August 18, 2025 • 51 mins
Contact Dr. Antonucci:
Dr. Antonucci's Neurobytes Blog - (totally worth reading in IMO)
Eliminate your hiccoughs in seconds! Blog post as promised :)
Show Description:
Ever wonder why your concussion symptoms persist despite seeing multiple specialists and undergoing countless tests? In this illuminating conversation, Dr. Matthew Antonucci reveals the systematic approach that's transformed the lives of thousands of patients with complex neurological conditions.
Dr. Antonucci approaches each patient like a detective, meticulously gathering clues without contaminating the evidence or jumping to conclusions. This data-driven method allows him to identify precisely where dysfunctions overlap across multiple neurological systems. As he explains, "It becomes like hundreds, if not thousands, of Venn diagrams, circles that overlap with each other. If you can figure out where all somebody's findings overlap, fixing that one thing fixes all the circles."
The discussion delves into the hierarchical nature of our nervous system, beginning with the bedrock of metabolic function and the often-overlooked autonomic nervous system. Dr. Antonucci emphasizes the critical role of the vestibular system - one of our oldest sensory systems - which is uniquely integrated throughout the entire brain. Unlike our visual or auditory systems that occupy specific regions, vestibular processing influences everything from eye movements to posture, hormones, and sleep cycles.
What makes concussion patients so challenging? "They are depression patients, headache patients, movement disorder patients, dysautonomia patients, chronic pain patients... take all the different patients you would have in a neurology practice and pop them together in one person," Dr. Antonucci explains. Yet with his structured framework, these complex cases become opportunities rather than overwhelming challenges.
Perhaps most powerful is his emphasis on patient education and empowerment. By helping patients understand what's happening in their nervous systems, he transforms their experience from one filled with "I can't do's" to one where they control their own recovery journey.
Whether you're a healthcare provi
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
Follow us on Instagram @lifeafterimpact
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.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Matt Antonucci (00:00):
It becomes like hundreds, if not thousands,
of Venn diagrams, circles thatoverlap with each other.
And that's what somebody who'sreally good at functional
neurology is able to do.
They're able to have all ofthese circles where they test
things and then they figure outwhere they overlap.
And if you can figure out whereall somebody's findings.
(00:20):
Remember when I said I playdetective for a day, when I lay
out all of my clues in my mindand I figure out where they all
overlap and I can say you knowwhat these all overlap, right
there.
Dr. Ayla Wolf (00:32):
Welcome to Life After Impact the concussion
recovery podcast.
I'm Dr Ayla Wolf 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
(00:53):
, 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
(01:15):
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, we're joined by one ofthe leading voices in functional
neurology and traumatic braininjury care Dr Matthew Antonucci
(01:39):
.
Dr Antonucci is a distinguishedchiropractic, neurologist,
clinician and researcher withmore than 15 years of experience
transforming the lives ofpatients with complex
neurological conditions.
Over his career, he has guidedthousands of individuals through
personalized functionalneurology rehabilitation
programs, helping them not onlyrecover from challenges like
(02:03):
traumatic brain injury, but alsounlock higher levels of
performance Beyond the clinic.
Dr Antonucci is aninternationally recognized
educator, having deliveredthousands of hours of advanced
training to tens of thousands ofhealthcare providers across the
globe.
He has also contributedextensively to the scientific
community with numerouspeer-reviewed publications.
(02:25):
Contributed extensively to thescientific community with
numerous peer-reviewedpublications.
Widely regarded as one of thetop chiropractic neurologists in
the world, his expertise anddedication have set new
standards for what's possible inbrain health and recovery.
Dr Matt Antonucci, welcome toLife After Impact.
I'm so excited to have you onthe show today.
Dr. Matt Antonucci (02:42):
Yeah, I'm so grateful to be here.
It's so great to see you, andyou know we always have a fun
time when we get together, soI'm excited to see what we
create together today.
Dr. Ayla Wolf (02:49):
Yeah well, one of the reasons why I wanted to
have you on is because you haveworked so diligently with
patients with really complexcases and many of these people
that come to see you they'vealready been to lots of other
doctors, they've had lots oftests done, and I know that you
love data, and so when thesepeople come to you, you collect
(03:12):
a ton of data ahead of time, yousift through all of it and then
, when they're in your office,you're spending a lot of time
doing very hands-on functionalexams, trying to figure out what
got missed, why are thesepeople still highly symptomatic,
and how you can help them.
But because you're also aworld-class instructor, in the
(03:32):
back of your mind I know you'realso always thinking how can I
teach other people what it isthat I do?
And even though you're verymuch giving people
individualized treatment plans,you've kind of created a
hierarchy or a way with whichyou can teach other clinicians
how to do what you do.
But you've also really figuredout what do these patients need?
(03:56):
What does their nervous systemneed to start out, to take them
from point A to point B in asafe way where you're not
pushing them too hard, you'renot frying their brain in the
process, and so I really wantedto have you talk a little bit
about this hierarchy within thenervous system and how you've
integrated that approach intoall of this complex care that
(04:19):
you do with people withpersistent post-concussion
syndrome.
Dr. Matt Antonucci (04:23):
Yeah, absolutely.
It's very exciting and you hitthe nail on the head that.
You know I really love helpingpeople and you know I can help a
couple people here and there,or I can train lots of doctors
to help lots of patients.
The challenge with the secondof the two things is that there
has to be some standardization.
It has to be some sort of asystem.
(04:43):
You know, we always know, and itdoesn't really matter what your
discipline is, whether you're amedical doctor, a chiropractor,
a physical therapist,acupuncturist, even a personal
trainer or whatever, there'salways an art and a science to
what you do.
People can be taught the ruleslike you do one, two and three
(05:03):
when you see A.
That's very methodical, veryscience-based, but there's
always going to be some artistryin there.
There's going to be experiencethat comes into it.
There's going to be.
You know that I've failed doingthis in the past, so I do it
differently now.
That's where the art comes inand different disciplines have
different, let's just say, uh,proportions of artistry versus
science.
Um, you know, you know, it'svery much like, um, when we look
(05:26):
at chiropractors I'm achiropractic by training uh,
chiropractors have a lot ofscience behind what they do, but
there's a lot of art.
You go to a hundredchiropractors and you'll find
200 different ways of treatingsomebody.
Um, that's because there is alot of art in in in chiropractic
.
And the opposite is also truewith medicine.
If you have strep throat, thereis one or two antibiotics for
(05:49):
strep throat, and that's thescience of it.
So, realistically, in order forus to make something scalable,
like medicine is, I really feelthere has to be a
systematization for it or somesort of a I don't want to call
it a protocol, but at least aframework, a structure to
approaching a complex patient.
And when you start talking aboutconcussions, in my humble
(06:10):
opinion, concussions are themost complex patient.
They are depression patients,they are headache patients, they
are movement disorder patients,they are dysautonomia patients,
they are chronic pain patients.
It's literally take all thedifferent patients you would
have in a neurology practice andpop them together in one person
and that's what you get whenyou get a concussion.
So it's a lot of times forproviders it's daunting to see
(06:34):
oh boy, here's anotherconcussion patient.
What am I getting?
But if you have a structure ora framework that you can follow,
every single of those patientsdon't become intimidating.
They become an opportunity tohelp somebody with confidence.
So that's kind of what I'vebeen trying to develop.
You know, over the past andrealistically, 15 years that
I've been doing this.
It started off as following myinstructor, my mentor, Dr
(06:57):
Carrick, and then learning whathe did, and then trying to make
it so that it's much, not muchmore.
It's systematized in a waythat's reproducible and
teachable.
Dr. Ayla Wolf (07:08):
Yeah, and I know too, every time I get a new
patient coming into my clinic,it's always that little bit of
nervousness of saying, gosh, Iknow I really want to help this
person.
I'm not quite sure what'scoming in my door, door, and so
it is so helpful to have, likeyou said, not necessarily a
protocol, because we're notdoing the same thing on
(07:29):
everybody, but to have theframework with which to approach
a complex problem is soimportant.
Dr. Matt Antonucci (07:33):
Yeah, and think about it from the
patient's perspective too.
You're not the only one they'veseen, and they know that.
Look on your face when theywalk in the door and you're like
, oh man, another one of thesepatients.
They know that, they feel it.
Imagine how much different itfeels to be in the patient's
scenario where you're walkinginto a doctor's office that has
(07:55):
a structure, that has a systemthat says, hey, I'm excited to
work with you.
I love these types ofchallenges and I know exactly
where to start so thatconfidence exudes from you.
The patients receive it andthat's the start of the healing
process.
Dr. Ayla Wolf (08:09):
I love that, yeah , so talk maybe a little bit
about all the data you collectahead of time and how that
guides you when you first startworking with somebody, when they
walk into your office.
Dr. Matt Antonucci (08:19):
Yeah, so I I straight up tell my patients
that the person I am today willnot be the person I am today
will not be the person I amtomorrow.
Today I'm Detective Matt,tomorrow I'll be Dr Matt.
And the thing is, when you havea detective, one of the
hallmarks of a detective isthey're very careful about
collecting clues not tocontaminate the information that
they have.
And the other thing a detectivedoesn't do is they don't make
(08:41):
any preconceived decisionsbefore they collect all their
data.
They're just a data collectorat that point in time.
So when somebody first comesand sees me, it all starts
actually before they see me.
With the questionnaires andintake forms that we put
together.
I've created a packet ofprobably 12 or 13 different
medical based we call them PROMSpatient reported outcome
(09:03):
measurement tools where thepatients can fill them out and
it scores them behind the scenesto give me an idea of what
systems are dysfunctional, whatsystems are functional.
And then, of course, we taketogether their goals, which are
so important.
I can't even begin to stressenough how important patients'
goals are into becomingsuccessful with them.
(09:25):
And super little tangent here.
If you have a certain goal,let's just say to make
somebody's eyes work better ortheir balance better, and they
have certain goals where it'slike I want to be out of pain.
Well, you might be successfulat fixing their eyes and their
balance, but they still might bein a lot of pain and that
patient will not see thebenefits and it'll be a failure
(09:47):
for them.
So if you're working from adifferent sheet of music,
singing from a different sheetof music, you're ultimately
always going to fail.
So I always put my patient'sgoals as number one priority and
then I try to figure out whatdata is going to be their
support.
So once we have the goals inthe history and we also look at
like a metabolic assessment formbecause I should probably make
a t-shirt that says it is I Ialways tell my patients god
(10:10):
didn't only say you can have oneproblem, right, but we're here
to figure out what problems youhave and figure out which ones
we can address and which onesother people will have to
address.
And by putting that out therefirst, you'll literally see
patients shoulders just go oh,okay.
So it's okay if I have morethan one thing, you're not maybe
going to solve everything, butyou're going to solve what you
can.
So we go through all themetabolic stuff just to make
(10:33):
sure that all that stuff is good.
And then that's when they getthere and we start doing testing
.
And the way that I do testing ispart of this whole framework
and the structure that I do.
Testing is part of this wholeframework in the structure, and
it involves things likeautonomic testing, cognitive
testing, vision testing, ocularmotor testing, balance testing.
(10:53):
You know it's, it's likeeverything.
But just saying it like thatonce again becomes like the pain
patient that walks in the doorsaying, oh my goodness, I got to
do all this testing.
Well, like the pain patientthat walks in the door saying,
oh my goodness, I got to do allthis testing.
Well, it's, it's not that it'sa lot, because it's.
It creates a picture for you.
And I always tell my patients,because they always ask me why
are you collecting so manypieces of data?
(11:14):
Like I go to my other doctor.
I'm there for 15 minutes, theydo a couple of little tests and
then that's it.
You're sitting here spendingthree hours of testing.
