If you're suffering from persistent symptoms after a concussion — a condition called post-concussion syndrome (PCS) — you might think that Stanford Healthcare (part of Stanford University) would be a serious contender as your treatment provider. After all, Stanford Healthcare is world-renowned for combining clinical care, clinical research, and education to provide coordinated and personalized healthcare covering many different conditions.
However, despite its well-deserved renown for providing state-of-the-art therapies, Stanford Healthcare does not have a dedicated clinic for treating patients who are experiencing persistent symptoms after a concussion or traumatic brain injury (TBI). Instead, they have two separate departments located in Palo Alto, California — a Neuropsychology Clinic and an Outpatient Neurologic Rehabilitation Program — that focus on treating a wide array of neurological conditions and are more suited for treating acute concussions (i.e., concussions that have recently been sustained).
As we’ll explain later in this article, their approach is not ideal for patients with persistent post-concussion symptoms. Patients who experience symptoms for months or years after their concussion have much lower recovery rates when using the same approach as patients with recent concussions because their needs are no longer the same as acute concussion patients’.
At Cognitive FX, we specialize in treating this complex group of PCS patients. Our clinic brings together clinicians from over a dozen specialties to collaboratively provide evidence-based, multidisciplinary treatment tailored to the unique brain injury of each person who visits our clinic. This treatment program is designed to address the root causes of the symptoms directly, rather than tackling individual symptoms one at a time. This personalized, holistic approach leads to our unprecedented 90 percent treatment success rate.
As a part of our evaluation process, we offer functional brain imaging that identifies which specific areas of your brain were affected by the injury and in what way. This allows us to tailor your treatment plan to your brain, something most clinics (including Stanford Medicine) simply cannot do.
Understanding which option — Stanford or Cognitive FX — is right for you depends largely on understanding the difference between recent concussion and post-concussion syndrome.
In this article, we’ll explain why each condition needs a different treatment approach and explore the differences between what we offer at Cognitive FX versus what is offered at Stanford, in terms of:
90% of our patients report reduced symptoms after their treatment at Cognitive FX. To see if you’re a good fit for our program, sign up for a consultation.
The brain’s first reaction to a concussion is to trigger a localized inflammatory response in the affected area. This happens within 24 hours of the injury and is a crucial part of the brain’s recovery mechanisms, involving a series of chemicals released in the brain to aid the injured tissue.
Concussions and the resulting inflammation affect blood flow in the brain and cause changes in the way brain cells communicate with surrounding blood vessels to receive the resources they need to function. In a healthy brain, brain cells and blood vessels share a highly dynamic connection, one which allows brain cells to request the oxygen and nutrients they need to perform a particular task and have them delivered to the right location at the right time in the right amount. This is called neurovascular coupling (NVC).
Concussions disrupt this link; consequently, cells either receive the wrong amount (too little or too much) or get it at the wrong time. When this happens, cells are no longer able to complete the tasks assigned to them. Your brain will try to complete the task using an alternative pathway, but this pathway will inevitably be less efficient, causing you to tire out more quickly. This NVC dysfunction causes a variety of symptoms, some of which are associated with different concussion subtypes, such as headaches, brain fog, and fatigue.
The brain has an incredible ability to recover, however, and can use brain cells that remain healthy after the injury. The brain can fix the neural pathways disrupted by the concussion or form new ones to regain lost functions. This mechanism is called neuroplasticity. In patients who recover within a few days after their concussion, this is a straightforward process. At this stage, neurovascular coupling disruption is easily reversible by itself or with some simple therapy (cardiovascular exercise, physical therapy, vision therapy, and/or vestibular therapy as needed) to “nudge” neuroplasticity in the right direction.
Unfortunately, for some patients, not all symptoms resolve within this period. At least 15 percent of patients experience persistent symptoms that last months or even years, but that number can be as high as 60 percent depending on geographical location, injury severity, quality of care, and so forth. These patients suffer from a condition called post-concussion syndrome (PCS).
In these patients, the brain keeps using less efficient pathways to complete tasks even after inflammation has resolved. Once neurovascular coupling disruption becomes more established, it’s more challenging to treat. Standard therapies used to treat concussed patients are often not enough to treat PCS patients. Instead, PCS patients benefit from a customized, multidisciplinary therapeutic approach to restore healthier neurovascular signaling pathways.
