Concussions are a serious and common injury, especially among young athletes. As a medical professional, it is important to stay up to date on the latest concussion management methods to treat both simple and complex cases.

The Complete Concussions Course, specifically tailored to meet the needs of physical therapists, chiropractors, and athletic therapists, contains 12 modules and close to 60 hours of evidence-based training that is designed to update your knowledge base on how to provide the best possible treatment for patients with brain trauma.

This signature course provides an in-depth overview of the signs, symptoms, and risks associated with concussions as well as the latest research and evidence-based protocols used in concussion management. Created by a multidisciplinary team of concussion experts and clinicians, this concussion training program offers a comprehensive resource for chiropractors looking to effectively treat concussions in their practice. 

In today’s blog, we’re going to give you a glimpse of the 12 modules and what you should expect to learn from each one, should you enroll.

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Module 1: Neurology Overview, Prevention, and Consensus Statements

Neurology Overview, Prevention, and Consensus Statements

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Globally, it is estimated that sixty-nine million people suffer a Traumatic Brain Injury (TBI) each year.  More than 90% of these injuries are thought to be mild in severity (concussions).  This means that up to 62,000,000 concussions occur globally each year.  That is 118 concussions per minute! 

Additionally, the United States alone spends $77 billion annually on Traumatic Brain Injury care.

With these alarming numbers, as a chiropractor, you play a key role in the management, prevention, and optimization of concussion care for your patients. With the concussion prevalence across various sports and industries on the rise, this 2-hour module helps to frame the concussion problem across sports, military, motor vehicle, and workplace accidents. You will learn the evidence surrounding concussion prevention strategies and which ones work, and which are theater.  Moreover, you will get the latest updates on the international concussion consensus statement, updated local and international reports about concussions, and learn how to coordinate care in a multidisciplinary framework.

Module Outline:
  • Introduction & Epidemiology of Concussion
    • Terminology
    • Common Features
    • Concussion Mechanisms by the numbers (top sports, motor vehicle, workplace, etc.)
    • Cost burden
  • Neurology
    • Brain composition
    • Neurons vs. Support Cells
    • Blood supply
  • The International Consensus Statement on Concussion in Sport 
    • Brain Injury Classification
    • Concussion Definition
    • Acute Signs & Symptoms
    • International Recommendations & Guidelines
  • Concussion Prevention and Recovery Optimization
    • Primary, Secondary, Tertiary Prevention & Supporting evidence for each
  • Concussion Management Problems & Proposed Solutions
    • Addressing knowledge gaps, technology gaps, etc.

Module 2: Pathophysiology of Acute concussion

Pathophysiology of Acute concussion

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This 4-hour module will walk you through the biological and neurological responses to a concussion, including the neurometabolic cascade  and its implications for long-term recovery. Additionally, this module also highlights the neurological impacts of concussion, the metabolic changes associated with it, and the alterations in autonomic function and cerebral blood flow

Lastly, this module will enable you to explore post-concussion vulnerability and second impact syndrome through the lens of pathophysiology and metabolic recovery.

Module Outline
  • The Neurometabolic Cascade of Concussion
    • Excitatory phase
    • Mitochondrial Dysfunction
    • Spreading Depression
    • Associated clinical signs
  • Cerebral Blood Flow & Autonomic Nervous System Dysregulation
    • Cerebral Autoregulation
    • Cerebrovascular Reactivity
    • Neurovascular Coupling
    • Neuroautonomic Cardiovascular Regulation
    • Blood Brain Barrier Disruption
  • Post-Traumatic Vulnerability, Physiologic Recovery, & Second Impact Syndrome
    • mTBI vs. Severe TBI
    • Second Impact Syndrome
    • Repeated mTBI & Susceptibility

Module 3: Pharmaceutical and Natural Interventions for Concussion

Pharmaceutical and Natural Interventions for Concussion

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Pharmaceutical and natural interventions for concussion should be discussed in any concussion training course. Pharmaceutical options such as medications to reduce pain, inflammation and other symptoms can be beneficial, while natural options such as diet, gut health, sleep and autonomic function can be even more effective. It is important to note that there is no one-size-fits-all solution to concussion. Thus, this 2.5 hour module will help you to gain a strong understanding of these principles to appropriately apply the right treatment strategy to the right patient. 

