A HappyNeuron Pro Case Study:

Post-concussion management is as much an art as it is a science.

About Toronto Concussion Clinic

The Toronto Concussion Clinic (TCC) is a multidisciplinary concussion center that offers behavioral, physiological, and cognitive rehabilitation services for people suffering from post-concussion syndrome ages 7 and up. Clients work with providers either in person or through telemedicine services. The TCC also provides informative podcasts, videos, and blogs for clients to better understand concussion and their recovery.

“I needed a way to help my clients practice cognitive skills while habituating them to a computer screen. This allows my clients to have a similar experience like they would encounter in a working environment” – Dr. Taher Chugh.

Oftentimes, clients with concussions struggle looking at computer screens for long periods of time. Using HappyNeuron Pro, Dr. Chugh wanted to adequately challenge his patients while habituating them to looking at screens for longer periods of time. This habituation to screen tolerance is essential for helping clients get back to work, as many jobs have a computer usage requirement.

Dr. Chugh runs his program with the help of a clinical assistant. The clinical assistant uses HappyNeuron Pro and facilitates Dr. Chugh’s programs. HappyNeuron Pro is designed to put the therapist in control. Any therapist, such as an OT, SLP, or psychologist is able to use HappyNeuron Pro easily with clients.

“I can delegate HappyNeuron Pro to my clinical assistant. They are able to use it with clients who may not need as much assistance as others. However, if a client had more significant difficulties, I am able to work with them”. – Dr. Taher Chugh.

However, Dr. Chugh also uses HappyNeuron Pro one-on-one with his patients. When he works with his patients using HappyNeuron Pro, he is better able to understand a client’s difficulties that may not be evident in other tasks. He is able to see a client’s cognitive sensitivities as a result of their concussion while they perform cognitive tasks.

“When a client begins an exercise, they often have no approach. As they get familiar with the exercise, they develop an approach but do not stick with it. This can lead to emotional frustration, or “choking”.” – Dr. Taher Chugh.

Psychological Status and Cognitive Rehabilitation

Concussions can cause a person to become depressed, anxious, or frustrated as they may experience cognitive deficits that interfere with their ability to perform daily life activities. Dr. Chugh is sensitive to the emotional and psychological state of his clients, as negative emotional experiences can interfere with performance on cognitive tasks. One way Dr. Chugh helps his clients maintain a healthy emotional state by using biofeedback techniques.

“[One client] I work with struggles with the exercise “Restaurant”. Using biofeedback, I am able to help this client regulate their autonomic nervous system to stay calm while completing the exercise”. – Dr. Taher Chugh.

Sleep, cognitive function, and psychological status are all interconnected. Clinical providers working with clients that have experienced a concussion or brain injury must address these different areas that can impact a client’s ability to function. One aspect of psychological functioning that Dr. Chugh sees as essential for a client’s recovery is resilience. Resilience is important to develop as it helps a person face an obstacle and be able to persevere through it to solve a problem at hand.

“I do not like switching from an exercise that is difficult for a client, as this can be demoralizing to the client and can encourage them to avoid challenges. Working with my clients, I encourage them to break up exercises into smaller steps and resume them. I work with them on taking time to complete tasks and not quitting”. – Dr. Taher Chugh.

Why Provide Cognitive Rehabilitation Services to Clients with Concussion?

Oftentimes, people develop concussions when a force is applied to the head. This force in turn causes the brain to make contact with the skull, resulting in tissue damage. Depending on the nature of the concussion, whether it is focused or a diffuse injury, a client may experience one or more cognitive deficits. Working on cognitive functioning can help clients build back the necessary skills to resume activities that bring them joy and allow them to live independently. Many people living with concussion and brain injury experience a loss of control, due to needing help or modifications to participate in life activities. Cognitive rehabilitation can help clients build these skills, which in turn can help them have a sense of control over their lives.

“Improving control allows the client to see that they can do something that is challenging. This helps the client build confidence in themselves, which in turn brings optimism”. – Dr. Taher Chugh.

Cognitive rehabilitation therapy can be provided using digital tools, paper and pencil exercises, and multimedia content that targets the cognitive functions that the client is struggling with. Clinical providers also provide concussion education to the client and their support team to help the client and their support team adjust to life post-concussion. An active ingredient in a client’s therapy success is the guidance and time with a clinical provider. Without guidance, clients may devise ways to avoid obstacles, which prevents them from getting the full benefit of completing cognitive exercises.

“Cognitive rehabilitation is like going to the gym. As long as you exercise properly and employ the exercises properly, you will get the benefit of the exercise. If you leave clients on their own without support, sometimes clients may “hack” exercises in finding a way to complete them easier without going through the proper challenge to get the cognitive practice that they need. This is why one-on-one interaction is essential, as the clinical provider can prevent the client from “hacking” the exercise”. – Dr. Taher Chugh.

Future Directions with Dr. Taher Chugh

In the future, Dr. Chugh will be employing a resilience program to help clients learn how to handle obstacles while also addressing common cognitive difficulties experienced as a result of concussion. This program will provide clients with group therapy that will allow them to learn about the decision making process and how to make better choices, as well as provide them with education on developing and utilizing their own support system for recovery.

Want to learn more about Dr. Chugh and the Toronto Concussion Clinic?

You can visit their website here: https://torontoconcussion.ca/. Please also listen to Dr. Chugh’s talk “An Athlete’s Mindset for Cognitive Healing”.