September 1, 2025 • 58 mins
The nervous system after concussion often remains stuck in fight-or-flight, making traditional rehabilitation challenging at best. Melissa Biscardi, an osteopathic therapist, registered nurse, and PhD candidate, reveals why gentle manual therapy creates a critical foundation for healing visual dysfunction after brain injury.
Drawing from over a decade of clinical experience, Biscardi explains how cranial work can release tension patterns affecting the extraocular muscles and create a parasympathetic shift that prepares the brain for more active rehabilitation. She shares fascinating insights into the subtle nuances of visual dysfunction that standard assessments often miss - from saccade accuracy problems to vergence issues that only appear when the head is in certain positions. These seemingly minor impairments can significantly impact daily function, much like "driving with a spare tire on" - you'll still get there, but with increased strain and decreased performance.
Her groundbreaking PhD research explores virtual reality applications for ocular motor rehabilitation, comparing traditional care with a six-week VR intervention combined with home exercises via her Brain Toolkit app. This innovative approach makes specialized rehabilitation more accessible and engaging for patients outside major medical centers. Biscardi also discusses her pioneering investigation into how concussions affect hormonal function in women, particularly anti-Müllerian hormone levels, which may impact reproductive health.
From her personal journey with medication-induced memory issues to her martial arts background and multiple concussions, Biscardi brings both professional expertise and lived experience to her work. Join us for this enlightening conversation about cutting-edge approaches to visual rehabilitation and discover practical strategies you can implement today for improved brain health and concussion recovery.
Melissa Biscardi:
Website: www.concussionrehab.ca
Instagram: @concussionrehab.ca
YouTube: @concussionrehab
Brain Tool Kit: https://www.instagram.com/braintoolkit
Carrick Institute:
W.E.S.H.I.N.E. virtual woman-led neurology conference:
Get 20% off your first order of Puori protein with code LIFEAFTERIMPACT by following this link.
Dr. Wolf's book Concussion Breakthrough: Discover the Missing Pieces of Concussion Recovery is now available on Amazon!
What topics do you want to hear more about? What questions do you have? Email us at lifeafterimpact@gmail.com
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Website: lifeafterimpact.com
Medical disclaimer: this video or podcast is for general informational purposes only, and does not constitute the practice of medicine or other professional healthcare services, including the giving of medical advice. No doctor patient relationship is formed. The use of this information and materials included is at the user's own risk. The content of this video or podcast is not intended to be a substitute for medical advice diagnosis or treatment. Consumers of this information should seek the advice of a medical professional for any and all health related issues.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Melissa Biscardi (00:00):
And so I really am a proponent of
starting with some gentle manualwork to create ease in the
system, to create a parasy hourslike.
They are just so revved up thatwe really need to bring them to
(00:26):
a space that okay, their systemis ready for something a little
more active.
Dr. Ayla Wolf (00:33):
Welcome to Life After Impact the concussion
recovery podcast.
I'm Dr Ayla Wolfe and I will behosting today's episode, where
we help you navigate the oftenconfusing, frustrating and
overwhelming journey ofconcussion and brain injury
recovery.
This podcast is your go-toresource for actionable
information, whether you'redealing with a recent concussion
(00:54):
, struggling withpost-concussion syndrome or just
feeling stuck in your healingprocess.
In each episode, we dive deepinto the symptoms, testing,
treatments and neurologicalinsights that can help you move
forward with clarity andconfidence.
We bring you leading experts inthe world of brain health,
functional neurology andrehabilitation to share their
(01:16):
wisdom and strategies.
So if you're feeling lost,hopeless or like no one
understands what you're goingthrough, know that you are not
alone.
This podcast can be your guideand partner in recovery, helping
you build a better life afterimpact.
Today's guest on the show, thefabulous Melissa Biscardi, is
(01:38):
the founder of Concussion Rehab,located in Toronto, where for
over a decade, she's helpedpatients recover from
concussions.
Since 2006, she's worked as anurse and since 2013, as an
osteopathic practitioner.
She earned her Master ofScience studying women-specific
concussion outcomes, includingthe first-ever investigation of
(02:00):
anti-malarian hormone in mildtraumatic brain injury, and is
now completing her PhD at theUniversity of Toronto, focusing
on ocular motor rehabilitationfor adults with post-concussion
syndrome, doing cutting-edgeresearch into virtual reality
and mobile app-based therapies.
Melissa has authored bookchapters, published peer review
(02:23):
papers and presented on stagesaround the globe.
She's also the creator of theBrain Toolkit app, putting
evidence-based concussion rehabexercises into people's hands
anywhere, anytime.
Please enjoy my conversationwith Melissa Biscardi, but first
a few announcements.
(02:47):
Biscardi, but first a fewannouncements.
On Thursday, september 25, 2025, I will be at Northwestern
Health Science University inBloomington, minnesota, from 12
to 1 to talk about my new book,the Concussion Breakthrough.
So if you happen to be astudent or faculty member on
campus, please join me on thatday.
Then, on Friday, october 24, Iam having a book signing and
book release party at theSchmidt Artist Loft in St Paul,
(03:10):
minnesota, from 630 to 830pm.
This is in the old SchmidtBrewery building and anybody who
wants to join is welcome, butplease RSVP to lifeafterimpact
at gmailcom and that will helpus with our planning.
If you are an acupuncturistinterested in learning more
about neurology and neurologicalconditions, I'm teaching a
(03:32):
seminar for the MontanaAssociation of Acupuncture and
Oriental Medicine in Bozeman,montana, october 4 to the 5th.
Registration is on theirwebsite, montanamaaomorg, and
early bird registration endsSeptember 4th.
Thanks and enjoy the show.
Melissa Biscardi, welcome toLife After Impact.
(03:56):
How are you today?
Melissa Biscardi (03:57):
I'm amazing.
Thank you so much for having me.
I'm excited to be here.
Dr. Ayla Wolf (04:01):
Yes, well, you have such an incredible
background you are a registerednurse, an osteopathic therapist,
a PhD candidate I can't wait totalk to you more about that and
a functional neurologypractitioner who has dedicated
your career to advancing brainhealth.
We are both presenting at awomen-only neurology conference
(04:22):
coming up women-only neurologyconference coming up and so your
presentation is on ocular motorrehabilitation, but
specifically the use of manualtherapy in ocular motor rehab.
So why don't you, for ourlisteners, define what that is
when you speak about manualtherapy and so kind of describe
what that is and then how you'reincorporating that into your
(04:46):
rehab for different aspects ofvision and eye teeming and eye
movement disorders that are socommon when people have
concussions?
Let's start there, absolutely.
Melissa Biscardi (04:56):
So I come from an osteopathy background, which
is really a gentle, manualtherapy, and it's important to
note that in the U?
S, osteopaths are doctors ofosteopathy, so they can also
prescribe medication and do allthe duties or at least most of
them that physicians would do.
And where I'm from, in Canada,we are manual therapists and not
(05:21):
medical doctors, so we wouldlook more similar to a
physiotherapist um than amedical doctor, and so our first
line of therapy is manualtherapy and we don't adjust the
way where that makes a sound.
So just to kind of set thestage, it's super gentle, layer
(05:43):
by layer.
So that is the type of manualwork that I'm speaking of when I
say manual therapy, and thiscan really sort of set the stage
for ocular motor rehab, whichis the way I think about it.
To say, eye movement exercises,which is terrible, but if
(06:07):
you're a fly on the wall, that'swhat it's going to look like,
right, even though it's full ofnuances.
And when someone has aconcussion they are in a state
of fight or flight.
The nervous system is usuallyreally heightened.
It's been through a trauma andit's not always easy to just
(06:28):
pull someone in and start doingactive rehab, and so I really am
a proponent of starting withsome gentle manual work to
create ease in the system, tocreate a parasympathetic shift,
just letting that body feel safeand open to other forms of
(06:50):
rehab.
And sometimes someone will comein they haven't blinked in 48
hours like they are just sorevved up that we really need to
bring them to a space that,okay, their system is ready for
something a little more active,that okay, their system is ready
for something a little moreactive.
Dr. Ayla Wolf (07:13):
And do you want to talk a little bit about when
you're doing manual work?
So I've also studied somecraniosacral therapy, both
through the Upledger Instituteand then also biodynamic cranial
work, and it is very subtlepalpation.
And when you talk about themanual work on the head, can you
talk about kind of what you'refeeling when you work on people
(07:33):
and kind of what kind of shiftsthat you pick up on?
And I know sometimes you cantell when you're working on
different tissue layers as well.
So maybe talk a little bitabout these kind of subtleties
of this, this palpation methodand this hands-on approach.
Melissa Biscardi (07:49):
Sure, absolutely.
I was wondering if you hadworked um with the up ledger
courses or not.
So my intuition was right Um,I'm not trained by up ledger,
but similar, different Um.
And so let's see when we are,when I'm palpating, when we're
palpating, let's say the cranium, one thing is looking for
(08:16):
directions of ease anddirections of fine.
So where does the tissue liketo go?
Um, and you know, someone caneven feel that just feeling the
tissue on their arm gently andmoving it in different
directions, and you probablywill find somewhere it doesn't
want to go.
And usually when someone comesin and they are in a sympathetic
(08:38):
state, we will go into the ease.
So, following the tissue whereit wants to go, like pushing a
drawer in when it's stuck,versus just yanking on it and
trying to pull it out.
Um, when it comes to cranial,especially with the extraocular
muscles, all of them come.
Well, most of them come to acommon um tendon and they are
(09:02):
connected to the cranial bones.
So as we create ease around thecranial tissue, which attaches
to the cranial bones, which thenattaches to the dura, like
really we are working on all thelayers and even working on the
brain, when you think about it.
Dr. Ayla Wolf (09:21):
Yeah, and I've also found too that a lot of
people, when they have that kindof sympathetic elevation and
their visual system is taxedmaybe because they're overusing
it or there's a lot of fatiguein the system that I get much
better results when I can guidesomebody through almost like an
(09:43):
eye exercise warmup, so to speak, with their eyes closed, yes,
and also just tuning into theirown ability to move their eyes
in different directions, feelinginto, does it feel, you know,
is there more strain in thesystem when I look left versus
right or up left versus downright?
And so I find, you know,anytime somebody exercises,
(10:07):
obviously we recommend let'swarm up your muscles first.
It only would make sense thenthat if you're doing visual
rehab and eye exercises, thatyou would want to warm your eyes
up first, and so do you alsokind of guide people through
some visualization exercises orjust more of like some eye
movements with their eyes closed, to be able wing of the
(10:30):
sphenoid to kind of unweight thetissue there and then having
them move left right up down.
Melissa Biscardi (10:51):
Even that in and of itself usually creates
some ease.
And, yes, having patientsnotice the subtleties instead of
just, oh, my eyes are tight ormy eyes are in pain, but okay,
what you know, which areas maybeneed a little more nurturing?
Um, and also, when you havesomeone on the table and you're
(11:13):
doing some of this more subtlework, sometimes you'll just
you'll visualize also when thenervous system is like oh yeah,
so I'm in a safe place now andthey'll do you know a big
inhalation, yeah, so I'm in asafe place now and they'll do.
you know a big inhalation,exhalation.
Dr. Ayla Wolf (11:33):
So the body's communicating with us all the
time.
Yeah, yeah.
And what would you say are themost common eye movement
impairments that you see withyour concussion patients that
maybe often get missed in kindof other types of settings?
Melissa Biscardi (11:43):
I would say that I think, hopefully, almost
everyone who's working inconcussion is looking at the eye
movements, but it's importantto pay attention to the nuances.
So, yes, maybe the eye can getfrom A to B, but does it take 10
(12:03):
stops along the way?