In PCS patients, treatment is further complicated because brain injuries can also lead to chronic symptoms stemming from a combination of secondary conditions, including autonomic nervous system dysfunction, vision and vestibular problems, hormone imbalance, and breathing problems.
For example, the autonomic nervous system (ANS) — which controls many bodily functions, including heart rate, blood pressure, digestion speed, and body temperature — often becomes dysfunctional after a concussion.
Under normal circumstances, the ANS’ main branches, the sympathetic nervous system (SNS, which controls the fight-or-flight reaction) and the parasympathetic nervous system (PNS, which controls the rest-and-digest response), work together in harmony. However, in TBI patients, the SNS can become dominant even when there’s no need to react to a stressful situation. As a result, patients experience symptoms such as irregular breathing, high or low blood pressure, neck pain, headaches, digestive issues, dizziness, sensitivity to light, and more.
Further reading: Post-concussion ANS dysfunction (dysautonomia)
Vision problems are also common after a concussion and can prevail for a long period if not treated properly. PCS patients may experience a wide range of post-concussion vision problems, such as double vision, tired eyes, and problems with focusing and eye teaming (how the eyes work together). Vision therapy is often effective for patients who experience visual symptoms for longer than three months.
Some patients also experience changes in vestibular function. Mild traumatic brain injuries can disrupt the connection between the brain, vision, and vestibular system, which makes it harder for the brain to understand where it's positioned relative to its surroundings. This leads to symptoms such as headache, dizziness or vertigo, balance problems, and spatial disorientation. Fortunately, post-concussion vestibular therapy is very effective for these issues.
Brain injuries can also damage the hypothalamus and pituitary glands and cause hormonal imbalance. These small structures are responsible for controlling hormone levels in the body. Structural or functional damage to these areas disrupts the production of many different hormones, causing multiple symptoms throughout the body, including low blood pressure, weight gain, low libido, amenorrhea, heart palpitations, hair loss, fatigue, mood swings, and headaches.
Further reading: Hormone dysfunction following head injury
Finally, concussions may affect breathing dynamics, disrupting the mechanisms that regulate the levels of carbon dioxide (CO2) and oxygen (O2) in the bloodstream. Breathing issues can cause patients to feel dizzy and lightheaded, have frequent headaches, or struggle with physical activity. Breathing exercises — an important part of the treatment we offer at Cognitive FX — go a long way to help accelerate the patient’s recovery.
As you can see, post-concussion syndrome is vastly more complex than acute concussion. This information is key to understanding which concussion treatments represent the best option for you.
Treatment plans for patients with a recent concussion typically involve cardiovascular exercise complimented by one or two standard therapies (physical, vision, and/or vestibular therapy) done over a few sessions. For most patients, this is usually enough to correct neurovascular dysfunction and eliminate symptoms.
In contrast, treatment for post-concussion syndrome is more challenging. Symptoms persisting longer than three months mean neurovascular disruption has become more established. In this case, patients need a more detailed evaluation process to find out exactly how and where the concussion affected their brain and which secondary conditions are present, followed by customized therapy sessions to address their specific situation.
With that in mind, we can now discuss key similarities and differences between the concussion treatment program at Stanford and Cognitive FX.
Stanford’s concussion treatment team is centered around treating recently concussed patients. They do not currently have a dedicated department for treating persistent post-concussion symptoms.
As we mentioned above, Stanford has two main departments that assess and treat concussion patients: the Neuropsychology Clinic and the Outpatient Neurologic Rehabilitation Program at Stanford Neuroscience Health Center.
Combined, these two departments offer the following in terms of staff expertise:
Neuropsychologists assess patients after a severe or mild traumatic brain injury, including:
Occupational therapists provide treatments to help patients with daily activities, including:
Physical therapists teach patients exercises to improve strength, flexibility, coordination, balance, and mobility skills. Treatments include:
Speech and language pathologists suggest treatments to improve communication and other cognitive skills. They can also help patients who struggle to swallow after a TBI. Treatment includes:
In extreme cases, patients can also be referred to the Neurosurgery Program (part of Stanford Brain Performance Center), where a team of neurosurgeons treats both adult and pediatric patients with complex head injuries.
