The Questions

Five questions, five answers by clinics to give you a good starting point for finding a clinic that’ll meet your needs. And a bonus question on their virtual offerings. Scroll down to read the questions and my thoughts behind them. Share this page with clinics whose answers you’d like to see.

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1. Does their stated philosophy weave itself through their diagnostic and treatment methods?

One of the problems I’ve found in looking for treatment for my concussion is that the clinic’s stated philosophy doesn’t pan out in the care I receive. Ninety-nine percent of the health care professionals I encountered are caring, compassionate human beings. It was difficult to square that with their lack of help. And it’s difficult to cope with how the compassionate specialist rationalizes not helping you while you’re floundering or worsening.

This leads to disillusionment. Many give up. I’ve fired some. No one should have to endure this kind of repeated disappointment.

Philosophy of care should square with actual care.

I hope that this website will arm you with the knowledge to read clinic websites critically and to ask health care professionals the pertinent questions that’ll reveal whether their philosophy aligns with their services.

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2. Do their diagnostics depend on human observation and answers to symptom and mood questions? Or do their primary diagnostic services include computerized testing, computer-interpreted scans, timed cognitive tests, and comprehensive history taking?

My book Concussion Is Brain Injury: Treating the Neurons and Me, and its associated web pages, provide the detailed background you need to answer these questions. Make a list of essential scans and tests. Check against a clinic’s Q&A Five and their websites to see if their diagnostics depend on human observation, either from a professional or from self. Sometimes, clinics will depend on referring physicians or the ER or other clinics to have done the diagnostics. In that case, have you had qEEG, evoke potentials, SPECT scans, and/or DTI scans done? If not, go back and demand them.

When it comes to diagnostics, computers and well-researched objective tests designed to challenge specific cognitive skills are more reliable than symptom checkers and human observation of cognitive skills, gait, balance, and so on.

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3A. Does their approach reflect the importance of individualized treatment solutions based on objective diagnostics?

3B. Does their clinic provide a foundation of collaboration within and outside their clinic?

Most physicians ignore research that is decades old. It’s easier to stay within the familiar milieu of medication and surgery, of the Diagnostics and Statistics Manual (DSM-5) and mood/personality theories as mental illness. It’s much harder to read through reports from objective tests, marry them with complex history taking and self-reported symptoms, and to seek systematic reporting from caregivers — in order to devise an individualized program of neurostimulation, talk therapy, and intensive cognitive, reading, and balance/physical rehabilitation to effect radical improvement, if not full restoration.

The principle that the brain controls everything ergo injury can affect anything must undergird treatment. Medicine has become so super-specialized and knowledge has grown so vast that it’s almost impossible for one person to grasp the totality of brain injury. It’s easier to remain within one’s subspecialty than to recognize how it fits into a whole and to collaborate with others in order to create a whole picture and treat the whole person.

The principle that neural networks power brain function must weave itself through a specialist’s approach to care. Disparate “symptoms” can be injury in a network, and that network must be evaluated and treated.

Mood is not an illness but an injury to the emotion centres or higher cognitive functions. Treating mood changes as a DSM-5 “diagnosis” with medication will not only avoid treating the real problem but also worsen the injury and do nothing for the despair. Phineas Gage didn’t rage because he had an anger management problem. He raged because an iron rod destroyed the areas of the brain that regulated emotion, impulsivity, and self-control. It probably also took out his vocabulary, and so he was left with swearing as his means of communication. To this day, no one has researched brain injury anger, and standard medical care does not address its neurophysiological causes, instead relying on inadequate and inappropriate behavioural strategies to compensate inadequately for neurophysiological damage. Shocking. Irresponsible. Betrayal of the injured. Neurostimulation treated my brain injury anger, and it reactivated my emotion centres.

Appropriate care combines neurostimulation with talk therapies including psychodynamic therapy and dialectical behaviour therapy and avoids medication. I suggest that positive thinking is collaboration between those providing neurostimulation and talk therapies. Negative thinking is prescribing medication to sort of quell symptoms while peddling mindfullness as a catch-all without actually healing the injury. Cognitive-behavioural therapy will only work if it’s done over the long-term. It’s inappropriate for short term as it doesn’t heal damaged neurons. Instead, it’s a way for a person to relearn emotions and thinking as their neurons heal during neurostimulation treatments. See the Solutions section for the many effective treatments available.

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4. Do they encourage through specific actions social support? And/or take into account lack of it?

Most health care professionals will become aware of how much social support a person has as they progress through treatment plans. But only psychiatrists or psychologists who include meetings with family and friends — the entire social support network — will work to facilitate more support or its retention.

Lack of social support threatens treatment success.

To change this, clinics must first believe a person when they say upon intake what their social support experience is. If it sounds bad, it’s probably worse.

Second, clinics must devise a way to meet with, educate, and work with the social network to ensure it doesn’t disintegrate and that people with brain injury can fully profit from the treatments. Exhaustion is a side effect of effective treatment. If people have to look after themselves, feed themselves, transport themselves, they will have much less energy to do the work. That will lead to less than optimal recovery or, at best, slow and long-delayed recovery. Thus social support must be part of the treatment plan.

Third, clinics must devise an action plan to compensate for lack of social support because there will always be awful families and friends who won’t support people in years-long crisis, that is, brain injury. Community care is critical in this circumstance; advocacy by brain injury associations in collaboration with clinics is the only way to ensure long-term community care that includes homecare, personal support workers, at-home occupational and behavioural therapists, at-home behavioural assistants to ensure treatment homework gets done, etc. Psychiatrists and psychologists are also critical in helping the person cope with the fallout from abandonment and a belying of everything they believed. Perhaps the pandemic will right the wrong that medicare pays only for psychiatrists, but it won’t right the wrong that most psychiatrists don’t understand that mood is from injury and environment and medications are inappropriate. Somehow this must change.

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5. Does the clinic’s future plans reflect an innovative mindset and understanding that neurostimulation is our current best method to heal injured brains?

Those clinics that talk about neurostimulation as not yet proven or who believe in neuroplasticity but advocate the deceptive term “evidence-based” as a way to deny the effectiveness of neurostimulation, are saying they prefer to stay in the old model. They’ve adopted the new terminology while not adopting the radical effectiveness of treatments based on the neuroscience of neuroplasticity.

Neurostimulation has been around since the 20th century. No longer can clinics credibly claim it’s new, or not proven, or remains to be seen. Thus future plans ought to not only include neurostimulation but also show interest in new understandings of the brain, widening the breadth of available neurostimulation and neuromodulation, and melding these with individual therapy and compensating for social determinants of health.

Social determinants of health or SDOH include poverty, lack of education, job status, family structure, and so on. You can read more on SDOH on the Government of Canada’s website. How can an individual clinic address these systemic issues? I don’t know. I do know that health care, including individual clinics, must start to think about and work on these significant impacts of brain injury because brain injury worsens SDOH.