Why and I'm like a metaphor guy, that's it.
You're sitting here spendingthree hours of testing.
Why and I'm like a metaphor guy.
It's just how I work, you know,I always tell my patients well,
you're going to go out and buy abrand new TV to watch your
favorite movie.
Do you want it to have threepixels or do you want it to be
(11:35):
4k?
Right, so doing three testsgives you three pixels.
Doing three hours of testinggives me a 4k television, so I
can see exactly what I'm tryingto see.
So the more data, the better.
So, yeah, you're right, I am alittle bit of a data freak
because you know there's allthese sayings, cliches.
You know data has data doesn'thave opinions.
It's just what is.
(11:55):
So I just like to see the factsand then from there we can
extrapolate how to use them.
Dr. Ayla Wolf (12:02):
Yeah, amazing.
And within this hierarchy thatyou've developed, or that you've
kind of noticed works reallywell with people with nervous
system dysfunction.
At the root of that is kind ofstep one, which is the brain
needs fuel, it needs oxygen.
If it's not getting these basicessentials, it can't work.
And so talk a little bit aboutthe basis of this foundation.
Dr. Matt Antonucci (12:27):
Yeah, absolutely so.
I would say metabolic functionis like if once again the
metaphor guy if we're looking ata house, right, metabolic
function is the bedrock that thehouse is built on.
If you don't have good oxygentransport, if you have
inflammation, if you don't haveneural substrates like you know,
for example, folate is thebackbone of most
(12:47):
neurotransmitters If you havemetabolic deficiencies, no
matter how much you do forsomebody whether it's spinning
them in a chair or giving themeye exercises or sticking
needles in them or adjustingthem, whatever it is no matter
how much of that you do, youmight get them a little bit
better, but ultimately they'regoing to come back.
So that's where, like themetabolic assessment form that
(13:09):
I'd have in my patient'spaperwork where they fill out,
we can.
We can ask tons of questionsabout the fundamentals, like do
you feel cold?
Do you feel tired, you know?
Do you have pale skin?
Do you find that you know allthese different things?
Do you feel like your nails arenot?
You know not how they should be?
All of these things kind oftell us if somebody has an
anemia or something like that.
But I have to say, the majorityof the time the patients that I
(13:31):
see they've gone to greatdoctors, they've screened a lot
of those things out andultimately what they have is
they have not a hardware problem, they have a software problem.
Like the brain, it wasbeautiful, it's just not working
right.
It's like this amazing computerthat's for some reason the
software got corrupted and it'sjust.
Every time you hit the letter b, the letter k pops up on the
(13:53):
screen.
How frustrating is that.
To have a perfect computer.
You wanted to do what youwanted to do and it doesn't do
it.
So ultimately, that's wherethis kind of a hierarchy comes
in and we start looking at thishierarchy, um, from we don't
necessarily look at humans tofind out this hierarchy.
We look at animals.
Like we fast for rewind all theway back four or five million
(14:14):
years ago, um, or maybe morethan that, four or five hundred
million years ago, and we startto look at the different
creatures that lived on theplanet and how simple they were,
even though they had nervoussystems.
So I always like to weigh.
The way I like to look at thisis if we can break down the
nervous system to its most basiccomponents and if we find
dysfunction there.
There's no way the basicfunction can be broken and the
(14:36):
high function works well.
It just doesn't work that way.
So that's where I go.
Looking all the way down to thebeginning, which we, the very
essential functions of humankind, is to take sensory information
in, to process it and create amotor output.
And that motor output is goingto be involuntary.
It's going to be things thatare subconscious and things that
(14:57):
you have no control over, likeyour heart beating, your blood
vessels contracting, your pupilscontracting.
These are all called autonomicreflexes, and autonomos means
self-governing, so you have nocontrol over these things.
They're simply there just toreact to either your internal
and external environment, and ifthose reflexes are not working
(15:18):
right, you can't expect to beable to think well or move well
or anything like that.
So that's where we start, atthe bottom of our hierarchy or
at the foundation of our home,is going to be autonomic
function and the reflexes thatare built into that.
Dr. Ayla Wolf (15:33):
And can you talk a little bit about the tests
that you do to assess that?
Because we've got kind of thebig clinics like Mayo that have
their autonomic reflex panel.
They've got their kind of keytests.
I know you do some thingsdifferently, so maybe talk a
little bit about all the thingsthat you're looking at to assess
this autonomic nervous systemfrom slightly different angles.
Dr. Matt Antonucci (15:56):
Yeah.
So there's a way to do itthat's efficient and there's a
way to do it that'scomprehensive.
And then somewhere in betweenthere's where you have to shoot,
for you go to Mayo Clinic.
You will get the mostcomprehensive evaluation, but
it's going to take hours andhours and hours just to
understand how your autonomicsystem is functioning, nevermind
(16:17):
your vestibular system, yourvisual system, your
proprioceptive system, your youknow everything else that you
need to assess.
So typically what I do is Iscreen first and I have
indications that tell me to lookfurther or not.
So, Mayo Clinic, now that youmentioned it, they created
something a while ago called theautonomic symptom profile.
It was like 169 question surveythat will ask you questions
(16:41):
about your autonomic function.
Well, they found out thatpeople didn't want to complete
169 questions.
So, yeah, go figure right.
So they did a factor analysisand what they said is 31 of
these questions actually clustertogether.
So if we ask these 31 questions, we get just as good as a
result.
This is called the Compass 31.
So the Compass 31 is ascreening tool that patients can
(17:03):
complete and if they scorehigher than a 20 on that, it
almost guarantees that they havemoderate autonomic dysfunction.
If somebody scores higher than a20, I say, all right, thought
pattern changes, we need to diveinto more comprehensive
autonomic screening.
If they're 19 or less, I justsay, okay, let's move on,
because the autonomic nervoussystem fundamentally is an
(17:27):
uncontrollable system thatresponds to environmental
perturbation.
So if there's something wrong,you're going to be more fight
and flight.
If everything's right, you'regoing to be more rest and digest
.
And that's super simple.
And I know some people thatstudy neurology might be going.
That's not exactly right.
I know it's not exactly right,but that's the direction that we
(17:48):
move.
And if we start to look atwhere there's errors, whether
that's your inner ears are notprocessing movement properly,
well then you're going to have afight or flight autonomic
response.
If you have two eyes that aresupposed to be looking straight
ahead and one eye is pointingout to the side and you're
constantly trying to bring youreye in, well that's going to
drain energy out of you, makeyou tired and it's going to make
(18:10):
your blood pressure go up andyour heart rate increase.
So these autonomic reflexes,they basically become slaves to
dysfunction.
They get entrapped bydysfunction and they stop
working appropriately.
And then the problem is thatthen your sensory system
re-ingests those issues and nowcreates a distorted sense of
(18:32):
reality.
So it becomes pervasive.
So, once again, binary, greaterthan 20, we do a full autonomic
assessment, looking at heartrate variability, you know,
seated, supine and standingblood pressure.
We're going to look at thingslike Valsalva maneuvers, so some
of the doctors watching thiswill know what those are For
(18:52):
those that are not doctors.
Basically it's when youincrease your pressure inside
your thoracic cavity your heartresponds a certain way.
So we study all those thingsand we understand what normal is
and abnormal and then we startto look at the different
receptors that trigger those.
Whether that's a lying down tostanding might be a baroreceptor
problem, it might be avestibular problem, it might be
(19:13):
a proprioceptive problem, itmight be a kidney problem where
you're not producing enoughblood.
So we just really have toconsider all those things.
But less than 20, weacknowledge it and move on and
assess the rest of the hierarchy.
Dr. Ayla Wolf (19:26):
So you feel like if somebody's scoring below 20,
you're likely going to findother things in the process of
testing and very likely, whenyou correct those imbalances,
then the autonomic nervoussystem is going to be able to
return back to its healthy,responsive nature without you
having to necessarily hammer atit directly.
Dr. Matt Antonucci (19:45):
Exactly.
It's secondary to somethingthat's primary.
Otherwise the symptoms would bemuch higher if it's primary.
So you're looking at a resultrather than a cause.
So let's go find the cause.
Dr. Ayla Wolf (19:56):
Yeah, excellent, okay.
So then the next step.
Dr. Matt Antonucci (20:00):
Yeah, so when we start looking at
autonomic function,realistically what we're looking
at is motor responses.
So remember we talked about thepurpose of the brain is to take
the inside and outside worldand to process and create a
motor response.
That motor response can beinvoluntary or voluntary, and
then it's kind of like it's agradual change.
So the next thing afterautonomic function is going to
(20:23):
be tone, right, so that isslightly more controllable but
slightly involuntary.
So right now you and I bothhave tone in our spine because
we're sitting up and we're notthinking about it.
You have tone of your eyemuscles because normally your
eye muscles, your eyes wouldpoint out and because you're
engaging, you get tonus in youreye muscles to let you look
straight ahead.
You're not telling your eyes todo that, but it's there.
(20:44):
So we start looking at tone andwe start looking at postural
changes like how well somebodycan regulate those tones
involuntary.
On top of that, then we startlooking at skeletal motor
reflexes, right, when you know,when you maybe tap a knee or leg
kicks or when you turn yourhead, your eyes move.
And then this is where thehierarchy starts to build.
(21:06):
And after that we start lookingat voluntary motion and then
coordinated motion, and then westart looking at thought and
then emotions, emotional control, and that's kind of one of the
pyramids, if you will, offunction.
I call that the motor pyramid.
And then we have a sensorypyramid that complements that.
Dr. Ayla Wolf (21:26):
And you kind of mentioned this concept of
looking back in time at thesecreatures that exist, that don't
necessarily have all of theemotional stuff that we deal
with, and saying, well, how aretheir systems designed?
And I know that one of the kindof oldest sensory systems is
the vestibular system and thatin fish they have what are
called lateral lines, which iskind of like their version of a
(21:48):
vestibular system.
So can you talk a little bitabout that importance of the
foundation of the vestibularsystem, because you kind of cued
into it a little bit earlierwhen you said if the inner ear
is kind of telling the brain thewrong information, we're going
to have an autonomic response tothat and it's kind of like this
constant drain on the battery.
Dr. Matt Antonucci (22:07):
Yeah, absolutely.
I can't even stress enough howimportant the vestibular system
is.
I'm starting to do a bit morework now with aerospace medicine
and we're kind of stating theeffects of microgravity and zero
gravity and the results keepcoming back that humans are
(22:28):
designed to live on earth, right, that's what it comes down to.
And whenever you look at anorganism that was designed to be
in some place the ocean, forexample, when you take a ocean
animal out of the ocean, whathappens to it?
They die.
Yeah, you put a land animalinside the ocean, what happens
to it?
They die.
(22:49):
Right, so we've adapted to liveinto environments that have been
adaptations over hundreds ofmillions of years.
Well, the one thing that hasnever changed in billions of
years is the fact that Earth hasa gravitational field.
So since life form has started,from single cell organisms all
(23:09):
the way up to humans, which webelieve are the epitome of
complex species, everything hasone anchor on this planet and
it's gravity.
The weather changes, barometricpressure changes, everything
changes except for gravity.
So that kind of leads to theimportance of what it's like to
have this gravity septive orgravity sensors in our inner
(23:33):
ears, and it's so important thatyou know, I kind of look at it
as like a I'm not a superreligious person, but this is
person.
But once you start learningmore about human anatomy and
physiology, it's kind of hard todeny that there's some sort of
intelligence out there thatcreated us, whether you call
that God or Allah or whatever,whatever you call it this
(23:57):
supreme power that created us inan organized fashion Because
the reality is is that when asperm eats an egg, the first
sensory system that developswhen we study embryology is the
vestibular system, and thathappens to develop right at the
same time as our nerves start tomyelinate.
