The medical community can be painfully slow to adopt best practices, and concussion care is no exception. Many doctors and clinics recommend “cocooning” — i.e., rest and inactivity in a dark room until symptoms disappear — even though research shows that is not the best way to treat a concussion.
As a patient, it can be difficult to know if the clinic you’re attending is even helping; after all, most symptoms of a concussion go away on their own after three months. Many of the post-concussion patients who come to our facility have already been to concussion experts who failed to resolve their symptoms.
That’s why we’ve put together a guide on how to find the best concussion clinics. We’ll cover:
In addition, you can use this concussion clinic evaluation summary to evaluate any clinic you might attend. Knowing early on whether they have the ability to help you heal will save you time, stress, and money.
If you’re experiencing symptoms that won’t resolve after one or more concussions, you’re not alone. And you’re not crazy. On average, our patients report 60% improvement in their symptoms after one week of treatment at our center specializing in post-concussion therapy. To see if you are eligible for treatment, sign up for a consultation.
Before we cover how to evaluate a concussion clinic, it makes sense to discuss whether or not a clinic would even meet your needs.
Most clinics offer some or all of the following four services: baseline testing, return to play services, acute concussion treatment, and post-concussion treatment.
Baseline testing is most frequently used by athletes who are in a sport known for concussion risk. In this case, the player takes a cognitive test designed to establish the ‘baseline’ — aka, what’s normal for them. If during the season they sustain a concussion, retaking the test will show how much they’ve been impacted and when they’ve returned to normal.
That said, not every baseline test is equally effective. IMPACT testing is perhaps the most well-known baseline test. Unfortunately, some players game the system by intentionally doing poorly on the initial test so that, if they do get a concussion, their scores will appear normal and they will be cleared for play.
Tests that include additional dimensions — such as eye movement tracking — cannot be sandbagged, and are thus more reliable. A few we know of are C3Logix, Canary Concussion, Sway, and Kinetisense.
Return to play service is for athletes (usually but not necessarily adolescents) who sustained a mild traumatic brain injury and are not allowed to rejoin their team or solo sport until they’ve been cleared by a doctor. In the best clinics, that doctor will put them through a battery of testing before giving them the OK to return to their chosen sport. It is not safe to resume sports until you have fully healed from a concussion — typically a two-week minimum.
Return to play services are usually used by middle school, high school, university, and professional athletes. Many states have laws that prevent them from returning to their sport until they are cleared by healthcare professionals.
You can learn more about return to play from the Center for Disease Control and Prevention (CDC) HEADS UP program.
Some clinics will offer therapy and other treatments during the first few weeks of your concussion. This can be helpful if you want the best chance at healing. If you do seek treatment for acute concussions, it’s important to find a clinic that specializes in active rehabilitation — but more on that later.
Some clinics also offer treatment plans for patients whose symptoms did not go away with rest or time. The criteria given below will help these patients the most.
The main determining factor in whether or not you should go to a concussion clinic is time. 70% of concussion patients recover within three months. That means that most people won’t see a marked difference between therapy and active rest at home during that time period.
If it has been over three months since your mild TBI and your symptoms have not subsided, you need treatment at a concussion clinic. While you may find ways to cope with your symptoms over time, the damage from your concussion will not go away without targeted therapy. Only the best concussion treatment centers are capable of handling this situation.
In the next section, we’ll address how to know if a clinic is good or not.
Sometimes, evaluating a clinic is as simple as glancing through its website. Other times, it might take an in-person visit (armed with the right questions) to determine if a clinic can help you.
This list of questions, along with what you’d observe in the best clinics, will help you evaluate any concussion clinic you’re interested in attending.
The brain is the most complex organ in your body. Different regions control different processes that can be disrupted by a concussion — things like your autonomic nervous system, decision-making, short term memory, emotions, and more.
One concussion specialist, no matter how knowledgeable and talented, would have a difficult time identifying and treating all areas impacted by a concussion. The best concussion clinics have a care team that can coordinate treatment for each patient and/or offer referrals for needed specialists they don’t have in-house..
