Brain Injury Medicine & Traumatic Brain Injury

With eight years of postdoctoral neurological training and extensive experience evaluating complex brain injury, Dr. Andrew J. Funk, DC, DACNB, integrates injury biomechanics, neurological examination, detailed neuroimaging review and objective functional findings to recognize patterns of post-traumatic dysfunction, precisely localize affected neurological systems, and develop highly individualized rehabilitation strategies.

Dr. Funk diagnoses and treats the neurological consequences of mild, moderate and severe traumatic brain injury (TBI), including injuries associated with motor vehicle collisions, falls, sports injuries, blast exposure and other forms of head trauma. Brain injury can affect multiple interconnected neurological systems and produce headaches and migraines, dizziness and vertigo, imbalance, visual and oculomotor dysfunction, cognitive and memory impairment, slowed information processing, fatigue, sleep disturbance, autonomic dysfunction and dysautonomia, sensory abnormalities, motor dysfunction, emotional or behavioral changes, and other persistent neurological symptoms.

A major component of Dr. Funk's brain injury evaluation is determining which neurological structures, pathways and networks have been affected. Depending on the patient's presentation, he evaluates cortical and subcortical function, brainstem and cerebellar systems, vestibular pathways, oculomotor networks, sensory and motor systems, autonomic regulation, cognitive networks, and the functional connectivity among these systems. This allows the neurological examination to move beyond simply establishing that a brain injury occurred and toward identifying the specific neurological consequences of that injury.

Neuroimaging is integrated directly into this process. Dr. Funk personally reviews relevant brain imaging and correlates structural findings with injury biomechanics, neurological examination findings and the patient's clinical presentation. When clinically indicated, he may order additional or advanced neuroimaging and other diagnostic studies to investigate suspected traumatic pathology, vascular injury, structural abnormalities or other neurological conditions that may contribute to persistent post-traumatic symptoms.

A polysubspecialty approach is particularly important in traumatic brain injury because a single injury may simultaneously affect multiple neurological systems. Dr. Funk integrates Brain Injury Medicine with Vestibular Neurology, Neuro-Ophthalmology and Oculomotor Neurology, Dysautonomia, Headache and Pain Medicine, Neuroendocrinology, Vascular Neurology, Cognitive and Memory Neurology, Neuroimaging, and other relevant neurological subspecialties. This allows vestibular, visual, autonomic, cognitive, endocrine, vascular and other post-traumatic abnormalities to be evaluated as interconnected consequences of the brain injury rather than isolated symptoms.

Dr. Funk also investigates physiological mechanisms that may influence recovery when clinically appropriate. Laboratory testing and other diagnostics may be used to evaluate neuroendocrine, metabolic, nutritional, inflammatory, neuroimmune and other abnormalities relevant to the patient's neurological presentation. This is particularly important in patients with persistent symptoms in whom the original injury may have initiated multiple interacting neurological and physiological problems.

Treatment follows the neurological localization. Rather than applying a standardized brain injury rehabilitation protocol, Dr. Funk develops an individualized neurological rehabilitation and neuromodulation program based on the specific brain regions, pathways and networks identified during the evaluation.

Depending on the neurological localization and the patient's clinical status, rehabilitation may incorporate individualized vestibular and oculomotor rehabilitation, neuro-optometric rehabilitation, sensory and motor rehabilitation, balance and coordination training, peripheral nerve stimulation, transcutaneous auricular vagus nerve stimulation (taVNS), transcranial photobiomodulation, vestibular caloric stimulation, pulsed electromagnetic field therapy (PEMF), autonomic rehabilitation, and other targeted neurological rehabilitation and neuromodulation strategies. Treatment may be continuously modified according to objective neurological findings and the patient's response.

The objective is not simply to diagnose a traumatic brain injury or manage a collection of post-traumatic symptoms. Dr. Funk determines how the injury affected the individual patient's nervous system, localizes the neurological structures and networks involved, identifies modifiable mechanisms that may be interfering with recovery, and develops a highly individualized treatment strategy designed to target those systems and promote neurological recovery and neuroplasticity.