Frequently asked questions

General

Yes. For concussion and mild traumatic brain injury, Cognitive Health Assessments™ inform what cognitive functions are performing below average to inform if cognitive rehabilitation is required and if a full neuropsychological assessment may be recommended. For acquired (ex. stroke, heart attack) and traumatic injuries (ex. car accidents, falls, victim of violence etc.), the assessments indicate cognitive functions that are responsive, and how close they are to healthy norm to indicate potential for rehabilitation.

Yes, our Cognitive Health Assessments™ do have utility in other areas. While our primary clientele are concussion and acquired brain injury patients (including injuries due to stroke, brain tumours, substance abuse, or physical trauma to the head), our assessments are valuable to anyone in need of reliable, trackable objective data on brain function. For example, understanding the effects of pharmaceuticals on brain function in clinical trials, monitoring the effects of aging, monitoring the brain health of athletes, to name a few.

Cognitive Health Assessments™ do not diagnose concussions or acquired brain injury. Like the majority of assessment tools, they are an asset for clinicians to utilize to objectively inform an initial diagnosis, or corroborate on an existing diagnosis. Diagnoses can be provided by primary care providers, nurse practitioners, and clinical specialist in brain injury.

Healthcare Providers

Concussion and acquired brain injury assessment solutions are in high demand due to increased recognition and attention to these types of injuries – with concussion in particular in recent years. The majority of these companies are focused on providing clinicians with a tool to aid in an objective diagnosis. This is a valuable piece to a patient’s recovery path – but what good is an objective diagnosis if it doesn’t inform recovery? VoxNeuro’s Cognitive Health Assessments™ provide the objective data clinicians need to create customized, targeted rehab plans specific to that patient’s unique needs. Cognitive Health Assessments™ continue to add value to a patients recovery path through follow-up assessments, providing data to track the patient’s progress, and in optimal cases – confirm when a patient has returned to a healthy norm to return to regular activity & play. By placing clinical teams on the right path from the start of rehabilitation, they are able to better predict recovery timelines, objectively inform, track and accelerate recovery of a patient. Read more

Executive function, language comprehension, working memory, automatic attention, reactive attention, concentration, information processing, auditory processing, and visual processing. The integrity of these functions are essential for a patient’s well-being and quality of life. Read more on The Science page. Additional source: ONF Brain Injury Guidelines, 3rd Edition – 2018

The report will be delivered 2 business days following the patient’s assessment, and will be delivered to the referring physician and or clinical specialist indicated during the intake process.

In the case of a concussion and mild traumatic brain injuries, an initial assessment is recommended within the first 6 months post-injury. Follow-ups are recommended mid-rehabilitation to confirm if the therapies selected are effective for that patient & inform if other methods should be tried, and post-rehabilitation to confirm if a patient has returned to a healthy norm or requires further rehabilitation.

For athletes, more frequent follow-ups are recommended throughout their recovery to assist in informing return-to-play timelines, and most importantly to ensure a patient does not return to play before symptoms and cognitive performance have returned to normal – avoiding risk of second impact syndrome.

For acquired brain injury patients, the initial assessment is recommended within the first month, or first few months post-injury. If rehabilitation is identified as a potential, follow-ups are recommended every 3-6 months to confirm if the therapies selected are effective for that patient & inform if other methods should be tried.

See Get Started. A member of our team will begin with a call to understand your utility and discuss your options for integration.

VoxNeuro’s Cognitive Health Assessments™ are Health Canada cleared and backed by 25+ years of globally funded, peer reviewed studies. See Foundational Research for publications and peer reviewed journals that document the research behind the methods performed in VoxNeuro’s Cognitive Health Assessments™ (CHA).

VoxNeuro’s Cognitive Health Assessments™ do not replace full neuropsychological assessments – that take into account a patient’s full history, physical, emotional and cognitive characteristics. VoxNeuro’s assessments quickly help place a patient on the right path to recovery and can be used as a screening tool for the need for cognitive rehabilitation and potentially a full neuropsychological assessment. VoxNeuro’s reports aid neuropsychologists in their assessments by providing objective data on a patient’s brain function to validate and support their cognitive assessments. Neuropsychological assessments provide a deeper analysis of a patient’s brain and emotional health overall. VoxNeuro’s assessments help streamline a patient care pathway, but like any concussion or acquired brain injury assessment tool – are always to be considered as part of a multidisciplinary approach.