And as our nerves start tocreate this protective sheath
(24:19):
around them that makes nervestravel faster, as they're
myelinating, these primitivemuscles start to contract and
twitch right.
So all of a sudden, now we havemovement, and now we have
finally a receptor that can feelthat movement.
At the same time, you're insideyour mom's womb and gravity is
affecting that.
Even though you're floatinginside of a fluid, there's
(24:41):
gravity there.
So you can kind of start torealize that, man, this is
really important and if we don'tprocess that constant force,
we're constantly going to bedysfunctional.
So and that's what we see inastronauts, but that's also what
we see in individuals who haveconcussions that affect their
vestibular system.
So yeah, it's very important.
Dr. Ayla Wolf (25:02):
And it's such a delicate system I mean those
like everything in that systemis just so delicate that it's
like no wonder you hit your headand that system is going to be
compromised in some way.
Dr. Matt Antonucci (25:15):
And the nice thing about the vestibular
system, which is different thanother systems, for example our
visual system or our auditorysystem.
Our visual system has aspecific real estate in the back
of our brain called ouroccipital lobe, where we see.
The auditory system has veryspecific real estate in the part
of our brain that's like overhere in our temporal lobe.
(25:37):
Our vestibular system isprofusely, pervasively
integrated in our entire brain.
There is no area of our brainthat the vestibular nucleus
doesn't have influence on.
So that's good and bad.
We'll never lose vestibularfunction altogether unless we
injure our inner ears themselves.
But as long as these organs inour inner ears work, we're
(25:59):
always going to be able toperceive gravity in some extent.
However, the downside aboutthat is because it's everywhere.
No matter where you injure inyour brain, you're going to
affect your ability to perceiveit accurately.
And specifically in the back ofour brainstem we have a part of
our brain called the littlebrain or cerebellum, that
basically sits on our brainstem,which is like a stock, and it
(26:22):
sits over here, and when youhave a concussion it moves
around and these fibers getstretched and we damage the
ability to perceive and regulatethat vestibular system.
So it's a.
It's at a vulnerable place, butit's also so redundantly
integrated that it never breakscompletely, which may be a bad.
A good thing that it doesn'tbreak completely, but it's also
a bad thing that it never breakscompletely, which may be a bad.
A good thing that it doesn'tbreak completely, but it's also
(26:42):
a bad thing that it never breakscompletely, because then you
have dysfunction rather thanjust not working.
Dr. Ayla Wolf (26:49):
Yeah, and the vestibular system also being
yoked to the nuclei that thencontrol our eye muscles means
that that imbalance often spillsover into the visual system and
I think that connection oftengets missed too.
I know like one of the things Ilove to do, because when
patients come in again, there'susually I'm hunting for those
(27:10):
little things that got missed inthe past and I pop these
infrared goggles on and whenthey don't have anything to
fixate on, all of a sudden youget to see this push pull happen
between what the vestibularsystem is trying to do to the
eyes and where the eyes thinkthey are in space, and I always
find really interesting thingshappen when I pop those goggles
(27:32):
on and I'm looking at someone'seyes in the dark.
Dr. Matt Antonucci (27:35):
Yeah, absolutely, and that's kind of
what we were sharing're sharinga little earlier is that you
know what you're going to see isthat faulty sensory integration
results in motor dysfunctionand then the eyes moving when
they're not supposed to move asa consequence of either a
perception of movement that'snot there or a misinterpretation
of movement that is therecauses all of these motor
(27:55):
imbalances.
And you know that the eyes youknow you've heard the expression
maybe for the eyes are thewindow to the soul, but
realistically, that the eyes arethe window to the brain,
because you can see all sorts ofthings from.
You know involuntary reflexfunction, autonomic function,
like pupils to you know tone,which is your eye, your eye
position, and especially whenyou remove vision, what happens
to your eyes.
(28:16):
You can see voluntary function,like ability to move your eyes
side to side.
You can also see complexfunction, like tracking targets
that move in space in threedimensions.
But you also see thatindividuals who have mental
health disorders a lot of thingschange with their eyes.
A lot of times when people havethings like schizophrenia,
their eyes will move a lot morethan somebody who doesn't.
(28:38):
So we can really look at theeyes as biomarkers of all sorts
of things.
But, yeah, the vestibular ocularconnection is very strong, as
well as the vestibulospinalconnection, so the vestibular
system sets the tone of all ofour spinal musculature.
So we have good posture, andI'm not mean like posture, like
you know, sit up straight,because it does affect that, but
also dynamic posture when we'restanding up, to control our
(29:01):
body, sway all sorts ofdifferent things.
And there's also vestibularautonomic functions and we have,
you know, there's even morethan that.
There's almost a direct pathwayfrom your vestibular nucleus to
a part of your brain calledyour hypothalamus, which
basically sets your hormonalrhythms.
Your sleep-wake cycles, yourhunger cycles, even breathing
(29:24):
cycles are affected by yourvestibular system.
So, yeah, when we say it'simportant, it really is.
Dr. Ayla Wolf (29:31):
Yeah, absolutely.
And so you're looking at allthese different sensory systems,
you're kind of testing them inisolation, but then also
together in terms of saying howis this system functioning?
And then how is it functioningin the context of when we're
looking at it with other systems.
So it's like, okay, I have somemotor control if I'm touching
(29:52):
my finger to happens, if I rollmy head to the left or the right
, and then all of a sudden yousee that motor system break down
.
And so I think that's just.
That's really the power of thisfunctional mindset in saying we
(30:13):
don't want to just know ifsomeone can perform a task one
way, we want to see how theyperform that task 10 different
ways in 10 different scenarios.
Dr. Matt Antonucci (30:19):
Exactly.
And that's kind of where youget the motor pyramid right.
Where we had the bottom, we hadautonomic function, at the top
we had cognitive and emotionalregulation.
What you really want to do isyou want to study the senses and
then in isolation, at thebottom, so you have your
vestibular autonomic, yourproprioceptive autonomic
(30:41):
integration.
Then you want to look at yourauditory and gustatory and
olfactory and then your visualautonomic responses and then you
want to start looking like,okay, well, how do these
responses play together?
How does the vestibular system,sensory system, play with the
visual processing system?
(31:01):
And if that's playing good, butthe vestibular and
proprioceptive systems areplaying bad, well then you know
it's not a problem with thevestibular system, it has to be
a problem with the integration,which is a different part of the
brain.
So it becomes like hundreds, ifnot thousands, of Venn diagrams
, circles that overlap with eachother.
And that's what somebody who'sreally good at functional
(31:22):
neurology is able to do.
They're able to have all ofthese circles where they test
things and then they figure outwhere they overlap.
And if you can figure out whereall somebody's findings,
remember when I said I playdetective for a day, when I lay
out all of my clues in my mindand I figure out where they all
overlap and I can say you knowwhat these all overlap right
(31:44):
there.
What that's going to do is it'sgoing to allow me to be uber
precise in whatever I'm going todo.
And that one thing, because ittouches every one of those
hundreds or thousands of circles, fixing that one thing fixes
all the circles.
Dr. Ayla Wolf (31:58):
Yeah, and isn't that awesome when you can like
just knock over the one dominoand everything falls in line.
Dr. Matt Antonucci (32:04):
Yeah, and the only thing I could really
think of is, like you know, Ikind of use this metaphor in
some of our courses.
You know, it's like if you'regoing to go into the army,
there's two different peoples.
There's people that carrymachine guns and there's people
that carry sniper rifles.
Um, the only difference betweenthe two they'll both get their
job done.
One's going to use a lot moreammunition and there's probably
(32:25):
going to be some collateraldamage with the guy in the
machine gun.
Uh, where the sniper gets theirjob done with one pole and one
projectile, right?
So it's not that one's bad andone's good.
There are two different stylesof practice.
I just like being a sniper.
Dr. Ayla Wolf (32:41):
Yeah, there's a lot of math involved with being
a sniper.
There's a lot of physics.
I like math.
There you go, there you go, andso I'll throw a little
curveball at you, because thiswasn't I mean, you mentioned it
on your hierarchy, but I haveread that when people have a
brain injury, that up to 55% ofpeople can actually have
alterations in their smellwithin the first year, and so
(33:03):
I'm curious how much do you payattention to smell Now that it's
extremely smoky out all daylong?
Yesterday I used that as a testbecause it smelled like a
campfire outside.
So every single patient thatwalked in my door I said, oh, is
it still smoky out?
And I was fascinated by theanswers because they were very
different from patient topatient.
Dr. Matt Antonucci (33:25):
Yeah, and that's a.
That's a good one.
You know there's there'smultiple different things to
look at.
So if you're looking atsomebody in the acute phase of
traumatic brain injury,concussion or more serious, the
way that our olfactory bulb sitsin the part of our skull called
the cribriform plate, it'sbasically behind our nose.
There's, like your olfactorybulb, which is basically where
(33:48):
the neurons live for smell, andthey've got these little hair
cells that go and go through thebone into our nose so that we
can catch all these odormolecules.
Well, when you hit your head,sometimes the shearing, the
moving your head back and forthon those olfactory nerves, they
get sheared and you basicallylose your sense of smell.
(34:08):
Post-traumatic anosmia isactually pretty high.
You said like 55%.
There's some that say a littlehigher, some that say a little
lower, but that's probably smackin the middle as a consequence
of that shearing.
But if you have somebody whohas had concussive symptoms for
months or years, they'll saythat it happened way early on.
(34:30):
If they know it.
Some people don't even knowthey lost their sense of smell.
But often if you go to a reallygood acute concussion
specialist, they're going toevaluate smell, even if
something as simple as takingsome coffee.
That's the real simple thing.
But they've got tests that theUniversity of Pennsylvania has
created called the UPSIT test,where you buy these kits and it
has like 20 different odors init and the person has to
(34:53):
identify a certain number ofthem to meet the threshold.
And the University of Floridaalso did something called the.
I think it's called the UPBOTtest.
It's a United Peanut ButterOdor Test or something like that
olfaction test, basically justusing peanut butter in a ruler
to figure out where somebody cansmell the scent of peanut
butter.
Both of these areevidence-based screening for
(35:14):
smells and it's so simple to dothat realistically anybody who
sees a concussion should do it.
And the more chronic phase oneof the things that we get
worried about is somebody whostill has chronic loss of smell.
Sometimes neuroinflammationdeposits proteins in that
olfactory bulb that causes themto lose their sense of smell,
and not from trauma but frominflammation.
(35:36):
And you know, a lot of timespeople had that with COVID as
well, where you know the viruswent in there and kind of used
it as a factory and kind ofcreated viral loads in that area
.
But a lot of people willunderstand that I had COVID.
I lost my smell for a couple ofmonths but then it came back
because those olfactory bulbscan regenerate tissue, like we
(35:58):
can lose that and it canregenerate.
But if it's not regenerating,we're concerned about, you know,
the cells being completelydamaged as a consequence of
protein deposition.
So that's concerning.
But you know that's what wewant to correlate that also with
motor findings, with cognitivefindings, before we get scared
Because there's also a.
It's actually, I think it'slike 11 percent of the
population actually hascongenital anosmia, like where
(36:21):
they just were born with thosepretty high number.
Yeah.
Dr. Ayla Wolf (36:27):
Yeah, I feel like after I got COVID I actually
became a super smellerafterwards and I heard that from
other people too, which is kindof an interesting concept.
So maybe there was some damageand then I kind of just like
hyper, responded by making allkinds of new nerves.
Dr. Matt Antonucci (36:42):
Yeah, absolutely.