Right, and even some of themore popular standardized
vestibular ocular assessments,like the VOMS I'll just say it
it doesn't really allow for thenuance.
Yes, if someone is symptomatic,but do they have a lot of
fatigue with it?
Right, are they blinking 10times when they're looking in
(12:27):
one direction?
Are the eyes watering?
Is there a twitch coming up inthe face?
So I think that there are a lotof yes, nuances, details to
pick up on, to see, okay,where's a problem?
Where can we get in?
Where's the low hanging fruit,which I feel like usually is a
manual therapy?
Um, and then get into thebigger issues.
(12:50):
Oh, I didn't answer yourquestion, sorry, um.
Can I add?
Dr. Ayla Wolf (12:56):
to that you can add.
Melissa Biscardi (12:57):
you can add so um, I mean and the research
supports it as well that thereare definitely issues in
pursuits, especially likevertical smooth eye movements
and although this comes to thenuances like saccade accuracy,
so maybe the eye is jumping inthe direction it's supposed to
(13:18):
go but it's not actually landingwhere it's supposed to land.
And I mean this might manifestwith someone is reading but then
they skip a word and they haveto go back, or they're skipping
lines, and then also saccadelatency, so you want someone to
look and then it takes a littlewhile before the eye actually
(13:41):
decides to go over there or isable to process the command to
get from A to B.
Dr. Ayla Wolf (13:47):
Right, right, there's that lag time between
them, maybe seeing the stimulusto move their eyes and then they
actually move it and actuallydoing it.
Melissa Biscardi (13:57):
And then the other thing is, if there's
asymmetry in that, then you haveasymmetrical information, sort
of all day long.
So that's definitely going tomake someone feel unwell or
anxious or whatnot.
Dr. Ayla Wolf (14:11):
Right and I think that the those subtleties are
so important.
I often liken it to drivingyour car with a spare tire on.
You know, having that sparetire still gets you from point A
to point B, but you're notgoing to be able to drive your
car at peak performance when youhave a spare tire on.
And it's like these littlesubtle struggles within the
(14:33):
system over time can reallycause a lot of almost wear and
tear or fatigue to the system,absolutely.
Melissa Biscardi (14:41):
I like that analogy and, yes, it drains the
battery faster.
I like to say right.
Dr. Ayla Wolf (14:46):
Yeah.
Melissa Biscardi (14:48):
What are the most common ones you think you
see in your practice?
Dr. Ayla Wolf (14:53):
Definitely vergence issues I see all the
time, yeah, whether that'sissues with convergence or
divergence, and I find, you know, when I assess it from maybe
straight on, people are fine,but as soon as I start looking
at angles, then all of a suddenpeople start to struggle.
And so I do think that you know, with a lot of these standard
(15:15):
tests, like you said, they'remissing the nuances of well,
what happens if your head isturned to the right.
You know what and so you know.
I have someone this week whocame in for a five day intensive
and vertical pursuits lookedreally good.
As soon as we moved her into aright yaw, vertical pursuits
broke down.
And so those subtleties arealso important, Because if
(15:38):
people know that they don't feelcomfortable in a certain head
position, that's going to changehow they they carry themselves
through life and that's going tohave consequences.
Absolutely, Going back to yourPhD that's also focused on
ocular motor function.
Is that correct?
Melissa Biscardi (15:55):
Yes, and in the PhD we need to have like
three studies or threecomponents.
So the first part I did asystematic review of what's out
there and it's, you know, it'sall in the optometry literature
for the most part, for myinclusion, exclusion criteria at
the very least.
(16:15):
And you know it was reallysurprising because there wasn't
much out there and even thoughwe know, or we see, at the very
least you know how effective itcan be, an optometrist use it,
or neuro optometrist, but therereally has not been a lot
published, which I think is oneof the reasons why there's, you
(16:37):
know, feisty debate about howgood it is or whatnot in the
medical community.
So, but I did, how good it is orwhatnot in the medical
community.
So but I did, I consolidatedthe literature to say this is,
these are the gaps.
And then study two was lookingat a sample of people who are
seen in the hospital I'm doingthe research out of, so like
(16:58):
okay, how many of these peopleare still having visual type
issues after 30 days?
And then study three, which isthe real fun one, is I'm doing a
ocular motor rehabilitationintervention delivered in VR,
compared to usual careessentially, which is not very
much around these parts and thepeople who are participating are
(17:23):
between 30 days and a yearpost-injury and if they get the
intervention, they get six weeksof this sort of oculomotor
rehab therapy in VR and thenhome-based reinforcement on an
app, and so it's really cool.
Dr. Ayla Wolf (17:46):
So they're physically going in to get the
vr.
Melissa Biscardi (17:49):
Yes, and in I.
In theory it would be better ifthey came in daily and did the
vr um, because the vr has moreoptions, but that is just not
feasible.
So it's like what can we dothat is feasible, and then
feasible when it translates intopractice, because even in the
intensive it's like what can wedo that is feasible, and then
feasible when it translates intopractice, because even in the
intensive it's five days, butthen you do something at home,
(18:10):
yeah, and so talk to me talk methrough what this virtual
reality experience is once theyhave the goggles on.
Yeah, so it's not immersive inthe way that they're not in a
grocery store or walking downthe street.
It's very much following dottargets.
We're following a targetthrough a maze.
(18:32):
There's one where targets arecoming at them like bullets.
I'm not sure why they thoughtthat was a good idea.
Dr. Ayla Wolf (18:41):
Yeah.
Melissa Biscardi (18:43):
But actually people love that one because the
bullets come and you explodethem with your saccades,
essentially, and then it getsmore challenging and as you
become less accurate or slowerand not getting it then, um,
well, then they end it so youdon't explode.
Okay, they haven't added thatpart yet.
(19:05):
Um, so there are different sortof trainings for lack of a
better word for pursuitssaccades, anti-saccades, vor
convergence, there is a virtualbrock string, so it covers sort
of all the foundational eyemovements in a simple, but I
(19:27):
don't want to say gamified, buta little bit creative way.
Yeah, and you can change thesettings for difficulty and
range.
It's not as personalized, asyou know.
If you had someone in front ofyou you could really do nuanced
angles and rates.
But I think it's pretty goodand it really can make the rehab
(19:51):
more accessible, right, becausethere are only so many clinical
neuroscientists andphysiotherapists, especially
outside of the major centers.
So I feel like there's a rolefor it.
I know in the previous researchnot on concussion participants
have said they like the VR.
(20:11):
Right, it's more engaging, itgives them more motivation than,
let's say, sticky notes andsuch, and so if it's going to
give motivation for people to dothe exercises at home.
I think that, in and of itself,will help get better results.
The flip side, though,especially with concussion, is
(20:32):
the VR is stimulating, so it'ssort of a.
You have to find a fine balance.
What we're seeing is thatpeople like it, though.
So even if you get a little bitof a headache or whatnot, you
it's a trade-off people are arewilling to have, and I see that
(20:53):
in the office too right, I sayokay, well, no, I want to do the
VR assessment, even if I'mgoing to feel a little unwell
after.
Dr. Ayla Wolf (21:03):
Yeah, and do you find that when people take the
goggles off after kind of doingall these different eye
movements, that they are alittle off balance or dizzy at
the end?
Melissa Biscardi (21:13):
Often, I would say the most common and you
might see this in office too issort of eye strain or headache,
sometimes a little bit ofdizziness, but I would say those
are the most common umresolving pretty quickly.
And so similar to, I want tosay, the protocol used for the
(21:33):
treadmill or whatnot, like usinga scale.
You know how much effort areyou exerting, what symptoms are
you having, how would you ratethem?
So not just pushing people ashard as we can, but okay, based
on how you tolerated this lasttime, based on how you tolerated
the homework, how far along canwe move you?
Dr. Ayla Wolf (21:53):
So they're coming back down to baseline rather
quickly.
Melissa Biscardi (21:56):
Yes, I would say so Like less than well.
I wouldn't say one minute formost people and then
occasionally like up to 10minutes.
Dr. Ayla Wolf (22:04):
Yeah yeah, which is pretty good.
Occasionally like up to 10minutes, yeah yeah, which is
pretty good.
I think it was last year, maybemy, uh, my nephew has an Oculus
prime and so I put it on forthe first time ever, and it was
this game where you're a monkeyand you had to move your arms in
order to move forwards and jump, and I had never done this
(22:25):
before.
I thought it was so cool and Ikept like so all of a sudden,
I'm playing it, I'm totally fine.
And then boom, it was likeinstant, intense nausea and it
was like, oh, I think I may haveoverdone it and, um, did you
have ever sensitivity before?
Two?
Melissa Biscardi (22:44):
screens or after your concussion.
Dr. Ayla Wolf (22:49):
I feel like I've always been pretty good with
movement, but I think that Ialso persevered.
Well, one of the symptoms that Ihad after my concussions is
when I would stop my car, Iwould feel like my seat was
still translating forward, soI'd feel like the car was still
translating forward, so I'd feellike the car was still moving
forward.
(23:10):
So I do think that, even thoughI'm not afraid of movements and
I do a lot of movements and alot of times I still like spin
around in my chair and like dosome full body rotation, just as
like let's take a break fromthe screen I do think that
perhaps maybe my brain was likeperseverating on movement a
little longer than it should.
Perhaps maybe my brain was likeperseverating on movement a
little longer than it should.
And the thing that surprised mewas that that nausea lasted for
(23:36):
like four hours after I tookthe goggles off and I didn't
come.
So I was like okay with beingnauseous, but surprised that I
didn't come back down tobaseline as quickly as I thought
I would after taking them off.
That's what I think.
That's the thing that surprisedme the most.
Melissa Biscardi (23:46):
You know that's interesting.
There is some research ActuallyI think they just published it
within the last year aboutimmersive VR like that and
people with concussion andexactly having getting some
symptoms.
So I think maybe that's wherethe balance is.
Maybe using VR in concussionrehab is keeping it very simple.
(24:09):
I know you weren't doing rehab,but just Right, yeah.
Dr. Ayla Wolf (24:14):
I agree.
I think that definitelythrowing somebody in an
immersive VR is completelydifferent from just having
somebody have the goggles on andhaving some dots to follow and,
yeah, very different.
Melissa Biscardi (24:28):
And I mean the immersive is probably a little
more fun, but they need to workup to that.
Dr. Ayla Wolf (24:38):
Exactly, exactly.
And I mean they say that forregular people too, that you
don't want to just pop a VR onand play for two hours straight.
Melissa Biscardi (24:42):
You got to work up to it, yeah and even
some other, like migraine, Ithink, is a, not a
contraindication, but, um, youprobably wouldn't want to use it
for two hours or really immerseyourself when you're first
using it.
And I probably some otherconditions too, but I know
migraine for sure and how big isyour study?
Dr. Ayla Wolf (25:03):
how many people are you including in this?
Melissa Biscardi (25:04):
So we need so far we have 43 and I need 62.
So I'm actually almost there,which is good.
And the biggest study, um, thatwas in the publication.
That wasn't like aretrospective review, I want to
say, was only like 12 people.
So I'm happy this will I don'twant to say make a dent, but it
(25:29):
will add.
It'll add to the researchnicely.
Dr. Ayla Wolf (25:32):
Yeah, absolutely.
And if you had endless funding,time and resources, what would
be like your next study?
What was?
What would be the next thingyou would want to do?
Melissa Biscardi (25:43):
Oh, that's a good question.
Oh, my goodness.
Okay.
Well, I definitely for selfishreasons, I would want to see how
far we could use my app.
Like what do people even needthe VR?
Can we just use something evenmore accessible?
So I say that is maybe onerabbit hole I would want to go
(26:05):
to.
And then my next step would bemaking more gamified activities
in the goggles.
So the goggles are not mine.