Various medications and psychoactive substances may cause the results of the assessment to deviate from ‘normal’ values. To ensure this is taken into consideration during the clinical examination of their report, we screen for this information during the patient intake process.

Owing to our decades of research preceding the commercial launch of our assessments, we have a rich database from patients of different genders spanning from 7 years of age to 70+. With this database to compare a patient’s results to, we do not need a baseline to produce meaningful results in our reports.

The sooner you can get a full understanding of your patient’s cognitive function, the faster you can start rehabilitating any areas of dysfunction identified in a VoxNeuro Cognitive Health Assessment™ report. Starting targeted rehab early in the patient’s recovery path helps in a number of ways: 1) it ensures the patient is only focusing on rehabilitating the functions that need attention – ensuring they don’t experience burn out from trying to address all functions at once, 2) it allows you to begin addressing issues before they manifest further, 3) you can avoid trial and error methods of rehabilitation, knowing you’re working on the specific needs for your patient.

First, please see the question and answer directly above. VoxNeuro’s assessments can be run anytime post-injury – from days following through years after the injury to assess cognitive effects of the injury. We recommend completing an assessment as soon as possible to set your patient on the appropriate path to recovery, addressing any cognitive issues they may have before they manifest further.

Yes, standard practice advises primary care providers monitor symptoms & provide patients’ with education on how to manage their symptoms through gradual return to activity, and to seek medical attention immediately if symptoms worsen for the first 4 weeks post-injury. When symptoms do not resolve in the initial 4 weeks of an injury, multidisciplinary examinations for a patient’s cognitive, physical and emotional complications are required. VoxNeuro’s Cognitive Health Assessments™ inform if the patient requires cognitive rehabilitation, and can identify if a full neuropsychological assessment is of benefit to the patient.

No, the Cognitive Health Assessments™ offered are extremely sensitive measurements and as a result can be useful in both the acute and chronic phases of injury. You can explore more on how our assessments benefit individuals years removed from their injuries in our publication Disruption of Function: Neurophysiological markers of cognitive deficits in retired football players  and in the award winning series Collision Course.

Patients

VoxNeuro’s assessments are run at the VoxNeuro Assessment Centre, located at McMaster University, 1280 Main St W, in Hamilton, Ontario.

Appointments are available Monday-Friday, 10am-8pm. Our appointment line to book an appointment by phone (1-833-869-6387) is open 10am-6pm. You may also contact us via email at [email protected].

For acquired brain injury patients unable to travel to the VoxNeuro Assessment Centre, please contact us to make arrangements for an assessment at the patient’s location.

A Cognitive Health Assessments™ report summarizes the health of a patient’s brain’s performance. It breaks performance into a patient’s key functions, so each can be examined individually. This allows clinicians to objectively review each cognitive function, and provide treatment plans specific to a patient’s unique needs as indicated by sub-normal responses within the report.

Coverage may be provided through workplace insurance and through motor-vehicle accident (MVA) insurance. Coverage may also be possible through personal extended benefits.

All coverage options are dependent on the nature of the patient’s injury and the coverage provided by the insurer. Granting funding is up to the insurer, on a case by case basis and not guaranteed.

If a patient is interested in seeking workplace or MVA coverage, VoxNeuro can facilitate applications for funding through our partnership with Bayshore Therapy & Rehab. To proceed, please contact us.

If a patient intends to have the assessment covered by their extended personal benefits, they are required to pay for the assessment prior to their assessment, and submit to their provider following the assessment. Reimbursement is up to the insurer and dependent on the patient’s coverage.

At the moment, Cognitive Health Assessments™ are not included under the publicly funded health program (OHIP).

Cognitive Health Assessments™ for concussed or mild-traumatic brain injury patients are booked in 1.45 hour appointment blocks, including intake, behavioural forms, EEG testing and clean up. The 60 minute EEG assessment includes short breaks.

Cognitive Health Assessments™ for traumatic or acquired brain injury patients are booked in 3.5 hour appointment blocks, including intake, behavioural forms, EEG testing and clean up. Additional time is provided to accommodate assistance in the patient completing the assessment, and longer breaks between the tests.

EEG is very different from neuroimaging techniques like MRI or CT scans in a few different ways. For starters, EEG is non-invasive and does not require any tight spaces to complete. It can be done in a relatively comfortable set up, with you seated in a chair and the EEG cap placed over your head – similar to a shower cap. Next, EEG does not give off any radiation because it is not actually taking images of your brain, but instead it is collecting the electrical activity that is naturally being emitted from your brain. All that is required to do this is to wear the EEG cap, and to put some gel between the electrodes on the cap and your scalp.

