Functional Neurology with Dr. Shane Steadman
Show Notes:
For many people the diagnosis of a concussion comes after a quick superficial examination, followed by a merry-go-round of medication, feedback, new medication (and repeat). Today’s guest, Dr. Shane Steadman does things differently, and this episode is all about how and why. As a functional neurologist, Dr. Shane tailors his treatment for each patient based on their unique symptoms. He has a toolbox packed with tools for diagnosing and treating people, and argues that you should be wary of practitioners with a single tool.
We hear how Bella’s experiences are not so different from other patients he has seen, and why an integrated approach to treatment has served Dr. Shane well. His long list of qualifications in chiropractic, neurology and nutrition, and his decades of experience make him one of the leading functional neurologists in the field, and today we hear what to expect from a treatment with him. Tune in to find out why a comprehensive patient history is so important, and why Dr. Shane does what he does in this engaging episode!
Key Points From This Episode:
• Welcome to Dr. Shane Steadman, chiropractor, neurologist, nutritionist, and owner of Integrated Brain Centers.
• How Dr. Shane’s second-hand experience of a chiropractic neurologist inspired him to take this route.
• The differences in the type of treatment you receive from a medical neurologist and a chiropractic neurologist.
• What functional neurology is.
• What to expect from Dr. Shane’s treatment and why he does the tests he does.
• The importance of taking a comprehensive patient history.
• Why the treatment plan for each patient should be individualized.
• The link between the head, the neck, and the eyes: why integrated treatment is key.
• What Dr. Shane feels is missing from the field: why one or two tools are not enough.
• Why assurance of 100% treatment success should make you wary.
• How you can help move the field forward by providing feedback to your practitioners
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Transcript - Click to Read
[INTRODUCTION]
[0:00:10.0] BP: Hi, I’m your host Bella Paige and welcome to The Post Concussion Podcast. All about life after experiencing a concussion. Help us make the invisible injury become visible.
The Post Concussion Podcast is strictly an information podcast about concussions and post-concussion syndrome. It does not provide nor substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast. The opinions expressed in this podcast are simply intended to spark discussion about concussions and post-concussion syndrome.
Welcome to today’s episode of The Post Concussion Podcast with myself, Bella Paige and today’s guest, Dr. Shane Steadman. Dr. Steadman is the owner of Integrated Brain Centers in Denver Colorado. He is a board-certified chiropractic, neurologist and nutritionist. He is a fellow of the American Association of Integrative Medicine. He is certified in chiropractic clinical neurology and is a certified nutrition specialist to the American College of Nutrition.
He has numerous hours of post graduate and advanced studies in functional neurology and functional medicine including functional blood chemistry and thyroid issues, as well as neurotransmitters and brain function to the University of Bridgeport. In 2021, he co-published Concussion Discussions: A functional approach to recovery after brain injury.
In 2014, Dr. Steadman was awarded educator of the year by the international association of neurology and rehabilitation.
[INTERVIEW]
[0:02:00.7] BP: Welcome to the show, Dr. Steadman. Do you want to start by telling everyone why you got into treating concussion patients?
[0:02:11.5] SS: Absolutely, kind of a fun story. When I was in high school, my mom worked for a chiropractic neurologist and she would come home with all these really amazing stories about what they saw, what they did and how people were better.
That’s always been a fun piece to hear when you’re growing up and I think it definitely stuck with me and what was kind of interesting is, my wife, who is my girlfriend at the time actually had a car accident and so she didn’t have a brain injury but definitely had a lot of symptoms that kind of manifested like that. At the time I didn’t know this, I was just like, “Hey, my girlfriend’s not feeling so great” and my mom said, “Can we fix her?” he says “Yes” and he did.
Then you fast forward into college and I decided, I really want to do what that guy did because it was pretty amazing. The response and the type of work that he got which is so cool and I was like, “I want to do what that guy did” and so, I went on to become a chiropractic neurologist so I changed my major in undergrad and went into premed and got my chiropractic degree with a double major specialty in neurology.