Most clinics have some combination of a physical therapist, a neuropsychologist, and a sports medicine doctor. The best also bring occupational, cognitive, or speech therapists on board. For some patients, a small team of dedicated specialists is sufficient. But for patients with persistent post-concussion symptoms, that combination may not be enough.
At Cognitive FX, our team includes clinical neuropsychologists, neuroradiologists, a neurosurgeon, clinical psychologists, neuromuscular therapists, neurocognitive therapists, occupational therapists, MRI technicians, and more. If your concussion symptoms haven’t responded to other treatment, we can help.
To learn more about all the types of doctors who could help with a brain injury — from pediatric physicians to neurosurgery experts to physical medicine practitioners — see our post on which doctors treat head injury.
If you hit your head and started having concussion symptoms afterward, you likely have a concussion. But if you go to a concussion clinic, they should do more for you than simply listen to your story when determining your diagnosis.
The best concussion clinics can use an array of diagnostic tools to ascertain whether you have a concussion and how you have been affected. They can also consider your symptoms in light of your medical records. Here are some examples of diagnostic tools used for concussion patients:
Diagnostic Imaging
One way to detect a concussion is by using a functional MRI (fMRI) or functional Neurocognitive Imaging (fNCI, a type of fMRI). Quantitative Electroencephalographs (qEEGs) are also sometimes used to diagnose a concussion, but they have a high rate of false positives. Regular MRIs cannot be used to diagnose a concussion because they only look at brain structure (not brain function), although they are useful if your doctor suspects serious structural damage.
Vision Testing
Roughly 20% of people who suffer symptoms from a concussion have problems with their eyesight. If your eyes aren’t tracking properly due to your concussion, that could cause symptoms like headaches, dizziness, and eye fatigue. You might also look for machines that measure visual-motor coordination, like a DynaVision board (map of lights that you have to tap when they light up).
Balance Testing
Do they have a way to examine your gait? What about equipment to test your balance? Vestibular function can also be affected by a concussion. It is difficult — and dangerous — to try to correct balance problems on your own.
Neurocognitive Testing
Do they administer any cognitive tests? Many concussion patients have slower reaction times, difficulty reading or retaining what they read, brain fog, short-term memory loss, and many other symptoms that might surface during neurocognitive testing.
As you may have noticed from the first two questions, concussion symptoms aren’t simple. Multiple important functions — like vision, balance, and memory — can be affected. Just as you need to be able to diagnose those issues, you need multiple strategies for repairing those functions.
If a clinic only offers one kind of treatment, then that treatment will only work for a certain subset of people. As a rule of thumb, the best clinics offer at least the following therapies:
There are, to our knowledge, less than 40 clinics across the U.S. that could offer all four. Those are your best bet. Any other clinics may or may not be able to help you. You’d have to know for sure that the kind of therapy they use to treat concussions matches the kind of therapy your symptoms require.
“Cocooning” is an outdated recommendation for concussion patients that goes like this: “Lie down in a dark room and don’t do anything until your symptoms get better."
In reality, concussion patients have the best chance at recovery through active rest by alternating between physical activity, cognitive exercise, and rest.
The best concussion clinics will be doing at least one of the following:
You can usually peruse the clinic’s website to determine if they are using or producing research. If not, it’s worth asking your point of contact to know how up to date their treatment regimens are. We keep a record of our published research on our website and our therapists regularly incorporate new findings and treatment improvements to therapy modalities.
Does the clinic offer personalized treatment options? Or do they stick to a specific regimen (usually because that’s what insurance will reimburse)?
A pre-programmed regimen can work. But because concussion patients vary significantly in how they’re affected, an ideal program can tweak the therapy regimen to meet the needs of each patient. For example, at Cognitive FX, we design our treatment to address individual concerns. We have an overall treatment method that can be adjusted to each patient's needs during the therapy.
The best case scenario is if your treatment is overseen by an MD or by a neuropsychologist. In many clinics, treatment is managed by a physical therapist or a nurse practitioner. Some even hand off all treatment to athletic trainers. While they may do a good job, they’re generally sticking to predetermined regimens and won’t have the knowledge needed to change up the routine if it’s not working for you.