Module Outline
  • Acute Immuno-Endocrine Aspects
    • Neuro-Inflammation
    • Gut-brain axis
    • Dysautonomia & the role of the Vagus Nerve
    • Endocrine dysfunction – HPA Axis
  • The Importance of Sleep
    • Structure of Sleep
    • Sleep-Wake Cycles
    • Neurophysiology of Sleep
    • Melatonin
    • Concussion & Sleep Modulation
    • Sleep disorders following concussion
    • Glymphatic System
    • Sleep recovery management

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Module 4: Biomechanics of Concussion, Subconcussive Impacts, and the Cervical Spine

Biomechanics of Concussion, Subconcussive Impacts, and the Cervical Spine

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How much force is required to cause a concussion?  Do smaller, subconcussive hits cause concussions over time?  How can we protect our athletes and leverage these biomechanical principles to reduce their concussion risk?

This 2-hour module breaks down the latest literature and dispels the most commonly believed myths regarding concussion and sport safety.  This module will completely reframe how you think about concussion.

The objective of this course is to give you a better understanding of the biomechanics of concussion,  subconcussive impacts, and the cervical spine to ensure efficient athlete performance and protect their health in the process.

Module Outline
  • Biomechanics of Concussion
    • Coup-Contracoup vs. Acceleration-Deceleration
    • Impact Frequencies
    • Concussion Magnitudes
    • Mean Impact Velocities across sports
    • Protective Equipment
  • Subconcussive Impacts
    • Definitions
    • Research & Controversy
  • Influence of Repeat Concussions
    • Available Research
    • Analysis of Findings
    • Verdict – does having a previous concussion make you more susceptible to suffering another one?
  • Impact Sensors & Wearables
    • How they work?
    • Utility
  • Influence of Cervical Spine
    • Cervical spine influence on head kinematics
    • Head to neck ratio in kids vs. adults & males vs. females
    • Does neck strengthening reduce concussion risk?

Module 5: CCMI Baseline Testing Protocol

CCMI Baseline Testing Protocol

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In one of our previous blogs, we discussed the importance of concussion baseline testing. This procedure provides evidence of an individual’s brain functioning prior to suffering a concussion. While most protocols focus on the elements listed within a CCMI battery, rational and support for testing should ensure that all appropriate tests are completed. It is important to consider the purpose behind each test and how it provides insight into an individual’s functioning. 

As such, the chiropractor must be knowledgeable about the tests being implemented, as well as the reasons behind why each test is included in the comprehensive baseline testing protocol. Understanding the evidence behind the tests and how to correctly perform the CCMI battery is key to ensuring proper administration, valid interpretation of results, and implementation of appropriate interventions which is what this 3.5-hour module will teach you.

Module Outline
  • Baseline Testing Evidence
    • Symptomatic vs. Functional Recovery
    • Arguments both for and against Baseline Testing
    • Evidence
    • Neurocognitive vs. Multimodal
    • Use of Normative Data
    • Psychometric Properties of Various Commonly Used Tests.
  • Baseline Testing Preparation
    • Ensuring proper rest, hydration, etc.
    • Testing Station Setup
    • Support Staff
  • Test Administration
    • Medical & Concussion Hx
    • Symptom Severity
    • Memory Recall
    • Concentration
    • Oculomotor Function
    • Balance & Postural Sway
    • Reaction Time
    • Delayed Recall

Module 6: Neurocognitive Test Administration, Interpretation, and Evidence

Neurocognitive Test Administration, Interpretation, and Evidence

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The DANA (Defense Automated Neurobehavioral Assessment) test consists of a cognitive-behavioral comprehension task that is used to provide a thorough summary of an individual’s neurocognitive profile. It assesses a range of cognitive functions including simple reaction time, executive function, memory, decision making, and mental health metrics. The test is preferred by Complete Concussions due to its increased sensitivity and diagnostic accuracy over other computerized neurocognitive tests for concussion beyond symptom resolution. 

During this 2-hour module, chiropractors will be taught how to effectively administer and interpret the DANA test in a variety of scenarios. 

Module Overview
  • DANA Test Administration & Interpretation
  • Evidence & Psychometric Properties

Module 7: Assessment of Acute Concussions

Assessment of Acute Concussions

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This 4-hour module provides a comprehensive and evidence-based approach to assessing and diagnosing acute concussion. Chiropractors will be taken through the process step-by-step and will gain an understanding of how to assess symptoms, rule out red-flags,  make an initial diagnosis, and provide initial management that utilizes the latest evidence to optimize patient recovery both on the sidelines as well as in the office.