Coming out, you definitely get into this world of brain rehabilitation and diagnosis and really concussions was a really unique, but at the time, I’ve been a practitioner for 20 years. At the time, nobody’s really talking about concussion rehab. The movie Concussion wasn’t out, people were still just shake-it-off and keep playing or they would get a concussion and go back in and so that was a time when I started to practice and I actually have the opportunity to watch it evolve to seeing Facebook groups and all these big, large groups of TBI survivors.
Now it’s a thing that we talk about and we talk about with youth sports and collegiate sports and professional sports, so I think I had the opportunity to be a part of this world. There wasn’t something specific where it’s like you often hear, “Well, I had a concussion so I want to help other people.” The doc that I knew was very influential and I just really wanted to do something that was similar that he did because I wanted to help people and I think that’s kind of my driving force was like, “How can I be better at this and help people?” and I think there’s a lot of people that have concussions that struggle day to day with their life post-concussion.
[0:04:34.5] BP: Yeah, for sure. It’s actually crazy to think that 20 years ago, you were thinking about concussions because 10 years ago when mine started, it was still a lot of a mystery and even just the last five years, the way research and medicine has improved is actually outstanding, which is a good thing. But it definitely changes quickly and that’s the one thing about concussion rehab and all that, which is really interesting because the number one recommendation for me 10 years ago was to stay in a dark room and then we learned that that’s not a good idea.
I just spent a lot of time adjusting because of that one suggestion and it’s good that the more we do research, the more we treat these injuries we’re getting a lot better at doing it. Do you want to talk about functional neurology? You are — your practice is a functional neurologist practice and it’s a little different than a conventional practice. Could you explain that for everyone?
[0:05:37.0] SS: Absolutely. In traditional medicine, we can kind of start it off, you have a primary degree which is you have chiropractic degree in osteopathic or a medical. Within each of those, they actually have board certification. You can have a chiropractic neurologist and osteopathic neurologist or a medical neurologist.
Now in medical neurology, a lot of their focus is diagnosing and they are so good at that and then also their other kind of big specialty is in pharmacology. You see kind of in that world, there’s a lot of diagnosing pharmacology, prescribe this, prescribe this. Even in the world of concussion, what you tend to see is that a lot of patients are referred from a medical neurologist down to a physical therapist for rehab.
That’s kind of where you get the concept of, “Well, you know, just stay in a dark room, turn the lights off, don’t be on a computer” and actually, I heard that yesterday from a new patient that that was her treatment plan and she’s like, “It’s just not working.” It’s still going on. In the chiropractic neurology world, there’s kind of where that term, functional neurology kind of originated.
Really, the concept of functional neurology was saying, how do we understand the function of the brain. If somebody has a concussion, you cannot do and MRI and say “Hey, they had a concussion, we found it on an MRI, the concussion is in the right frontal lobe.” It just doesn’t happen.
This is where you hear the words like invisible injuries and some of these things that are out there because people go, “Well, my brain’s not working” and they go, “Well, we can’t find anything wrong.” “No, I’m telling you, my brain is not working.” In functional neurology, the concept of saying, how do we identify the dysfunction, how do we restore function? That term, functional neurology really kind of was birthed out of this chiropractic neurology realm.
What that really includes is, you do a comprehensive exam so not just a simple exam and a lot of patients say that they get this in traditional medicine. They’ll check a couple of things, have them touch a finger to nose and they’re like, “Oh, you must be okay” or “Oh, let’s give you this medication” or “Oh, let’s do an MRI.” In functional neurology, our exams are almost two hours long where we’re looking at different aspects of balance and different aspects of vision and perception and strength and motor and the brain stem and your autonomics and you’re really just saying, head to toe, what’s going on with you.
And by finding the dysfunction, then we can say “Okay, here is the area the brain is not working.” We find that in this patient, it’s in their left frontal lobe. Then the next step becomes, “Well, how do we improve function?” Well, we could do things that activate the left frontal lobe. I’m oversimplifying it but you got to make this a little bit simple. Now, how do we activate the left frontal lobe?
