Concussion Rehab with Creator of the Brain Tool Kit App - Melissa Biscardi | E33

The nervous system after concussion often remains stuck in fight-or-flight, making traditional rehabilitation challenging at best. Melissa Biscardi, an osteopathic therapist, registered nurse, and PhD candidate, reveals why gentle manual therapy creates a critical foundation for healing visual dysfunction after brain injury.

Drawing from over a decade of clinical experience, Biscardi explains how cranial work can release tension patterns affecting the extraocular muscles and create a parasympathetic shift that prepares the brain for more active rehabilitation. She shares fascinating insights into the subtle nuances of visual dysfunction that standard assessments often miss - from saccade accuracy problems to vergence issues that only appear when the head is in certain positions. These seemingly minor impairments can significantly impact daily function, much like "driving with a spare tire on" - you'll still get there, but with increased strain and decreased performance.

Her groundbreaking PhD research explores virtual reality applications for ocular motor rehabilitation, comparing traditional care with a six-week VR intervention combined with home exercises via her Brain Toolkit app. This innovative approach makes specialized rehabilitation more accessible and engaging for patients outside major medical centers. Biscardi also discusses her pioneering investigation into how concussions affect hormonal function in women, particularly anti-Müllerian hormone levels, which may impact reproductive health.

From her personal journey with medication-induced memory issues to her martial arts background and multiple concussions, Biscardi brings both professional expertise and lived experience to her work. Join us for this enlightening conversation about cutting-edge approaches to visual rehabilitation and discover practical strategies you can implement today for improved brain health and concussion recovery.

Melissa Biscardi:

Website: www.concussionrehab.ca

Instagram: @concussionrehab.ca

YouTube: @concussionrehab

Brain Tool Kit: https://www.instagram.com/braintoolkit

Carrick Institute:

W.E.S.H.I.N.E. virtual woman-led neurology conference: 

Get 20% off your first order of Puori protein with code LIFEAFTERIMPACT by following this link.

Chapters

• 0:33 Welcome to Life After Impact
• 1:34 Meet Melissa Biscardi: Concussion Expert
• 3:53 Manual Therapy for Visual Rehabilitation
• 8:53 Eye Movement Impairments After Concussion
• 18:17 PhD Research: VR Ocular Rehabilitation
• 25:30 Women, Hormones and Concussion Research
• 34:39 Martial Arts Journey and Concussions
• 48:23 Daily Brain Health Practices
• 58:49 Medical Disclaimer

Transcript

Melissa Biscardi: 0:00

And so I really am a proponent of starting with some gentle manual work to create ease in the system, to create a parasy hours like. They are just so revved up that we really need to bring them to a space that okay, their system is ready for something a little more active.

Dr. Ayla Wolf: 0:33

Welcome to Life After Impact the concussion recovery podcast. I'm Dr Ayla Wolfe and I will be hosting today's episode, where we help you navigate the often confusing, frustrating and overwhelming journey of concussion and brain injury recovery. This podcast is your go-to resource for actionable information, whether you're dealing with a recent concussion, struggling with post-concussion syndrome or just feeling stuck in your healing process. In each episode, we dive deep into the symptoms, testing, treatments and neurological insights that can help you move forward with clarity and confidence. We bring you leading experts in the world of brain health, functional neurology and rehabilitation to share their wisdom and strategies. So if you're feeling lost, hopeless or like no one understands what you're going through, know that you are not alone. This podcast can be your guide and partner in recovery, helping you build a better life after impact.

Dr. Ayla Wolf: 1:34

Today's guest on the show, the fabulous Melissa Biscardi, is the founder of Concussion Rehab, located in Toronto, where for over a decade, she's helped patients recover from concussions. Since 2006, she's worked as a nurse and since 2013, as an osteopathic practitioner. She earned her Master of Science studying women-specific concussion outcomes, including the first-ever investigation of anti-malarian hormone in mild traumatic brain injury, and is now completing her PhD at the University of Toronto, focusing on ocular motor rehabilitation for adults with post-concussion syndrome, doing cutting-edge research into virtual reality and mobile app-based therapies. Melissa has authored book chapters, published peer review papers and presented on stages around the globe. She's also the creator of the Brain Toolkit app, putting evidence-based concussion rehab exercises into people's hands anywhere, anytime. Please enjoy my conversation with Melissa Biscardi, but first a few announcements.