You turned up the sensitivityof the system for a loss of
function, which is, you know, ithappens to a lot of different
people for many reasons.
Dr. Ayla Wolf (36:51):
Yeah, we talk about this idea that at the top
of the pyramid you've gotcognition, emotions.
So when people lose their senseof smell or any of their senses
, that always creates a certainamount of anxiety.
So another reason why that kindof needs to be assessed, maybe
beforehand.
But then let's now talk aboutthe top of the pyramid here
where you're looking atcognition.
(37:12):
You had mentioned in one of thecourses I took with you
recently how you had a patientwho filled out all of your
questionnaires and data ahead oftime and they scored really,
really high on a lot of theircognitive assessments and their
mood assessments, which kind ofgave you a green light to say
this person's going to be ableto handle certain therapies.
(37:32):
And so I kind of like the waythat, again, you are looking at
the data ahead of time andhelping that to inform how you
work with somebody over thecourse of a five-day intensive.
Dr. Matt Antonucci (37:43):
Yeah, yeah, and that's right, because when
we look at cognitive function,when something cognitively
aligns, there's an expressionthat pretty much everybody says
they say, oh, that makes what.
That makes sense, right.
So it's not by randomexplanation that we say that,
(38:05):
but it makes sense because allthe sensory systems added up to
agreeing right.
So where I'm going with this iscognitive function is an
accumulation of sensoryinformation that agrees with
each other.
If your sensory processing isdysfunctional as a consequence
for an injury, nothing makessense anymore because you've got
(38:26):
one system saying one thing,another system saying something
else.
So when we look at somebody'scognitive testing and it's
really high there's twopossibilities.
Number one is that they weresuper high to begin with and
what they lost made them normalor maybe above normal, and
there's really no way to knowthat unless they've had prior
cognitive testing.
The other is that, well, maybethat whatever they lost didn't
(38:54):
impede their ability to makesense of things.
So you can still have brokenreflexes in that situation,
whether that person is wellcompensated or they have what's
called a high cognitive reserve.
I mean, they've got a littlebit extra money in the bank to
spend it and blow it on thingsthat you really shouldn't be
spending.
So they've just got a littleextra cognitive reserve and that
(39:16):
usually suggests to me thatpeople will have a better
response to the treatment thatwe do, because they can
cognitively engage, they canprocess the information.
And when we process information,we talked about it being bottom
up, meaning making sense fromsensory systems up, but we also
know that there's a very largecontribution of what we call
top-down influence and anybodywho's in some sort of mind-body
(39:38):
connection, medicine, where it'slike affirmations and putting
things out into the universe andmanifestations all of those
things come from top-downneurological function.
That requires good cognitiveabilities.
So, for example, you can sayyou know what?
Oh, I want to.
I want to get a new jacket.
Nobody I know has a lime greenjacket.
I'm going to stand out and allof a sudden you're going to the
(40:01):
jacket store to buy a store andall of a sudden you see three
guys walking out with lime greenjackets.
Right, because you were goingthere for the lime green jacket.
All of a sudden your brain wasattuned to it and you start
seeing it elsewhere in the world.
So people that have bettercognitive function when we're
doing sensory-based modalities,they seem to have a better
ability to assimilate thatinformation and create the
neuroplasticity to rewire thereflexes that are not really
(40:26):
working properly.
Dr. Ayla Wolf (40:28):
And so in that case you might be able to say,
stack different therapies on topof each other or make different
rehab more challenging, Whereaswith somebody who's struggling
cognitively, that might be thatindicator of like.
Let's kind of take this andsimplify it a little bit and
start in a little differentplace compared to somebody else,
(40:48):
for example.
Dr. Matt Antonucci (40:50):
Yeah, absolutely.
The concept in neuroplasticityis called convergent
facilitation.
So basically what we do is wetake different things that all
meet in the same place and weuse all X number of those things
to facilitate the brokenfunction.
Well, if you don't have goodcognitive function, it's X minus
at least one.
You know.
How many different cognitivefunctions do you have?
(41:11):
Deficient will be, you know, xminus however many cognitive
functions you have deficient into promote convergent
facilitation or facilitatedconvergence.
So, just like you said, whensomebody has a really good
cognitive brain, you know,instead of just making them,
let's just say a very genericexercise that every physical
therapist in the world basicallydoes or knows of most
(41:32):
chiropractors know, justvestibular rehab, with looking
at a dot, moving your head backand forth.
Well, that's called times oneviewing or gaze stabilization
exercises.
But somebody who has reallygood neurological function, we
can give them dual tasking withthat.
We can make them think aboutcertain things, like when you're
going to the right, think aboutspinning to the right.
When you go to the left, don'tthink about anything, so you can
(41:53):
bias it there's also, it almostbecomes exponentially uh, your,
your tool set becomesexponential in amounts when you
have some other cognitivesystems that are working, and
then also it's exponential whenyou have other sensory systems
that are working.
So if you've got a very goodvisual system but a poor,
dysfunctional vestibular system,well we can use vision to
(42:15):
promote function in thevestibular system with cognition
as well, and we can even useauditory cueing right when we
can play sounds from a differentaspect or even loud sounds from
one size, shift your spatialimage of where you are in space.
There's all sorts of coolthings that you can do once you
understand how the systems work.
Dr. Ayla Wolf (42:33):
Yeah and talk a little bit, explain kind of how
you would just okay.
Let me back up.
One of the things that I see iswhen people come in to see me
and they say, well, I wasreferred to PT and I went
through PT and I say, okay, sowhat did they have you do?
What have you already done sofar?
Many, many times people say,well, I don't know, and they
(42:55):
can't describe the exercises,they don't know why they were
doing them.
And so what is your thoughtprocess on?
How much do you educate yourpatients while you're doing the
therapy?
Because I really feel likehaving a patient understand why
they're doing something, it addsa whole nother level to it
versus just saying I'm going totell you what to do and without
(43:17):
you knowing why I want you toperform this exercise.
So how do you walk that fineline between not burdening
people with too much informationbut making sure, like that,
there is a bit of a buy in andan understanding of why am I
doing this weird thing thatyou're having me do?
Dr. Matt Antonucci (43:34):
Yeah Well, I mean, some people are probably
listening or watching this andsay, man, this just flows out of
this guy he's.
So I'm not that smart.
I mean, the thing is is I'vesaid this so many times because
I teach all of my patients whatI'm teaching you.
Maybe not to the degree that wetalk about it, and, of course,
you know any.
The hallmark of a good teacheris being able to read their
student.
You know, it's like.
(43:54):
You know, look at body language.
When are they spacing out?
When do you see deer inheadlights?
When are they engaging?
When do they want more?
You know.
So I do that with my patientsbecause you know, ultimately,
you know the term doctororiginates from educator, right,
and doctors are supposed to beeducators, not necessarily
healers.
In many parts of the world, youcan't call yourself a doctor
(44:15):
unless you have a PhD, whichmeans that you're an educator.
So the reality is, I feel likewe have a duty to educate our
patients, and it comes withinformed consent as well.
You know, if you're going toask somebody to do something,
they need to know what they'redoing, and you can't just tell
people to do something and makethem do it.
So I think that's a reallyimportant thing, and patient
empowerment is probably one ofthe biggest, the biggest but
(44:41):
least known effective tools thatyou can do with a patient,
having them control their owndestiny.
Think about this They've beenindentured to their condition
for a certain period of timewhether it's days, months, weeks
or years that I can't go to themovies because my head hurts, I
can't play with my kids becauseI get a headache, I can't read
a book because my eyes hurt, Ican't watch TV.
(45:02):
Their life is filled with Ican't do's.
And it all of a sudden.
If you as a provider give themcontrol over what they can and
cannot do, that itself hasbecome really pretty powerful.
So I do educate my patients alot.
I've got the liberty andability to do that because my
practice model doesn't say hey,you have 15 minutes with Dr A
(45:25):
and then he's on to the nextpatient.
You know my average session isabout an hour and 15 minutes and
my patients know that, hey, Imight go over with my patient
and I might go under with youone visit.
We might get things done fasterand there might be visits where
I take more time with you andless time with them.
So it's this give and take sortof thing, because everybody
needs to get what they need outof a session.
So maybe a part of the timewill be just talking and letting
(45:49):
them understand.
And if you're my patient, I'mgoing to tell you hey, listen,
we're going to talk for 15minutes.
That's not going to necessarilymean that you're getting 15
less treatment minutes lesstreatment because I don't do
anything in my sessions.
That's not directlygoal-directed for whatever you
want to accomplish.
So you understanding what we'reabout to do is going to pay
dividends on when we do it.
(46:10):
So taking five minutes now oftalking is probably equal to
doing 50 minutes of therapy.
So it's just about making surethat people understand it.
And it comes down to more of ascientific basis as well.
When we talked about theautonomic nervous system.
There's one way to explain howthe autonomic nervous system
(46:31):
responds.
It responds to error.
Okay, normally it's justregulating itself, nice and
balanced until it perceiveserror.
When it perceives error, itgoes into its repertoire of
increasing heart rate,increasing cortisol, increasing
adrenaline, norepinephrine.
It goes into this, what we callthe fight and flight state.
Well, if you do something to apatient and they don't know what
(46:53):
you're doing, their brain isgoing to say there's error here.
I'm not.
I wasn't expecting this, Ididn't know what's going on and
now, all of a sudden, youroutcomes go down because you
didn't explain it.
So I think there's there's ahuge superpower in explanation
and education.
Dr. Ayla Wolf (47:08):
I love that answer.
Well, thank you so much.
I know I've taken up a lot ofyour time today, so this was
amazing.
You shared so much valuableinformation.
Where can people find you?
Dr. Matt Antonucci (47:21):
So three weeks a month I teach for the
Carrick Institute.
I teach doctors all over theworld about this type of
information.
We really aim to help as manypatients as possible through our
doctors, through education.
So I teach a bunch of coursesfor the Carrick Institute.
Dr. Ayla Wolf (47:35):
And we all thank you for doing that.
Dr. Matt Antonucci (47:38):
Yeah, yeah, my pleasure.
So if you're a doctor andyou're interested in learning
more about the stuff we'retalking about,
carrickinstitutecom.
And as far as patients, oneweek a month I see patients up
where you are in Minnesota,drantinuccicom.
Doctor is not spelled out, justd-R-A-N-T-O-N-U-C-C-Icom, and
we have a bunch of informationon there.
(47:59):
I try to keep up my blog.
I try to make really differentnovel types of blog posts.
So if anything is appealing toyou, just let us know, and if
you need any help, let us knowas well.
Dr. Ayla Wolf (48:09):
Yeah, I will add all of that to the show notes.
And I just want to say youposted a blog post that went
into this whole in-depthphysiology of how to shut down
hiccups, and so I have a friendwho gets them all the time, and
so I shared with her thetechnique that you described and
boom, they were gone.
Dr. Matt Antonucci (48:30):
It literally works every time I like I
literally maybe I'll get a NobelPrize or something for curing
hiccups.
It literally works every time Ilike, I literally maybe I'll
get a Nobel prize or somethingfor curing hiccups.
It literally works every singletime.
And if you want to know how todo it, go to my blog post.
Dr. Ayla Wolf (48:41):
I'll put that link in there too.
Oh, thank you so much, this wasgreat.
Dr. Matt Antonucci (48:46):
Pleasure Great speaking with you and I
guess we'll see everybody nexttime maybe.
Dr. Ayla Wolf (48:49):
Excellent yeah.
Dr. Matt Antonucci (48:55):
Oh cause, we may have an exciting
announcement.
Fingers crossed.
We got a paper in review thatwe're hoping gets published, and
if it does get published, Iwould love to share that with
you and all of your subscribers.