Great question. There are a number of different ways EEG can be utilized in clinical testing. Visit The Science to learn more.

No, you will not feel anything happening to your brain or body during the Cognitive Health Assessment™ that you would not otherwise feel during your regular daily life. None of the procedures should cause any physical pain or discomfort whatsoever. You may experience mental fatigue from concentrating on completing the tasks.

If you suffer from epileptic seizures, hearing or visual impairments, please make your technologist aware in advance of testing. Alternate test formats may be used.

Yes, we offer accommodations to the testing protocol to allow those with auditory and visual impairments to complete the testing. Please note this at time of booking.

VoxNeuro currently only offers assessments in English. If English is not the patient’s first language, accommodations may be made to facilitate the assessment.

No. Assessments are available through clinician referrals or independent assessment requests. Independent patients will be referred to a VoxNeuro partner for treatment. See Get Started.

2-5 days post-assessment: Your report will be delivered to your care provider. Using your report, they can create a customized plan based on the specific areas of cognitive function that have been impacted by your injury. If you do not have an existing care provider, VoxNeuro can refer you to a rehab partner specialized in concussion and brain injury.

Within two weeks:
For concussions: You’ll meet with your care provider to discuss your care plan. VoxNeuro’s rehab partners create customized cognitive rehab plans based off a patient’s unique needs. Specialists in areas like Neuropsychology, Occupational Therapy (OT), Speech Language Pathology (SLP), and Physiotherapy (PT), can work together to create a holistic plan designed to optimize your recovery care path. You may be eligible for funding if you have insurance coverage.

For ABIs: You’ll consult with a care provider to review the patient’s cognitive performance and impairments to determine their potential for rehabilitation including cognitive remediation and compensatory approaches. VoxNeuro’s rehab partners specialize in Occupational Therapy (OT) for patients with non-catastophic through catastrophic ABIs. You may be eligible for funding if you have insurance coverage.

Tracking Success
If interventions are pursued, VoxNeuro recommends retesting the patient throughout the intervention to quantify progress and improvements in cognitive functioning.

By providing objective measurement to track against a patient’s recovery and treatment methods, VoxNeuro is working with multidisciplinary rehab clinics to optimize cognitive rehabilitation for individual patients, while also working towards population medicine optimization in the treatment of brain injuries.

No, VoxNeuro is a private outsourced lab developed service.

See Q: Are Cognitive Health Assessments™ eligible for coverage from any types of insurance? for more details.

No, VoxNeuro does not facilitate funding coverage directly.

See Q: Are Cognitive Health Assessments™ eligible for coverage from any types of insurance? for more details.

All independently booked assessments (not through a VoxNeuro partner), payment is required at least 48 hours prior to the appointment. If a next-day appointment is booked, payment is due at time of booking. VoxNeuro does not accept payments in person at the time of your appointment. If payment is not submitted within these time frames, your appointment will be cancelled and you will need to re-book at an alternate time.

If you need to cancel or reschedule your appointment, it is required to do so prior to 24 hours of your confirmed appointment. If you cancel your appointment within 24 hours of your scheduled time, or fail to show-up for your appointment, you will be charged 25% of the full assessment cost.

If you cancel your appointment within 24 hours of your scheduled time, or fail to show-up for your appointment, you will not be able to request a new time for your appointment until all of the required intake steps, including full payment, are complete.

A concussion is an injury to the brain that results in temporary loss of normal brain function. (Definition by the American Association of Neurological Surgeons).

Concussion are caused by a biomechanical force, meaning any situation that may induce a sudden/dramatic biomechanical force are potential mechanisms of injury. Some of the most common are motor vehicle collisions, falls, assaults, and non-intentional strikes during sport or other recreation.

The observable effects of a concussion or acquired brain injury can be noticeable immediately, or become noticeable over time. Every concussion presents with its own unique cluster of signs and symptoms, however some of the more common categories of signs and symptoms are cognitive-based symptoms (difficulties with various areas of cognition), vestibular and vision dysfunction (persistent vertigo, dizziness, nausea, eye characteristics etc.), mental health (irritability, sadness, anxiety, etc.), post-traumatic headache, sleep-wake disturbances, and fatigue.