Well, we have to improve function through different rehab modalities so we could utilize for instance, things on the right side of the body. We could use eye exercises, we could do cognitive exercises, we can do different things to improve the function of the left frontal lobe and so that’s where this functional neurology concept really kind of gain roots and legs and this is what I think people really hearing more and more in the concussion arena.
[0:08:58.7] BP: Yeah, it’s definitely something that’s growing significantly actually. I know I always call it the — what you mentioned at the beginning, the pharmaceutical route, I call it the three-month merry-go-round that you go on, where you see a neurologist and every three months you get given a new med and you tell them how it went and then you get back on the merry-go-round with your new med and that’s really what it feels like.
It is hard because it is something that is often invisible. Concussion, scans and all those things so I remember arguing with not so often medical professionals but other people in my life that there was something wrong with me because they’d be like, “Oh well, but there’s nothing — all your scans are clean and you look fine” and he said to be like “Yes, I am aware of that fact” and it’s definitely interesting to deal with for sure.
You said your exams are about two hours. Do you want to take us a bit through your process of beginning to treat a new concussion patient?
[0:10:05.9] SS: Yes, I think the exam is probably one of the most important features of what we do, which kind of sounds silly but what you see too often out there is that you get these really quick evaluations and then you’re on a merry-go-round for the next several months or years and I always feel that if we can do a very thorough comprehensive evaluation at the beginning, then I think we get to the area that we need to address a little bit sooner.
Now, somebody can argue and say, “Well, I don’t need to take two hours because I’m super smart” and that’s great. I think overall, when we look at some of these vestibular systems, you can take that into play and you can actually kind of walk through that and that might take a good 20 minutes and we come look at the eye movements and that might take another 20 minutes and then we look at sensory motors. That process when somebody walks through it is really kind of fun.
We have patients that stand on what’s called a computerized posturography device where we can actually measure their balance and we can look at things like adaptability, fatigability and then we have a vestibular diskography goggle system so we can actually look at their eyes in the light, we can look at it in a dark then we can graft their fast eye movements, their slow eye movements, can they fixate or stare at a target without jumping off of it and then we kind of go from there, we go into doing our entire sensory exam where we look at do you know where your limbs are in space, do you know where your body’s at?
It’s kind of shocking sometimes when people have no idea where they’re at in space and then, how’s your motor and your coordination? You got fine motor and gross motor coordination and it’s kind of like, what you see on this roadside sobriety test when somebody’s drinking. Those are all like basically like cerebellar tests, so how is your cerebellum doing?
That’s kind of what you expect and then we do a really thorough history because the other thing that I learned with the concussions is that you can have a concussion but it can also impact other systems in the body and people don’t really look at that either. We actually do a really full history to say, “Is there other things going on like sleep?”
Has it changed your hormone cycles, has it changed your digestion, are you now getting ulcers, do you now get bloated? Those are all things they can be impacted by concussions and so not only do we look at brain function but then we do a really thorough history to say, “What’s the rest of you look like? What things do we need to address that?”
It’s really fascinating that I think sometimes those pieces get overlooked because you can have somebody for instance, who is anemic and that’s not an uncommon thing to see and so now they’re going through months and months and months of brain therapy and the whole time, they don’t have enough iron to actually sustain proper function.
I think that’s kind of our initial approach is like “Let’s look at the entire person and collect data” and then from there, then we decide, “Okay, here is what we’re going to work on” let’s say we need to work on iron, we need to work on blood sugar and we need to work on the cerebellum and the frontal lobe.
Now that becomes our treatment plan. From there, then we put together different plans and so for some people, we can do intensive types of visits where they come in multiple times a day for a week. There’s some other patients that we might modify that and say, “You know, over the next two to three months, we’re going to be working on these things.”
We kind of develop different individualized treatment plans based on what we see and that’s kind of what people can expect. I think when you go to a functional neurologist, you should see similar types of modalities. I think what’s kind of popular out there right now is intensive, week-long intensive therapies, which I think are super awesome and that’s our most favorite way of treating patients but not everybody needs that, so we kind of individualize each of our plans to each person.