I didn't make the games inthere.
It's by a company calledNeuroflex, so I'm using the ones
they've already designed.
I would want to add to the menu, I guess make more gamified
(26:29):
ones, because that's what peoplelike, right?
So?
And then also ones that willgive people scores.
So like the bullet one tellsyou how many bullets you
exploded, the maze tells you howwell you did on the maze.
So I feel like if we can givesome more fun and positive
reinforcement, that would begreat.
Dr. Ayla Wolf (26:48):
Yeah, I love that .
And then, for people who aren'tfamiliar with your Brain
Toolkit app, why don't you talka little bit about when you
developed it, kind of how it'sevolved over time and what it
has to offer people?
Melissa Biscardi (27:02):
Sure, sure.
So the Brain Toolkit app is anapp for clinicians and patients
and it is for Android and iOS,which was actually the like, the
first motivation for it,because I'm an Android user and
there just wasn't much out there.
So I said, okay, you know, Ineed a basic app just for
(27:24):
pursuit, saccades, opk,hemi-stim.
So that was the first edition.
It was very bare bones and overtime, with feedback from people
and just thinking, oh, it'd benice if I could do this and that
, and oh, I guess people needinstructions in there.
So it's really evolved.
And more recently we improvedthe user interface, which is
(27:47):
great, and it has things for eyemovement assessment or
intervention, like the basicsthat I just mentioned.
And then it has a few, I wantto say, cognitive ones, or you
could use them that way, likememory, and there's one where it
flashes a random letter so youcan be creative with how you use
(28:11):
it, random shapes, which Iactually use a lot, somehow just
being creative.
And then recently we put insubjective, visual, vertical
assessment, which is great, Iwant to say, because it gives
you an objective angle for theclinician.
So some of the things are moreclinician targeted, I want to
(28:32):
say, but even some of them thepatients can use to just sort of
assess themselves or assess,you know, do this and send me
how it went.
Yeah, and it's super easy touse, which I think is important
for accessibility, especiallywhen people have a brain injury.
Dr. Ayla Wolf (28:52):
Yeah Well, and it's nice to be able to send
patients home with exerciseswhere you're not having to be
like OK, I need you to teachyour husband how to move his
thumbs like this sure,especially with the anti-sicades
right when you need an oppositetarget, or yeah, so I find it's
helpful, for sure.
(29:12):
Yeah, so it sounds like in yourpractice you're doing a really
lovely combination of bothhands-on stuff.
You also do acupuncture.
We should talk about that too.
Melissa Biscardi (29:24):
It's funny because so I am not as
well-versed as yourself inacupuncture.
I did the here it's calledmedical acupuncture, quote
unquote.
So we learn I want to say itwas six months, but not
intensive, right?
So you go every three weeks forthree days and you learn the
acupuncture points more relatedto the nerves, which are the
(29:48):
same as the meridians,essentially.
So we learn a little bit of thelanguage from Chinese medicine,
but I will think about it alittle bit differently.
But I find that also, it's just, it's such a great tool for
people.
Dr. Ayla Wolf (30:04):
Yeah, yeah, I find especially, you know,
around the eyes there's so manypoints that just help to relax
the muscles, relax, you know,the the face, but then also
helping with headaches so manypeople with concussions or jaw
clenchers, which contributes tothe headaches and the eye strain
A lot of times.
What people will say after atreatment they're like I feel
(30:26):
like I can open my eyes wider,so they're not like walking
around with kind of the squintyeyes as much.
Melissa Biscardi (30:33):
Oh, I'm glad you raised that point that
people are squinting their eyes,because then you have a lot of
face tension from that andexactly you come in like that
and how great is it if we canwork on that before we start
working on other things yeah,yeah, absolutely.
Dr. Ayla Wolf (30:52):
And then in terms of the, the manual therapy, um
are there for kind of people whoare maybe interested in
pursuing it?
You talked a little bit aboutthe difference between kind of
craniosacral therapy versusosteopathic and kind of manual
manipulation from an osteopathicperspective.
Are there any limitations orcontraindications or things that
(31:13):
people should be aware of?
Melissa Biscardi (31:15):
One important thing to note is if someone has
a lot of autonomic symptoms,like placing pressure on the
eyes sometimes can cause anegative response.
So I would say, especially ifyou're trying this at home or
just trying it with yourpatients for the first time, to
sort of work around the eyes ormake sure that, like I would say
(31:39):
for POTS probably not thegreatest thing or other people
that are having just theirnervous system up and down,
heart issues we don't want toput a lot of pressure on the
eyes, so just safely workingaround those tissues.
That would be the majorcontraindication.
Dr. Ayla Wolf (32:00):
Let's go back to the research that you did on
women and concussions and aspecific hormone, the
anti-malarian hormone or AMH,and talk a little bit about why
you decided to focus on thatparticular hormone.
What was the study design?
What did you find?
What did you discover?
Melissa Biscardi (32:21):
Sure.
So when I started my master's Ididn't come up with this idea.
I came in to this research laband my supervisor, dr Cole
Antonio, she had the idea tolook at.
Okay, we know women havedisruptions in their periods, or
some women do after concussion,and sometimes this lasts for
(32:44):
years, sometimes they don't havetheir period for years or
months.
Could this actually beaffecting time to menopause?
Which we didn't know and westill kind of don't know.
But how we wanted to test thatthen with an objective marker
was with anti-malarian hormone,which is ovarian reserve or time
(33:08):
to menopause.
So we recruited people from thesame hospital that I'm
recruiting from now, but adifferent area, and we did one
blood, blood test to measuretheir levels.
And I mean, my sample was only10 people, so we can't say too
much Um, but there weredefinitely changes, I want to
(33:34):
say, versus the norms for the,the women, like the women's age,
and in those 10 people,definitely everyone was having
some sort of um menstrualirregularities since their
injury.
So I want to say it's, it's apossibility that it's related.
(33:55):
Um, what I've seen clinicallyis that women who are close to
menopausal age and tell me ifyou've seen this as well
sometimes the injury can pushthem into menopause, or that's
what it looks like from theclinical perspective.
Dr. Ayla Wolf (34:13):
I think it's worth keeping an eye on.
Did you also look at FSH levels?
Melissa Biscardi (34:18):
We didn't.
I know I wish we did actually.
So if I had unlimited funding Iwould actually.
So the only reason I didn't dothat study on a bigger scale for
my PhD, or not the only reasonbut one is that I can't as a
practitioner, translate thatinto my clinical practice, like
I can't order blood tests or doany sort of interventions
(34:41):
related to those findings.
So I thought, clinically theother research I was interested
in and also made more sense, butI really wish someone would
finish that study or do it witha fully powered sample.
Dr. Ayla Wolf (34:56):
Right.
I mean because if you'refinding abnormalities even in
that one particular hormone injust 10 people that have
symptoms, that really seems likesomebody does need to pick up
that mantle and keep runningwith it and doing more research
and figuring this out, becausethere are lots of women of
childbearing age that probablywant to have more children and
(35:19):
need to know if a concussioncould potentially interfere with
that, yeah yeah, and the meanage for concussion in women is
31.
Melissa Biscardi (35:29):
So it's like right when many are trying to
conceive, are planning to.
So maybe when I'm done my PhD,maybe I'll pick that up for a
postdoc.
Dr. Ayla Wolf (35:41):
Yeah, yeah, well, okay, so one of the fascinating
things that I noticed kind ofat the intersection of
fascinating things that Inoticed, um, kind of at the
intersection of, you know, I wasworking in fertility for a long
time.
Then I started studyingneurology and when I started
learning about primitivereflexes, I started to recognize
that a lot of my, uh, femalepatients that were having
(36:03):
trouble getting pregnant stillhad primitive reflexes, like a
spinal gallant, and I was like,well, this makes perfect sense.
If somebody still has aprimitive reflex, it means a
part of their brain is stuck, ithasn't fully developed.
So of course their brain islike I'm not ready to have
babies, I'm still stuck in thisprimitive reflex pattern.
Wow, yeah, so I think that's awhole nother avenue that needs
(36:27):
to be explored.
And so how?
Melissa Biscardi (36:30):
did you yes, when you're working with those
patients, what kind of outcomesdid you see on the other?
Dr. Ayla Wolf (36:37):
end.
You know there's like thetraditional classical spinal
gallant test.
What I would find because as anacupuncturist you're often
palpating people's backs andyou're inserting needles so what
I would see is that a lot ofthese women had incredibly
ticklish backs where so as soonas you touched them, they had
kind of a startle response andthey'd would call kind of a
(37:04):
functional finding of like moreof this, like subtle response in
terms of just having somebody,you know, lightly palpate your
low back.
But I definitely would see thatkind of hip hike, you know
spinal gallant type pattern andI found over time, you know,
just with doing the acupuncture,that that would go away, and
(37:25):
then I did have really goodoutcomes.
You know, doing a combinationof acupuncture, that that would
go away, and then I did havereally good outcomes.
You know, doing a combinationof acupuncture, herbal medicine.
Many of these women were also,you know, seeking out
reproductive medicine atdifferent fertility clinics too.
So there were many differentscenarios, whether they were
doing it just, you know, likeworking on things in my clinic
or also doing IUIs or IVF.
(37:48):
So lots of different scenarios.
But that concept of findingthese primitive reflexes or some
subtle variation of it felt tome like it was important and
needed to be explored.
Melissa Biscardi (38:03):
Absolutely, and that's Lord, absolutely, and
that's it's really fascinating,because we know that IVF is not
100% or any of the uh, let'ssay medical approaches, and so I
feel like in combination that'sso much more powerful.
Right, you're finding somethingthat actually might be the
reason why things are not beingso successful on the other end,
(38:25):
but together, yeah, you mighthave some babies, absolutely,
absolutely Well.
Dr. Ayla Wolf (38:40):
So switching gears, cause I know you have a
black belt in jujitsu, and isthat how you got your concussion
?
Cause I know you also had aconcussion.
Melissa Biscardi (38:45):
Is that how you got your concussion?
Because I know you also had aconcussion.
So I actually this is a veryhow I got into concussion work
is I had a concussion, butthat's not why, like what led me
to being interested in thebrain.
Can I tell that story?
Tell that story, yeah, okay, Ithink people will be interested.
Um, so I well, I've had sleepissues forever, and then
(39:11):
actually, when I was in osteoschool, I while I needed to
sleep and so I started to takesleep ease, which in Canada is
the same as Benadryl over thecounter, and at first I just
took a sprinkle, cut the pill,you know, in four, and then I
had half.
Then I don't know if I ever wentto a hole, but I was doing it
(39:32):
every night.
And then I was losing my memory, or my started to lose my
memory.
How old were you at this time?
Okay, so I would have been,let's say, 30 ish, yes, 30, 31.
And I, I, yeah, so I'm losingmy memory.
So I started slowly, but thenit was very noticeable to me
(39:56):
Like I was well not rememberingthings that I learned, but not
because I wasn't payingattention, like I would just
have no recollection of learningsomething, or even seeing it,
and then I started to get facialblindness, where I just
wouldn't recognize people, andeveryone was just like, oh it's
(40:16):
nothing, oh it's stress.
You know the whole invisibleinjury thing, um, and I'm a
medical practitioner, so I wasable to access everyone.
You know, I had MRI, I had thegreat sports doctor look at me
and no one was asking the rightquestions.
That's really what it came downto.
Um, and I just happened to bechatting Actually it relates to
(40:37):
jujitsu because I was chattingwith and no one was asking the
right questions.
That's really what it came downto.
And I just happened to bechatting Actually it relates to
jujitsu because I was chattingwith a teammate about sleep and
then he said oh, did you hearabout that study that showed
that Benadryl is associated withAlzheimer's?