The module will also address management strategies and when to defer exercise/activity in cases of concussion. It is designed to provide medical practitioners with the necessary clinical knowledge, plus practical assessment tools, to be utilized when assessing and diagnosing acute concussion.

Module Overview
  • On-Field & Sideline Evaluation
    • Observable Signs
    • First Response Field Management & Red-Flags
    • Immediate Management and Monitoring
    • Overnight care
    • Canadian C-Spine Rules
    • Canadian CT Head Rule
  • In-Office Evaluation
    • Neurological Examination
      • Cranial Nerves
      • Cerebellar
      • Upper & Lower Limb Neuro
    • Special Testing
    • Vestibular & Oculomotor Screening
    • Concussion Biomarkers and Special Imaging
    • Red-Flags & When to Refer Out
  • Concussion Education & Prognosis
    • Diet Plan
    • Sleep Plan
    • Recovery Optimization

Module 8: Management of Acute Concussions

Management of Acute Concussions

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Returning patients back to their everyday lives is an important, yet delicate process. During the process of returning back to school, work, or sport following a concussion, chiropractors should ensure that a gradual, prescribed progression of activities is implemented, easing the patient back into normal activities, while monitoring their progress to avoid any further injury. 

Lastly, any home or school modifications, as well as physical or occupational therapy referrals should be considered, if deemed necessary. This enclosed module strives for both the medical safety of all patients and provides proper means of achieving an appropriate, successful recovery.

Module Overview
  • Return to Learn & Work
    • In-Depth Explanation of Stages 1 -5
    • Case-Based Examples
    • Applying appropriate Academic Accommodations
    • Returning to Sedentary vs. Physical Occupations
    • Helping Complex Patients
  • Return to Driving
    • Driving Risks
    • Assessing Readiness
    • Evidence & Graduated Protocol
  • Return to Play
    • Applying Metabolic Recovery Principles to Step-wise recovery
    • In-depth explanation of Stages 1-6
    • Buffalo Concussion Treadmill Testing for Acute Patients
    • Buffalo Concussion Bike Test
    • Returning to Non-Contact Activity
    • Medical Clearance
    • The Chicago Blackhawks Test
    • Baseline Retesting
  • Discharge Instructions & Considerations
    • Subsequent Concussion Risk
    • Risk of Musculoskeletal Injury
    • When to initiate treatment if symptoms continue
    • When to consider retirement

Module 9: Pathophysiology of Post-Concussion Syndrome

Pathophysiology of Post-Concussion Syndrome

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The Pathophysiology of Post-Concussion Syndrome (or Persistent Concussion Symptoms) is a 3.5-hour module within our CCMI training course that provides an overview of the physiological, neurological, and psychological changes that occur after a traumatic brain injury. It discusses the etiological causes of post-concussion syndrome, how the symptoms evolve over time, and the implications for long-term treatment and management. 

Chiropractors will be exposed to the current medical literature and research to gain a comprehensive understanding of the condition and its management strategies. This will provide them with the necessary background to discuss this condition with patients and other medical professionals.

Module Overivew
  • Overview
    • Evidence-Based Algorithm
    • Definitions
    • Pathophysiology
    • Symptom Trajectories
  • Blood Flow & ANS Dysregulation
    • Evidence
    • Exercise
    • Dysautonomia & POTS
  • Metabolic, Inflammatory, & Hormonal Issues
    • Evidence for each in PCS patients
  • Visual & Vestibular Dysfunction
    • Evidence for each in PCS patients
  • Cervical Spine Dysfunction
    • Connection with Whiplash & Idiopathic Neck pain
    • Neurophysiological connections
    • Trigeminocervical Nucleus
    • Referred Pain Patterns
    • Cervicogenic Dizziness
  • Mental Health
    • Depression & Anxiety
    • PTSD
    • Coping Styles & Behaviours
    • Social Support
    • Suicidality
    • Resilience and High vs. Low Adapters
    • Recall Bias
    • Cognitive Dysfunction
    • Default Mode Interference
    • Somatization & Chronic Pain

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Module 10: Post-Concussion Syndrome Treatment

Post-Concussion Syndrome Treatment

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Persistent Concussion Symptoms are driven by 5 main dysfunctions and the correct application of treatment is contingent upon the correct determination of which of the 5 areas need the most attention. Treatment differs, depending on the needs of the individual, and commonly includes an educational component, cognitive, emotional, and executive functioning interventions, cognitive rehabilitation, physical and occupational therapy, vestibular & oculomotor rehabilitation, manual therapy directed at the cervical spine, diet & supplement support, subsymptom threshold exercise protocols, and more.