By comparison, the staff at Cognitive FX specializes in PCS patients who develop persistent cognitive, physical, and emotional symptoms for months or even years after their head injury.
To treat PCS patients, we have a diverse team of nurses, doctors, and therapists including:
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Our team has years of experience diagnosing and treating the main causes of PCS symptoms, including the common problems discussed above:
Thanks to our advanced imaging capabilities (described below), our team can determine exactly what areas were affected by the concussion and design a treatment plan tailored to each patient’s needs.
Stanford’s neuropsychological evaluation (offered through their Neuropsychology Clinic) starts with a series of clinical interviews with the patient and their family (or close friend) to review the patient’s medical history and understand how the concussion has affected their emotional and cognitive skills. Typically, this initial interview takes about an hour to complete.
The second step involves a series of standardized cognitive and behavioral tests to check the patient’s:
All the information is then gathered and used to design personalized treatment recommendations for the patient. Results can help therapists at their Outpatient Neurologic Rehabilitation Program assess whether patients are ready to return to work/school and engage in important life activities, such as managing their finances and driving. If needed, they can also suggest adaptations at home or work to optimize their chance of a successful return.
All our patients receive a comprehensive evaluation, starting with the patient’s medical history and symptoms. Patients undergo a variety of exams, including:
![EPIC Treatment Yellow Puzzle [V1]](https://www.cognitivefxusa.com/hs-fs/hubfs/EPIC%20Treatment%20Yellow%20Puzzle%20%5BV1%5D.jpg?width=1999&height=1241&name=EPIC%20Treatment%20Yellow%20Puzzle%20%5BV1%5D.jpg)
One of the timed exercises included in patient evaluations at Cognitive FX.
During the initial evaluation, our team also looks for signs of ANS dysfunction, and a neurointegration specialist evaluates how well the patient’s inner ear, eyes, and body communicate with each other. We repeat the same tests at the end of the treatment week to assess how much the patient has improved.
Patients also complete a specialized brain scan called functional Neurocognitive Imaging (fNCI). This scan assesses blood flow in 100 different regions in the brain while patients complete a set of predetermined cognitive tasks. The resultant near-real-time images are then combined and compared to a healthy control database to identify the areas where NVC dysfunction is disrupting normal functioning. Key regions of the brain each receive a score that reflects their performance. Scores in the yellow to red sections indicate neurovascular coupling dysfunction in the areas of the brain responsible for that particular cognitive function.
The scan also measures how different brain regions communicate with each other. In this case, regions in green are normal, whereas areas in blue are less active than expected. For example, in the image below, rACC (the right anterior cingulate cortex) shows less activity than usual. This area is crucial for attention and could contribute to memory problems if not functioning normally.
This scan is a key part of our patient evaluation and is something Stanford does not offer.
Patient story: How a former figure skater learned years of chronic illness was due to post-concussion syndrome
Once all assessments are complete, our team can design a personalized treatment plan to target exactly the areas of the brain that showed dysfunction.
Because Stanford’s Neuropsychology Clinic only offers assessment and treatment recommendations, their treatment is limited to what they offer through their Outpatient Neurologic Rehabilitation Program, which typically includes occupational, physical, and speech therapy.
Some of their facilities include:
Treatment options offered for concussion patients include:
After treatment, the team at Stanford also provides patients with a list of exercises to do at home. This program is gradually adapted as patients improve and reach their goals. If needed, the therapists also discuss with patients the options for continuing treatment in a community-based setting.
At Cognitive FX, our therapists use a cutting-edge combination of aerobic exercise and multidisciplinary therapies to target the root causes of PCS symptoms in patients, including neurovascular coupling disruption, autonomic dysfunction, vision changes, and vestibular issues.
Once patients complete the patient evaluation, they are ready to start treatment. Typically, this involves a three-step cycle that is repeated throughout treatment: Prepare, Activate, and Recover.
Treatment starts with short sessions of aerobic exercise intervals, typically on a stationary bike or treadmill. Physical exercise promotes healthy blood flow within the brain and triggers the release of many helpful neurochemicals, including one called brain-derived neurotrophic factor (BDNF). BDNF helps the brain to learn new information and boosts the efficacy of subsequent therapies.