That said, even primary care doctors, sports medicine doctors, and neuropsychologists may not have enough background in concussion treatment and research to provide cutting-edge, appropriate treatment, even if they have the equipment to make a diagnosis. It’s very important to find someone who specializes in concussion treatment.
For concussion treatment to be effective, the brain needs to be taxed enough to change. So, good therapy will stress the brain frequently enough to force it to change.
If your visits are scheduled once a week for six weeks, that’s not likely to push the brain into making a change. A good minimum therapy level would be 2-3 sessions per week. At Cognitive FX, we often compact treatment into one week of rigorous therapy, which results in an average improvement of 75% in our patients.
This question ties in with what kind of therapy is being done. It’s most important that the clinic can handle multiple types of therapy. But knowing what kind of tools they have to execute their treatment plans also tells you what kind of clinic they are.
A DynaVision board, plenty of cognitive games, and exercise equipment that can challenge balance and coordination are all good signs.
Finally, consider whether you’re being treated all under one roof or if you have to travel to several different locations to complete your treatment regimen. The best clinics have in-house specialists who can coordinate as a team to make sure your treatment runs smoothly.
The good news with concussion clinics is that, usually, they won’t do any harm, even if they fail to help you. But there are a handful of indicators that mean you should turn around, walk out, and find someone else to help you. Here are three problematic situations:
If a clinic tells you to treat your concussion with rest in a dark room and no activity, they’re not basing that recommendation on good neuroscience research. Try to find a doctor who will work with you to prescribe active rest and therapy if needed. Your brain health is too important to entrust to someone who can’t help you engage in “active rest” during your recovery.
Some doctors (especially neurologists) will prescribe medication to get rid of symptoms like nausea and migraines without finding and fixing what’s causing your problems. While medication is helpful in managing day-to-day living, it’s not a cure and it’s not even effective at managing symptoms for most concussion patients. Any doctor who wants to push medication without first determining whether those symptoms stem from a treatable condition is worth leaving for a second opinion.
Note: Many doctors simply don’t have the tools to determine the underlying cause of your symptoms. This is not to say they are bad doctors, and they may help you keep your symptoms under control. But medication is not a substitute for treatment. You deserve more.
As you probably know, there are some people who are happy to take your money while making fantastic claims about what they can do for you. If a treatment center tells you that one treatment program can fix things like concussions, bipolar disorder, marriage woes, and even autism, then you should take your money elsewhere. (Yes, there are places that make these claims to capitalize on people who experience real suffering and desperation.)
TL;DR: There is no one-size-fits-all treatment for every ailment and disorder. Make sure you find a clinic that specializes in treating concussions and has the credentials and research-based methods to make a real difference in your life. It’s a good sign if they have a team actively involved in concussion research.
There are a handful of clinics we can recommend based on our knowledge of their treatment programs. If it’s been three months or more and your symptoms haven’t resolved, these treatment centers have the best chance of helping you.
Full disclosure, we recommend ourselves first. Why? To date, there is no other post-concussion treatment center that offers the comprehensive, multidisciplinary, research-based treatment that we offer every patient. We hold ourselves to the highest standards of care and are constantly improving our program so that we’re better able to serve you.
If you’re unable to visit us for treatment, the other five locations named here may be able to help you:
If you’re experiencing symptoms that won’t resolve after one or more concussions, you’re not alone. And you’re not crazy. 90% of our patients experience symptom improvement after one week of treatment at our center specializing in post-concussion therapy. To see if you are eligible for treatment, sign up for a consultation.
We don’t have the time or the resources to thoroughly vet every concussion clinic — there are thousands in the U.S. alone. But now that we’ve equipped you with the knowledge and know-how, you can evaluate local clinics yourself. Here are a few well-known concussion clinics in each state.
If you’re experiencing symptoms that won’t resolve after one or more concussions, you’re not alone. And you’re not crazy. Using a brain scan called fNCI, we see evidence of how your brain changes with treatment. On average, our patients notice a 60% improvement in symptoms after one week. To see if you are eligible for treatment, sign up for a consultation.