[0:13:43.5] BP: It is becoming really common. I actually recorded with a guest the other day that just came back from a weeklong concussion therapy and it’s definitely getting more popular. Where you are in space, I like that you mentioned that because actually, I don’t think I’ve mentioned it on the podcast before but that was one of my issues.
I would walk into things on the left side of my body all the time. I would be going through a doorway and I’d walk into the left side of the door way. I’d walk into the left side of a desk and it was something that I had to actually address and do rehab and things for because I never really thought about it until I think my friend was watching me and she’s like, “I think you walked into three things now on the left side of your body in five minutes.”
I was like, “Oh yeah, that happens all the time.” We just don’t really think about it but it is definitely an issue but I also think our previous health is really important. I think that’s something a lot of us miss especially because if you are someone who hasn’t spent a lot of the time with chiropractors, doctors, medical professionals before your concussions, there’s a lot of things that could be going on that you are just shoving off every day like a lot of people tend to do.
I even see like in those Facebook groups that you mentioned, people mentioning, “Oh well, did anyone have this after their concussion?” and they’re completely unrelated types of illnesses and a lot of the time it is just because now you are being aware of your health. You are paying attention more, you are actually getting tests, you’re getting blood work so you are starting to learn about all of these other things that you could be treating and making yourself feel better every day.
With all of that, we are going to take a short break and then we’ll be back to talk more about concussion recovery and rehab.
[BREAK]
[0:15:39.0] BP: I just wanted to say thank you. The podcast is just over six months old and I couldn’t be happier with the response. If you truly love the podcast, please consider leaving a tip in our support the podcast tip jar down at the bottom of our episode description. All tips are greatly appreciated and help cover cost of the show.
[INTERVIEW CONTINUED]
[0:16:04.0] BP: Welcome back to The Post Concussion Podcast with myself, Bella Paige and today’s guest, Dr. Steadman. Something you mentioned before was connecting everything, so do you want to talk a little bit about how our neck, head and vision are all connected?
[0:16:19.1] SS: Yes, I think that might be one of the most important things that I have learned in my years of working with concussions and I think that is an area that is missed very often is kind of that link between your head and your neck and we’ll say like eyes maybe even vestibular and the reason why I am kind of bringing that up is like connect this because a lot of times people, they will go to a vestibular therapist and then that’s all they work on.
Then they’ll go to a vision therapist and that’s all they work on but then they’re still saying, “Oh things are not quite better” and there’s a good example of this is a lady that came in probably two weeks ago. She’s literally been getting vestibular rehab like eight to nine months and so I was talking to her on the phone and she said, “Yeah, I had this concussion and you know, I still feel dizzy. I am not doing as well as I should.”
I go, “Okay” so she comes in the office and we do an exam, she has to hold on to her husband. She walks incredibly slow, she doesn’t have hardly any coordination when she walks and then she’s saying, “Hey, I’m a teacher in a school and when the kids are in the hallway, I have to use a walker because there is so much commotion but I feel like I am going to fall over” so I’m like, “Well, that doesn’t sound completely like the vestibular system” but that is all she’s had for eight to nine months.
We go to do a simple finger to nose test, we have to take the tip of your finger to touch to your nose, she has no idea where her face is. She is totally off balance, she has — her eyes are all over the place and not even in sync and then when she tries to move her eyes, she is also moving her head. She’s compensating with her head how poorly her eyes are moving and I am just like, “Oh my gosh, you don’t know where you’re at and in space at all.”
I was like, “You’re so un-synced.” That actually became our rehab for that week, this is kind of where the intensive weeks can really come into play but for that week, all we did was we focused on providing proprioception for her neck, doing vision exercises, doing vestibular exercises, we actually put some tape on her neck like sports tape just so that she knew where her neck was and her body was.
Then we put some lasers on her trunk so that she knew where right and left and up and down was, so what I do is something like visual feedback and that’s all we did all week and it was crazy because it took forever and I say forever as far as like how many times we had to do that within a few days just to get her body to know where she was at. She couldn’t even put her feet together without falling apart.