Lauren Taylor Brem during neurointegration (advanced vision and vestibular) therapy.
During the second step, patients attend therapy to treat their PCS symptoms. While patients receive most of the therapies we offer, the exact combination of exercises within each therapy varies considerably depending on the results of the brain scan. This level of personalized treatment is something that Stanford does not offer.
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At Cognitive FX, the primary purpose of each therapy is to stimulate healthier NVC in the brain regions identified as underperforming for each patient. Different therapies excel at helping different brain regions. All therapies are conducted in-house with close, daily communication between therapists to ensure they are fine-tuned for your needs. |
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Cognitive therapy |
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Occupational therapy |
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Neuromuscular therapy |
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Sensorimotor therapy |
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Vision therapy |
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Neurointegration therapy (vestibular therapy) |
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Psychotherapy |
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Note: While care for pediatric post-concussion syndrome patients is similar to that for adults, we tailor our approach based on age.
For further information, see our post on post-concussion syndrome in children.
Patient Scotty Allen (from the Strange Parts YouTube channel) tries Dynavision therapy.
The final step involves time to unwind in between therapies. Patients learn a variety of breathing and mindfulness exercises, listen to brainwaves, or receive a neuromuscular massage of the neck and shoulders.
At the end of treatment, patients undergo a second scan to see how their brain is responding to therapy. Then, patients meet with one of our therapists to discuss their progress and how to continue recovery at home.
Patients receive a series of exercises to do at home, typically including aerobic exercises, cognitive games, and relaxation techniques. These exercises take about one hour every day, five days a week. When patients start to feel better, they can gradually do these exercises less often. If needed, we refer patients to additional specialists, such as endocrinologists, psychologists, and vision therapists.
At Stanford, patients receive a pricing range for their treatment, but estimated prices are not guaranteed. The actual therapies that patients receive may differ from the services used to compile the estimated price. This is especially true if doctors need to order more tests than originally thought. Patients can use the Cost Estimator to estimate out-of-pocket costs for some of the services offered by Stanford Health Care.
Stanford Health Care is contracted with most major health insurance carriers including CalPERS, Medi-Cal, Medicare, TRICARE and TriWest. Financial counseling is available to help patients identify possible ways to pay for their care if they do not have adequate funds or health insurance.
Cognitive FX is not an in-network provider with any insurance providers, but we can provide CPT codes (see the full list on our pricing page), and some of our patients may obtain partial reimbursement when filing with their insurance companies.
One advantage that we have over Stanford is that patients know exactly how much their treatment is going to cost. There are no hidden or extra costs. We offer four packages for patients to choose from, ranging from $2,500 to $24,700. If patients choose one of the packages with just the brain scan — “fNCI only” or the “fNCI + Action plan” — but then decide to continue treatment with us, the initial cost is credited to the cost of treatment. For example, if you choose the fNCI scan only but then decide to attend one week of treatment, your treatment plan cost would be $10,500 ($13,000 less the $2,500 you already paid for the scan).
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Patient Evaluation: Patient evaluation starts similarly between both clinics, but Cognitive FX then goes one step further by using a functional brain scan to identify the exact areas affected by the concussion. Results from the scan are then used to design a customized treatment for each patient.
Treatments Offered: Both clinics cover some of the same therapies, but at Stanford, each therapy is offered in isolation by different therapists. At Cognitive FX, we know the key to treating PCS patients is integration between therapies. Our team members are close collaborators who constantly communicate with each other to monitor patients and adjust treatment as needed.
In conclusion, the treatments offered by the Stanford team may be enough to treat patients shortly after their concussion, but their methods are not ideal for patients with persistent PCS symptoms lasting more than three months. We understand that PCS patients have unique needs and offer them multidisciplinary, evidence-based methods and cutting-edge technology to give them the best chance at recovery.
The average symptom improvement reported by our patients is 60 percent. To see if you’re a good fit for our program, sign up for a consultation.
If you have post-concussion syndrome, you might think that the Mayo Clinic would be a serious contender as your treatment provider. After all, the Mayo Clinic is a world-renowned medical and research...
