It’s Complicated: Why Symptom Diagnosis and Management are Critical After Concussion


The severity of a concussion, increasingly referred to as a mild traumatic brain injury (MTBI), can vary from one incident to the next, and symptoms can tell us a great deal about what issues need to be addressed during rehab. Particularly in the case of multiple sustained concussions, repeated blows can result in serious damage to the cervical spine, brain, vestibular and ocular systems. Evaluation by a competent sports neurologist is the first step in identifying which systems have been affected, and what treatment measures are called for to address them.

Frequently Reported Symptoms of MTBI

Most patients who sustain an MTBI report more than one symptom, which may include any combination of:

● Temporary loss of consciousness
● Muddled thinking
● Trouble concentrating
● Memory loss
● Persistent headache
● Blurred vison
● Bouts of dizziness
● Nausea and vomiting
● Balance issues
● Running into objects
● Loss of sense of time
● Other various issues

Damage sustained from an MTBI may affect more than one system, and careful diagnosis by an experienced concussion specialist is called for to identify appropriate and effective treatment.

A Winning Team is Key to Recovery

Many practitioners claim to be concussion specialists, yet lack the tools, credentials and expertise to effectively diagnose and treat MTBIs. In fact, effective rehab may require a team of specialists to treat multiple symptoms in the same patient. Team members might include:

● Sports neurologist
● Optometrist
● Neuropsychologist
● Physical therapist
● Occupational therapist
● Speech therapist
● Other specialists

Brain injuries are complicated, and accurately assessing and diagnosing symptoms is key to developing a treatment strategy to restore an MTBI patient to full functionality.

Virtual Reality for Diagnosis and Treatment

Every case of MTBI is unique to the injured and the incident, and therefore all cases of MTBI should be evaluated on a case-by-case basis. The length of time and the strategies needed for recovery will vary from one individual to the next.

One cutting-edge approach to evaluating MTBI symptoms is C.A.R.E.N, acronym for Computer Assisted Rehab Environment. This virtual reality environment helps concussion specialists fully evaluate the severity and types of injuries sustained by MTBI patients, and provides a safe environment in which to treat them without risk of further injury. Presently, NYDNRehab in Manhattan is the only facility in the United States that uses C.A.R.E.N as an integral part of their MTBI treatment approach. The team of concussion specialists at NYDNRehab are professional, experienced and equipped to diagnose and treat MTBI in a state-of-the-art facility in the heart of NYC.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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