Speaker 0 00:00:00 Hello, survivors and friends. I hope that you are enjoying December and all the joys that the holidays bring. I hope also that you’re finding some rest because it’s busy and it can be tiring. But most of all, I hope that you’re finding joy today on the podcast. My guest, Melissa Biscardi, joins us for a wonderful discussion. She’s a registered nurse and osteopathic therapist. She calls herself a brain crusader in her practice. Her research focuses on concussion treatment and brain optimization. She is the founder of Concussion Rehab Lab and the Brain Toolkit. During the podcast today, we talk about all sorts of things. We kind of did some deep dives and just got into a lot of fun topics. She talks about the importance of functional neurology. She finds that doing a really detailed assessment of each system of the body is essential. We talk about the pillars of concussion recovery, such as sleep, nutrition, and mental health.
Speaker 0 00:01:17 She says there’s always room for improvement. You can always get better. And she talks about how we really need to want to be a Ferrari at any stage of recovery. What she meant by that is that often we can settle for symptoms that are impairing our lives and that she wants you to function at the highest level. Melissa and I, Melissa and I discuss the importance of mental health, and she turns the tables on me and asks me a lot of questions about my work and mental health and concussion. I hope you enjoy this rich discussion with Melissa Biscardi. Hi everyone. Welcome to the TBI Therapist podcast. I’m your host, Dr. Jen Bishot, where we explore the heart of brain injury. Hi Melissa. Welcome to the TBI Therapist Podcast.
Speaker 2 00:02:31 Thank you so much for having me.
Speaker 0 00:02:33 So Melissa Bacardi is a registered nurse, correct? I hope I’m getting that correct. Um, and I’m just gonna kick it off to you to talk a little bit about what your role is in brain injury and how your working with these wonderful warriors.
Speaker 2 00:02:49 Yeah, absolutely. Thank you so much. So I am a registered nurse and I’m also a osteopathic practitioner. And since I’m in Canada, it’s a little bit different. In Canada, osteopathic practitioners, we are manual, the therapists, whereas in the USA there are medical doctors. So it’s a little bit different. Um, and I just like to call myself a brain crusader. My clinical practice, my research is all focused on concussion rehab and brain optimization. So I do have a clinical practice and more recently I started to mentor clinicians in sort of my methods, but of course they’re not mine. I learned them from from the universe. So just passing on the knowledge.
Speaker 0 00:03:38 So give us a little insight into how someone who specializes in functional medicine, functional neurology, you know, that’s, I think those are big kind of buzz words now, right now. How someone can understand how that would be helpful to them in their concussion recovery or in their brain injury, brain injury recovery and maybe if, if that’s different or not different if they’re they have concussion or a different type of injury.
Speaker 2 00:04:05 Yeah, absolutely. So functional neurology is, is really interesting and it’s really powerful. I will say it focuses very much on the individual patient and finding out where the deficits are or the dysfunctions are, and personalizing care. So as opposed to protocol based care, which mm-hmm. <affirmative>, you know, I think was a standard for a while and still is. And while we do need protocols to a certain extent, of course for safety and such in functional neurology, yes, it’s really doing a lot of assessment. Often clinics will have some objective measures as well. Looking at the eye movements, for example, the eyes are, you know, an extension of the brain looking at balance reflexes and saying, okay, what parts or pathways of the brain are optimal? And, you know, where do we need to bring the health back into the system?
Speaker 0 00:05:05 Yeah, yeah, that’s really good. I’m wondering from that, how would somebody know, you know, maybe from their symptoms or you know, what they’re noticing with that, if they’re noticing differences with their eyes or their balance, who they should go to? Cause I think that’s the biggest question. When people are working with me, I, I’m falling over, shutting down the middle of the day. So maybe what can give them some hints or tips or clues for referrals?
Speaker 2 00:05:32 Yes. So I’m definitely biased towards finding a functional neurologist in your area. Um, you know, and you can just Google that. Um, but now of course because of the online world, sometimes you can get stuff done virtually. Now symptom-wise, so for the eyes you might be having, and there is vision, but vision itself, like having 2020 vision is a very small part of what our eyes do. And that would be more an optometrist, but our eyes do so much more. They move the interpret information. So if you are having blurred vision, trouble reading, the words are moving on the page. If you’re having visual motion sensitivity, so like when you’re out in the world, the car is passing by or being in a busy environment like a grocery store is really, you just can’t handle it. Mm-hmm. <affirmative>, that certainly indicates that system might be off with the balance.