Dr. Ayla Wolf (49:07):
Yeah, we will absolutely get you back on to
talk about that, because that islike the cutting edge and I'm
just so excited to hear moreabout it.
So I'm sure it's going to getpublished, because you guys are
just doing incredible work andthe world needs it.
So thank you.
Dr. Matt Antonucci (49:21):
Thank you.
Dr. Ayla Wolf (49:27):
Medical disclaimer this video or podcast
is for general informationalpurposes only and does not
constitute the practice ofmedicine or other professional
health care services, includingthe giving of medical advice.
No doctor-patient relationshipis formed.
The use of this information andmaterials included is at the
(49:47):
user's own risk.
The content of this video orpodcast is not intended to be a
substitute for medical advice,diagnosis or treatment, and
consumers of this informationshould seek.
Thank you.
It becomes like hundreds, if not thousands,
of Venn diagrams, circles thatoverlap with each other.
And that's what somebody who'sreally good at functional
neurology is able to do.
They're able to have all ofthese circles where they test
things and then they figure outwhere they overlap.
And if you can figure out whereall somebody's findings.
(00:20):
Remember when I said I playdetective for a day, when I lay
out all of my clues in my mindand I figure out where they all
overlap and I can say you knowwhat these all overlap, right
there.
Dr. Ayla Wolf (00:32):
Welcome to Life After Impact the concussion
recovery podcast.
I'm Dr Ayla Wolf 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
(00:53):
, 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
(01:15):
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, we're joined by one ofthe leading voices in functional
neurology and traumatic braininjury care Dr Matthew Antonucci
(01:39):
.
Dr Antonucci is a distinguishedchiropractic, neurologist,
clinician and researcher withmore than 15 years of experience
transforming the lives ofpatients with complex
neurological conditions.
Over his career, he has guidedthousands of individuals through
personalized functionalneurology rehabilitation
programs, helping them not onlyrecover from challenges like
(02:03):
traumatic brain injury, but alsounlock higher levels of
performance Beyond the clinic.
Dr Antonucci is aninternationally recognized
educator, having deliveredthousands of hours of advanced
training to tens of thousands ofhealthcare providers across the
globe.
He has also contributedextensively to the scientific
community with numerouspeer-reviewed publications.
(02:25):
Contributed extensively to thescientific community with
numerous peer-reviewedpublications.
Widely regarded as one of thetop chiropractic neurologists in
the world, his expertise anddedication have set new
standards for what's possible inbrain health and recovery.
Dr Matt Antonucci, welcome toLife After Impact.
I'm so excited to have you onthe show today.
Dr. Matt Antonucci (02:42):
Yeah, I'm so grateful to be here.
It's so great to see you, andyou know we always have a fun
time when we get together, soI'm excited to see what we
create together today.
Dr. Ayla Wolf (02:49):
Yeah well, one of the reasons why I wanted to
have you on is because you haveworked so diligently with
patients with really complexcases and many of these people
that come to see you they'vealready been to lots of other
doctors, they've had lots oftests done, and I know that you
love data, and so when thesepeople come to you, you collect
(03:12):
a ton of data ahead of time, yousift through all of it and then
, when they're in your office,you're spending a lot of time
doing very hands-on functionalexams, trying to figure out what
got missed, why are thesepeople still highly symptomatic,
and how you can help them.
But because you're also aworld-class instructor, in the
(03:32):
back of your mind I know you'realso always thinking how can I
teach other people what it isthat I do?
And even though you're verymuch giving people
individualized treatment plans,you've kind of created a
hierarchy or a way with whichyou can teach other clinicians
how to do what you do.
But you've also really figuredout what do these patients need?
(03:56):
What does their nervous systemneed to start out, to take them
from point A to point B in asafe way where you're not
pushing them too hard, you'renot frying their brain in the
process, and so I really wantedto have you talk a little bit
about this hierarchy within thenervous system and how you've
integrated that approach intoall of this complex care that
(04:19):
you do with people withpersistent post-concussion
syndrome.
Dr. Matt Antonucci (04:23):
Yeah, absolutely.
It's very exciting and you hitthe nail on the head that.
You know I really love helpingpeople and you know I can help a
couple people here and there,or I can train lots of doctors
to help lots of patients.
The challenge with the secondof the two things is that there
has to be some standardization.
It has to be some sort of asystem.
(04:43):
You know, we always know, and itdoesn't really matter what your
discipline is, whether you're amedical doctor, a chiropractor,
a physical therapist,acupuncturist, even a personal
trainer or whatever, there'salways an art and a science to
what you do.
People can be taught the ruleslike you do one, two and three
(05:03):
when you see A.
That's very methodical, veryscience-based, but there's
always going to be some artistryin there.
There's going to be experiencethat comes into it.
There's going to be.
You know that I've failed doingthis in the past, so I do it
differently now.
That's where the art comes inand different disciplines have
different, let's just say, uh,proportions of artistry versus
science.
Um, you know, you know, it'svery much like, um, when we look
(05:26):
at chiropractors I'm achiropractic by training uh,
chiropractors have a lot ofscience behind what they do, but
there's a lot of art.
You go to a hundredchiropractors and you'll find
200 different ways of treatingsomebody.
Um, that's because there is alot of art in in in chiropractic
.
And the opposite is also truewith medicine.
If you have strep throat, thereis one or two antibiotics for
(05:49):
strep throat, and that's thescience of it.
So, realistically, in order forus to make something scalable,
like medicine is, I really feelthere has to be a
systematization for it or somesort of a I don't want to call
it a protocol, but at least aframework, a structure to
approaching a complex patient.
And when you start talking aboutconcussions, in my humble
(06:10):
opinion, concussions are themost complex patient.
They are depression patients,they are headache patients, they
are movement disorder patients,they are dysautonomia patients,
they are chronic pain patients.
It's literally take all thedifferent patients you would
have in a neurology practice andpop them together in one person
and that's what you get whenyou get a concussion.
So it's a lot of times forproviders it's daunting to see
(06:34):
oh boy, here's anotherconcussion patient.
What am I getting?
But if you have a structure ora framework that you can follow,
every single of those patientsdon't become intimidating.
They become an opportunity tohelp somebody with confidence.
So that's kind of what I'vebeen trying to develop.
You know, over the past andrealistically, 15 years that
I've been doing this.
It started off as following myinstructor, my mentor, Dr
(06:57):
Carrick, and then learning whathe did, and then trying to make
it so that it's much, not muchmore.
It's systematized in a waythat's reproducible and
teachable.
Dr. Ayla Wolf (07:08):
Yeah, and I know too, every time I get a new
patient coming into my clinic,it's always that little bit of
nervousness of saying, gosh, Iknow I really want to help this
person.
I'm not quite sure what'scoming in my door, door, and so
it is so helpful to have, likeyou said, not necessarily a
protocol, because we're notdoing the same thing on
(07:29):
everybody, but to have theframework with which to approach
a complex problem is soimportant.
Dr. Matt Antonucci (07:33):
Yeah, and think about it from the
patient's perspective too.
You're not the only one they'veseen, and they know that.
Look on your face when theywalk in the door and you're like
, oh man, another one of thesepatients.
They know that, they feel it.
Imagine how much different itfeels to be in the patient's
scenario where you're walkinginto a doctor's office that has
(07:55):
a structure, that has a systemthat says, hey, I'm excited to
work with you.
I love these types ofchallenges and I know exactly
where to start so thatconfidence exudes from you.
The patients receive it andthat's the start of the healing
process.
Dr. Ayla Wolf (08:09):
I love that, yeah , so talk maybe a little bit
about all the data you collectahead of time and how that
guides you when you first startworking with somebody, when they
walk into your office.
Dr. Matt Antonucci (08:19):
Yeah, so I I straight up tell my patients
that the person I am today willnot be the person I am today
will not be the person I amtomorrow.
Today I'm Detective Matt,tomorrow I'll be Dr Matt.
And the thing is, when you havea detective, one of the
hallmarks of a detective isthey're very careful about
collecting clues not tocontaminate the information that
they have.
And the other thing a detectivedoesn't do is they don't make
(08:41):
any preconceived decisionsbefore they collect all their
data.
They're just a data collectorat that point in time.
So when somebody first comesand sees me, it all starts
actually before they see me.
With the questionnaires andintake forms that we put
together.
I've created a packet ofprobably 12 or 13 different
medical based we call them PROMSpatient reported outcome
(09:03):
measurement tools where thepatients can fill them out and
it scores them behind the scenesto give me an idea of what
systems are dysfunctional, whatsystems are functional.
And then, of course, we taketogether their goals, which are
so important.
I can't even begin to stressenough how important patients'
goals are into becomingsuccessful with them.
(09:25):
And super little tangent here.
If you have a certain goal,let's just say to make
somebody's eyes work better ortheir balance better, and they
have certain goals where it'slike I want to be out of pain.
Well, you might be successfulat fixing their eyes and their
balance, but they still might bein a lot of pain and that
patient will not see thebenefits and it'll be a failure
(09:47):
for them.
So if you're working from adifferent sheet of music,
singing from a different sheetof music, you're ultimately
always going to fail.
So I always put my patient'sgoals as number one priority and
then I try to figure out whatdata is going to be their
support.
So once we have the goals inthe history and we also look at
like a metabolic assessment formbecause I should probably make
a t-shirt that says it is I Ialways tell my patients god
(10:10):
didn't only say you can have oneproblem, right, but we're here
to figure out what problems youhave and figure out which ones
we can address and which onesother people will have to
address.
And by putting that out therefirst, you'll literally see
patients shoulders just go oh,okay.
So it's okay if I have morethan one thing, you're not maybe
going to solve everything, butyou're going to solve what you
can.
So we go through all themetabolic stuff just to make
(10:33):
sure that all that stuff is good.
And then that's when they getthere and we start doing testing
.
And the way that I do testing ispart of this whole framework
and the structure that I do.
Testing is part of this wholeframework in the structure, and
it involves things likeautonomic testing, cognitive
testing, vision testing, ocularmotor testing, balance testing.
(10:53):
You know it's, it's likeeverything.
But just saying it like thatonce again becomes like the pain
patient that walks in the doorsaying, oh my goodness, I got to
do all this testing.
Well, like the pain patientthat walks in the door saying,
oh my goodness, I got to do allthis testing.
Well, it's, it's not that it'sa lot, because it's.
It creates a picture for you.
And I always tell my patients,because they always ask me why
are you collecting so manypieces of data?
(11:14):
Like I go to my other doctor.
I'm there for 15 minutes, theydo a couple of little tests and
then that's it.
You're sitting here spendingthree hours of testing.
Why and I'm like a metaphor guy, that's it.
You're sitting here spendingthree hours of testing.
Why and I'm like a metaphor guy.
It's just how I work, you know,I always tell my patients well,
you're going to go out and buy abrand new TV to watch your
favorite movie.
Do you want it to have threepixels or do you want it to be
(11:35):
4k?
Right, so doing three testsgives you three pixels.
Doing three hours of testinggives me a 4k television, so I
can see exactly what I'm tryingto see.
So the more data, the better.
So, yeah, you're right, I am alittle bit of a data freak
because you know there's allthese sayings, cliches.
You know data has data doesn'thave opinions.
It's just what is.
(11:55):
So I just like to see the factsand then from there we can
extrapolate how to use them.
Dr. Ayla Wolf (12:02):
Yeah, amazing.
And within this hierarchy thatyou've developed, or that you've
kind of noticed works reallywell with people with nervous
system dysfunction.
At the root of that is kind ofstep one, which is the brain
needs fuel, it needs oxygen.
If it's not getting these basicessentials, it can't work.
And so talk a little bit aboutthe basis of this foundation.