And I was like, no, I haven'tseen that study actually.
And then I was like, holy crap,this is what is happening in my
(40:58):
brain.
So then of course, I had tochange a few things and then,
slowly, my memory started.
You know, now I want to sayit's fine, but who knows?
But it's definitely back to, Iwant to say, a functioning
normal.
Um, so that's how I gotinterested in invisible injury,
for sure.
And then I wanted to say, maybetwo or three years later then I
got a concussion.
I was already in the concussionworld for lack of better
(41:23):
language, so I went right to thebest in the city.
I feel like I had a good starton it, but I also feel like I
had an unremarkable concussion.
So I got foot in the face orwhatever, a heel on the head.
I had some symptoms, but withina few weeks I was, I was, I was
back to jujitsu and life Got it.
Dr. Ayla Wolf (41:48):
So, going back to the Ben and Jill thing, when I
was writing the sleep chapter inmy book, I was doing a lot of
research to see what the morerecent research was saying,
because I remember back in like2016, 2017, that was when those
headlines were coming out If I'mremembering the dates correctly
.
For sure, that's around thesame time.
(42:09):
And yeah, and so I felt like fora moment there that was in the
spotlight, and then it was likenothing happened.
Nothing happened, there weren'tI mean, there wasn't any new
like laws or rules or anythingFunny how that happens.
And so it's like, oh hey, by theway, benadryl can like really
(42:30):
cause dementia and, you know,affects your brain if you take
it every night.
And then all of a suddeneverything went quiet, never
heard about it again, peoplewent on with their lives.
So as I'm writing my book, Iwas like, well, let me just see
if there's new research out andin fact there was, and there was
this really large study thattook place in france and they
looked at people's use ofbenadryl and they categorized it
(42:52):
as like no use, low use,moderate use and high use, and
they were actually able to showthat like the people who were
using Benadryl more frequentlyhad indeed, you know, like more
risk of having dementia, and sothey even showed this like dose
dependent nature to using it.
Melissa Biscardi (43:11):
But I'm like, but now nobody's talking about
it anymore and I was like thismakes me so mad.
I'm like I try and mention itto my patients because it comes
up especially around allergyseason.
So I'm pretty adamant about itbecause even when patients come
in and they'll be having memoryloss but or issues, and their
(43:35):
brain is in a like thatblood-brain barrier is more
permeable.
So it's even, I want to say,worse to take it when you have a
concussion and then also,people don't know Benadryl is
sleepies, right, like we havethe same chemical that is put in
(43:55):
different boxes with differentnames.
So, yeah, I feel like we have abig responsibility to educate
as much as we can.
Yep, absolutely.
And so tell me about you andyour martial arts life.
Dr. Ayla Wolf (44:12):
Okay, well, I started out doing kickboxing and
taekwondo when I was 15.
And my very first concussionwas when I was 18.
I got kicked in the head, and Iwould say that I recovered from
that very quickly, to my bestof recollection, um, minus what
(44:37):
I would say was like permanentchange in my hearing.
Um, so when I'm in loudenvironments, I can't hear the
people in front of me very well,I can't make out what what the
people are saying, and that'sbeen there ever since that
particular injury.
Um, but the really sad thingwas that that so I got my black
belt in taekwondo and Iimmediately had major imposter
(44:59):
syndrome where I just felt likeI have this black belt and I
don't deserve it, and eventhough I can do 20 tornado kicks
in a row, if somebody like gotme on the ground I'd be totally
useless, yep.
And so I was like, okay, I gotto go learn jujitsu.
And so I started trainingjujitsu, but that was during my
(45:22):
master's program and I had theopportunity at the jujitsu
school to teach the kickboxingclasses.
And so, as a broke master'sstudent, I was like, do I make
money or do I spend money?
And I didn't have time to doboth, so I ended up stopping the
jujitsu, which in hindsight Iwish I hadn't.
So then I taught kickboxing fora while, and then in my 30s at
(45:48):
this point I was living inOregon I decided to start
training again.
Only I went from.
So when I was younger I did gi,and when I started back up I
did nogi.
So I trained nogi for a longtime, pretty consistently.
but that was also at the peak ofmy kind of post-concussion
(46:10):
syndrome, and so the sad pieceof it was that I was showing up
to class every day and I wasn'tremembering anything like you
were saying before Right and andso I was really struggling and
I also was in a really badtraining environment where I was
like the only female and a lotof the guys were younger than me
(46:31):
and they were bigger andstronger and they just lock me
up into a body triangle for fourminutes.
Oh my gosh, that's the worst Iknow.
I'm like I'm not learninganything, trying to struggle out
of your 200 pound body triangleand so you're not learning
anything either right, yeahsilly it is, yeah.
(46:52):
So I was in bad environment.
It was not conducive to my ownlearning.
My head injury was notconducive to my own learning and
I but I mean I was like full ondoing MMA, I was studying like
takedowns, I was doing sparring,I was doing jujitsu no gi and I
went to a couple of jujitsutournaments and at one point one
(47:16):
of my friends who taughtjujitsu and had his own school,
he just looked at me and he goesyou don't want this as bad as
these other people that you'recompeting against.
And he was right, because I was35 years old, I owned my own
business, I was working fulltime.
I wasn't out for blood likesome of these 21-year-old
(47:38):
females with a chip on theirshoulder were at the time.
And so this, like a whole MMAscene back then, was very just
cutthroat and some of thesegirls were, you know, a little
nasty Like they.
Just they didn't care if theyinjured you, they just wanted to
win and prove themselves.
And again, coming from ahealthcare background, I didn't
(47:58):
want to go in and give otherpeople concussions, or you know.
I just so he was right, youknow, he just looked me dead in
the eye and he said you don'twant?
Uh, so I, I kept training, butwith a different attitude, right
(48:20):
, um, I actually got out of theno gi and I started training gi
again, um, at his school and itwhich was hilarious because no
gi is so much faster, and so hejust kept screaming at me slow
down, slow down, slow it down.
Um, yeah, so between all theback and forth of gi, no gi, mma
(48:41):
, to just straight jujitsu, likeI was just kind of all over the
place, um, and then eventuallyI um had a back surgery.
I had to have a fusion in mylow back.
I tried to go and at this pointI'm now living in Dallas, texas
, and I'm at a much moreprofessional gym environment
with great people but after myback surgery I think I tried to
(49:03):
go back to jujitsu a little toosoon.
It was about five monthsafterwards and I remember
getting stacked up and twistedand my back just kind of went
and I was like, oh, this is not,this is not good.
And then a week later I gotneed in the head accidentally
and a lot of my concussionsymptoms came back, and so I was
(49:26):
like, okay, between the backsurgery and the low back issue
and then getting like theconcussion symptoms again.
That was finally when I waslike, okay, I'm just going to do
kickboxing, but I'm not goingto spar, I'm just going to train
, like let me just take myselfout of all of the potential head
impact scenarios.
But because I love it so much,fast forward 2018,.
(49:50):
I'm like you know what?
Let's go back, let's do this.
And so I started doing it.
It is yeah.
And so I started doing privateMMA lessons with a MMA with a
former UFC fighter.
She had retired at the time,and so I was in a session with
(50:10):
her and she was like giving mecues, just cue, cue, cue, cue,
like justice and justice, and itwas just like rapid fire cues.
And all of a sudden my brainjust went and it just paused for
like half a second and in thathalf a second she clocked me
right between the eyes and I allmy concussion symptoms came
back again.
Melissa Biscardi (50:29):
And so again it's like all right, okay.
Dr. Ayla Wolf (50:31):
How many times does the universe want to tell
me Like I can't, I can't do thisanymore.
I have too much on the linewith my career.
Melissa Biscardi (50:39):
It's tough though, when yeah, when you like
something a lot and it makesyou feel good in some ways, you
get the endorphins, the physicalactivity.
So I can see why you have goingback.
Dr. Ayla Wolf (50:54):
Yeah, I mean when , when you do something for 20
years, you know it becomes partof your identity.
And I think that's that's a bigpart of why it's hard for
fighters to retire, or you know,it's like their whole identity
is wrapped up in themselves as a, as a competitor, and I get
that.
I mean, how many concussionsdid it take until I was finally
like okay let's do CrossFitinstead.
Melissa Biscardi (51:18):
I didn't know we had so much in common and I
actually have hearing loss, so,but that's a whole other episode
.
So, yeah, so we have.
We're in busy places.
Same thing I have troublehearing people and I never
realized how.
I don't want to use the wordsevere, but I'll throw it in
(51:41):
like how severe the loss wasuntil COVID, because people
would come in wearing masks.
And then I realized, oh my gosh, I'm relying quite a bit on
actually seeing people's lipsmove and I just didn't realize
it.
Dr. Ayla Wolf (51:52):
So, yeah, that clued you into like the severity
of it.
Melissa Biscardi (51:56):
Oh interesting .
Dr. Ayla Wolf (51:58):
And was your hearing loss from a concussion
or something different?
No, I think so.
Melissa Biscardi (52:03):
It happened in the beginning.
I didn't really even notice it.
It was.
It's kind of similar to the, tothe memory thing like asking
people to repeat themselves, oris that actually loud or not?
But I think it was fromantibiotic use, okay, because I
had lots of strep and basicallyjust strep, but multiple times a
(52:24):
year when I was growing up.
So I feel like it might've beenthat.
Dr. Ayla Wolf (52:29):
Sure, just an ototoxic antibiotic that killed
some hair cells.
Melissa Biscardi (52:35):
All the medications are getting me
basically yeah, on the otherside, like that's good to know,
right, because often we takethings and don't look at the
fine print or maybe are not asinformed as we could be.
Dr. Ayla Wolf (52:53):
Right.
And it's so hard when you'relike okay, well, this is a known
side effect, but it's not acommon one.
And so it's like how do I evenweigh the pros and cons of do I
take this or not?
Based on what I know, it's notan easy decision for anybody,
For sure, For sure.
Oh gosh.
Well, is there anything else wehaven't talked about that you
(53:14):
want to cover?
Melissa Biscardi (53:16):
well, actually , yes, the fact that, just to
remind people that we're bothtalking at, we shine, yes
september 1st.
Dr. Ayla Wolf (53:28):
So the we shine is a virtual symposium that is
all female, female led andfemale, all female speakers.
So, yeah, I'll put a link tothe show notes to the conference
.
Yeah, awesome.
And so I'm curious so what areyou doing on a daily basis for
your brain health?
Melissa Biscardi (53:50):
That's a good question.
So I always get movement in,like now I like to run, that's
how I get my endorphins that Idon't get from jujitsu.
And I use the red light, maybenot every day, but a few days a
week, and I try and do somemindfulness.
But I would say for me, right,mindfulness, oh yeah, nevermind,
(54:13):
I just started a big gratitudeposter, so not every day.
Dr. Ayla Wolf (54:17):
Is that what's in the background there?
Melissa Biscardi (54:18):
That's a different thing that I do, but
it's almost the same.
It's like things that I want toremember that happened through
the year, and this is like mythird year of doing it and it's
really cool because then youjust have a stack of post-it
notes and yeah, so there's thatstack of post-it notes and, um,
yeah, so there's that a lot ofgratitude and reframing things
(54:39):
as um on either the positive, orI get to do this, or wouldn't
it be fun if this happens, or ifI could do this instead of like
, oh my God, I can't believe Ihave to write my thesis.
Yeah, and I try and eat healthy, but I'm definitely not perfect
.
Oh, and sleep, yes, I make sureI get as much, you know, eight
(55:03):
hours sleep, if I can.
Dr. Ayla Wolf (55:06):
Absolutely Awesome.
Movement, sleep, gratitude,yeah, goes a long way.
Absolutely Well.
Thank you so much for coming onthe show.