Speaker 2 00:06:37 It can be your balance center, it can also be your inner ear sometimes will actually, a crystal will be dislodged in the ear and then that will really throw off your balance. And also, um, it will contribute to nausea. So any of those symptoms. And then there are also symptoms like word finding or not really being able to interpret what people are saying, like some, or reading. So those are more sort of memory, cognitive or information recall. And that would be a different area of the brain. So, and then coordination, bumping into things, going to reach for the glass and you miss it is so interesting, <laugh>, Right. And also, so for example, my intake is four pages long and listing in groups these symptoms. So right when the patient comes in, we say, Okay, wow, it looks like this area is compromised. So we really wanna focus on teasing that out a little bit more.
Speaker 2 00:07:47 And the thing is, with practitioners that have that sort of functional approach is definitely go see them if you’re not feeling great, but go see them if you’re feeling well also because right, you wanna be the Ferrari, right? Mm-hmm. <affirmative>, so we all have, uh, room for improvement and we can’t. So for example, my, sorry, I’m just talking, talking, talking. But, um, you’re fine <laugh>, I, I know a lot about assessment and treating the brain, but I go see someone because they’re gonna have an objective, um, view of me and say, Oh, well Melissa, you know, you’re not doing too great here. Why don’t we give you these exercises? Or how has your diet been? Or, or your sleep. So yes, I just love the holistic approach and really sort of digging deep.
Speaker 0 00:08:45 Yeah. Yeah. I know that when I’ve referred people to functional neurology, that’s why I wanted to talk to you, that they, their symptoms, their, their symptoms get much better. Even people who have been, you know, recovered from a concussion or a brain injury for years, they, they’re kind of like, this is my new normal quote unquote. And I, I hate to even use the word normal in this world because it’s, it’s, I think it’s almost a trigger for people. <laugh>.
Speaker 2 00:09:09 I think so. I think so. But
Speaker 0 00:09:12 I mean, they find, I guess they find like the concept you’re talking about regarding like the Ferrari that like you, you can have this other level and you don’t have to live with a certain amount of symptoms that you’ve had grown accustomed to, but there can be something else, something better. Absolutely. There are people that can look at things in a different way that can help you.
Speaker 2 00:09:35 Yeah. And often I talk about pillars. So of course, just like with everything we need the foundation, like the sleep, the nutrition and the mindfulness, mental health, those are always going to be contributing. And then we get into, okay, well how is the tissue, how is the body moving? How are the eyes moving? And then you’re just kind of building, building to make sure the whole system is working as well as possible. And I do think no matter how long ago the injury was or how bad you’re feeling in the moment that there’s always room for improvement. It’s not linear, but you can get it moving in a better direction.
Speaker 0 00:10:19 Yeah. And I would say that’s true. Definitely. Very true. Yeah. I was reading some research about post-concussion syndrome and teasing out PTSD and post-concussion syndrome that a lot of times folks stop having concussion symptoms, but they, they have trauma symptoms and it, to them, they are confused because it feels like their attention or their lack of concentration could possibly be due to their concussion or brain injury versus trauma. Which, you know, I’m, I can speak to this, I know that trauma impacts, impacts, uh, concentration in those types of cognitive processes.
Speaker 2 00:11:01 Yeah, I think you are totally correct and I see this in my practice too, where we get a lot of sort of the other things working well, but people are not necessarily feeling better because of the psychological trauma of the event, which then can even impact sleep. Mm-hmm. <affirmative> and not sleeping can create the symptoms of the concussion, right? Yes. Like concussion symptoms are often not specific, right. Headaches, um, irritability concentration. So I think it’s a vicious spiral. I know here at uh, one of the hospitals slash university, they’re actually doing well mri, but also is it m e g, like other sort of magnet assessment comparing, um, military and PTSD population with concussion patients. And I don’t have any results from that. I know they’re still recruiting cuz I’m sort of sending some people over there, but they’re, you know, that question is out there and definitely a valid one. Like is it the, is it the PTSD or is it the concussion?