She had to stand with her legs really far apart just to know where she was and I was like, “Okay, yeah you could have had a vestibular issue and maybe vestibular rehab but you can do all the rehab in the world but if you don’t know where your body is at, you don’t know where your neck is at, your eyes are moving in weird directions then you’re never going to get better.”
With that patient, she was kind of a clear example of how we had to do simultaneously vestibular, vision, proprioception, body awareness just to get everything to recalibrate so that she could move appropriately and everything worked in a synchronized way. By the third day, we actually had her with her feet together and touching, doing finger to nose. I was like, “Finally, we were getting somewhere.”
Literally like this massive retraining of where she was and so yeah, that’s probably I think that’s such an important and over missed aspect of care when it comes to concussions.
[0:19:54.2] BP: Yeah and I really don’t think we always realized that, “Well, I’m treating this.” Well, have you tried other things? Because a lot of the time, you’re not improving because everything else is preventing you from improving because you are only working on one aspect of it for sure. Like you said, if you don’t know where you’re are in space that’s a really big thing. You should not fall over when you close your eyes and try to walk.
A lot of people with concussions I know they will be like, “Oh, I don’t have a lot of balance when I stand up” I was like, “Well, what happens when you close your eyes?” “Oh, I can’t do that” like okay, this, that’s something you should go talk to someone about and it is definitely a bigger issue than a lot of people realize. But there are a lot of things missing in concussion treatment but it also has to do with limited research out there. It is definitely getting better. Is there anything specific that you find is missing a lot of the time?
[0:20:51.1] SS: That’s a great question. I think what is probably missing is I think there’s too many practitioners that only have one or two tools in their tool box and I think they try to make everybody fit into their mold or their model of care and that is just not how people with concussions work. I mean, it is just not whatsoever and if they did get better with your one tool then I think they’re super fortunate and probably the outlier.
I think when you have a concussion and your head has been whipped back and forth where you’re in a car accident or you slipped and fall — fell and hit your head on the ground, you know those kind of things, there is a lot more going on than just a one to two modalities that you see some of these practitioners have and so that is what I think is missing. I think sometimes the education that goes into it, I think a lot of people have jumped on the band wagon of concussions.
You know, it is kind of a financial gain for some people and it is sometimes frustrating for those of us who have a ton of education in this. I took like a 15-month course on brain injuries and spent tons of money on education and then you see somebody that has like this one really cool fancy tool and so therefore they can get everybody better and I think that’s kind of missing. I wish it wasn’t the case but obviously there is some people that is going to get well anyways.
I think that’s missing is that the education piece and it was all involved and those are probably the two big things that I would throw out there.
[0:22:22.1] BP: Yeah, well “concussion expert” is an interesting term to me because I’ve been to a lot of the neurology conferences. I actually go as probably the only non-medical expert in the audience every single time. One of my favorite things that a lot of the speakers start with is, “We don’t know that much” because it’s true especially when you are talking about the brain as a whole and I have seen a lot of professionals.
I can’t actually count them all but one of the things that will make me never walk into an office again is when they tell me I will be a 100% better when I leave or they guarantee that everything will be a 100% right. It makes me kind of nervous because I have been doing this for a long time. Tell me you are going to help me, tell me you want to help, tell me you have ideas and things that we can try but that 100% guarantee with something that is such a mystery in just even the research fields of it is a little bit of a shock when I’ve heard it.
Especially when they are offering like you said, one treatment, one thing, just we do this one thing and everything in your life will improve and maybe it will but it seems like a bit of a long shot and that perspective actually makes me nervous when you are talking to people who claim that they are concussion experts.
[0:23:45.1] SS: Yeah, I couldn’t agree more. I lecture all over the country and I don’t even claim to be a concussion expert, which is ironic. There’s a lot of times when I’m sitting in a conference and I am lecturing at the front and somebody will come up and be like, “I figured it out” and I’m like, “Wow, then I must be really dumb” because I sitting up here and actually teaching. Yeah, I get really frustrated and I try not to get angry sometimes when people come up and tell me they got the answers figured out.