Dr. Ayla Wolf: 2:47

Biscardi, but first a few announcements. On Thursday, september 25, 2025, I will be at Northwestern Health Science University in Bloomington, minnesota, from 12 to 1 to talk about my new book, the Concussion Breakthrough. So if you happen to be a student or faculty member on campus, please join me on that day. Then, on Friday, october 24, I am having a book signing and book release party at the Schmidt Artist Loft in St Paul, minnesota, from 630 to 830pm. This is in the old Schmidt Brewery building and anybody who wants to join is welcome, but please RSVP to lifeafterimpact at gmailcom and that will help us with our planning. If you are an acupuncturist interested in learning more about neurology and neurological conditions, I'm teaching a seminar for the Montana Association of Acupuncture and Oriental Medicine in Bozeman, montana, october 4 to the 5th. Registration is on their website, montanamaaomorg, and early bird registration ends September 4th. Thanks and enjoy the show. Melissa Biscardi, welcome to Life After Impact. How are you today?

Melissa Biscardi: 3:57

I'm amazing. Thank you so much for having me. I'm excited to be here.

Dr. Ayla Wolf: 4:01

Yes, well, you have such an incredible background you are a registered nurse, an osteopathic therapist, a PhD candidate I can't wait to talk to you more about that and a functional neurology practitioner who has dedicated your career to advancing brain health. We are both presenting at a women-only neurology conference coming up women-only neurology conference coming up and so your presentation is on ocular motor rehabilitation, but specifically the use of manual therapy in ocular motor rehab. So why don't you, for our listeners, define what that is when you speak about manual therapy and so kind of describe what that is and then how you're incorporating that into your rehab for different aspects of vision and eye teeming and eye movement disorders that are so common when people have concussions? Let's start there, absolutely.

Melissa Biscardi: 4:56

So I come from an osteopathy background, which is really a gentle, manual therapy, and it's important to note that in the U? S, osteopaths are doctors of osteopathy, so they can also prescribe medication and do all the duties or at least most of them that physicians would do. And where I'm from, in Canada, we are manual therapists and not medical doctors, so we would look more similar to a physiotherapist um than a medical doctor, and so our first line of therapy is manual therapy and we don't adjust the way where that makes a sound. So just to kind of set the stage, it's super gentle, layer by layer. So that is the type of manual work that I'm speaking of when I say manual therapy, and this can really sort of set the stage for ocular motor rehab, which is the way I think about it. To say, eye movement exercises, which is terrible, but if you're a fly on the wall, that's what it's going to look like, right, even though it's full of nuances.

Melissa Biscardi: 6:14

And when someone has a concussion they are in a state of fight or flight. The nervous system is usually really heightened. It's been through a trauma and it's not always easy to just pull someone in and start doing active rehab, and so I really am a proponent of starting with some gentle manual work to create ease in the system, to create a parasympathetic shift, just letting that body feel safe and open to other forms of rehab. And sometimes someone will come in they haven't blinked in 48 hours like they are just so revved up that we really need to bring them to a space that, okay, their system is ready for something a little more active, that okay, their system is ready for something a little more active.

Dr. Ayla Wolf: 7:13

And do you want to talk a little bit about when you're doing manual work? So I've also studied some craniosacral therapy, both through the Upledger Institute and then also biodynamic cranial work, and it is very subtle palpation. And when you talk about the manual work on the head, can you talk about kind of what you're feeling when you work on people and kind of what kind of shifts that you pick up on? And I know sometimes you can tell when you're working on different tissue layers as well. So maybe talk a little bit about these kind of subtleties of this, this palpation method and this hands-on approach.

Melissa Biscardi: 7:49

Sure, absolutely. I was wondering if you had worked um with the up ledger courses or not. So my intuition was right Um, I'm not trained by up ledger, but similar, different Um. And so let's see when we are, when I'm palpating, when we're palpating, let's say the cranium, one thing is looking for directions of ease and directions of fine. So where does the tissue like to go?

