What to expect from your initial phone consultation
We know deciding where to seek treatment can be overwhelming, so we want to be as helpful as possible. This initial consultation, carried out by Claire Keiser, is your opportunity to ask any questions you may have about our practice, Dr. Keiser’s methodology, traveling to Chelsea, etc.
We want to hear your story, answer your questions, and determine how we may be able to help.
Every patient we treat is different, so it is essential we learn about you. No detail is too trivial.
Please be prepared to discuss your story and what you hope to gain from treatment.
What to expect from your Intake Appointment
The Intake Appointment is the first opportunity for Dr. Keiser to evaluate what may be the source of your neurological symptoms. It will take place in 3 parts.
Tell your story
Undergo a Comprehensive Physical and Neurological Exam.
Discuss Findings and Work To Create a Treatment Plan
Diagnostic Tests Used In Clinic
In the clinic, we use the latest in non-invasive diagnostic technologies to get the best, objective picture of each patient’s individual neurophysiology and function.
Comprehensive Physical and
Physical and Neurological Evaluation that typically takes about 30mins. This includes balance and gait analysis.
The Pupillometer is used to measure a patient’s pupillary reflexes while shining a light in their eye. This is another way to look at autonomic nervous system function and nervous system strain.
VOG consists of a series of tests to evaluate individual eye movements, eye teaming, and the relationship between the visual and vestibular systems. This technology allows doctors to track the eye movements directly and better pinpoint areas of dysfunction that may be contributing to your symptoms
tilt table test
The Tilt Table Test assesses autonomic function with postural change and is used to better understand problems with the autonomic system. This allows doctors to take objective measurements of sympathetic and parasympathetic nervous system function that will inform your treatment plan.
During the test, software will record EKG readings, continuous blood pressure, breathing rate, blood oxygen levels, cerebral blood flow and the amount of CO2 in your system. These measurements are a window into the internal physiology that can cause autonomic symptoms.
Deep breathing test
In the Deep breathing test your heart rate, blood pressure, cerebral blood flow and CO2 production are compared to measure how well your brain is able to control your cardiovascular system while at rest. Understanding this system at rest can indicate problems with rest and recovery as well as how the body compensates to higher levels of activity.
In the valsalva test you will blow hard into a mouthpiece (think blowing up a pool raft). While you are creating pressure in your body, we are measuring the speed and strength of your autonomic responses and recovery. This test is correlated to the results from your other tests like deep breathing and tilt testing to find the source of your autonomic problem.
Transcranial Doppler Ultrasound (TCD)
Transcranial doppler ultrasound is a diagnostic tool that can measure the "blood pressure" in your brain. You will wear a headset with 2 small probes the size of a dime over your temples. The probes record the blood flow through the arteries in your brain. In many post-concussion and dysautonomia cases, problems with blood flow in the brain can be the source of many symptoms and one of the primary targets of treatment.
Capnography or End-tidal CO2 (ETCO2) testing is used alongside TCD testing. The blood vessels in the brain are very sensitive to changes in the CO2 circulating in the blood stream. Injuries and infections can lead to problems with the blood vessels in the brain that affect cerebral blood flow. ETCO2 monitoring is done by sampling the amount of CO2 in the air you exhale throughout rest, the deep breathing test and tilt test. It can help show the effects of breathing on blood flow in the brain.
What to expect after you leave the clinic
Once you are showing strong improvements in the clinic we will tailor a program of exercises for you to continue making progress at home.
The patients who consistently put forth effort and complete their home rehab see the best results.
While cliche, “practice makes perfect” rings particularly true with regards to neuroplasticity. Just like a weightlifter will struggle to increase the amount they can lift if they don’t put in the time to do the reps, retraining the brain is also dependent on repeatedly activating the target pathways.
Just like in the gym, we are cognizant of knowing when and how hard to push patients as they progress to more demanding tasks. To ensure we keep you on the right track, Dr. Keiser will check in frequently and schedule both remote and in person follow ups at routine intervals.