The goal is to reduce symptoms, improve functioning in areas of deficiencies, reduce stress on the body and mind, and ultimately improve the patient’s quality of life. This 8-hour module will enable chiropractors to develop expertise in the assessment, treatment, and rehabilitation of patients with complex concussion presentations.

Module Overview
  • History & Physical Exam
    • Important Medical Hx
    • Neurological Examination
    • Oculomotor Examination
    • Vestibular Ocular Reflex Testing & Management
    • BPPV Assessment & Management
  • Exercise Tolerance & Autonomic Dysregulation Testing & Treatment
    • Buffalo Concussion Treadmill (And Bike) Testing for PCS patients
    • Exercise Prescription & Progression
    • Remote Testing & Management for Exercise Intolerance
    • POTS & Dysautonomia – Assessment & Management
  • Vestibular & Oculomotor Assessment & Management
    • Vestibular Oculomotor Screening
    • Initial Rehabilitation for Visual & Vestibular Disorders
    • In-Depth Visual Assessment & Management
    • In-Depth Vestibular Assessment & Management/Rehab
  • Cervical Spine Assessment & Treatment
    • Soft-Tissues
    • Joints
    • Manual Therapy
    • Acupuncture
    • Proprioceptive Rehab program
    • Assessment & Treatment of Cervicogenic Headaches
    • Assessment & Treatment of Cervicogenic Dizziness
  • Ongoing Care & Considerations
    • Education & Reassurance
    • Re-evaluation and re-testing frequency
    • When to refer
    • Migraine detection
    • Sleep Issues and Recommendations
    • Hyperacusis
    • Light Sensitivity
    • Cognitive Rehabilitation
    • Pituitary Dysfunction & Hormones

Module 11: Chronic Traumatic Encephalopathy

Chronic Traumatic Encephalopathy

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Chronic traumatic encephalopathy (CTE) is a degenerative condition, commonly found in athletes, that is widely suspected to be due to repetitive head trauma. It is thought to lead to a range of symptoms over time, including poor decision-making, heightened aggression, and difficulty concentrating; the challenge however is the subjective nature of these symptoms. CTE is characterized on post-mortem evaluation  by a buildup of hyperphosphorylated tauproteins in specific regions of the brain.

In this module we explore the existing literature in this area and discuss the controversy surrounding this condition.  It is important to recognize that CTE is an important medical concern that may be the result of repetitive head trauma, and may have lasting negative effects on an individual’s health. However, with little evidence to support all these statements, how can medical professionals know how to best manage their patients. This 4-hour module helps you put it all together.

Module Overview
  • What is CTE
  • Diagnostic Criteria
  • Signs and Symptoms In Vivo
  • Pathophysiology
  • Neuroinflammation
  • Accelerated Decline Hypothesis
  • Controversy
  • Levels of Evidence
  • Associations with Other Neurodegenerative Conditions
  • Influencing Factors

Module 12: Impacting Your Community and Your Practice

Impacting Your Community and Your Practice

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This is a 1-hour module designed to help chiropractors increase their impact on their communities and their practice. Through this module, they will gain the knowledge, skills, and motivation to actively engage in activities to ensure the success of their concussion management program.

The module discusses topics such as civic engagement, professional networks, community outreach, and resource development. Medical professionals will practice the skills they develop within the module to build relationships, enhance their practice, and improve concussion awareness within their community.

Module Overview
  • Reframing the Concussion Problem
  • Translating Knowledge into Practice at Your Clinic
  • Starting a Concussion Program at Your Facility

Bottom Line.

Whether you are looking to deepen your general knowledge about how to treat simple or complex concussion cases or specific topics which will enable you to provide better concussion care to your patients, the Complete Concussions Training Course has it all.

As concussion management is an ongoing and ever-evolving field, it is important for medical professionals to stay up to date on best practices. The assistance of an experienced mentor and specialized courses from Complete Concussions makes sure healthcare professionals are equipped to handle just about any situation. For more information on concussion courses for medical and healthcare professionals, visit Complete Concussions today and get started with the CCMI course.

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