Speaker 0 00:12:17 You know, a lot of times what I see is that people, they are becoming, they have the trauma, which is their brain injury for most of the folks that I see. And, and then these other experiences, like you talked about going to the store, which is so overstimulating for them, but sometimes it, it becomes, they have like panic attacks and so I’m doing treatment on the panic attack, but it’s really because their concussion symptoms have caused that new situation where now the store feels like dangerous to them. And I have to, you know, this isn’t dangerous. You did have an onset of symptoms. What made you feel like totally out of body and out of control? I think from the concussion or from the brain injury, I’m dealing with all these other symptoms that are related to the mental health side of things. I think they’re all part of the picture personally.
Speaker 2 00:13:04 Yeah. And isn’t that interesting because let’s say someone does have a panic attack then in the grocery store, then that itself is like a new trauma in a sense, right? That they might be afraid to go back to the grocery store.
Speaker 0 00:13:19 Right. I think they, maybe they’re symptomatic with their concussion. They go there, then it, then the panic attack happens. It’s not the actual trauma, you know, so trauma is some is a life or death experience, Right. Which could be their brain injury, but I call those other ones like the store, I went to the store when I was con concussed and that’s another little ty trauma because I thought that I was going to die, like I thought my body told me. So your body reacts whether you we like it or not. Like it’s, it’s things, it’s dangerous, it, all these things are going off in the body and then your body just goes in response to things.
Speaker 2 00:13:54 Yeah. Our primitive, our primitive body that, uh, you know, it hasn’t necessarily adapted, What did you call it? You called it something, something trauma. The grocery store.
Speaker 0 00:14:06 Um, I think there’s like this discussion in the, in like the trauma world of a little ty trauma or like a, um, not that it’s not that it doesn’t feel like it’s dangerous or feel like life or death, but it’s not actually a life or death experience. Right? Right. Our, our body believes it, but in reality when we look at the situation, no, I can’t die at the grocery store. Right. But I felt like I did and my body, my heart was racing and I, I had this outer body thing out of body thing happen, but it wasn’t actually dangerous. And I have all kinds of therapies to do that, but <laugh> convince the body then that this, this situation isn’t actually dangerous and actually work on maybe the trauma that is making that is generalizing that anxiety to other situations.
Speaker 2 00:14:49 Yeah, absolutely. You know, I was looking at the literature and there is a discussion around quote unquote, so I mostly deal with concussions not the more severe, although I guess I have a few moderate for sure from motor vehicle accidents. Yeah. But, um, regardless, there’s this discussion around concussion subtypes, so cervical or ocular motor, and then there’s one around effective or mood anxiety. It was saying that about 30% of people suffer from this. And I’m curious what you think, because I think it’s more like 99.9 <laugh> <laugh>. So, um, if not, and I guess, you know, there’s the sports concussions and some concussions or mild injuries where there’s a smooth recovery, right? Yeah. But then the rest, and I, it’s very interesting because I see sometimes people will have that effective, um, anxiety, depression, irritability early on and then sometimes it comes later. So yeah, I’m interested in what you see and, and sort of your experience with that.
Speaker 0 00:16:02 Yeah, I mean, I think I see, I’ve mostly seen people probably like six months or a year out from their concussion, I think for a lot of reasons. So I think in the initial phases of concussion, you know, the family is surrounding the person. They are going to so many therapies, they’re going to OTE speech, you know, they’re seeing their doc all the time. They don’t have time for me in the recovery at that point. And it’s very much, it’s physical and it’s time heavy. Um, they, they are just kind of like at the end of the rope, right. Honestly, when I see them and they’re just like, I’ve tried everything a lot of times after that year mark where they felt like, Oh my gosh, I’m stuck with this stuff. I want you to keep going. You know, no one really knows what you’re gonna end up with, which we don’t really know. Right.
Speaker 2 00:16:48 No, it’s true. And hope goes a long way.
Speaker 0 00:16:51 Of course. Yeah. And I think just someone that knows that there’s anxiety, there’s trauma, there’s depression that comes associated with concussion with brain injury. So that I know that and I’ve worked with that and that I understand what’s happening for them, I think is just, it goes a long way. Think of the answer
Speaker 2 00:17:12 <laugh>, I was asking if you Well, I was saying how I thought a lot of, um, a lot of people suffer from that, from a men the mental health point of view. And that’s, and um, I think you answered it, <laugh>.
