DISCOVERY DAY
What is a Discovery Day?
A Discovery Day is the first day you come into the clinic. You could consider this a new patient visit, however, we go more in depth than an initial meet and greet. Our doctors, diagnostic technicians, rehab technicians, and administrative staff are all involved in your initial visit and help create a plan of action to best help you start walking towards your recovery goals. By the end of the Discovery Day, each patient will have a blueprint of what kind of therapies they may require, which duration of therapy best fits their specific needs, and a start date for care.
“But you have more questions, we’re here for you.”
How is the Discovery Day Structured?
Your Discovery Day begins with one of our rehab technicians getting you settled into a patient care room and taking your vitals (heart rate, blood oxygenation, and blood pressure) at the start of the visit. Following this, Dr. Glen Zielinski will come in and discuss your health history with you. This is your opportunity to share what led you to our clinic, what treatments you have previously tried, as well as any symptoms and concerns you may have. This initial history typically lasts about 30 minutes.
At the end of the initial intake, Dr. Zielinski will bring in our diagnostic technician to begin your testing.This testing is non-invasive, and utilizes cutting-edge, gold-standard diagnostics and examination procedures. The reason for this testing is to identify the underlying causes of people’s neurological problems. Our diagnostic testing allows us to precisely pinpoint the area of neurological dysfunction in our patients. Knowing this area of dysfunction allows us to develop innovative and individualized treatment plans that address the unique needs of our patients. We can find the specific therapies, provide them at the correct time, and with the exact frequency and intensity needed to generate the best outcomes.
This testing lasts approximately 45-60 minutes and then when it is finished, you are placed back into a patient care room where we will enter the final phase of our Discovery Day. The last stage of the Discovery Day is the review with Dr. Zielinski and the rehab team. This is where Dr. Zielinski will first perform a non-invasive physical assessment (such as testing reflexes and range of motion) to round out the data needed to create your plan. A rehab technician will be present to scribe and help review the visit data with the doctor.
Following this brief physical, the medical team will then have you take a seat with the doctor and will review all the testing data results from your physical and the diagnostic testing. You will see videos of how your body is responding in space, how your cognitive function is responding to different stimuli, as well as numerical graphs and data to explain and support your symptoms. Dr. Zielinski and his team will then explain what this means to you and how this data explains your personal symptoms and experience.
Finally, the team will then design a specific and customized treatment plan that is built completely around your results, your symptoms, and your specific needs. In total you can expect your discovery day to last approximately 3 hours and by the end of it you will have an action plan ready to be put into place immediately.
What kind of tests will be done during the “Diagnostic Testing” stage?
Our rehab technician will first bring you back to the testing room where you will begin your first test which is Computerized Dynamic Posturography (CDP). CDP allows us to measure your ability to balance in a number of different conditions. We use the CAPS system, which is sensitive enough to read your heartbeat through your feet. Measurement of whole-body sway in different sensory conditions is the best way to see how your brain makes sense of input from your eyes, your vestibular system, and your proprioceptive feedback from muscles and joints. More importantly, it lets us see how your brain integrates these inputs, and gives us a way to tell when these inputs do not match properly. It also gives us wonderful measures of neurological fatigue, and is a tremendous tool for tracking your progress towards complete NeuroRestoration.
Following this, our technician will have you take a seat in a chair and rest for a moment before we begin our next test. This test is called Videonystagmography (VNG). The VNG software allows us to record and quantify eye movements. Why is this important? Well, impaired eye movements are an important part of the clinical picture in most neurological conditions. Eye movements are impaired in individuals who suffer from concussions, traumatic brain injuries, vertigo, movement disorders, Alzheimer’s disease, Parkinson’s disease, neurodevelopmental disorders, and virtually all points in between. Proper objective analysis of eye movements is usually the critical step in restoring neurological function.
There are numerous classes of eye movements, and they work together to help you create a coherent picture of your world. The various classes of eye movements are generated by specific parts of the brain. Analysis of these movements helps us to determine which parts of the brain are working well, which parts are not, and what we need to do to make all of them work well again.
Unlike conventional neurological imaging, videonystagmography allows us to assess the differing rates of neurological fatigability in individual brain regions. Rebuilding neurological endurance is one of the critical steps in the NeuroRestoration program, and videonystagmography gives us a precise way to evaluate functional endurance.
During this VNG testing, we will also be assessing your eye movements through Saccadometry. Saccadometry allows precise evaluation of a specific class of eye movements called Saccades. These are important eye movements, as they are the primary system you use to generate your visual map of the world. They are generated by the frontal lobes, and thus impact cognitive function. They are very commonly impacted in concussions and traumatic brain injuries, and are a critical part of our rehabilitation strategies for almost every condition we treat. The unique patterns of saccades seen with saccadometry can help us to better localize your neurological dysfunction. They help us devise the correct strategy for your unique NeuroRescue program.
The final test performed on your Discovery Day is the Video Head Impulse Testing (VHIT). The VHIT software allows us to gain critical insight into the inner workings of your inner ear’s vestibular system. The vestibular system is one of the key mechanisms by which we determine where we are in space. It allows us to make sense of our relationship with gravity and head motion, and compare that with feedback from eyes, muscles, and joints. This allows us to localize ourselves in the world.
There are several functional parts to the vestibular system, including the six semicircular canals. These canals act as sensors to detect head motion and head position. They provide input that the brain uses to fire core stabilizing muscles. They work with the brainstem and cerebellum to generate vestibulo-ocular reflexes, which help us stabilize our gaze and know where the visual world is as our head moves. Impairment of these reflexes is usually the primary driver of dizziness and vertigo. Damage to these reflexes is extremely common in concussions and traumatic brain injuries, and functional imbalances in these systems can be involved in everything from movement disorders and neurodegenerative diseases to psychiatric conditions. VHIT testing allows us to precisely quantify the function and fatigability of all six vestibular canals and their associated reflexes. This is another critical part for designing your unique NeuroRescue program.
Once all these tests are performed, we will have a broad spread of data to properly quantify what you are experiencing symptom wise, as well as pinpoint the exact areas of dysfunction you are facing. This specialized testing is what makes it possible to design your customized recovery program. Please contact us today so we can begin your to customized healing.