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Concussion Assessment & Management Process

Getting a brain evaluation as soon as possible following a head injury will provide insight to the extent and location of the injury. For participants of high impact sports, an electrophysiologic evaluation of the brain can be a valuable tool for tracking brain functioning and potential brain trauma over time.

Getting non-invasive, pain-free, non-pharmaceutical treatment for your concussion can restore proper brain functioning, including sleep, which will allow you to return to the field, court, or life, with lower risk for repeat concussion and greater likelihood of success.  Dr. Keifer is the only provider in the state of Hawaii trained to treat patients with advanced techniques and technology currently being used at the highest level of collegiate and professional sports, and military.  

Symptoms of brain injury or concussion may go unnoticed at first, but can appear later and worsen over time.  Concussions (mTBI) can have long lasting impacts on memory and speech, often presenting with co-morbid depression, anxiety and mood disorders. A personalized brain functional evaluation is particularly important if you have experienced the following:

  • Repeat head blows from impact sports

  • Other sports injury

  • Car accident

  • Stroke

  • Incidents of falling

  • Other head trauma


Sports Injury Prevention

For athletes of high impact sports such as football, soccer, lacrosse, wrestling, cheerleading, bicycling, Dr. Keifer recommends getting an electrophysiologic study (brainwave analysis) before and after your season to monitor possible damage. While abnormalities may not show immediately, especially in the case of repeat blows to the head, damage may develop over time so follow-up brain assessments are important.


Using Brainwave Analysis to evaluate Sports Injury and Concussion (mTBI)

Using functional brain study techniques, Dr. Keifer is able to see a more detailed analysis of brainwave activity in the various regions of your brain. This type of testing is important because pictures (CT, MRI) of the brain are normal greater than 90% of the time and are not currently effective at assessing functioning of the brain.  Our unique approach to brainwave evaluation allows us to get a deeper understanding of the way your brain is functioning, optimally or not, and correlate this data with symptoms you are experiencing.   Understanding the extent and location of the brain injury objectively at the time of brain injury or while establishing a baseline will allow you to track changes over time (both positive and negative) and adjust treatment accordingly.

Our electrophysiologic brain study is done painlessly and in a relatively brief amount of time.  After scanning, we construct a 'map' of your brain based on the pattern of brainwaves, which can be evaluated for patterns known to be associated with clinical conditions and symptoms.  Even better comparison and understanding is possible when you have a pre-season, or pre-injury, evaluation on file as a baseline.


Step 1 - Brainwave Analysis & Neuro-cognitive testing for baseline measurement 

             Dr. Keifer uses brainwave analysis to understand your unique brain activity along with neurocognitive tests to further assess and correlate clinically how different areas of your brain function & communicate.  The testing process is non-invasive, painless and can be completed typically in 30-60 minutes.


Step 2 - In season/post-injury brainwave analysis & neuro-cognitive testing

                    Should you see signs of concussion and have concern about your health and brain functioning following an injury or series of blows, or you or your loved one are uncertain and would like peace of mind, follow up brain wave analysis and neuro-cognitive scoring is performed to determine if the brain suffered damage causing symptoms. 


Step 3  - Individualized management & treatment protocol

              Analysis & comparison of brainwave & neurocognitive scores allows Dr. Keifer to create a personalized & targeted approach aimed at promoting proper brain functioning, health and performance.  Using the best available information about the state of your unique brain will allow optimal planning for your return to work, school, practice, and/or exercise in a brain-safe manner.

Our Personalized Version of Treatment is:





What is a Concussion?

A concussion is a category, or type, of traumatic brain injury (TBI), caused by a blow or jar to the head that alters the way your brain normally functions.  Concussions can also occur from falls or blows to the body that cause the brain to move quickly back and forth inside (rotational force) the skull.  While concussions may be clinically described as mild TBI (mTBI), their effects can be serious and long-lasting when not diagnosed and managed properly.

The most common causes of concussion are motor vehicle accidents (30%), sports (20%), bicycle accidents (15%).  Anyone can suffer a concussion, young or old are at risk.  Statistically, the highest rate of concussion diagnosis is in kids 12 and under.  National studies are showing an increasing number of kids and teenagers, are being diagnosed with concussions that result from play, falling, bicycling and while participating in games and practices. 

The signs and symptoms of concussions may be hard to establish early on, and can be missed by the person suffering, family members and doctors as the concussed person may look fine, almost normal, even though they are feeling or acting differently.


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Signs & Symptoms of Concussions:

Sleep - some sleep more than usual, others sleep less than usual and/or have trouble falling asleep

Thinking/Memory - difficulty thinking clearly, difficulty concentrating, feeling slowed down or foggy, difficulty remembering new information

Emotional - Irritability, Sadness, more emotional, sense of nervousness, worry and/or restlessness

Physical - early on you may experience nausea or vomitting; Headache with fuzzy or blurry vision, dizziness, sensitivity to noise or light, fatigue, difficulty maintaining balance


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