyperphagia, executive dysfunction, and hormonal problems.
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