Do you want to let people knowwhere they can find you?
I mean, I'll put the link inthe show notes too.
But what are the best ways tocontact you or reach out to you?
Melissa Biscardi (55:24):
I would say all the fun stuff happens on
instagram, which is easy toremember.
It's conrehabca is my littlehandle and, yes, find me there
and if you have questions,comments.
I love to talk to people andit's going to make me live
longer.
Dr. Ayla Wolf (55:46):
Perfect, okay, good.
Well, I'll put all that in theshow notes and thank you again,
and maybe once you wrap up yourresearch we'll have you back on
the show.
We can talk about that too,once you get all your
participants through and crunchsome numbers.
Melissa Biscardi (56:01):
Awesome, I'd love that.
Dr. Ayla Wolf (56:02):
Cool.
All right Well have a goodnight, you, too.
Medical Disclaimer this videoor podcast is for general
informational purposes only anddoes not constitute the practice
of medicine or otherprofessional health care
services, including the givingof medical advice.
No doctor patient relationshipis formed.
(56:25):
The use of this information andmaterials included not intended
to be a substitute for medicaladvice, diagnosis or treatment,
and consumers of thisinformation should seek the
advice of a medical professionalfor any and all health related
issues.
A link to our full medicaldisclaimer is available in the
(56:47):
notes.
And so I really am a proponent of
starting with some gentle manualwork to create ease in the
system, to create a parasy hourslike.
They are just so revved up thatwe really need to bring them to
(00:26):
a space that okay, their systemis ready for something a little
more active.
Dr. Ayla Wolf (00:33):
Welcome to Life After Impact the concussion
recovery podcast.
I'm Dr Ayla Wolfe and I will behosting today's episode, where
we help you navigate the oftenconfusing, frustrating and
overwhelming journey ofconcussion and brain injury
recovery.
This podcast is your go-toresource for actionable
information, whether you'redealing with a recent concussion
(00:54):
, struggling withpost-concussion syndrome or just
feeling stuck in your healingprocess.
In each episode, we dive deepinto the symptoms, testing,
treatments and neurologicalinsights that can help you move
forward with clarity andconfidence.
We bring you leading experts inthe world of brain health,
functional neurology andrehabilitation to share their
(01:16):
wisdom and strategies.
So if you're feeling lost,hopeless or like no one
understands what you're goingthrough, know that you are not
alone.
This podcast can be your guideand partner in recovery, helping
you build a better life afterimpact.
Today's guest on the show, thefabulous Melissa Biscardi, is
(01:38):
the founder of Concussion Rehab,located in Toronto, where for
over a decade, she's helpedpatients recover from
concussions.
Since 2006, she's worked as anurse and since 2013, as an
osteopathic practitioner.
She earned her Master ofScience studying women-specific
concussion outcomes, includingthe first-ever investigation of
(02:00):
anti-malarian hormone in mildtraumatic brain injury, and is
now completing her PhD at theUniversity of Toronto, focusing
on ocular motor rehabilitationfor adults with post-concussion
syndrome, doing cutting-edgeresearch into virtual reality
and mobile app-based therapies.
Melissa has authored bookchapters, published peer review
(02:23):
papers and presented on stagesaround the globe.
She's also the creator of theBrain Toolkit app, putting
evidence-based concussion rehabexercises into people's hands
anywhere, anytime.
Please enjoy my conversationwith Melissa Biscardi, but first
a few announcements.
(02:47):
Biscardi, but first a fewannouncements.
On Thursday, september 25, 2025, I will be at Northwestern
Health Science University inBloomington, minnesota, from 12
to 1 to talk about my new book,the Concussion Breakthrough.
So if you happen to be astudent or faculty member on
campus, please join me on thatday.
Then, on Friday, october 24, Iam having a book signing and
book release party at theSchmidt Artist Loft in St Paul,
(03:10):
minnesota, from 630 to 830pm.
This is in the old SchmidtBrewery building and anybody who
wants to join is welcome, butplease RSVP to lifeafterimpact
at gmailcom and that will helpus with our planning.
If you are an acupuncturistinterested in learning more
about neurology and neurologicalconditions, I'm teaching a
(03:32):
seminar for the MontanaAssociation of Acupuncture and
Oriental Medicine in Bozeman,montana, october 4 to the 5th.
Registration is on theirwebsite, montanamaaomorg, and
early bird registration endsSeptember 4th.
Thanks and enjoy the show.
Melissa Biscardi, welcome toLife After Impact.
(03:56):
How are you today?
Melissa Biscardi (03:57):
I'm amazing.
Thank you so much for having me.
I'm excited to be here.
Dr. Ayla Wolf (04:01):
Yes, well, you have such an incredible
background you are a registerednurse, an osteopathic therapist,
a PhD candidate I can't wait totalk to you more about that and
a functional neurologypractitioner who has dedicated
your career to advancing brainhealth.
We are both presenting at awomen-only neurology conference
(04:22):
coming up women-only neurologyconference coming up and so your
presentation is on ocular motorrehabilitation, but
specifically the use of manualtherapy in ocular motor rehab.
So why don't you, for ourlisteners, define what that is
when you speak about manualtherapy and so kind of describe
what that is and then how you'reincorporating that into your
(04:46):
rehab for different aspects ofvision and eye teeming and eye
movement disorders that are socommon when people have
concussions?
Let's start there, absolutely.
Melissa Biscardi (04:56):
So I come from an osteopathy background, which
is really a gentle, manualtherapy, and it's important to
note that in the U?
S, osteopaths are doctors ofosteopathy, so they can also
prescribe medication and do allthe duties or at least most of
them that physicians would do.
And where I'm from, in Canada,we are manual therapists and not
(05:21):
medical doctors, so we wouldlook more similar to a
physiotherapist um than amedical doctor, and so our first
line of therapy is manualtherapy and we don't adjust the
way where that makes a sound.
So just to kind of set thestage, it's super gentle, layer
(05:43):
by layer.
So that is the type of manualwork that I'm speaking of when I
say manual therapy, and thiscan really sort of set the stage
for ocular motor rehab, whichis the way I think about it.
To say, eye movement exercises,which is terrible, but if
(06:07):
you're a fly on the wall, that'swhat it's going to look like,
right, even though it's full ofnuances.
And when someone has aconcussion they are in a state
of fight or flight.
The nervous system is usuallyreally heightened.
It's been through a trauma andit's not always easy to just
(06:28):
pull someone in and start doingactive rehab, and so I really am
a proponent of starting withsome gentle manual work to
create ease in the system, tocreate a parasympathetic shift,
just letting that body feel safeand open to other forms of
(06:50):
rehab.
And sometimes someone will comein they haven't blinked in 48
hours like they are just sorevved up that we really need to
bring them to a space that,okay, their system is ready for
something a little more active,that okay, their system is ready
for something a little moreactive.
Dr. Ayla Wolf (07:13):
And do you want to talk a little bit about when
you're doing manual work?
So I've also studied somecraniosacral therapy, both
through the Upledger Instituteand then also biodynamic cranial
work, and it is very subtlepalpation.
And when you talk about themanual work on the head, can you
talk about kind of what you'refeeling when you work on people
(07:33):
and kind of what kind of shiftsthat you pick up on?
And I know sometimes you cantell when you're working on
different tissue layers as well.
So maybe talk a little bitabout these kind of subtleties
of this, this palpation methodand this hands-on approach.
Melissa Biscardi (07:49):
Sure, absolutely.
I was wondering if you hadworked um with the up ledger
courses or not.
So my intuition was right Um,I'm not trained by up ledger,
but similar, different Um.
And so let's see when we are,when I'm palpating, when we're
palpating, let's say the cranium, one thing is looking for
(08:16):
directions of ease anddirections of fine.
So where does the tissue liketo go?
Um, and you know, someone caneven feel that just feeling the
tissue on their arm gently andmoving it in different
directions, and you probablywill find somewhere it doesn't
want to go.
And usually when someone comesin and they are in a sympathetic
(08:38):
state, we will go into the ease.
So, following the tissue whereit wants to go, like pushing a
drawer in when it's stuck,versus just yanking on it and
trying to pull it out.
Um, when it comes to cranial,especially with the extraocular
muscles, all of them come.
Well, most of them come to acommon um tendon and they are
(09:02):
connected to the cranial bones.
So as we create ease around thecranial tissue, which attaches
to the cranial bones, which thenattaches to the dura, like
really we are working on all thelayers and even working on the
brain, when you think about it.
Dr. Ayla Wolf (09:21):
Yeah, and I've also found too that a lot of
people, when they have that kindof sympathetic elevation and
their visual system is taxedmaybe because they're overusing
it or there's a lot of fatiguein the system that I get much
better results when I can guidesomebody through almost like an
(09:43):
eye exercise warmup, so to speak, with their eyes closed, yes,
and also just tuning into theirown ability to move their eyes
in different directions, feelinginto, does it feel, you know,
is there more strain in thesystem when I look left versus
right or up left versus downright?
And so I find, you know,anytime somebody exercises,
(10:07):
obviously we recommend let'swarm up your muscles first.
It only would make sense thenthat if you're doing visual
rehab and eye exercises, thatyou would want to warm your eyes
up first, and so do you alsokind of guide people through
some visualization exercises orjust more of like some eye
movements with their eyes closed, to be able wing of the
(10:30):
sphenoid to kind of unweight thetissue there and then having
them move left right up down.
Melissa Biscardi (10:51):
Even that in and of itself usually creates
some ease.
And, yes, having patientsnotice the subtleties instead of
just, oh, my eyes are tight ormy eyes are in pain, but okay,
what you know, which areas maybeneed a little more nurturing?
Um, and also, when you havesomeone on the table and you're
(11:13):
doing some of this more subtlework, sometimes you'll just
you'll visualize also when thenervous system is like oh yeah,
so I'm in a safe place now andthey'll do you know a big
inhalation, yeah, so I'm in asafe place now and they'll do.
you know a big inhalation,exhalation.
Dr. Ayla Wolf (11:33):
So the body's communicating with us all the
time.
Yeah, yeah.
And what would you say are themost common eye movement
impairments that you see withyour concussion patients that
maybe often get missed in kindof other types of settings?
Melissa Biscardi (11:43):
I would say that I think, hopefully, almost
everyone who's working inconcussion is looking at the eye
movements, but it's importantto pay attention to the nuances.
So, yes, maybe the eye can getfrom A to B, but does it take 10
(12:03):
stops along the way?
Right, and even some of themore popular standardized
vestibular ocular assessments,like the VOMS I'll just say it
it doesn't really allow for thenuance.
Yes, if someone is symptomatic,but do they have a lot of
fatigue with it?
Right, are they blinking 10times when they're looking in
(12:27):
one direction?
Are the eyes watering?
Is there a twitch coming up inthe face?
So I think that there are a lotof yes, nuances, details to
pick up on, to see, okay,where's a problem?
Where can we get in?
Where's the low hanging fruit,which I feel like usually is a
manual therapy?
Um, and then get into thebigger issues.
(12:50):
Oh, I didn't answer yourquestion, sorry, um.
Can I add?
Dr. Ayla Wolf (12:56):
to that you can add.
Melissa Biscardi (12:57):
you can add so um, I mean and the research
supports it as well that thereare definitely issues in
pursuits, especially likevertical smooth eye movements
and although this comes to thenuances like saccade accuracy,
so maybe the eye is jumping inthe direction it's supposed to
(13:18):
go but it's not actually landingwhere it's supposed to land.
And I mean this might manifestwith someone is reading but then
they skip a word and they haveto go back, or they're skipping
lines, and then also saccadelatency, so you want someone to
look and then it takes a littlewhile before the eye actually
(13:41):
decides to go over there or isable to process the command to
get from A to B.