Melissa Biscardi: 8:22

Um, and you know, someone can even feel that just feeling the tissue on their arm gently and moving it in different directions, and you probably will find somewhere it doesn't want to go. And usually when someone comes in and they are in a sympathetic state, we will go into the ease. So, following the tissue where it wants to go, like pushing a drawer in when it's stuck, versus just yanking on it and trying to pull it out. Um, when it comes to cranial, especially with the extraocular muscles, all of them come. Well, most of them come to a common um tendon and they are connected to the cranial bones. So as we create ease around the cranial tissue, which attaches to the cranial bones, which then attaches to the dura, like really we are working on all the layers and even working on the brain, when you think about it.

Dr. Ayla Wolf: 9:21

Yeah, and I've also found too that a lot of people, when they have that kind of sympathetic elevation and their visual system is taxed maybe because they're overusing it or there's a lot of fatigue in the system that I get much better results when I can guide somebody through almost like an eye exercise warmup, so to speak, with their eyes closed, yes, and also just tuning into their own ability to move their eyes in different directions, feeling into, does it feel, you know, is there more strain in the system when I look left versus right or up left versus down right? And so I find, you know, anytime somebody exercises, obviously we recommend let's warm up your muscles first. It only would make sense then that if you're doing visual rehab and eye exercises, that you would want to warm your eyes up first, and so do you also kind of guide people through some visualization exercises or just more of like some eye movements with their eyes closed, to be able wing of the sphenoid to kind of unweight the tissue there and then having them move left right up down.

Melissa Biscardi: 10:51

Even that in and of itself usually creates some ease. And, yes, having patients notice the subtleties instead of just, oh, my eyes are tight or my eyes are in pain, but okay, what you know, which areas maybe need a little more nurturing? Um, and also, when you have someone on the table and you're doing some of this more subtle work, sometimes you'll just you'll visualize also when the nervous system is like oh yeah, so I'm in a safe place now and they'll do you know a big inhalation, yeah, so I'm in a safe place now and they'll do.

Melissa Biscardi: 11:27

you know a big inhalation, exhalation.

Dr. Ayla Wolf: 11:33

So the body's communicating with us all the time. Yeah, yeah. And what would you say are the most common eye movement impairments that you see with your concussion patients that maybe often get missed in kind of other types of settings?

Melissa Biscardi: 11:43

I would say that I think, hopefully, almost everyone who's working in concussion is looking at the eye movements, but it's important to pay attention to the nuances. So, yes, maybe the eye can get from A to B, but does it take 10 stops along the way? Right, and even some of the more popular standardized vestibular ocular assessments, like the VOMS I'll just say it it doesn't really allow for the nuance. Yes, if someone is symptomatic, but do they have a lot of fatigue with it? Right, are they blinking 10 times when they're looking in one direction? Are the eyes watering? Is there a twitch coming up in the face? So I think that there are a lot of yes, nuances, details to pick up on, to see, okay, where's a problem? Where can we get in? Where's the low hanging fruit, which I feel like usually is a manual therapy? Um, and then get into the bigger issues. Oh, I didn't answer your question, sorry, um. Can I add?

Dr. Ayla Wolf: 12:56

to that you can add.

Melissa Biscardi: 12:57

you can add so um, I mean and the research supports it as well that there are definitely issues in pursuits, especially like vertical smooth eye movements and although this comes to the nuances like saccade accuracy, so maybe the eye is jumping in the direction it's supposed to go but it's not actually landing where it's supposed to land. And I mean this might manifest with someone is reading but then they skip a word and they have to go back, or they're skipping lines, and then also saccade latency, so you want someone to look and then it takes a little while before the eye actually decides to go over there or is able to process the command to get from A to B.

Dr. Ayla Wolf: 13:47

Right, right, there's that lag time between them, maybe seeing the stimulus to move their eyes and then they actually move it and actually doing it.

Melissa Biscardi: 13:57

And then the other thing is, if there's asymmetry in that, then you have asymmetrical information, sort of all day long. So that's definitely going to make someone feel unwell or anxious or whatnot.