Dr. Matt Antonucci (12:27):
Yeah, absolutely so.
I would say metabolic functionis like if once again the
metaphor guy if we're looking ata house, right, metabolic
function is the bedrock that thehouse is built on.
If you don't have good oxygentransport, if you have
inflammation, if you don't haveneural substrates like you know,
for example, folate is thebackbone of most
(12:47):
neurotransmitters If you havemetabolic deficiencies, no
matter how much you do forsomebody whether it's spinning
them in a chair or giving themeye exercises or sticking
needles in them or adjustingthem, whatever it is no matter
how much of that you do, youmight get them a little bit
better, but ultimately they'regoing to come back.
So that's where, like themetabolic assessment form that
(13:09):
I'd have in my patient'spaperwork where they fill out,
we can.
We can ask tons of questionsabout the fundamentals, like do
you feel cold?
Do you feel tired, you know?
Do you have pale skin?
Do you find that you know allthese different things?
Do you feel like your nails arenot?
You know not how they should be?
All of these things kind oftell us if somebody has an
anemia or something like that.
But I have to say, the majorityof the time the patients that I
(13:31):
see they've gone to greatdoctors, they've screened a lot
of those things out andultimately what they have is
they have not a hardware problem, they have a software problem.
Like the brain, it wasbeautiful, it's just not working
right.
It's like this amazing computerthat's for some reason the
software got corrupted and it'sjust.
Every time you hit the letter b, the letter k pops up on the
(13:53):
screen.
How frustrating is that.
To have a perfect computer.
You wanted to do what youwanted to do and it doesn't do
it.
So ultimately, that's wherethis kind of a hierarchy comes
in and we start looking at thishierarchy, um, from we don't
necessarily look at humans tofind out this hierarchy.
We look at animals.
Like we fast for rewind all theway back four or five million
(14:14):
years ago, um, or maybe morethan that, four or five hundred
million years ago, and we startto look at the different
creatures that lived on theplanet and how simple they were,
even though they had nervoussystems.
So I always like to weigh.
The way I like to look at thisis if we can break down the
nervous system to its most basiccomponents and if we find
dysfunction there.
There's no way the basicfunction can be broken and the
(14:36):
high function works well.
It just doesn't work that way.
So that's where I go.
Looking all the way down to thebeginning, which we, the very
essential functions of humankind, is to take sensory information
in, to process it and create amotor output.
And that motor output is goingto be involuntary.
It's going to be things thatare subconscious and things that
(14:57):
you have no control over, likeyour heart beating, your blood
vessels contracting, your pupilscontracting.
These are all called autonomicreflexes, and autonomos means
self-governing, so you have nocontrol over these things.
They're simply there just toreact to either your internal
and external environment, and ifthose reflexes are not working
(15:18):
right, you can't expect to beable to think well or move well
or anything like that.
So that's where we start, atthe bottom of our hierarchy or
at the foundation of our home,is going to be autonomic
function and the reflexes thatare built into that.
Dr. Ayla Wolf (15:33):
And can you talk a little bit about the tests
that you do to assess that?
Because we've got kind of thebig clinics like Mayo that have
their autonomic reflex panel.
They've got their kind of keytests.
I know you do some thingsdifferently, so maybe talk a
little bit about all the thingsthat you're looking at to assess
this autonomic nervous systemfrom slightly different angles.
Dr. Matt Antonucci (15:56):
Yeah.
So there's a way to do itthat's efficient and there's a
way to do it that'scomprehensive.
And then somewhere in betweenthere's where you have to shoot,
for you go to Mayo Clinic.
You will get the mostcomprehensive evaluation, but
it's going to take hours andhours and hours just to
understand how your autonomicsystem is functioning, nevermind
(16:17):
your vestibular system, yourvisual system, your
proprioceptive system, your youknow everything else that you
need to assess.
So typically what I do is Iscreen first and I have
indications that tell me to lookfurther or not.
So, Mayo Clinic, now that youmentioned it, they created
something a while ago called theautonomic symptom profile.
It was like 169 question surveythat will ask you questions
(16:41):
about your autonomic function.
Well, they found out thatpeople didn't want to complete
169 questions.
So, yeah, go figure right.
So they did a factor analysisand what they said is 31 of
these questions actually clustertogether.
So if we ask these 31 questions, we get just as good as a
result.
This is called the Compass 31.
So the Compass 31 is ascreening tool that patients can
(17:03):
complete and if they scorehigher than a 20 on that, it
almost guarantees that they havemoderate autonomic dysfunction.
If somebody scores higher than a20, I say, all right, thought
pattern changes, we need to diveinto more comprehensive
autonomic screening.
If they're 19 or less, I justsay, okay, let's move on,
because the autonomic nervoussystem fundamentally is an
(17:27):
uncontrollable system thatresponds to environmental
perturbation.
So if there's something wrong,you're going to be more fight
and flight.
If everything's right, you'regoing to be more rest and digest
.
And that's super simple.
And I know some people thatstudy neurology might be going.
That's not exactly right.
I know it's not exactly right,but that's the direction that we
(17:48):
move.
And if we start to look atwhere there's errors, whether
that's your inner ears are notprocessing movement properly,
well then you're going to have afight or flight autonomic
response.
If you have two eyes that aresupposed to be looking straight
ahead and one eye is pointingout to the side and you're
constantly trying to bring youreye in, well that's going to
drain energy out of you, makeyou tired and it's going to make
(18:10):
your blood pressure go up andyour heart rate increase.
So these autonomic reflexes,they basically become slaves to
dysfunction.
They get entrapped bydysfunction and they stop
working appropriately.
And then the problem is thatthen your sensory system
re-ingests those issues and nowcreates a distorted sense of
(18:32):
reality.
So it becomes pervasive.
So, once again, binary, greaterthan 20, we do a full autonomic
assessment, looking at heartrate variability, you know,
seated, supine and standingblood pressure.
We're going to look at thingslike Valsalva maneuvers, so some
of the doctors watching thiswill know what those are For
(18:52):
those that are not doctors.
Basically it's when youincrease your pressure inside
your thoracic cavity your heartresponds a certain way.
So we study all those thingsand we understand what normal is
and abnormal and then we startto look at the different
receptors that trigger those.
Whether that's a lying down tostanding might be a baroreceptor
problem, it might be avestibular problem, it might be
(19:13):
a proprioceptive problem, itmight be a kidney problem where
you're not producing enoughblood.
So we just really have toconsider all those things.
But less than 20, weacknowledge it and move on and
assess the rest of the hierarchy.
Dr. Ayla Wolf (19:26):
So you feel like if somebody's scoring below 20,
you're likely going to findother things in the process of
testing and very likely, whenyou correct those imbalances,
then the autonomic nervoussystem is going to be able to
return back to its healthy,responsive nature without you
having to necessarily hammer atit directly.
Dr. Matt Antonucci (19:45):
Exactly.
It's secondary to somethingthat's primary.
Otherwise the symptoms would bemuch higher if it's primary.
So you're looking at a resultrather than a cause.
So let's go find the cause.
Dr. Ayla Wolf (19:56):
Yeah, excellent, okay.
So then the next step.
Dr. Matt Antonucci (20:00):
Yeah, so when we start looking at
autonomic function,realistically what we're looking
at is motor responses.
So remember we talked about thepurpose of the brain is to take
the inside and outside worldand to process and create a
motor response.
That motor response can beinvoluntary or voluntary, and
then it's kind of like it's agradual change.
So the next thing afterautonomic function is going to
(20:23):
be tone, right, so that isslightly more controllable but
slightly involuntary.
So right now you and I bothhave tone in our spine because
we're sitting up and we're notthinking about it.
You have tone of your eyemuscles because normally your
eye muscles, your eyes wouldpoint out and because you're
engaging, you get tonus in youreye muscles to let you look
straight ahead.
You're not telling your eyes todo that, but it's there.
(20:44):
So we start looking at tone andwe start looking at postural
changes like how well somebodycan regulate those tones
involuntary.
On top of that, then we startlooking at skeletal motor
reflexes, right, when you know,when you maybe tap a knee or leg
kicks or when you turn yourhead, your eyes move.
And then this is where thehierarchy starts to build.
(21:06):
And after that we start lookingat voluntary motion and then
coordinated motion, and then westart looking at thought and
then emotions, emotional control, and that's kind of one of the
pyramids, if you will, offunction.
I call that the motor pyramid.
And then we have a sensorypyramid that complements that.
Dr. Ayla Wolf (21:26):
And you kind of mentioned this concept of
looking back in time at thesecreatures that exist, that don't
necessarily have all of theemotional stuff that we deal
with, and saying, well, how aretheir systems designed?
And I know that one of the kindof oldest sensory systems is
the vestibular system and thatin fish they have what are
called lateral lines, which iskind of like their version of a
(21:48):
vestibular system.
So can you talk a little bitabout that importance of the
foundation of the vestibularsystem, because you kind of cued
into it a little bit earlierwhen you said if the inner ear
is kind of telling the brain thewrong information, we're going
to have an autonomic response tothat and it's kind of like this
constant drain on the battery.
Dr. Matt Antonucci (22:07):
Yeah, absolutely.
I can't even stress enough howimportant the vestibular system
is.
I'm starting to do a bit morework now with aerospace medicine
and we're kind of stating theeffects of microgravity and zero
gravity and the results keepcoming back that humans are
(22:28):
designed to live on earth, right, that's what it comes down to.
And whenever you look at anorganism that was designed to be
in some place the ocean, forexample, when you take a ocean
animal out of the ocean, whathappens to it?
They die.
Yeah, you put a land animalinside the ocean, what happens
to it?
They die.
(22:49):
Right, so we've adapted to liveinto environments that have been
adaptations over hundreds ofmillions of years.
Well, the one thing that hasnever changed in billions of
years is the fact that Earth hasa gravitational field.
So since life form has started,from single cell organisms all
(23:09):
the way up to humans, which webelieve are the epitome of
complex species, everything hasone anchor on this planet and
it's gravity.
The weather changes, barometricpressure changes, everything
changes except for gravity.
So that kind of leads to theimportance of what it's like to
have this gravity septive orgravity sensors in our inner
(23:33):
ears, and it's so important thatyou know, I kind of look at it
as like a I'm not a superreligious person, but this is
person.
But once you start learningmore about human anatomy and
physiology, it's kind of hard todeny that there's some sort of
intelligence out there thatcreated us, whether you call
that God or Allah or whatever,whatever you call it this
(23:57):
supreme power that created us inan organized fashion Because
the reality is is that when asperm eats an egg, the first
sensory system that developswhen we study embryology is the
vestibular system, and thathappens to develop right at the
same time as our nerves start tomyelinate.
And as our nerves start tocreate this protective sheath
(24:19):
around them that makes nervestravel faster, as they're
myelinating, these primitivemuscles start to contract and
twitch right.
So all of a sudden, now we havemovement, and now we have
finally a receptor that can feelthat movement.
At the same time, you're insideyour mom's womb and gravity is
affecting that.
Even though you're floatinginside of a fluid, there's
(24:41):
gravity there.
So you can kind of start torealize that, man, this is
really important and if we don'tprocess that constant force,
we're constantly going to bedysfunctional.
So and that's what we see inastronauts, but that's also what
we see in individuals who haveconcussions that affect their
vestibular system.
So yeah, it's very important.
Dr. Ayla Wolf (25:02):
And it's such a delicate system I mean those
like everything in that systemis just so delicate that it's
like no wonder you hit your headand that system is going to be
compromised in some way.
Dr. Matt Antonucci (25:15):
And the nice thing about the vestibular
system, which is different thanother systems, for example our
visual system or our auditorysystem.