Speaker 0 00:17:25 Yes.
Speaker 2 00:17:25 Well definitely the people that see you do. So maybe we both have bias samples, <laugh>, right? Yeah.
Speaker 0 00:17:35 Yeah. I think when I’m, and I’ll, I’ll probably have to have my, my supervisor on that trained me. He, you know, he told me, he’s like, you know, someone’s not depressed after a brain injury, Something’s wrong. Mm,
Speaker 2 00:17:46 Mm-hmm. <affirmative>
Speaker 0 00:17:47 Because usually it’s, it’s such a difficult experience for most people that some sadness. I think a lot with my work is a lot of grief work as well. Yes. And for the longest time in the dsm, bereavement was not part of anything that we would give them as a clinical diagnosis, you know, that we can give a diagnosis just because they can get services. Right. Um,
Speaker 2 00:18:10 It’s,
Speaker 0 00:18:11 But I think there’s just inherent grief in this process and inherent loss. So a lot of my work, I feel like I’m a grief therapist in doing a lot of this work because number one I’m willing to talk with you about it. That like, you lost something, like something happened and you lost something. And that I think for folks is huge.
Speaker 2 00:18:29 Yeah, absolutely. And there’s so many losses too, right? Because some people have to take time off work, right? Sometimes there are relationships that are disrupted experiences, right. Depending on symptom severity. Mm-hmm. <affirmative>
Speaker 0 00:18:45 Physical ability. So in your, in your realm of work, I would say like going away from their sport or Yeah, absolutely. You probably have dealt with that when folks have
Speaker 2 00:18:55 And identity like identity loss. I actually have a lot of patients, not necessarily from a sports concussion, but um, from a concussion in general who will change their path. One patient who decided not to finish her PhD and go in another direction. So it’s really interesting. It’s terrible to have the traumatic event, but sometimes it, people are able to turn it around for sure. Into a, a gift they didn’t necessarily ask for, but,
Speaker 0 00:19:27 You know. Yeah. And I think there’s a whole, you know, there whole literature on posttraumatic growth and how,
Speaker 2 00:19:31 You know Yes,
Speaker 0 00:19:32 Yes. How trauma can, how we can grow from trauma. While we never wanted that thing to happen, Right. But we, we can find new ways of being from, from that experience that we just can’t imagine life differently. I think one of my guests was just saying like, you know, I, I can’t see my life differently now. Like my brain injury is part of my story. It is part of me. And to change it would mean I would’ve change who I am now and I don’t want that. So, and I loved the way she worded.
Speaker 2 00:20:00 Oh, that’s
Speaker 0 00:20:00 Beautiful. That piece. Yes. So awesome. Like, I love this discussion by the way, <laugh>. So I am transitioning us hoping to think about three tips, insights, and maybe speaking to just in general, like what I got from your work when I would listen to some of your stuff was just some new recommendations for concussion. So I don’t know if you wanna like go into any of that.
Speaker 2 00:20:27 Yeah, absolutely. So can I just run with it?
Speaker 0 00:20:32 <laugh> Got it. So,
Speaker 2 00:20:33 So, well you know what the thing is, like I was saying, the multi pillars and starting with the basics. If you or loved one is sustained a concussion, lay the foundation first, make sure you’re getting the rest, the nutrition, healthy stuff. Nothing inflammatory, right? Nothing that’s going to just sort of light a fire because the body is healing and the body knows how to heal. Sometimes it needs a little bit of help, but, um, definitely laying the foundation cells need nutrients, oxygen and stimulation, right? So provide and rest. So providing them with that, going for walks, being in nature, you know, we used to say rest was best and lock people up, but now we know no, it’s actually safe and encouraged to be up and doing what’s tolerated early. And then of course supporting that mental health. I often recommend people to do yoga nidra, like as something very just accessible, which is like a restful form of yoga. Usually you’re just listening. It’s more like a meditation. And the research shows that doing that is very restful and rejuvenating to the body. So I think there are some like those easy, well easy, um, to implement steps that people can do on their own before even investing and accessing a practitioner. Right? Those are some things you can start on. And then definitely, definitely work with someone who will help you on your path because it will be faster, more than likely to. Right. That objective person.