Dr. Ayla Wolf: 15:21

Right and I think that the those subtleties are so important. I often liken it to driving your car with a spare tire on. You know, having that spare tire still gets you from point A to point B, but you're not going to be able to drive your car at peak performance when you have a spare tire on. And it's like these little subtle struggles within the system over time can really cause a lot of almost wear and tear or fatigue to the system, absolutely.

Melissa Biscardi: 15:51

I like that analogy and, yes, it drains the battery faster. I like to say right.

Dr. Ayla Wolf: 15:56

Yeah.

Melissa Biscardi: 15:58

What are the most common ones you think you see in your practice?

Dr. Ayla Wolf: 16:03

Definitely vergence issues I see all the time, yeah, whether that's issues with convergence or divergence, and I find, you know, when I assess it from maybe straight on, people are fine, but as soon as I start looking at angles, then all of a sudden people start to struggle. And so I do think that you know, with a lot of these standard tests, like you said, they're missing the nuances of well, what happens if your head is turned to the right. You know what and so you know. I have someone this week who came in for a five day intensive and vertical pursuits looked really good. As soon as we moved her into a right yaw, vertical pursuits broke down. And so those subtleties are also important, Because if people know that they don't feel comfortable in a certain head position, that's going to change how they they carry themselves through life and that's going to have consequences. Absolutely, Going back to your PhD that's also focused on ocular motor function. Is that correct?

Melissa Biscardi: 17:05

Yes, and in the PhD we need to have like three studies or three components.

Melissa Biscardi: 17:12

So the first part I did a systematic review of what's out there and it's, you know, it's all in the optometry literature for the most part, for my inclusion, exclusion criteria at the very least.

Melissa Biscardi: 17:26

And you know it was really surprising because there wasn't much out there and even though we know, or we see, at the very least you know how effective it can be, an optometrist use it, or neuro optometrist, but there really has not been a lot published, which I think is one of the reasons why there's, you know, feisty debate about how good it is or whatnot in the medical community.

Melissa Biscardi: 17:54

So, but I did, how good it is or whatnot in the medical community. So but I did, I consolidated the literature to say this is, these are the gaps. And then study two was looking at a sample of people who are seen in the hospital I'm doing the research out of, so like okay, how many of these people are still having visual type issues after 30 days? And then study three, which is the real fun one, is I'm doing a ocular motor rehabilitation intervention delivered in VR, compared to usual care essentially, which is not very much around these parts and the people who are participating are between 30 days and a year post-injury and if they get the intervention, they get six weeks of this sort of oculomotor rehab therapy in VR and then home-based reinforcement on an app, and so it's really cool.

Dr. Ayla Wolf: 18:56

So they're physically going in to get the vr.

Melissa Biscardi: 18:59

Yes, and in I. In theory it would be better if they came in daily and did the vr um, because the vr has more options, but that is just not feasible. So it's like what can we do that is feasible, and then feasible when it translates into practice, because even in the intensive it's like what can we do that is feasible, and then feasible when it translates into practice, because even in the intensive it's five days, but then you do something at home, yeah, and so talk to me talk me through what this virtual reality experience is once they have the goggles on.

Melissa Biscardi: 19:27

Yeah, so it's not immersive in the way that they're not in a grocery store or walking down the street. It's very much following dot targets. We're following a target through a maze. There's one where targets are coming at them like bullets. I'm not sure why they thought that was a good idea.

Dr. Ayla Wolf: 19:52

Yeah.

Melissa Biscardi: 19:53

But actually people love that one because the bullets come and you explode them with your saccades, essentially, and then it gets more challenging and as you become less accurate or slower and not getting it then, um, well, then they end it so you don't explode. Okay, they haven't added that part yet. Um, so there are different sort of trainings for lack of a better word for pursuits saccades, anti-saccades, vor convergence, there is a virtual brock string, so it covers sort of all the foundational eye movements in a simple, but I don't want to say gamified, but a little bit creative way. Yeah, and you can change the settings for difficulty and range. It's not as personalized, as you know. If you had someone in front of you you could really do nuanced angles and rates. But I think it's pretty good and it really can make the rehab more accessible, right, because there are only so many clinical neuroscientists and physiotherapists, especially outside of the major centers. So I feel like there's a role for it.