The most frequently reported impairments as a result of a concussion and brain injury that prevent individuals from returning to work / regular activity are cognitive difficulties (ONF Brain Injury Guidelines, 3rd Edition – 2018, Pg 5). Some examples include issues with: thinking, concentrating, memory, processing environmental stimuli, and executive function: a complex cognitive process that affects an individual’s ability to multitask, prioritize, organize, and have effective time management.

A full list of noticeable signs and symptoms a patient may experience following a concussion or acquired brain injury may include: (source: Brain Injury Canada (2018)).

Cognitive:

  • Slowed information processing
  • Problems planning, organizing or starting tasks
  • Difficulty following conversations, finding the right word, or speaking in complete sentences
  • Difficulty making decisions
  • Easily distracted
  • Easily confused
  • Poor memory
  • Lowered inhibition (saying or doing something before thinking it through)

Physical:

  • Problems with balance, walking, sitting, bathing, household or everyday tasks
  • Slurred speech
  • Chronic pain such as headaches
  • Dizziness
  • Fatigue
  • Sleep difficulties
  • Change in vision
  • Sensitivity to noise
  • Sensitivity to light
  • Sensory changes: ringing in the ears, trouble with hand-eye coordination, unpleasant tastes or smells, sensations on the skin like tingling, pain, or itching, difficulty with balance, dizziness

Emotional:

  • Irritable
  • Depression
  • Anxiety
  • Sadness
  • Lack of emotional responses
  • Emotionally vulnerable (ex. Crying without cause, emotional outbursts)

Behavioral:

  • Engaging in risky behavior, impulsive
  • Isolating oneself
  • Difficulty with social and work relationships
  • Changing/inconsistent sleep patterns
  • Change in role – often from being independent to relying on others for care and support

If you believe you have sustained a concussion, you should seek out your primary care physician or an urgent care facility, however if you suspect there may be a more serious injury, present yourself to an emergency department immediately.

Observing one of the following clinical signs constitutes an alteration in brain function and should be a cause for immediate medical attention following an injury (source: Centers for Disease Control and Prevention. (2015)). Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. Atlanta, GA.

  1. Any period of loss of or decreased consciousness;
  2. Any loss of memory for events immediately before (retrograde amnesia) or after the injury (post-traumatic amnesia)
  3. Neurologic deficits such as muscle weakness, loss of balance and coordination, disruption of vision, change in speech and language, or sensory loss
  4. Any alteration in mental state at the time of the injury such as confusion, disorientation, slowed thinking, or difficulty with concentration.

Concussion timeline & stats

Acute
Symptoms may present immediately, or develop within a few days post injury. With proper guidance on symptom management, the majority of patients will recover within 1-4 weeks.

  • ≈ 80% of the adult population recover in 2 weeks
  • ≈ 70% of children and adolescents recover within 4 weeks

Action: Consult with your primary care provider immediately if a concussion is suspected. Follow-up with your primary care provider to monitor your symptoms until they resolve.

Persistent
On average, symptoms that last beyond 3 weeks.

  •  ≈ 15-20% of the adult population
  • ≈ 30% of children and adolescents

Action: Interdisciplinary care required.

Post Concussion Syndrome (PCS)
May be diagnosed when symptoms persist past 2-3 months post injury

Action: Re-evaluation and continued care from interdisciplinary team required.

* Infographic informed by Ontario Neurotrauma Foundation’s Concussion Recovery Pattern and Post-Concussion Care Pathway 2017

The exact rehabilitation strategy will depend on the category of symptoms being addressed, and will be planned by your rehabilitation provider to address your unique injuries needs. The best management strategy is to be treated by a multidisciplinary team, meaning regular visits with your primary care provider to manage your symptoms, and specialist to address cognitive (brain function), physical and emotional issues you may be dealing with as a result of your injury.

While treatment is a custom fit to the patient based off their unique presentation of symptoms and assessment findings, some of the most prevalent management strategies are presented alongside the most common clinical symptom categories documented. These recommendations follow the latest guidelines published by the Ontario Neurotrauma Foundation.

Management Strategy / SpecialistsCategory of Symptoms
Neuropsychological Assessment & Rehabilitation of Problem Area of Cognition (e.g., neuropsychologist, occupational therapist, physiotherapist)Cognitive Dysfunction
Neuro-OphthalmologistsComplex Visual Symptoms
Qualified OptometristsImpairments of Eye Movement and Photosensitivity
Healthcare Practitioners Specialized in Coordinating Eye-Head Movements, Balance, and MobilityVestibular System
PharmacotherapyMental Health Headaches
Sleep-Wake Disturbances Fatigue

ABI refers to damage to the brain resulting from events incurred after birth.