Speaker 0 00:22:16 Can you speak a little bit about, you know, when a person should access care if they’re symptomatic or has that changed? I feel like I had that 30 day, you know, if you’re not better on 30 day, then go to the, you know, go see a specialist. Yes. Talk to me about that.
Speaker 2 00:22:31 I would actually say right away.
Speaker 0 00:22:34 Right
Speaker 2 00:22:34 Away. Yes. And this, the reason I say that is because we used to think you had to rest, right? So just stay in a dark room and see if the symptoms go away. But now we know that depending on the injury and the injury severity, it can be safe to be walking or sometimes even riding the bike at 48 hours. And we know that in the concussions, the milder injuries, that early intervention is associated with faster recovery. But also if people, if you’re being tested with exercise tolerance, if you’re intolerant, it gives us information about how you’re going to recover. So even just saying, Okay, you didn’t do too well with this, so you’re probably not going to be playing your sport in two weeks. Or we might need to be a little bit more strategic on your work hours, et cetera. Mm-hmm. <affirmative>. But yeah, I would say early intervention is best if possible. Or at least just doing a virtual session with someone. Right. Get out there, get some information and get yourself on track early on.
Speaker 0 00:23:47 So exercise early, see someone early. Mm-hmm.
Speaker 2 00:23:52 <affirmative>, it’s all about early
Speaker 0 00:23:54 <laugh>. Early, early, early exercise. See someone early. I might add the, the mental health to that. It’s like stay in your social network, like reach out to people.
Speaker 2 00:24:02 Oh yes, yes. Definitely.
Speaker 0 00:24:05 Because I think just letting people in is so important. Cuz I, what I notice is that people tend to, because of maybe they told them rest in like dark room before mm-hmm. <affirmative>. But I know that when I see folks about six months or a year out, they are pretty socially deprived. They’ve moved away from their circle and I’d say phone a friend,
Speaker 2 00:24:26 <laugh>. Yes, absolutely.
Speaker 0 00:24:28 Have them and tell them, say really keep up on me. Really check up on me. If I don’t call you within 48 hours, call me, bug me. Get me outta the house.
Speaker 2 00:24:37 Yeah, I love that. Because if you are isolated then you can get the rumination and just essentially your mind can lead you down a path of feeling worse just from the isolation.
Speaker 0 00:24:50 Awesome. So are you ready for some rapid fire?
Speaker 2 00:24:55 Oh sure.
Speaker 0 00:24:56 <laugh>. Okay. So what’s, what’s one routine that you recommend for brain injury? Concussion. It could even be your routine.
Speaker 2 00:25:12 Let’s see. I will combine my routine and what’s good for brain injury. So movement. Movement is medicine. So no matter what, try and move daily. The basics, I always say it’s easy, it’s simple, but it’s not easy. Make sure you sleep when you should be sleeping. So sleep at night or whatever your schedule is. Sleep at night, Um, exercise daily, try and get out in nature. Those would be my, my three big ones and hydrate. So the simple stuff.
Speaker 0 00:25:44 Awesome.
Speaker 2 00:25:45 It’s not, it’s not um, what’s the word, like flashy <laugh>, but it
Speaker 0 00:25:51 Works. Water 21. Right. I know. But it’s simple. It’s true. You know, going back to basics, I’m really just taking care of our bodies and
Speaker 2 00:26:02 Absolutely. And, um, I say nature is mindfulness, but, um, meditating, which is really hard for a lot of people. Even myself. I go in and out on my practice. But it’s those simple things that will add up and actually make a difference.
Speaker 0 00:26:19 True. Yeah. And there’s, there’s great, actually there’s great nature. The therapy literature on in just Poors and how that’s restorative to our mind and to our bodies. So I would agree with that.
Speaker 2 00:26:30 Oh, amazing.
Speaker 0 00:26:31 Yeah. So what is your favorite holiday food and what does it remind you of? Or who?
Speaker 2 00:26:39 Oh, so it’s actually salt water cod. So it’s like, oh my gosh, breaded cod. That is fried. And we have that like I’m Italian, we have that every year. And my n and I used to make it and now my mom makes it, but it’s like, oh, it’s delicious and salty. <laugh>
Speaker 0 00:26:59 Awesome. When do you guys usually have that?
