The NRA measures so much more than a baseline. It is so much better in identifying patients benefiting from some specific rehabilitation for optimizing their neurological function. The benefits of this can be realized in many facets of their lives in addition to reducing their risk for prolonged/more severe post-concussion syndrome.
We see many patients with prolonged and debilitating post-concussion syndrome. For many of these patients there is a medical history of a previous vision, vestibular and/or cognitive issues. For many others, their clinical course is highly suspicious for pre-morbid (i.e., before their injury) issues in these areas although the patients were never checked for the same. It is known that patients with pre-morbid issues in these areas are at risk of a prolonged and more severe post-concussion syndrome than those that don’t have these issues. If only these people had known about their conditions before their injuries; or had known the benefits of fully rehabilitating their issue before their injury; their risk of having such a post-concussion syndrome would have been reduced. This is the reason for the NRA program:
• to educate patients about many facets of their neurological system of which they likely weren’t aware
• to educate patients about the sort of neurological consequences that frequently occur in post-concussion syndrome and their nature
• to show patients how they measure up to their expected metrics
• to identify patients with binocular visual, vestibular or dynamic movement disorders and the risks these carry with them
• to identify patients with increased risk of post-concussion syndrome
• to identify those who would benefit from rehabilitation to improve their conditions (if they have any) and provide the rehabilitation in an expert, multi-disciplinary environment
We perform multiple tests of visual integrity, visual efficiency, visual perception, oculomotor function, dynamic balance and neuro-cognitive performance. We test for visual acuity, the vestibulo-ocular reflex, oculomotor function including saccades, stereopsis, tropias/phorias, vergence ability, accommodative ability, dynamic balance/neuromuscular strategies and neurocognitive function.
Firstly, it should be noted that baseline tests are no longer recommended by many professionals; Parachute Canada released a statement about this in August 2017.
A baseline tests measures some measurement of your child’s ability to perform on certain tests when they are well (i.e., they don’t have a concussion) so that if your child were to get a concussion, the treating team would use this to guide them towards a rehabilitative endpoint commensurate with your child’s baseline performance.
The problem with this approach is the following:
• Every organization picks different tests to represent a patient’s baseline; the tests chosen by an organization are usually limited by their skill set
• The tests chosen often don’t represent the child’s baseline neurological potential. For example, some organizations use static balance (i.e., standing still) as a baseline test and record a patient’s sway with a force plate. Measures of static balance on a force plate have been shown to go back to normal 3 days after having received a concussion. So if a patient were to have balance issues lasting longer than 3 days (very common) but their static balance force plate measurement pattern is back to baseline, then how is this measurement helpful? That is, many of the tests chosen for baselines are not sensitive to deficiencies that occur post-concussion and don’t correlate with patients’ clinical course.
• The tests almost never identify those with binocular vision, vestibular or neuromuscular problems that can put them at higher risk of a prolonged/more severe post-concussion syndrome
• Organizations that offer baseline testing usually doesn’t offer comprehensive, multi-disciplinary post-concussion care/rehabilitation
• Baseline performance, despite it’s shortcomings as mentioned above, are often used as a rehabilitative end-point for those with post-concussion syndrome. As such, we are at risk of under-treating many patients this way. Why not treat a patient to their maximal potential/benefit if the patient is so inclined?
The NRA is a test that measures many facets of one’s neurological function. Neurological function is intimately related to performance at work, school, extra-curricular activities, sport and socially. We believe that if we are rehabilitating patients with post-concussion signs and symptoms, we should be rehabilitating them to the best of their potential regardless of what their “baseline” ability was; this obviates the need for a baseline test. The NRA measures so much more than a baseline; it identifies patients that will benefit from some rehabilitation to optimize function in many facets of life as well as reducing the risk of post-concussion syndrome. It is true that many of us are not performing optimally in some facets of our neurological function. If there is a sub-par metric in one’s binocular vision, vestibular, dynamic motion or cognitive function, a patient should at least know about it and decide whether one would like to treat it…especially if they are playing a sport that carries a higher risk of concussion.
The main advantages are the following:
• It can identify those at higher risk of prolonged/more severe post-concussion syndrome
• It can identify those who can benefit from rehabilitation to reduce the risk of prolonged/more severe post-concussion syndrome
• In most cases, it serves as rehab assessment for those who go on to do rehab to correct the abnormality
• In those who are identified as having an issue, correcting the issue is likely to have beneficial spill-over effects to other aspects of one’s life – school, work, mood, sport and extra-curricular activities.
• In those who are identified as not having any issues in the areas tested, it is reassuring but also educational – many are not consciously aware of the sophistication of the brain and many of it’s visual, vestibular and neuromuscular functions
No. While everyone is at risk of a concussion, e.g. motor-vehicle accidents, slips & falls, etc., athlete’s and youth as a group are at a higher risk. Our mandate is to treat all aspects of the injury including identifying those at higher risk of a prolonged/more severe post-concussion syndrome. As concussion is a serious injury, avoiding the same is imperative.
It is performed by our team.
If an entire team is doing the NRA at the same time, it is performed by an MD, Sports MD, Behavioural Optometrist, Chiropractor or Physiotherapist and 4 clinical assistants. The assessment is performed in a turn-key fashion where patients rotate between stations.
If an individual is doing the NRA alone, it is performed by a Sports MD and a Chiropractor or Physiotherapist.
The cost for an individual NRA is $150 and is covered under your extended health benefits (i.e., Physiotherapy and/or Chiropractic benefits).
Because of economies of scale, the cost for a team is discounted depending on the number of athletes on a team. Feel free to contact us to get a rate for your team. Similarly, individual team members can claim the expense of the NRA under their individual extended health benefits.
Just click on the “Contact Us” button below!