There are two classifications for ABIs, traumatic and non-traumatic.

Traumatic Brain Injury

ABIs occurring due to an external force such as a bump, blunt force, or jolt to the head are classified as traumatic brain injuries (TBIs). An external force to the head does not always result in a TBI.

TBIs range in severity from “severe”, such as coma or Unresponsive Wakefulness Syndrome (vegetative state), to “mild” (mTBI), commonly referred to as concussion. (Source: Traumatic Brain Injury & Concussion (2017, April 27)).

TBIs can result in temporary injury or more severe, long-term damage to brain cells.

Non-Traumatic Acquired Brain Injury

Non-Traumatic Acquired Brain Injuries are caused by something that happens inside the body or a substance introduced into the body that damages brain tissues. (source: Brain Injury Canada (2018). Brain injury info: Acquired brain injuries (ABI) – the basics).

Causes include: motor vehicle accidents, falls, assault, gunshot wounds, domestic violence, shaken baby syndrome, sports injuries, explosive blasts and combat injuries.

Causes include: (source: Brain Injury Canada (2018). Brain injury info: Acquired brain injuries (ABI) – the basics.)

  • Ischemic stroke (stroke from a blocked blood vessel in the brain)
  • Hemorrhagic stroke (stroke from a burst blood vessel in the brain)
  • Aneurysm (a bulge in a blood vessel in the brain that may leak/rupture)
  • Seizure disorders
  • Brain tumour
  • Poisoning
  • Substance abuse
  • Opioid overdose (heroin, fentanyl, codeine, morphine…)
  • Meningitis
  • Encephalitis
  • Hydrocephalus (fluid accumulates in the brain)
  • Vasculitis (inflammation of the blood vessel walls in the brain)
  • Hematoma (blood collecting on the surface of the brain)
  • Events where the brain has been deprived of oxygen
  • Toxic exposures

Funders

VoxNeuro’s concussion & acquired brain injury assessments run advanced electroencephalography (EEG) simultaneous to neuropsychological tests. By pairing widely used and validated neuropsychological assessment methods with EEG, VoxNeuro transforms what would be qualitative results from traditional, subjective testing into objective, quantifiable measurements of brain function. The objective data on the patient’s brain function helps healthcare providers create customized treatment plans specific to the patient’s unique injury, and accelerate & track recovery with unprecedented precision.

Concussions and brain injuries cause disruption in normal brain function. Too often concussions and brain injuries are only treated for their symptoms, not addressing the root-cause of many of the issues the patient may be experiencing – issues in their cognitive function.

The most frequently reported impairments as a result of a concussion and brain injury that prevent individuals from returning to work / regular activity are cognitive difficulties (ONF Brain Injury Guidelines, 3rd Edition – 2018, Pg 5). Some examples include thinking, concentrating, memory, processing environmental stimuli, and executive function: a complex cognitive process that affects an individual’s ability to multitask, prioritize, organize, and have effective time management. 

VoxNeuro’s assessments arm clinicians with vital, objective data on a patient’s brain activity in all core functions, including: 

  • auditory processing (ability to hear a stimulus)
  • visual processing (ability to see a stimulus)
  • information processing
  • language comprehension (ie. ability to follow conversations or reading text)
  • automatic attention
  • reactive attention
  • working memory
  • concentration
  • executive function (ie. ability to make decisions, working memory, problem solving, planning & organization) 

This objective data allows clinicians to pinpoint and address the root of the cognitive impairments a patient is dealing with, in addition to treating  observable/reported symptoms and functional impairments. Knowing areas of cognitive deficit is essential for rehabilitation professionals to facilitate the patient’s return to pre-accident functioning and improve their quality of life.

VoxNeuro’s assessments screen the need for cognitive rehabilitation, and the potential need for a full neuropsychological assessment. Additionally, VoxNeuro’s assessments add value in confirming if a patient’s symptoms are not associated with cognitive deficits, meaning their symptoms may be due to mood disorders, pain, musculoskeletal injuries or other causes. With VoxNeuro, healthcare teams are armed with objective data to customize a patient’s care path and rehabilitation quickly and efficiently with a 60-minute assessment and 2-5 day report turn around (2 for concussions, 5 for ABIs) – helping cut down timelines and streamline paths for specialized care.

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