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functional Neurocognitive Imaging (fNCI)

fNCI brain scans empower us to effectively treat concussions by showing which regions of the brain are malfunctioning after an injury.​

What is fNCI?

fNCI is an advanced form of a functional MRI that has been standardized for clinical application.

Cognitive FX's fNCI imaging and testing protocol includes six different cognitive tests performed inside an MRI machine. fNCI is measuring neurovascular coupling (NVC), which is the connection between neurons and blood in the brain.  

fNCI gives us over 7000 near real-time images of your brain. By processing these images and comparing them to a healthy control database, we measure and understand the severity of an injury in each region of the brain.

What is NVC-1

What is Neurovascular Coupling (NVC) and Why Is It Important?

Neurovascular Coupling (NVC) is the connection between neurons (brain cells) and blood vessels. Neurons need a lot of energy to do their job - blood vessels bring that energy to neurons. When an injury or neurological disorder occurs, the connection between blood vessels and neurons can be disrupted. This prevents some regions of the brain from receiving the necessary energy to perform. We call this Neurovascular Coupling Dysfunction.

This results in post-concussion symptoms that include, but are not limited to, fatigue, headaches, attention difficulties, memory issues, sleep problems, and emotional distress. 

Most clinics attempt to treat post-concussion syndrome by focusing on symptoms – which is a challenging diagnostic approach for effective treatments. To effectively treat PCS you must treat Neurovascular Coupling Dysfunction. This makes the fNCI brain scan such a powerful tool. fNCI scans show how blood flows throughout the brain while the brain is at work. fNCI detects problems with blood flow and energy by determining where there is too little or too much activity in key regions of the brain.

fNCI Measurements

Regions of the Brain

Regions of the Brain.

fNCI shows which areas of the brain function normally and which areas are hypo or hyper activated. The chart shows blood flow to specific regions of the brain. A normal, non-injured, brain would show a generally straight line right down the middle. 

Anything that is extremely high or low is a measurement of dysregulation in neurovascular coupling (NVC). Marks below the center portion show a lack of blood flow and marks above the center show that there's too much.

fNCI provides valuable insights to understand each patient’s brain. When we can see where the brain is compensating, using too much blood, or not enough blood we can target specific treatments to significantly improve the way their brain functions.

fNCI brain scan

Severity Index Score.

After the fNCI, we generate a report that shows a Severity Index Score. SIS is an overall score of the brain regions we measure compared to the healthy control group.

For example, if you have a score of 2.12, you are between two and three standard deviations away from healthy. The average severity score for the healthy population is 0. The average severity score for concussion patients is 2.5.

We have also found that regardless of where your score is on this scale your life can be drastically altered. Regional impairments contribute to a variety of symptoms. Occasionally, we find individuals generally healthy, but they still have other impairments which we see when looking at specific regions and the biomarkers of their overall scan. This is why we analyze the complete fNCI report for each patient.

An example of what an SIS score can look like for a concussed person


By scanning thousands of concussion patients and healthy individuals, we've discovered patterns of energy dysregulation unique to concussions and brain injuries. We call these objective patterns "biomarkers." The more biomarkers that are present in a brain, the more PCS difficulties they can expect.

On average, 4% of concussion patients meet all five biomarkers, 43% meet four biomarkers, 88% meet three biomarkers, and 100% meet both two and one biomarkers.

The majority of CFX patients have three or more biomarkers before treatment and only one biomarker after treatment.

a chart showing how majority of concussed people have all 5 biomarkers when compared to a healthy brain

“Before I came to Cognitive FX, I had three MRIs done. All the results came out good, and all of the doctors said I was fine. Some even suggested I was making it up, or I had depression and anxiety. When we came to Cognitive FX, and I got the fNCI it was nice to see the proof and results that there was something wrong with my head and that they knew how to fix it,”

Sophie Wirth
Past Patient

More Patient Success Stories

How fNCI Works

Imaging Protocol

1. Imaging Protocol

fNCI is administered in an MRI machine. During the fNCI, each patient will go through a series of cognitive tests while we are taking images of their brain.

Step 1 - Imaging
Process the Imaging

2. Process the Imaging

Each fNCI is processed by a radiologist and neuroscientist. With the aid of our database, we then create a comprehensive report that shows the results, a Severity Index Score, an overview of 60 brain regions, and objective biomarkers.

Step 2 - Process Imaging
Report of Findings

3. Report of Findings

CFX doctors share your brain scan results (showing areas that function incorrectly) with you in a report of findings. 

Step 3 - Report of Findings
Application to Treatment

4. Application to Treatment

After the report of findings, and if a patient chooses to do EPIC Treatment, this scan is used to prescribe treatments to individualize each patient’s therapy. This scan is also used in every therapy session to guide our therapists and trainers to do specific exercises that target the necessary regions of the brain.

This is why, without the fNCI brain scan, it is almost impossible to effectively treat post-concussion symptoms.

Step 4 - Application to Treatment

Frequently Asked Questions

Here we will review common questions and answers about fNCI.

What role does fNCI play in EPIC Treatment?

fNCI is vital to the success of EPIC Treatment. Throughout treatment, our therapists and trainers will be targeting the areas of the brain that are hyperactive or hypoactive as measured by the fNCI.

Because fNCI is measuring NVC, and during treatment, we are addressing the cause of the injury which is dysregulation of neurovascular coupling. Treating PCS requires addressing many systems that are at the root cause of the dysregulation including NVC.

We do a fNCI scan at the beginning and end of each week so that we can measure improvements to NVC. Giving our patients clarity in how their brain is functioning before treatment and after treatment.

What is the difference between fNCI & fMRI?

fMRI has been around for over 15 years as a research tool, with occasional use in pre-surgical planning. fMRI detects changes in blood flow while a patient is performing a cognitive task, providing a three-dimensional map of the brain regions that are used to accomplish that task. fMRI is limited in its clinical application because it is not standardized, particularly for the use of understanding neurological disease or injuries.

fNCI is an advanced form of fMRI because it uses an integrated system of fMRI development, administration, analysis, and clinical interpretation that overcomes the limitations and applications of fMRI. fNCI also has a standardize normative database making it more useful to understand concussion.

Is fNCI the same as SPECT?

No. fNCI utilizes fMRI and MRI technology that is non-invasive and does not use any radioactive materials to see what is happening in the brain. SPECT is an advanced form of a CT scan that uses a radioactive substance to produce an image.

CTA: Learn more about different imaging used in concussion >

How long does an fNCI take?

When you follow the full six cognitive test protocol, a complete fNCI takes around 45 minutes.

Can you have an fNCI done at another location?

Currently, Notus is not offering this imaging at any other location. In the past, it was used in hospitals around the United States, but it is no longer available.

Who developed fNCI?

Notus Neuropsychological Imaging developed fNCI, and Cognitive FX uses this imaging protocol for clinical application.

How is an fNCI processed?

Our experts use their extensive knowledge of neuroimaging and neuroanatomy and advanced software programs to process images and compare them to a normative database.

How much does an fNCI cost?

This imaging can cost anywhere from $5225 to $3500. 

Get Started on Your Recovery Today

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