Blog: EYE-SYNC Webinar: Concussion Subtypes Q&A

Recently, we hosted a webinar featuring Concussion Guidelines author and SyncThink founder, Dr. Jam Ghajar. Dr. Ghajar discussed the recent Concussion Guidelines: Evidence for Subtype Classification publication and provided a detailed review of the subtypes; ocular-motor, vestibular, headache/migraine, cognitive, anxiety/mood and the associated conditions of sleep disturbance and cervical strain.  Many questions were asked during the Q&A, including many that we were unable to answer due to time constraints. This blog post includes those questions and Dr. Ghajar’s replies to each. Thank you to all who attended!

1. Any new evidence for supplementation/vitamins to augment concussion rehab?

There is no new evidence for supplementation/vitamins to augment concussion rehab. I would recommend concentrating on advocating cardio exercise and good sleep habits and correcting deficits identified in the clinical exam.

2. What criteria do you use to allow a concussed patient to return to driving?

It depends on the specific deficit they present with. Once this is resolved, I let them resume driving, especially if the issue is related to dynamic vision. Overall, the best way to do this is to see an occupational therapist and take a simulated driving test to ensure readiness.

3.  When performing vestibular rehabilitation with the EYE-SYNC device, should we be doing progressions of body posture? Sitting, standing, etc?

Yes. Incorporating movement is a great way to escalate difficulty and training to better understand the rate and progression of progress being made by the patient.

4. How do we distinguish between a ‘fuel’/metabolic issue being the cause of symptom exacerbation vs. a ‘ normal’ or acceptable level of symptom exacerbation from the eye exercises? For example: the patient’s ability to perform a vision skill during therapy drops dramatically with exacerbation of symptoms- do you continue?

I do not see evidence that exacerbation of symptoms delays recovery. That said, when training patients on dynamic vision tasks they can tire, and the learning effect wears off. In those cases, I would tailor the training to engage the patient appropriately, but if they fall off then switch to a new task.

5. I understand symptom exacerbation is part of the treatment, but would “uncontrol” symptom exacerbation, such as a teenager playing video games provide a positive effect?

I think that the patient needs direct feedback to improve- unlike just passive viewing. Just exacerbating symptoms without feedback would be not as useful. An example would be walking down a grocery aisle and moving head back and forth- this would exacerbate symptoms but not provide feedback. If you had the patient do the same task but read the labels of items on the grocery aisles then that would provide direct feedback and serve as a good training example.

6. Another new subtypes paper was released on the first of this month in Future Medicine, discussing subtype representation in post-concussion symptom rating scales. Can you discuss the findings of this and what they mean?

We published this paper to provide the groundwork for the next paper on a novel subtype classification scale. The Future Medicine publication showed that current concussion questionnaires do not address subtype classification and especially fail in Vestibular and Ocular-motor symptoms.

7. Why do sleep disturbances not occur in isolation?

I have not seen that but it may exist. Referring to the Cerebellar- Predictive Brain State hypothesis, there is good evidence that cerebellar and sleep impairments co-exist. So, I would expect cerebellar output functions (particularly ocular-motor and vestibular) to be affected as well as sleep.

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