Melissa Biscardi: 21:15

I know in the previous research not on concussion participants have said they like the VR. Right, it's more engaging, it gives them more motivation than, let's say, sticky notes and such, and so if it's going to give motivation for people to do the exercises at home. I think that, in and of itself, will help get better results. The flip side, though, especially with concussion, is the VR is stimulating, so it's sort of a. You have to find a fine balance. What we're seeing is that people like it, though. So even if you get a little bit of a headache or whatnot, you it's a trade-off people are are willing to have, and I see that in the office too right, I say okay, well, no, I want to do the VR assessment, even if I'm going to feel a little unwell after.

Dr. Ayla Wolf: 22:13

Yeah, and do you find that when people take the goggles off after kind of doing all these different eye movements, that they are a little off balance or dizzy at the end?

Melissa Biscardi: 22:23

Often, I would say the most common and you might see this in office too is sort of eye strain or headache, sometimes a little bit of dizziness, but I would say those are the most common um resolving pretty quickly. And so similar to, I want to say, the protocol used for the treadmill or whatnot, like using a scale. You know how much effort are you exerting, what symptoms are you having, how would you rate them? So not just pushing people as hard as we can, but okay, based on how you tolerated this last time, based on how you tolerated the homework, how far along can we move you?

Dr. Ayla Wolf: 23:03

So they're coming back down to baseline rather quickly.

Melissa Biscardi: 23:06

Yes, I would say so Like less than well. I wouldn't say one minute for most people and then occasionally like up to 10 minutes.

Dr. Ayla Wolf: 23:14

Yeah yeah, which is pretty good. Occasionally like up to 10 minutes, yeah yeah, which is pretty good. I think it was last year, maybe my, uh, my nephew has an Oculus prime and so I put it on for the first time ever, and it was this game where you're a monkey and you had to move your arms in order to move forwards and jump, and I had never done this before. I thought it was so cool and I kept like so all of a sudden, I'm playing it, I'm totally fine. And then boom, it was like instant, intense nausea and it was like, oh, I think I may have overdone it and, um, did you have ever sensitivity before? Two?

Melissa Biscardi: 23:54

screens or after your concussion.

Dr. Ayla Wolf: 23:59

I feel like I've always been pretty good with movement, but I think that I also persevered.

Dr. Ayla Wolf: 24:06

Well, one of the symptoms that I had after my concussions is when I would stop my car, I would feel like my seat was still translating forward, so I'd feel like the car was still translating forward, so I'd feel like the car was still moving forward. So I do think that, even though I'm not afraid of movements and I do a lot of movements and a lot of times I still like spin around in my chair and like do some full body rotation, just as like let's take a break from the screen I do think that perhaps maybe my brain was like perseverating on movement a little longer than it should. Perhaps maybe my brain was like perseverating on movement a little longer than it should. And the thing that surprised me was that that nausea lasted for like four hours after I took the goggles off and I didn't come. So I was like okay with being nauseous, but surprised that I didn't come back down to baseline as quickly as I thought I would after taking them off. That's what I think. That's the thing that surprised me the most.

Melissa Biscardi: 24:56

You know that's interesting. There is some research Actually I think they just published it within the last year about immersive VR like that and people with concussion and exactly having getting some symptoms. So I think maybe that's where the balance is. Maybe using VR in concussion rehab is keeping it very simple. I know you weren't doing rehab, but just Right, yeah.

Dr. Ayla Wolf: 25:25

I agree. I think that definitely throwing somebody in an immersive VR is completely different from just having somebody have the goggles on and having some dots to follow and, yeah, very different.

Melissa Biscardi: 25:38

And I mean the immersive is probably a little more fun, but they need to work up to that.

Dr. Ayla Wolf: 25:48

Exactly, exactly. And I mean they say that for regular people too, that you don't want to just pop a VR on and play for two hours straight.

Melissa Biscardi: 25:52

You got to work up to it, yeah and even some other, like migraine, I think, is a, not a contraindication, but, um, you probably wouldn't want to use it for two hours or really immerse yourself when you're first using it. And I probably some other conditions too, but I know migraine for sure and how big is your study?

