Concussion & Persistent Post-Concussion Symptoms

Concussion is classified as a mild traumatic brain injury—but its consequences are not always mild. Approximately 15–30% of patients develop persistent post-concussion symptoms that can last months, years, and potentially become lifelong, disrupting cognition, vision, balance, autonomic function, headache regulation, sleep, exercise tolerance, and quality of life.

Dr. Funk diagnoses and treats concussion and persistent post-concussion symptoms by determining how the injury has affected the individual patient's nervous system. Concussion can disrupt multiple interacting neurological systems, producing headache and migraine, dizziness and vertigo, visual motion sensitivity, light sensitivity, blurred or double vision, impaired eye movements, imbalance, nausea, cognitive and memory difficulties, slowed information processing, brain fog, fatigue, sleep disturbance, exercise intolerance, autonomic dysfunction, orthostatic intolerance, sensory abnormalities, and other persistent neurological symptoms.

Dr. Funk does not treat concussion as one uniform disorder. He identifies and localizes the injured and dysfunctional brain regions, neural pathways, and interconnected neural networks responsible for each patient's unique pattern of impairment. His comprehensive neurological examination evaluates cortical and subcortical function, brainstem and cerebellar systems, vestibular pathways, oculomotor networks, sensory and motor integration, balance and coordination, autonomic regulation, cognition, and the functional interactions among these systems.

Vestibular and oculomotor dysfunction are particularly important after concussion. Dr. Funk evaluates abnormalities involving gaze fixation and gaze-holding, smooth pursuit, saccadic eye movements, convergence and vergence, ocular alignment and coordination, vestibulo-ocular reflex function, visual-motion processing, balance, and other vestibular and visual neurological functions. These findings can help localize dysfunction within specific brainstem, cerebellar, cortical, vestibular, and oculomotor pathways and networks.

Autonomic dysfunction can also become an important component of persistent post-concussion symptoms. When clinically indicated, Dr. Funk evaluates orthostatic heart rate and blood pressure responses, exercise intolerance, cerebral and systemic physiological responses to positional change, and other findings suggestive of post-traumatic dysautonomia or orthostatic intolerance. These abnormalities are incorporated into the larger neurological picture rather than treated as unrelated symptoms.

Neuroimaging is integrated when clinically relevant. Dr. Funk personally reviews relevant brain imaging and correlates neuroimaging findings with injury biomechanics, neurological examination findings, symptoms, and the patient's clinical course. When appropriate, he may order additional neuroimaging, laboratory testing, neuromarkers, autonomic testing, or other diagnostics to investigate persistent symptoms, identify contributing pathology, and distinguish the effects of concussion from other neurological conditions that may produce a similar clinical presentation.

A polysubspecialty approach is particularly important in persistent concussion because the injury may simultaneously involve multiple neurological systems. Dr. Funk integrates Concussion and Brain Injury Medicine with Vestibular Neurology, Neuro-Ophthalmology and Oculomotor Neurology, Dysautonomia, Headache and Pain Medicine, Neuroendocrinology, Cognitive and Memory Neurology, Vascular Neurology, Neuroimaging, and other relevant neurological subspecialties to understand how the patient's post-traumatic abnormalities interact.

That localization directly determines treatment. Rather than applying a generic concussion protocol, Dr. Funk develops individualized neurological rehabilitation directed toward the specific injured and dysfunctional brain regions, pathways, and networks identified during the evaluation. Rehabilitation is continuously modified according to neurological findings, symptom response, physiological tolerance, and the patient's changing neurological function.

Depending on the neurological localization and clinical presentation, concussion rehabilitation may incorporate individualized vestibular and oculomotor rehabilitation, neuro-optometric rehabilitation, balance and coordination rehabilitation, sensory and motor rehabilitation, graded autonomic and exercise rehabilitation, peripheral nerve stimulation, transcutaneous auricular vagus nerve stimulation (taVNS), transcranial photobiomodulation, vestibular caloric stimulation, pulsed electromagnetic field therapy (PEMF), and other targeted neurological rehabilitation and neuromodulation strategies.

The objective is not simply to reduce a concussion symptom score. Dr. Funk determines which neurological systems were affected by the injury, localizes the specific brain regions, pathways, and networks contributing to persistent symptoms, and identifies modifiable factors that may interfere with recovery.

Rehabilitation is then precisely targeted to repeatedly activate those neurological systems and drive adaptive neuroplasticity—the brain's capacity to reorganize, strengthen existing neural connections, form new synapses, and promote axonal and dendritic remodeling. The goal is to build and strengthen functional neural pathways and networks so the injured brain can recover neurological function, compensate for damaged circuitry, and develop more efficient connections through experience-dependent neuroplasticity.