Dr. Ayla Wolf (13:47):
Right, right, there's that lag time between
them, maybe seeing the stimulusto move their eyes and then they
actually move it and actuallydoing it.
Melissa Biscardi (13:57):
And then the other thing is, if there's
asymmetry in that, then you haveasymmetrical information, sort
of all day long.
So that's definitely going tomake someone feel unwell or
anxious or whatnot.
Dr. Ayla Wolf (14:11):
Right and I think that the those subtleties are
so important.
I often liken it to drivingyour car with a spare tire on.
You know, having that sparetire still gets you from point A
to point B, but you're notgoing to be able to drive your
car at peak performance when youhave a spare tire on.
And it's like these littlesubtle struggles within the
(14:33):
system over time can reallycause a lot of almost wear and
tear or fatigue to the system,absolutely.
Melissa Biscardi (14:41):
I like that analogy and, yes, it drains the
battery faster.
I like to say right.
Dr. Ayla Wolf (14:46):
Yeah.
Melissa Biscardi (14:48):
What are the most common ones you think you
see in your practice?
Dr. Ayla Wolf (14:53):
Definitely vergence issues I see all the
time, yeah, whether that'sissues with convergence or
divergence, and I find, you know, when I assess it from maybe
straight on, people are fine,but as soon as I start looking
at angles, then all of a suddenpeople start to struggle.
And so I do think that you know, with a lot of these standard
(15:15):
tests, like you said, they'remissing the nuances of well,
what happens if your head isturned to the right.
You know what and so you know.
I have someone this week whocame in for a five day intensive
and vertical pursuits lookedreally good.
As soon as we moved her into aright yaw, vertical pursuits
broke down.
And so those subtleties arealso important, Because if
(15:38):
people know that they don't feelcomfortable in a certain head
position, that's going to changehow they they carry themselves
through life and that's going tohave consequences.
Absolutely, Going back to yourPhD that's also focused on
ocular motor function.
Is that correct?
Melissa Biscardi (15:55):
Yes, and in the PhD we need to have like
three studies or threecomponents.
So the first part I did asystematic review of what's out
there and it's, you know, it'sall in the optometry literature
for the most part, for myinclusion, exclusion criteria at
the very least.
(16:15):
And you know it was reallysurprising because there wasn't
much out there and even thoughwe know, or we see, at the very
least you know how effective itcan be, an optometrist use it,
or neuro optometrist, but therereally has not been a lot
published, which I think is oneof the reasons why there's, you
(16:37):
know, feisty debate about howgood it is or whatnot in the
medical community.
So, but I did, how good it is orwhatnot in the medical
community.
So but I did, I consolidatedthe literature to say this is,
these are the gaps.
And then study two was lookingat a sample of people who are
seen in the hospital I'm doingthe research out of, so like
(16:58):
okay, how many of these peopleare still having visual type
issues after 30 days?
And then study three, which isthe real fun one, is I'm doing a
ocular motor rehabilitationintervention delivered in VR,
compared to usual careessentially, which is not very
much around these parts and thepeople who are participating are
(17:23):
between 30 days and a yearpost-injury and if they get the
intervention, they get six weeksof this sort of oculomotor
rehab therapy in VR and thenhome-based reinforcement on an
app, and so it's really cool.
Dr. Ayla Wolf (17:46):
So they're physically going in to get the
vr.
Melissa Biscardi (17:49):
Yes, and in I.
In theory it would be better ifthey came in daily and did the
vr um, because the vr has moreoptions, but that is just not
feasible.
So it's like what can we dothat is feasible, and then
feasible when it translates intopractice, because even in the
intensive it's like what can wedo that is feasible, and then
feasible when it translates intopractice, because even in the
intensive it's five days, butthen you do something at home,
(18:10):
yeah, and so talk to me talk methrough what this virtual
reality experience is once theyhave the goggles on.
Yeah, so it's not immersive inthe way that they're not in a
grocery store or walking downthe street.
It's very much following dottargets.
We're following a targetthrough a maze.
(18:32):
There's one where targets arecoming at them like bullets.
I'm not sure why they thoughtthat was a good idea.
Dr. Ayla Wolf (18:41):
Yeah.
Melissa Biscardi (18:43):
But actually people love that one because the
bullets come and you explodethem with your saccades,
essentially, and then it getsmore challenging and as you
become less accurate or slowerand not getting it then, um,
well, then they end it so youdon't explode.
Okay, they haven't added thatpart yet.
(19:05):
Um, so there are different sortof trainings for lack of a
better word for pursuitssaccades, anti-saccades, vor
convergence, there is a virtualbrock string, so it covers sort
of all the foundational eyemovements in a simple, but I
(19:27):
don't want to say gamified, buta little bit creative way.
Yeah, and you can change thesettings for difficulty and
range.
It's not as personalized, asyou know.
If you had someone in front ofyou you could really do nuanced
angles and rates.
But I think it's pretty goodand it really can make the rehab
(19:51):
more accessible, right, becausethere are only so many clinical
neuroscientists andphysiotherapists, especially
outside of the major centers.
So I feel like there's a rolefor it.
I know in the previous researchnot on concussion participants
have said they like the VR.
(20:11):
Right, it's more engaging, itgives them more motivation than,
let's say, sticky notes andsuch, and so if it's going to
give motivation for people to dothe exercises at home.
I think that, in and of itself,will help get better results.
The flip side, though,especially with concussion, is
(20:32):
the VR is stimulating, so it'ssort of a.
You have to find a fine balance.
What we're seeing is thatpeople like it, though.
So even if you get a little bitof a headache or whatnot, you
it's a trade-off people are arewilling to have, and I see that
(20:53):
in the office too right, I sayokay, well, no, I want to do the
VR assessment, even if I'mgoing to feel a little unwell
after.
Dr. Ayla Wolf (21:03):
Yeah, and do you find that when people take the
goggles off after kind of doingall these different eye
movements, that they are alittle off balance or dizzy at
the end?
Melissa Biscardi (21:13):
Often, I would say the most common and you
might see this in office too issort of eye strain or headache,
sometimes a little bit ofdizziness, but I would say those
are the most common umresolving pretty quickly.
And so similar to, I want tosay, the protocol used for the
(21:33):
treadmill or whatnot, like usinga scale.
You know how much effort areyou exerting, what symptoms are
you having, how would you ratethem?
So not just pushing people ashard as we can, but okay, based
on how you tolerated this lasttime, based on how you tolerated
the homework, how far along canwe move you?
Dr. Ayla Wolf (21:53):
So they're coming back down to baseline rather
quickly.
Melissa Biscardi (21:56):
Yes, I would say so Like less than well.
I wouldn't say one minute formost people and then
occasionally like up to 10minutes.
Dr. Ayla Wolf (22:04):
Yeah yeah, which is pretty good.
Occasionally like up to 10minutes, yeah yeah, which is
pretty good.
I think it was last year, maybemy, uh, my nephew has an Oculus
prime and so I put it on forthe first time ever, and it was
this game where you're a monkeyand you had to move your arms in
order to move forwards and jump, and I had never done this
(22:25):
before.
I thought it was so cool and Ikept like so all of a sudden,
I'm playing it, I'm totally fine.
And then boom, it was likeinstant, intense nausea and it
was like, oh, I think I may haveoverdone it and, um, did you
have ever sensitivity before?
Two?
Melissa Biscardi (22:44):
screens or after your concussion.
Dr. Ayla Wolf (22:49):
I feel like I've always been pretty good with
movement, but I think that Ialso persevered.
Well, one of the symptoms that Ihad after my concussions is
when I would stop my car, Iwould feel like my seat was
still translating forward, soI'd feel like the car was still
translating forward, so I'd feellike the car was still moving
forward.
(23:10):
So I do think that, even thoughI'm not afraid of movements and
I do a lot of movements and alot of times I still like spin
around in my chair and like dosome full body rotation, just as
like let's take a break fromthe screen I do think that
perhaps maybe my brain was likeperseverating on movement a
little longer than it should.
Perhaps maybe my brain was likeperseverating on movement a
little longer than it should.
And the thing that surprised mewas that that nausea lasted for
(23:36):
like four hours after I tookthe goggles off and I didn't
come.
So I was like okay with beingnauseous, but surprised that I
didn't come back down tobaseline as quickly as I thought
I would after taking them off.
That's what I think.
That's the thing that surprisedme the most.
Melissa Biscardi (23:46):
You know that's interesting.
There is some research ActuallyI think they just published it
within the last year aboutimmersive VR like that and
people with concussion andexactly having getting some
symptoms.
So I think maybe that's wherethe balance is.
Maybe using VR in concussionrehab is keeping it very simple.
(24:09):
I know you weren't doing rehab,but just Right, yeah.
Dr. Ayla Wolf (24:14):
I agree.
I think that definitelythrowing somebody in an
immersive VR is completelydifferent from just having
somebody have the goggles on andhaving some dots to follow and,
yeah, very different.
Melissa Biscardi (24:28):
And I mean the immersive is probably a little
more fun, but they need to workup to that.
Dr. Ayla Wolf (24:38):
Exactly, exactly.
And I mean they say that forregular people too, that you
don't want to just pop a VR onand play for two hours straight.
Melissa Biscardi (24:42):
You got to work up to it, yeah and even
some other, like migraine, Ithink, is a, not a
contraindication, but, um, youprobably wouldn't want to use it
for two hours or really immerseyourself when you're first
using it.
And I probably some otherconditions too, but I know
migraine for sure and how big isyour study?
Dr. Ayla Wolf (25:03):
how many people are you including in this?
Melissa Biscardi (25:04):
So we need so far we have 43 and I need 62.
So I'm actually almost there,which is good.
And the biggest study, um, thatwas in the publication.
That wasn't like aretrospective review, I want to
say, was only like 12 people.
So I'm happy this will I don'twant to say make a dent, but it
(25:29):
will add.
It'll add to the researchnicely.
Dr. Ayla Wolf (25:32):
Yeah, absolutely.
And if you had endless funding,time and resources, what would
be like your next study?
What was?
What would be the next thingyou would want to do?
Melissa Biscardi (25:43):
Oh, that's a good question.
Oh, my goodness.
Okay.
Well, I definitely for selfishreasons, I would want to see how
far we could use my app.
Like what do people even needthe VR?
Can we just use something evenmore accessible?
So I say that is maybe onerabbit hole I would want to go
(26:05):
to.
And then my next step would bemaking more gamified activities
in the goggles.
So the goggles are not mine.
I didn't make the games inthere.
It's by a company calledNeuroflex, so I'm using the ones
they've already designed.
I would want to add to the menu, I guess make more gamified
(26:29):
ones, because that's what peoplelike, right?
So?
And then also ones that willgive people scores.
So like the bullet one tellsyou how many bullets you
exploded, the maze tells you howwell you did on the maze.
So I feel like if we can givesome more fun and positive
reinforcement, that would begreat.
Dr. Ayla Wolf (26:48):
Yeah, I love that .
And then, for people who aren'tfamiliar with your Brain
Toolkit app, why don't you talka little bit about when you
developed it, kind of how it'sevolved over time and what it
has to offer people?
Melissa Biscardi (27:02):
Sure, sure.
So the Brain Toolkit app is anapp for clinicians and patients
and it is for Android and iOS,which was actually the like, the
first motivation for it,because I'm an Android user and
there just wasn't much out there.
So I said, okay, you know, Ineed a basic app just for
(27:24):
pursuit, saccades, opk,hemi-stim.
So that was the first edition.
It was very bare bones and overtime, with feedback from people
and just thinking, oh, it'd benice if I could do this and that
, and oh, I guess people needinstructions in there.
So it's really evolved.