Our visual system has aspecific real estate in the back
of our brain called ouroccipital lobe, where we see.
The auditory system has veryspecific real estate in the part
of our brain that's like overhere in our temporal lobe.
(25:37):
Our vestibular system isprofusely, pervasively
integrated in our entire brain.
There is no area of our brainthat the vestibular nucleus
doesn't have influence on.
So that's good and bad.
We'll never lose vestibularfunction altogether unless we
injure our inner ears themselves.
But as long as these organs inour inner ears work, we're
(25:59):
always going to be able toperceive gravity in some extent.
However, the downside aboutthat is because it's everywhere.
No matter where you injure inyour brain, you're going to
affect your ability to perceiveit accurately.
And specifically in the back ofour brainstem we have a part of
our brain called the littlebrain or cerebellum, that
basically sits on our brainstem,which is like a stock, and it
(26:22):
sits over here, and when youhave a concussion it moves
around and these fibers getstretched and we damage the
ability to perceive and regulatethat vestibular system.
So it's a.
It's at a vulnerable place, butit's also so redundantly
integrated that it never breakscompletely, which may be a bad.
A good thing that it doesn'tbreak completely, but it's also
a bad thing that it never breakscompletely, which may be a bad.
A good thing that it doesn'tbreak completely, but it's also
(26:42):
a bad thing that it never breakscompletely, because then you
have dysfunction rather thanjust not working.
Dr. Ayla Wolf (26:49):
Yeah, and the vestibular system also being
yoked to the nuclei that thencontrol our eye muscles means
that that imbalance often spillsover into the visual system and
I think that connection oftengets missed too.
I know like one of the things Ilove to do, because when
patients come in again, there'susually I'm hunting for those
(27:10):
little things that got missed inthe past and I pop these
infrared goggles on and whenthey don't have anything to
fixate on, all of a sudden youget to see this push pull happen
between what the vestibularsystem is trying to do to the
eyes and where the eyes thinkthey are in space, and I always
find really interesting thingshappen when I pop those goggles
(27:32):
on and I'm looking at someone'seyes in the dark.
Dr. Matt Antonucci (27:35):
Yeah, absolutely, and that's kind of
what we were sharing're sharinga little earlier is that you
know what you're going to see isthat faulty sensory integration
results in motor dysfunctionand then the eyes moving when
they're not supposed to move asa consequence of either a
perception of movement that'snot there or a misinterpretation
of movement that is therecauses all of these motor
(27:55):
imbalances.
And you know that the eyes youknow you've heard the expression
maybe for the eyes are thewindow to the soul, but
realistically, that the eyes arethe window to the brain,
because you can see all sorts ofthings from.
You know involuntary reflexfunction, autonomic function,
like pupils to you know tone,which is your eye, your eye
position, and especially whenyou remove vision, what happens
to your eyes.
(28:16):
You can see voluntary function,like ability to move your eyes
side to side.
You can also see complexfunction, like tracking targets
that move in space in threedimensions.
But you also see thatindividuals who have mental
health disorders a lot of thingschange with their eyes.
A lot of times when people havethings like schizophrenia,
their eyes will move a lot morethan somebody who doesn't.
(28:38):
So we can really look at theeyes as biomarkers of all sorts
of things.
But, yeah, the vestibular ocularconnection is very strong, as
well as the vestibulospinalconnection, so the vestibular
system sets the tone of all ofour spinal musculature.
So we have good posture, andI'm not mean like posture, like
you know, sit up straight,because it does affect that, but
also dynamic posture when we'restanding up, to control our
(29:01):
body, sway all sorts ofdifferent things.
And there's also vestibularautonomic functions and we have,
you know, there's even morethan that.
There's almost a direct pathwayfrom your vestibular nucleus to
a part of your brain calledyour hypothalamus, which
basically sets your hormonalrhythms.
Your sleep-wake cycles, yourhunger cycles, even breathing
(29:24):
cycles are affected by yourvestibular system.
So, yeah, when we say it'simportant, it really is.
Dr. Ayla Wolf (29:31):
Yeah, absolutely.
And so you're looking at allthese different sensory systems,
you're kind of testing them inisolation, but then also
together in terms of saying howis this system functioning?
And then how is it functioningin the context of when we're
looking at it with other systems.
So it's like, okay, I have somemotor control if I'm touching
(29:52):
my finger to happens, if I rollmy head to the left or the right
, and then all of a sudden yousee that motor system break down
.
And so I think that's just.
That's really the power of thisfunctional mindset in saying we
(30:13):
don't want to just know ifsomeone can perform a task one
way, we want to see how theyperform that task 10 different
ways in 10 different scenarios.
Dr. Matt Antonucci (30:19):
Exactly.
And that's kind of where youget the motor pyramid right.
Where we had the bottom, we hadautonomic function, at the top
we had cognitive and emotionalregulation.
What you really want to do isyou want to study the senses and
then in isolation, at thebottom, so you have your
vestibular autonomic, yourproprioceptive autonomic
(30:41):
integration.
Then you want to look at yourauditory and gustatory and
olfactory and then your visualautonomic responses and then you
want to start looking like,okay, well, how do these
responses play together?
How does the vestibular system,sensory system, play with the
visual processing system?
(31:01):
And if that's playing good, butthe vestibular and
proprioceptive systems areplaying bad, well then you know
it's not a problem with thevestibular system, it has to be
a problem with the integration,which is a different part of the
brain.
So it becomes like hundreds, ifnot thousands, of Venn diagrams
, circles that overlap with eachother.
And that's what somebody who'sreally good at functional
(31:22):
neurology is able to do.
They're able to have all ofthese circles where they test
things and then they figure outwhere they overlap.
And if you can figure out whereall somebody's findings,
remember when I said I playdetective for a day, when I lay
out all of my clues in my mindand I figure out where they all
overlap and I can say you knowwhat these all overlap right
(31:44):
there.
What that's going to do is it'sgoing to allow me to be uber
precise in whatever I'm going todo.
And that one thing, because ittouches every one of those
hundreds or thousands of circles, fixing that one thing fixes
all the circles.
Dr. Ayla Wolf (31:58):
Yeah, and isn't that awesome when you can like
just knock over the one dominoand everything falls in line.
Dr. Matt Antonucci (32:04):
Yeah, and the only thing I could really
think of is, like you know, Ikind of use this metaphor in
some of our courses.
You know, it's like if you'regoing to go into the army,
there's two different peoples.
There's people that carrymachine guns and there's people
that carry sniper rifles.
Um, the only difference betweenthe two they'll both get their
job done.
One's going to use a lot moreammunition and there's probably
(32:25):
going to be some collateraldamage with the guy in the
machine gun.
Uh, where the sniper gets theirjob done with one pole and one
projectile, right?
So it's not that one's bad andone's good.
There are two different stylesof practice.
I just like being a sniper.
Dr. Ayla Wolf (32:41):
Yeah, there's a lot of math involved with being
a sniper.
There's a lot of physics.
I like math.
There you go, there you go, andso I'll throw a little
curveball at you, because thiswasn't I mean, you mentioned it
on your hierarchy, but I haveread that when people have a
brain injury, that up to 55% ofpeople can actually have
alterations in their smellwithin the first year, and so
(33:03):
I'm curious how much do you payattention to smell Now that it's
extremely smoky out all daylong?
Yesterday I used that as a testbecause it smelled like a
campfire outside.
So every single patient thatwalked in my door I said, oh, is
it still smoky out?
And I was fascinated by theanswers because they were very
different from patient topatient.
Dr. Matt Antonucci (33:25):
Yeah, and that's a.
That's a good one.
You know there's there'smultiple different things to
look at.
So if you're looking atsomebody in the acute phase of
traumatic brain injury,concussion or more serious, the
way that our olfactory bulb sitsin the part of our skull called
the cribriform plate, it'sbasically behind our nose.
There's, like your olfactorybulb, which is basically where
(33:48):
the neurons live for smell, andthey've got these little hair
cells that go and go through thebone into our nose so that we
can catch all these odormolecules.
Well, when you hit your head,sometimes the shearing, the
moving your head back and forthon those olfactory nerves, they
get sheared and you basicallylose your sense of smell.
(34:08):
Post-traumatic anosmia isactually pretty high.
You said like 55%.
There's some that say a littlehigher, some that say a little
lower, but that's probably smackin the middle as a consequence
of that shearing.
But if you have somebody whohas had concussive symptoms for
months or years, they'll saythat it happened way early on.
(34:30):
If they know it.
Some people don't even knowthey lost their sense of smell.
But often if you go to a reallygood acute concussion
specialist, they're going toevaluate smell, even if
something as simple as takingsome coffee.
That's the real simple thing.
But they've got tests that theUniversity of Pennsylvania has
created called the UPSIT test,where you buy these kits and it
has like 20 different odors init and the person has to
(34:53):
identify a certain number ofthem to meet the threshold.
And the University of Floridaalso did something called the.
I think it's called the UPBOTtest.
It's a United Peanut ButterOdor Test or something like that
olfaction test, basically justusing peanut butter in a ruler
to figure out where somebody cansmell the scent of peanut
butter.
Both of these areevidence-based screening for
(35:14):
smells and it's so simple to dothat realistically anybody who
sees a concussion should do it.
And the more chronic phase oneof the things that we get
worried about is somebody whostill has chronic loss of smell.
Sometimes neuroinflammationdeposits proteins in that
olfactory bulb that causes themto lose their sense of smell,
and not from trauma but frominflammation.
(35:36):
And you know, a lot of timespeople had that with COVID as
well, where you know the viruswent in there and kind of used
it as a factory and kind ofcreated viral loads in that area
.
But a lot of people willunderstand that I had COVID.
I lost my smell for a couple ofmonths but then it came back
because those olfactory bulbscan regenerate tissue, like we
(35:58):
can lose that and it canregenerate.
But if it's not regenerating,we're concerned about, you know,
the cells being completelydamaged as a consequence of
protein deposition.
So that's concerning.
But you know that's what wewant to correlate that also with
motor findings, with cognitivefindings, before we get scared
Because there's also a.
It's actually, I think it'slike 11 percent of the
population actually hascongenital anosmia, like where
(36:21):
they just were born with thosepretty high number.
Yeah.
Dr. Ayla Wolf (36:27):
Yeah, I feel like after I got COVID I actually
became a super smellerafterwards and I heard that from
other people too, which is kindof an interesting concept.
So maybe there was some damageand then I kind of just like
hyper, responded by making allkinds of new nerves.
Dr. Matt Antonucci (36:42):
Yeah, absolutely.
You turned up the sensitivityof the system for a loss of
function, which is, you know, ithappens to a lot of different
people for many reasons.
Dr. Ayla Wolf (36:51):
Yeah, we talk about this idea that at the top
of the pyramid you've gotcognition, emotions.
So when people lose their senseof smell or any of their senses
, that always creates a certainamount of anxiety.
So another reason why that kindof needs to be assessed, maybe
beforehand.
But then let's now talk aboutthe top of the pyramid here
where you're looking atcognition.
(37:12):
You had mentioned in one of thecourses I took with you
recently how you had a patientwho filled out all of your
questionnaires and data ahead oftime and they scored really,
really high on a lot of theircognitive assessments and their
mood assessments, which kind ofgave you a green light to say
this person's going to be ableto handle certain therapies.
(37:32):
And so I kind of like the waythat, again, you are looking at
the data ahead of time andhelping that to inform how you
work with somebody over thecourse of a five-day intensive.
Dr. Matt Antonucci (37:43):
Yeah, yeah, and that's right, because when
we look at cognitive function,when something cognitively
aligns, there's an expressionthat pretty much everybody says
they say, oh, that makes what.
That makes sense, right.