I have one individual that was a practitioner and he’s like, “We should join together because I am going to be treating all of these concussion patients and I had a concussion and I just know what to do” and I was like, “Wow, well, I have been doing this for 20 years and I feel like I don’t know what I’m doing some days but you must have it all figured out. That’s amazing.”
[0:24:37.0] BP: It’s one of those injuries, diseases, illnesses, whatever you want to call it where we’re not all the same, so it is very selective in treatment and recovery.
[0:24:49.1] SS: Absolutely. I mean, even what we do in the office. I mean, we see concussion patients all the time and I don’t do the same things day to day. There is one patient we might be doing a lot of coordinating exercises and another patient that we’re doing a ton of eye exercises and vision and then another patient, you know, we’re putting tape on their feet so that you get them aware of that…
[0:25:09.2] BP: And lasers.
[0:25:10.1] SS: The ground underneath them that they should be aware of at some point. It is just all over the place in the office. I mean, I got so many tools in my toolbox because I get my butt kicked and so, I can go on and sell boxes probably out there but yeah, I would agree with you. If anybody goes to an office and they’re like, “We can fix your concussion” I’ll be like, “See you.”
[0:25:28.1] BP: Yes, those are my one-time-only doctor medical professional visits that I’ve had and I like to also recommend you can keep looking. There is a lot of people that claim they are concussion experts but there is a lot of specialists popping up and people getting more into the field, which is a good thing at the same time because we need more people that are helping with this for sure but it is definitely one of my favorite topics because it is interesting, but is there anything else you would like to add before ending today’s episode?
[0:26:02.0] SS: I think there is always hope and I like to tell patients that I think there’s hope and I know it’s hard because I get to watch the patients go through it. My daughter plays soccer so I watch her have a concussion and had to rehab her and so from a parent’s standpoint, I understand how scary it can be and from a doctor’s standpoint, I’ve watched patients suffer and I think there is still hope and I think that’s a —
It might be hard in some patients I know and people are like, “Dude, I have lost all of hope” there is still hope out there and there are a lot of great practitioners. I think the goal is you have to go through it. You got to do a little bit of due diligence and do your research and interview them and just because they claim to be something, it doesn’t mean you have to go with them and I think it is always good to interview and interview, get two or three opinions and then kind of go from there.
If somebody doesn’t work out, then definitely keep the communication high I think with practitioners and let them know, “Hey, I am super discouraged. I think we need to do more” and/or maybe say, “Maybe we’re just not a great fit” and I think having the communication is an okay thing to do that when patients I think put all their eggs in one basket for eight months, 12 months, two years, if you are not seeing results in that and I am not even saying like perfect results but if you are not seeing results that give you hope within a couple of two, three months, then I think conversation is needed.
I would kind of put that out there to everybody is that don’t kind of get sucked into these weird big six month, 12-month packages and then sitting on month seven, going like, “Well, I still don’t feel better.” If we are doing our job, you should know something enough to give you hope to just stick around.
[0:27:45.2] BP: Well, and I always say try it. Just because it didn’t work for your friend doesn’t mean it’s not going to work for you because that is how this all works and it is worth trying. Like I said, I’ve tried everything that you can think of really and I am significantly better because of it because I was my own advocate and kept trying after doing one patient visits or a few months or a few weeks, a few years, in some situations as well because you have to figure out what works for you, who you work with well as well.
I just want to thank you so much for joining and taking your time to share your work with us and concussion survivors today.
[0:28:26.0] SS: Absolutely. Thanks Bella for having me on, it’s been fun to hang out with you today.
[END OF INTERVIEW]
[0:28:32.1] BP: Has your life been affected by concussions? Join our podcast by getting in touch. Thank you so much for listening to The Post Concussion Podcast and be sure to help us educate the world about the reality of concussion by giving us a share and to learn more, don’t forget to subscribe.
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