And more recently we improvedthe user interface, which is
(27:47):
great, and it has things for eyemovement assessment or
intervention, like the basicsthat I just mentioned.
And then it has a few, I wantto say, cognitive ones, or you
could use them that way, likememory, and there's one where it
flashes a random letter so youcan be creative with how you use
(28:11):
it, random shapes, which Iactually use a lot, somehow just
being creative.
And then recently we put insubjective, visual, vertical
assessment, which is great, Iwant to say, because it gives
you an objective angle for theclinician.
So some of the things are moreclinician targeted, I want to
(28:32):
say, but even some of them thepatients can use to just sort of
assess themselves or assess,you know, do this and send me
how it went.
Yeah, and it's super easy touse, which I think is important
for accessibility, especiallywhen people have a brain injury.
Dr. Ayla Wolf (28:52):
Yeah Well, and it's nice to be able to send
patients home with exerciseswhere you're not having to be
like OK, I need you to teachyour husband how to move his
thumbs like this sure,especially with the anti-sicades
right when you need an oppositetarget, or yeah, so I find it's
helpful, for sure.
(29:12):
Yeah, so it sounds like in yourpractice you're doing a really
lovely combination of bothhands-on stuff.
You also do acupuncture.
We should talk about that too.
Melissa Biscardi (29:24):
It's funny because so I am not as
well-versed as yourself inacupuncture.
I did the here it's calledmedical acupuncture, quote
unquote.
So we learn I want to say itwas six months, but not
intensive, right?
So you go every three weeks forthree days and you learn the
acupuncture points more relatedto the nerves, which are the
(29:48):
same as the meridians,essentially.
So we learn a little bit of thelanguage from Chinese medicine,
but I will think about it alittle bit differently.
But I find that also, it's just, it's such a great tool for
people.
Dr. Ayla Wolf (30:04):
Yeah, yeah, I find especially, you know,
around the eyes there's so manypoints that just help to relax
the muscles, relax, you know,the the face, but then also
helping with headaches so manypeople with concussions or jaw
clenchers, which contributes tothe headaches and the eye strain
A lot of times.
What people will say after atreatment they're like I feel
(30:26):
like I can open my eyes wider,so they're not like walking
around with kind of the squintyeyes as much.
Melissa Biscardi (30:33):
Oh, I'm glad you raised that point that
people are squinting their eyes,because then you have a lot of
face tension from that andexactly you come in like that
and how great is it if we canwork on that before we start
working on other things yeah,yeah, absolutely.
Dr. Ayla Wolf (30:52):
And then in terms of the, the manual therapy, um
are there for kind of people whoare maybe interested in
pursuing it?
You talked a little bit aboutthe difference between kind of
craniosacral therapy versusosteopathic and kind of manual
manipulation from an osteopathicperspective.
Are there any limitations orcontraindications or things that
(31:13):
people should be aware of?
Melissa Biscardi (31:15):
One important thing to note is if someone has
a lot of autonomic symptoms,like placing pressure on the
eyes sometimes can cause anegative response.
So I would say, especially ifyou're trying this at home or
just trying it with yourpatients for the first time, to
sort of work around the eyes ormake sure that, like I would say
(31:39):
for POTS probably not thegreatest thing or other people
that are having just theirnervous system up and down,
heart issues we don't want toput a lot of pressure on the
eyes, so just safely workingaround those tissues.
That would be the majorcontraindication.
Dr. Ayla Wolf (32:00):
Let's go back to the research that you did on
women and concussions and aspecific hormone, the
anti-malarian hormone or AMH,and talk a little bit about why
you decided to focus on thatparticular hormone.
What was the study design?
What did you find?
What did you discover?
Melissa Biscardi (32:21):
Sure.
So when I started my master's Ididn't come up with this idea.
I came in to this research laband my supervisor, dr Cole
Antonio, she had the idea tolook at.
Okay, we know women havedisruptions in their periods, or
some women do after concussion,and sometimes this lasts for
(32:44):
years, sometimes they don't havetheir period for years or
months.
Could this actually beaffecting time to menopause?
Which we didn't know and westill kind of don't know.
But how we wanted to test thatthen with an objective marker
was with anti-malarian hormone,which is ovarian reserve or time
(33:08):
to menopause.
So we recruited people from thesame hospital that I'm
recruiting from now, but adifferent area, and we did one
blood, blood test to measuretheir levels.
And I mean, my sample was only10 people, so we can't say too
much Um, but there weredefinitely changes, I want to
(33:34):
say, versus the norms for the,the women, like the women's age,
and in those 10 people,definitely everyone was having
some sort of um menstrualirregularities since their
injury.
So I want to say it's, it's apossibility that it's related.
(33:55):
Um, what I've seen clinicallyis that women who are close to
menopausal age and tell me ifyou've seen this as well
sometimes the injury can pushthem into menopause, or that's
what it looks like from theclinical perspective.
Dr. Ayla Wolf (34:13):
I think it's worth keeping an eye on.
Did you also look at FSH levels?
Melissa Biscardi (34:18):
We didn't.
I know I wish we did actually.
So if I had unlimited funding Iwould actually.
So the only reason I didn't dothat study on a bigger scale for
my PhD, or not the only reasonbut one is that I can't as a
practitioner, translate thatinto my clinical practice, like
I can't order blood tests or doany sort of interventions
(34:41):
related to those findings.
So I thought, clinically theother research I was interested
in and also made more sense, butI really wish someone would
finish that study or do it witha fully powered sample.
Dr. Ayla Wolf (34:56):
Right.
I mean because if you'refinding abnormalities even in
that one particular hormone injust 10 people that have
symptoms, that really seems likesomebody does need to pick up
that mantle and keep runningwith it and doing more research
and figuring this out, becausethere are lots of women of
childbearing age that probablywant to have more children and
(35:19):
need to know if a concussioncould potentially interfere with
that, yeah yeah, and the meanage for concussion in women is
31.
Melissa Biscardi (35:29):
So it's like right when many are trying to
conceive, are planning to.
So maybe when I'm done my PhD,maybe I'll pick that up for a
postdoc.
Dr. Ayla Wolf (35:41):
Yeah, yeah, well, okay, so one of the fascinating
things that I noticed kind ofat the intersection of
fascinating things that Inoticed, um, kind of at the
intersection of, you know, I wasworking in fertility for a long
time.
Then I started studyingneurology and when I started
learning about primitivereflexes, I started to recognize
that a lot of my, uh, femalepatients that were having
(36:03):
trouble getting pregnant stillhad primitive reflexes, like a
spinal gallant, and I was like,well, this makes perfect sense.
If somebody still has aprimitive reflex, it means a
part of their brain is stuck, ithasn't fully developed.
So of course their brain islike I'm not ready to have
babies, I'm still stuck in thisprimitive reflex pattern.
Wow, yeah, so I think that's awhole nother avenue that needs
(36:27):
to be explored.
And so how?
Melissa Biscardi (36:30):
did you yes, when you're working with those
patients, what kind of outcomesdid you see on the other?
Dr. Ayla Wolf (36:37):
end.
You know there's like thetraditional classical spinal
gallant test.
What I would find because as anacupuncturist you're often
palpating people's backs andyou're inserting needles so what
I would see is that a lot ofthese women had incredibly
ticklish backs where so as soonas you touched them, they had
kind of a startle response andthey'd would call kind of a
(37:04):
functional finding of like moreof this, like subtle response in
terms of just having somebody,you know, lightly palpate your
low back.
But I definitely would see thatkind of hip hike, you know
spinal gallant type pattern andI found over time, you know,
just with doing the acupuncture,that that would go away, and
(37:25):
then I did have really goodoutcomes.
You know, doing a combinationof acupuncture, that that would
go away, and then I did havereally good outcomes.
You know, doing a combinationof acupuncture, herbal medicine.
Many of these women were also,you know, seeking out
reproductive medicine atdifferent fertility clinics too.
So there were many differentscenarios, whether they were
doing it just, you know, likeworking on things in my clinic
or also doing IUIs or IVF.
(37:48):
So lots of different scenarios.
But that concept of findingthese primitive reflexes or some
subtle variation of it felt tome like it was important and
needed to be explored.
Melissa Biscardi (38:03):
Absolutely, and that's Lord, absolutely, and
that's it's really fascinating,because we know that IVF is not
100% or any of the uh, let'ssay medical approaches, and so I
feel like in combination that'sso much more powerful.
Right, you're finding somethingthat actually might be the
reason why things are not beingso successful on the other end,
(38:25):
but together, yeah, you mighthave some babies, absolutely,
absolutely Well.
Dr. Ayla Wolf (38:40):
So switching gears, cause I know you have a
black belt in jujitsu, and isthat how you got your concussion
?
Cause I know you also had aconcussion.
Melissa Biscardi (38:45):
Is that how you got your concussion?
Because I know you also had aconcussion.
So I actually this is a veryhow I got into concussion work
is I had a concussion, butthat's not why, like what led me
to being interested in thebrain.
Can I tell that story?
Tell that story, yeah, okay, Ithink people will be interested.
Um, so I well, I've had sleepissues forever, and then
(39:11):
actually, when I was in osteoschool, I while I needed to
sleep and so I started to takesleep ease, which in Canada is
the same as Benadryl over thecounter, and at first I just
took a sprinkle, cut the pill,you know, in four, and then I
had half.
Then I don't know if I ever wentto a hole, but I was doing it
(39:32):
every night.
And then I was losing my memory, or my started to lose my
memory.
How old were you at this time?
Okay, so I would have been,let's say, 30 ish, yes, 30, 31.
And I, I, yeah, so I'm losingmy memory.
So I started slowly, but thenit was very noticeable to me
(39:56):
Like I was well not rememberingthings that I learned, but not
because I wasn't payingattention, like I would just
have no recollection of learningsomething, or even seeing it,
and then I started to get facialblindness, where I just
wouldn't recognize people, andeveryone was just like, oh it's
(40:16):
nothing, oh it's stress.
You know the whole invisibleinjury thing, um, and I'm a
medical practitioner, so I wasable to access everyone.
You know, I had MRI, I had thegreat sports doctor look at me
and no one was asking the rightquestions.
That's really what it came downto.
Um, and I just happened to bechatting Actually it relates to
(40:37):
jujitsu because I was chattingwith and no one was asking the
right questions.
That's really what it came downto.
And I just happened to bechatting Actually it relates to
jujitsu because I was chattingwith a teammate about sleep and
then he said oh, did you hearabout that study that showed
that Benadryl is associated withAlzheimer's?
And I was like, no, I haven'tseen that study actually.
And then I was like, holy crap,this is what is happening in my
(40:58):
brain.
So then of course, I had tochange a few things and then,
slowly, my memory started.
You know, now I want to sayit's fine, but who knows?
But it's definitely back to, Iwant to say, a functioning
normal.
Um, so that's how I gotinterested in invisible injury,
for sure.
And then I wanted to say, maybetwo or three years later then I
got a concussion.
I was already in the concussionworld for lack of better
(41:23):
language, so I went right to thebest in the city.
I feel like I had a good starton it, but I also feel like I
had an unremarkable concussion.
So I got foot in the face orwhatever, a heel on the head.
I had some symptoms, but withina few weeks I was, I was, I was
back to jujitsu and life Got it.
Dr. Ayla Wolf (41:48):
So, going back to the Ben and Jill thing, when I
was writing the sleep chapter inmy book, I was doing a lot of
research to see what the morerecent research was saying,
because I remember back in like2016, 2017, that was when those
headlines were coming out If I'mremembering the dates correctly
.
For sure, that's around thesame time.
(42:09):
And yeah, and so I felt like fora moment there that was in the
spotlight, and then it was likenothing happened.
Nothing happened, there weren'tI mean, there wasn't any new
like laws or rules or anythingFunny how that happens.