So it's not by randomexplanation that we say that,
(38:05):
but it makes sense because allthe sensory systems added up to
agreeing right.
So where I'm going with this iscognitive function is an
accumulation of sensoryinformation that agrees with
each other.
If your sensory processing isdysfunctional as a consequence
for an injury, nothing makessense anymore because you've got
(38:26):
one system saying one thing,another system saying something
else.
So when we look at somebody'scognitive testing and it's
really high there's twopossibilities.
Number one is that they weresuper high to begin with and
what they lost made them normalor maybe above normal, and
there's really no way to knowthat unless they've had prior
cognitive testing.
The other is that, well, maybethat whatever they lost didn't
(38:54):
impede their ability to makesense of things.
So you can still have brokenreflexes in that situation,
whether that person is wellcompensated or they have what's
called a high cognitive reserve.
I mean, they've got a littlebit extra money in the bank to
spend it and blow it on thingsthat you really shouldn't be
spending.
So they've just got a littleextra cognitive reserve and that
(39:16):
usually suggests to me thatpeople will have a better
response to the treatment thatwe do, because they can
cognitively engage, they canprocess the information.
And when we process information,we talked about it being bottom
up, meaning making sense fromsensory systems up, but we also
know that there's a very largecontribution of what we call
top-down influence and anybodywho's in some sort of mind-body
(39:38):
connection, medicine, where it'slike affirmations and putting
things out into the universe andmanifestations all of those
things come from top-downneurological function.
That requires good cognitiveabilities.
So, for example, you can sayyou know what?
Oh, I want to.
I want to get a new jacket.
Nobody I know has a lime greenjacket.
I'm going to stand out and allof a sudden you're going to the
(40:01):
jacket store to buy a store andall of a sudden you see three
guys walking out with lime greenjackets.
Right, because you were goingthere for the lime green jacket.
All of a sudden your brain wasattuned to it and you start
seeing it elsewhere in the world.
So people that have bettercognitive function when we're
doing sensory-based modalities,they seem to have a better
ability to assimilate thatinformation and create the
neuroplasticity to rewire thereflexes that are not really
(40:26):
working properly.
Dr. Ayla Wolf (40:28):
And so in that case you might be able to say,
stack different therapies on topof each other or make different
rehab more challenging, Whereaswith somebody who's struggling
cognitively, that might be thatindicator of like.
Let's kind of take this andsimplify it a little bit and
start in a little differentplace compared to somebody else,
(40:48):
for example.
Dr. Matt Antonucci (40:50):
Yeah, absolutely.
The concept in neuroplasticityis called convergent
facilitation.
So basically what we do is wetake different things that all
meet in the same place and weuse all X number of those things
to facilitate the brokenfunction.
Well, if you don't have goodcognitive function, it's X minus
at least one.
You know.
How many different cognitivefunctions do you have?
(41:11):
Deficient will be, you know, xminus however many cognitive
functions you have deficient into promote convergent
facilitation or facilitatedconvergence.
So, just like you said, whensomebody has a really good
cognitive brain, you know,instead of just making them,
let's just say a very genericexercise that every physical
therapist in the world basicallydoes or knows of most
(41:32):
chiropractors know, justvestibular rehab, with looking
at a dot, moving your head backand forth.
Well, that's called times oneviewing or gaze stabilization
exercises.
But somebody who has reallygood neurological function, we
can give them dual tasking withthat.
We can make them think aboutcertain things, like when you're
going to the right, think aboutspinning to the right.
When you go to the left, don'tthink about anything, so you can
(41:53):
bias it there's also, it almostbecomes exponentially uh, your,
your tool set becomesexponential in amounts when you
have some other cognitivesystems that are working, and
then also it's exponential whenyou have other sensory systems
that are working.
So if you've got a very goodvisual system but a poor,
dysfunctional vestibular system,well we can use vision to
(42:15):
promote function in thevestibular system with cognition
as well, and we can even useauditory cueing right when we
can play sounds from a differentaspect or even loud sounds from
one size, shift your spatialimage of where you are in space.
There's all sorts of coolthings that you can do once you
understand how the systems work.
Dr. Ayla Wolf (42:33):
Yeah and talk a little bit, explain kind of how
you would just okay.
Let me back up.
One of the things that I see iswhen people come in to see me
and they say, well, I wasreferred to PT and I went
through PT and I say, okay, sowhat did they have you do?
What have you already done sofar?
Many, many times people say,well, I don't know, and they
(42:55):
can't describe the exercises,they don't know why they were
doing them.
And so what is your thoughtprocess on?
How much do you educate yourpatients while you're doing the
therapy?
Because I really feel likehaving a patient understand why
they're doing something, it addsa whole nother level to it
versus just saying I'm going totell you what to do and without
(43:17):
you knowing why I want you toperform this exercise.
So how do you walk that fineline between not burdening
people with too much informationbut making sure, like that,
there is a bit of a buy in andan understanding of why am I
doing this weird thing thatyou're having me do?
Dr. Matt Antonucci (43:34):
Yeah Well, I mean, some people are probably
listening or watching this andsay, man, this just flows out of
this guy he's.
So I'm not that smart.
I mean, the thing is is I'vesaid this so many times because
I teach all of my patients whatI'm teaching you.
Maybe not to the degree that wetalk about it, and, of course,
you know any.
The hallmark of a good teacheris being able to read their
student.
You know, it's like.
(43:54):
You know, look at body language.
When are they spacing out?
When do you see deer inheadlights?
When are they engaging?
When do they want more?
You know.
So I do that with my patientsbecause you know, ultimately,
you know the term doctororiginates from educator, right,
and doctors are supposed to beeducators, not necessarily
healers.
In many parts of the world, youcan't call yourself a doctor
(44:15):
unless you have a PhD, whichmeans that you're an educator.
So the reality is, I feel likewe have a duty to educate our
patients, and it comes withinformed consent as well.
You know, if you're going toask somebody to do something,
they need to know what they'redoing, and you can't just tell
people to do something and makethem do it.
So I think that's a reallyimportant thing, and patient
empowerment is probably one ofthe biggest, the biggest but
(44:41):
least known effective tools thatyou can do with a patient,
having them control their owndestiny.
Think about this They've beenindentured to their condition
for a certain period of timewhether it's days, months, weeks
or years that I can't go to themovies because my head hurts, I
can't play with my kids becauseI get a headache, I can't read
a book because my eyes hurt, Ican't watch TV.
(45:02):
Their life is filled with Ican't do's.
And it all of a sudden.
If you as a provider give themcontrol over what they can and
cannot do, that itself hasbecome really pretty powerful.
So I do educate my patients alot.
I've got the liberty andability to do that because my
practice model doesn't say hey,you have 15 minutes with Dr A
(45:25):
and then he's on to the nextpatient.
You know my average session isabout an hour and 15 minutes and
my patients know that, hey, Imight go over with my patient
and I might go under with youone visit.
We might get things done fasterand there might be visits where
I take more time with you andless time with them.
So it's this give and take sortof thing, because everybody
needs to get what they need outof a session.
So maybe a part of the timewill be just talking and letting
(45:49):
them understand.
And if you're my patient, I'mgoing to tell you hey, listen,
we're going to talk for 15minutes.
That's not going to necessarilymean that you're getting 15
less treatment minutes lesstreatment because I don't do
anything in my sessions.
That's not directlygoal-directed for whatever you
want to accomplish.
So you understanding what we'reabout to do is going to pay
dividends on when we do it.
(46:10):
So taking five minutes now oftalking is probably equal to
doing 50 minutes of therapy.
So it's just about making surethat people understand it.
And it comes down to more of ascientific basis as well.
When we talked about theautonomic nervous system.
There's one way to explain howthe autonomic nervous system
(46:31):
responds.
It responds to error.
Okay, normally it's justregulating itself, nice and
balanced until it perceiveserror.
When it perceives error, itgoes into its repertoire of
increasing heart rate,increasing cortisol, increasing
adrenaline, norepinephrine.
It goes into this, what we callthe fight and flight state.
Well, if you do something to apatient and they don't know what
(46:53):
you're doing, their brain isgoing to say there's error here.
I'm not.
I wasn't expecting this, Ididn't know what's going on and
now, all of a sudden, youroutcomes go down because you
didn't explain it.
So I think there's there's ahuge superpower in explanation
and education.
Dr. Ayla Wolf (47:08):
I love that answer.
Well, thank you so much.
I know I've taken up a lot ofyour time today, so this was
amazing.
You shared so much valuableinformation.
Where can people find you?
Dr. Matt Antonucci (47:21):
So three weeks a month I teach for the
Carrick Institute.
I teach doctors all over theworld about this type of
information.
We really aim to help as manypatients as possible through our
doctors, through education.
So I teach a bunch of coursesfor the Carrick Institute.
Dr. Ayla Wolf (47:35):
And we all thank you for doing that.
Dr. Matt Antonucci (47:38):
Yeah, yeah, my pleasure.
So if you're a doctor andyou're interested in learning
more about the stuff we'retalking about,
carrickinstitutecom.
And as far as patients, oneweek a month I see patients up
where you are in Minnesota,drantinuccicom.
Doctor is not spelled out, justd-R-A-N-T-O-N-U-C-C-Icom, and
we have a bunch of informationon there.
(47:59):
I try to keep up my blog.
I try to make really differentnovel types of blog posts.
So if anything is appealing toyou, just let us know, and if
you need any help, let us knowas well.
Dr. Ayla Wolf (48:09):
Yeah, I will add all of that to the show notes.
And I just want to say youposted a blog post that went
into this whole in-depthphysiology of how to shut down
hiccups, and so I have a friendwho gets them all the time, and
so I shared with her thetechnique that you described and
boom, they were gone.
Dr. Matt Antonucci (48:30):
It literally works every time I like I
literally maybe I'll get a NobelPrize or something for curing
hiccups.
It literally works every time Ilike, I literally maybe I'll
get a Nobel prize or somethingfor curing hiccups.
It literally works every singletime.
And if you want to know how todo it, go to my blog post.
Dr. Ayla Wolf (48:41):
I'll put that link in there too.
Oh, thank you so much, this wasgreat.
Dr. Matt Antonucci (48:46):
Pleasure Great speaking with you and I
guess we'll see everybody nexttime maybe.
Dr. Ayla Wolf (48:49):
Excellent yeah.
Dr. Matt Antonucci (48:55):
Oh cause, we may have an exciting
announcement.
Fingers crossed.
We got a paper in review thatwe're hoping gets published, and
if it does get published, Iwould love to share that with
you and all of your subscribers.
Dr. Ayla Wolf (49:07):
Yeah, we will absolutely get you back on to
talk about that, because that islike the cutting edge and I'm
just so excited to hear moreabout it.
So I'm sure it's going to getpublished, because you guys are
just doing incredible work andthe world needs it.
So thank you.
Dr. Matt Antonucci (49:21):
Thank you.
Dr. Ayla Wolf (49:27):
Medical disclaimer this video or podcast
is for general informationalpurposes only and does not
constitute the practice ofmedicine or other professional
health care services, includingthe giving of medical advice.
No doctor-patient relationshipis formed.
The use of this information andmaterials included is at the
(49:47):
user's own risk.
The content of this video orpodcast is not intended to be a
substitute for medical advice,diagnosis or treatment, and
consumers of this informationshould seek.
Thank you.
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
NFL Daily with Gregg Rosenthal
Gregg Rosenthal and a rotating crew of elite NFL Media co-hosts, including Patrick Claybon, Colleen Wolfe, Steve Wyche, Nick Shook and Jourdan Rodrigue of The Athletic get you caught up daily on all the NFL news and analysis you need to be smarter and funnier than your friends.