Speaker 2 00:27:01 So we have it on Christmas Eve.
Speaker 0 00:27:03 Awesome. Awesome. I love this question. I’ve gotten so many different answers that my favorite was like McDonald’s cheeseburgers so far. Really?
Speaker 2 00:27:13 <laugh>, What was the holiday?
Speaker 0 00:27:15 I think they got it like before Thanksgiving or something. Cause they didn’t like Thanksgiving food. It was great.
Speaker 2 00:27:20 Oh, that’s awesome. <laugh>.
Speaker 0 00:27:22 Yeah, I’ve had all kinds of, I, it made me, it makes me think of the holiday food. I just made one that I usually make, which is Beta coa.
Speaker 2 00:27:30 Oh, what’s that?
Speaker 0 00:27:31 It’s a Greek dish. I’m not Greek, but our family just likes to try random food. Yeah. So what is one thing you tell your younger self? If you could? It could be just a younger version.
Speaker 2 00:27:47 Hmm. And I, it’s something that I still have to tell myself, but um, also wish my younger self would just know that like our, my thoughts and our thoughts are our most limiting feature. Or I guess the other way is like you, you can achieve anything you can imagine in a sense to a certain extent. Like think big, think positive because you’re, you’re really laying your own path.
Speaker 0 00:28:18 I love that.
Speaker 2 00:28:20 Powerful. It’s crazy. Really <laugh>. It
Speaker 0 00:28:23 Is. It is. Yes. Yes.
Speaker 2 00:28:26 You know more and more than me about that too, because that’s your realm.
Speaker 0 00:28:32 I find that, I try to tell people, you have to find your own truth, right? That’s my job is to find my my people’s truth. What’s your truth and how do we, how do we get all that stuff outta you? This question is good for the person who’s my interviewee because I wanna hear from them because they might speak to somebody who maybe can identify with you or think like you, you know what I’m saying?
Speaker 2 00:28:55 Absolutely. I just, I listened to a lot of podcasts and I was just listening to a podcast and the person was saying they wrote something on a piece of paper and kept it in their pocket. And so they were thinking about it every day and then it manifested. And I thought, oh, that’s super interesting. I haven’t done it, but it’s on my list of things to try
Speaker 0 00:29:16 <laugh>. I like that too. Right? Yeah. So like literally holding on to the, the thing that I, that you want to happen.
Speaker 2 00:29:24 Yes, absolutely. Yes.
Speaker 0 00:29:27 Love it. So Melissa, where can people connect with you and maybe,
Speaker 2 00:29:32 Yeah, so people, The best place to find me is on Instagram, which, and my handle is the.rehab dot lab. And I post a lot, lot for patients. And also anytime I have something coming up for, for clinicians sharing my knowledge and of course I would love to have
Speaker 0 00:29:51 All that people could jump into
Speaker 2 00:29:52 Doing. Oh yes. So you know what I’m going to do in October again. So that will at least give people time to put it in their calendar. Perfect. And something where I will go live for the week and just sort of talk about concussion recovery and the different pillars of care. So love to have people there just engaging with me on Instagram meeting.
Speaker 0 00:30:14 And I, and I just a little plug for that. That was a lot that you offered. Cause I went to that and that’s why I connected with you. And so I think that, Yeah, and I think it was great information. I mean, I, I learned things myself that I had am trying to unlearn from what I learned as a professional in brain injury. I’m so happy about the work you’re doing. Process
Speaker 2 00:30:34 I feel like is, you know, we’re always learning more, which means we have to unlearn the other things <laugh>. But I guess that’s what keeps it exciting.
Speaker 0 00:30:45 <laugh>. Yes. Yeah. So we’re al that. We’re always learning, we’re always growing. I think that’s what’s important. Well, thank you so much for joining me and thank, I hope to connect with you really soon.
Speaker 2 00:30:56 Absolutely.
Speaker 3 00:31:02 Thank you for joining us today on the TBI Therapist podcast. Please visit tbi therapist.com for more information on brain injury, concussion and mental health. The information shared on today’s podcast is intended to provide information, awareness, and discussion on the topic. It is not clinical or medical advice. If you need mental health or medical advice, please seek a professional.