And so it's like, oh hey, by theway, benadryl can like really
(42:30):
cause dementia and, you know,affects your brain if you take
it every night.
And then all of a suddeneverything went quiet, never
heard about it again, peoplewent on with their lives.
So as I'm writing my book, Iwas like, well, let me just see
if there's new research out andin fact there was, and there was
this really large study thattook place in france and they
looked at people's use ofbenadryl and they categorized it
(42:52):
as like no use, low use,moderate use and high use, and
they were actually able to showthat like the people who were
using Benadryl more frequentlyhad indeed, you know, like more
risk of having dementia, and sothey even showed this like dose
dependent nature to using it.
Melissa Biscardi (43:11):
But I'm like, but now nobody's talking about
it anymore and I was like thismakes me so mad.
I'm like I try and mention itto my patients because it comes
up especially around allergyseason.
So I'm pretty adamant about itbecause even when patients come
in and they'll be having memoryloss but or issues, and their
(43:35):
brain is in a like thatblood-brain barrier is more
permeable.
So it's even, I want to say,worse to take it when you have a
concussion and then also,people don't know Benadryl is
sleepies, right, like we havethe same chemical that is put in
(43:55):
different boxes with differentnames.
So, yeah, I feel like we have abig responsibility to educate
as much as we can.
Yep, absolutely.
And so tell me about you andyour martial arts life.
Dr. Ayla Wolf (44:12):
Okay, well, I started out doing kickboxing and
taekwondo when I was 15.
And my very first concussionwas when I was 18.
I got kicked in the head, and Iwould say that I recovered from
that very quickly, to my bestof recollection, um, minus what
(44:37):
I would say was like permanentchange in my hearing.
Um, so when I'm in loudenvironments, I can't hear the
people in front of me very well,I can't make out what what the
people are saying, and that'sbeen there ever since that
particular injury.
Um, but the really sad thingwas that that so I got my black
belt in taekwondo and Iimmediately had major imposter
(44:59):
syndrome where I just felt likeI have this black belt and I
don't deserve it, and eventhough I can do 20 tornado kicks
in a row, if somebody like gotme on the ground I'd be totally
useless, yep.
And so I was like, okay, I gotto go learn jujitsu.
And so I started trainingjujitsu, but that was during my
(45:22):
master's program and I had theopportunity at the jujitsu
school to teach the kickboxingclasses.
And so, as a broke master'sstudent, I was like, do I make
money or do I spend money?
And I didn't have time to doboth, so I ended up stopping the
jujitsu, which in hindsight Iwish I hadn't.
So then I taught kickboxing fora while, and then in my 30s at
(45:48):
this point I was living inOregon I decided to start
training again.
Only I went from.
So when I was younger I did gi,and when I started back up I
did nogi.
So I trained nogi for a longtime, pretty consistently.
but that was also at the peak ofmy kind of post-concussion
(46:10):
syndrome, and so the sad pieceof it was that I was showing up
to class every day and I wasn'tremembering anything like you
were saying before Right and andso I was really struggling and
I also was in a really badtraining environment where I was
like the only female and a lotof the guys were younger than me
(46:31):
and they were bigger andstronger and they just lock me
up into a body triangle for fourminutes.
Oh my gosh, that's the worst Iknow.
I'm like I'm not learninganything, trying to struggle out
of your 200 pound body triangleand so you're not learning
anything either right, yeahsilly it is, yeah.
(46:52):
So I was in bad environment.
It was not conducive to my ownlearning.
My head injury was notconducive to my own learning and
I but I mean I was like full ondoing MMA, I was studying like
takedowns, I was doing sparring,I was doing jujitsu no gi and I
went to a couple of jujitsutournaments and at one point one
(47:16):
of my friends who taughtjujitsu and had his own school,
he just looked at me and he goesyou don't want this as bad as
these other people that you'recompeting against.
And he was right, because I was35 years old, I owned my own
business, I was working fulltime.
I wasn't out for blood likesome of these 21-year-old
(47:38):
females with a chip on theirshoulder were at the time.
And so this, like a whole MMAscene back then, was very just
cutthroat and some of thesegirls were, you know, a little
nasty Like they.
Just they didn't care if theyinjured you, they just wanted to
win and prove themselves.
And again, coming from ahealthcare background, I didn't
(47:58):
want to go in and give otherpeople concussions, or you know.
I just so he was right, youknow, he just looked me dead in
the eye and he said you don'twant?
Uh, so I, I kept training, butwith a different attitude, right
(48:20):
, um, I actually got out of theno gi and I started training gi
again, um, at his school and itwhich was hilarious because no
gi is so much faster, and so hejust kept screaming at me slow
down, slow down, slow it down.
Um, yeah, so between all theback and forth of gi, no gi, mma
(48:41):
, to just straight jujitsu, likeI was just kind of all over the
place, um, and then eventuallyI um had a back surgery.
I had to have a fusion in mylow back.
I tried to go and at this pointI'm now living in Dallas, texas
, and I'm at a much moreprofessional gym environment
with great people but after myback surgery I think I tried to
(49:03):
go back to jujitsu a little toosoon.
It was about five monthsafterwards and I remember
getting stacked up and twistedand my back just kind of went
and I was like, oh, this is not,this is not good.
And then a week later I gotneed in the head accidentally
and a lot of my concussionsymptoms came back, and so I was
(49:26):
like, okay, between the backsurgery and the low back issue
and then getting like theconcussion symptoms again.
That was finally when I waslike, okay, I'm just going to do
kickboxing, but I'm not goingto spar, I'm just going to train
, like let me just take myselfout of all of the potential head
impact scenarios.
But because I love it so much,fast forward 2018,.
(49:50):
I'm like you know what?
Let's go back, let's do this.
And so I started doing it.
It is yeah.
And so I started doing privateMMA lessons with a MMA with a
former UFC fighter.
She had retired at the time,and so I was in a session with
(50:10):
her and she was like giving mecues, just cue, cue, cue, cue,
like justice and justice, and itwas just like rapid fire cues.
And all of a sudden my brainjust went and it just paused for
like half a second and in thathalf a second she clocked me
right between the eyes and I allmy concussion symptoms came
back again.
Melissa Biscardi (50:29):
And so again it's like all right, okay.
Dr. Ayla Wolf (50:31):
How many times does the universe want to tell
me Like I can't, I can't do thisanymore.
I have too much on the linewith my career.
Melissa Biscardi (50:39):
It's tough though, when yeah, when you like
something a lot and it makesyou feel good in some ways, you
get the endorphins, the physicalactivity.
So I can see why you have goingback.
Dr. Ayla Wolf (50:54):
Yeah, I mean when , when you do something for 20
years, you know it becomes partof your identity.
And I think that's that's a bigpart of why it's hard for
fighters to retire, or you know,it's like their whole identity
is wrapped up in themselves as a, as a competitor, and I get
that.
I mean, how many concussionsdid it take until I was finally
like okay let's do CrossFitinstead.
Melissa Biscardi (51:18):
I didn't know we had so much in common and I
actually have hearing loss, so,but that's a whole other episode
.
So, yeah, so we have.
We're in busy places.
Same thing I have troublehearing people and I never
realized how.
I don't want to use the wordsevere, but I'll throw it in
(51:41):
like how severe the loss wasuntil COVID, because people
would come in wearing masks.
And then I realized, oh my gosh, I'm relying quite a bit on
actually seeing people's lipsmove and I just didn't realize
it.
Dr. Ayla Wolf (51:52):
So, yeah, that clued you into like the severity
of it.
Melissa Biscardi (51:56):
Oh interesting .
Dr. Ayla Wolf (51:58):
And was your hearing loss from a concussion
or something different?
No, I think so.
Melissa Biscardi (52:03):
It happened in the beginning.
I didn't really even notice it.
It was.
It's kind of similar to the, tothe memory thing like asking
people to repeat themselves, oris that actually loud or not?
But I think it was fromantibiotic use, okay, because I
had lots of strep and basicallyjust strep, but multiple times a
(52:24):
year when I was growing up.
So I feel like it might've beenthat.
Dr. Ayla Wolf (52:29):
Sure, just an ototoxic antibiotic that killed
some hair cells.
Melissa Biscardi (52:35):
All the medications are getting me
basically yeah, on the otherside, like that's good to know,
right, because often we takethings and don't look at the
fine print or maybe are not asinformed as we could be.
Dr. Ayla Wolf (52:53):
Right.
And it's so hard when you'relike okay, well, this is a known
side effect, but it's not acommon one.
And so it's like how do I evenweigh the pros and cons of do I
take this or not?
Based on what I know, it's notan easy decision for anybody,
For sure, For sure.
Oh gosh.
Well, is there anything else wehaven't talked about that you
(53:14):
want to cover?
Melissa Biscardi (53:16):
well, actually , yes, the fact that, just to
remind people that we're bothtalking at, we shine, yes
september 1st.
Dr. Ayla Wolf (53:28):
So the we shine is a virtual symposium that is
all female, female led andfemale, all female speakers.
So, yeah, I'll put a link tothe show notes to the conference
.
Yeah, awesome.
And so I'm curious so what areyou doing on a daily basis for
your brain health?
Melissa Biscardi (53:50):
That's a good question.
So I always get movement in,like now I like to run, that's
how I get my endorphins that Idon't get from jujitsu.
And I use the red light, maybenot every day, but a few days a
week, and I try and do somemindfulness.
But I would say for me, right,mindfulness, oh yeah, nevermind,
(54:13):
I just started a big gratitudeposter, so not every day.
Dr. Ayla Wolf (54:17):
Is that what's in the background there?
Melissa Biscardi (54:18):
That's a different thing that I do, but
it's almost the same.
It's like things that I want toremember that happened through
the year, and this is like mythird year of doing it and it's
really cool because then youjust have a stack of post-it
notes and yeah, so there's thatstack of post-it notes and, um,
yeah, so there's that a lot ofgratitude and reframing things
(54:39):
as um on either the positive, orI get to do this, or wouldn't
it be fun if this happens, or ifI could do this instead of like
, oh my God, I can't believe Ihave to write my thesis.
Yeah, and I try and eat healthy, but I'm definitely not perfect
.
Oh, and sleep, yes, I make sureI get as much, you know, eight
(55:03):
hours sleep, if I can.
Dr. Ayla Wolf (55:06):
Absolutely Awesome.
Movement, sleep, gratitude,yeah, goes a long way.
Absolutely Well.
Thank you so much for coming onthe show.
Do you want to let people knowwhere they can find you?
I mean, I'll put the link inthe show notes too.
But what are the best ways tocontact you or reach out to you?
Melissa Biscardi (55:24):
I would say all the fun stuff happens on
instagram, which is easy toremember.
It's conrehabca is my littlehandle and, yes, find me there
and if you have questions,comments.
I love to talk to people andit's going to make me live
longer.
Dr. Ayla Wolf (55:46):
Perfect, okay, good.
Well, I'll put all that in theshow notes and thank you again,
and maybe once you wrap up yourresearch we'll have you back on
the show.
We can talk about that too,once you get all your
participants through and crunchsome numbers.
Melissa Biscardi (56:01):
Awesome, I'd love that.
Dr. Ayla Wolf (56:02):
Cool.
All right Well have a goodnight, you, too.
Medical Disclaimer this videoor podcast is for general
informational purposes only anddoes not constitute the practice
of medicine or otherprofessional health care
services, including the givingof medical advice.
No doctor patient relationshipis formed.
(56:25):
The use of this information andmaterials included not intended
to be a substitute for medicaladvice, diagnosis or treatment,
and consumers of thisinformation should seek the
advice of a medical professionalfor any and all health related
issues.
A link to our full medicaldisclaimer is available in the
(56:47):
notes.
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