Dr. Ayla Wolf: 26:13

how many people are you including in this?

Melissa Biscardi: 26:15

So we need so far we have 43 and I need 62. So I'm actually almost there, which is good. And the biggest study, um, that was in the publication. That wasn't like a retrospective review, I want to say, was only like 12 people. So I'm happy this will I don't want to say make a dent, but it will add. It'll add to the research nicely.

Dr. Ayla Wolf: 26:42

Yeah, absolutely. And if you had endless funding, time and resources, what would be like your next study? What was? What would be the next thing you would want to do?

Melissa Biscardi: 26:53

Oh, that's a good question. Oh, my goodness. Okay. Well, I definitely for selfish reasons, I would want to see how far we could use my app. Like what do people even need the VR? Can we just use something even more accessible? So I say that is maybe one rabbit hole I would want to go to. And then my next step would be making more gamified activities in the goggles. So the goggles are not mine. I didn't make the games in there. It's by a company called Neuroflex, so I'm using the ones they've already designed. I would want to add to the menu, I guess make more gamified ones, because that's what people like, right? So? And then also ones that will give people scores. So like the bullet one tells you how many bullets you exploded, the maze tells you how well you did on the maze. So I feel like if we can give some more fun and positive reinforcement, that would be great.

Dr. Ayla Wolf: 27:58

Yeah, I love that. And then, for people who aren't familiar with your Brain Toolkit app, why don't you talk a little bit about when you developed it, kind of how it's evolved over time and what it has to offer people?

Melissa Biscardi: 28:12

Sure, sure. So the Brain Toolkit app is an app for clinicians and patients and it is for Android and iOS, which was actually the like, the first motivation for it, because I'm an Android user and there just wasn't much out there. So I said, okay, you know, I need a basic app just for pursuit, saccades, opk, hemi-stim. So that was the first edition. It was very bare bones and over time, with feedback from people and just thinking, oh, it'd be nice if I could do this and that, and oh, I guess people need instructions in there. So it's really evolved.

Melissa Biscardi: 28:54

And more recently we improved the user interface, which is great, and it has things for eye movement assessment or intervention, like the basics that I just mentioned. And then it has a few, I want to say, cognitive ones, or you could use them that way, like memory, and there's one where it flashes a random letter so you can be creative with how you use it, random shapes, which I actually use a lot, somehow just being creative. And then recently we put in subjective, visual, vertical assessment, which is great, I want to say, because it gives you an objective angle for the clinician. So some of the things are more clinician targeted, I want to say, but even some of them the patients can use to just sort of assess themselves or assess, you know, do this and send me how it went. Yeah, and it's super easy to use, which I think is important for accessibility, especially when people have a brain injury.

Dr. Ayla Wolf: 30:02

Yeah Well, and it's nice to be able to send patients home with exercises where you're not having to be like OK, I need you to teach your husband how to move his thumbs like this sure, especially with the anti-sicades right when you need an opposite target, or yeah, so I find it's helpful, for sure. Yeah, so it sounds like in your practice you're doing a really lovely combination of both hands-on stuff. You also do acupuncture. We should talk about that too.

Melissa Biscardi: 30:34

It's funny because so I am not as well-versed as yourself in acupuncture. I did the here it's called medical acupuncture, quote unquote. So we learn I want to say it was six months, but not intensive, right? So you go every three weeks for three days and you learn the acupuncture points more related to the nerves, which are the same as the meridians, essentially. So we learn a little bit of the language from Chinese medicine, but I will think about it a little bit differently. But I find that also, it's just, it's such a great tool for people.

Dr. Ayla Wolf: 31:14

Yeah, yeah, I find especially, you know, around the eyes there's so many points that just help to relax the muscles, relax, you know, the the face, but then also helping with headaches so many people with concussions or jaw clenchers, which contributes to the headaches and the eye strain A lot of times. What people will say after a treatment they're like I feel like I can open my eyes wider, so they're not like walking around with kind of the squinty eyes as much.

Melissa Biscardi: 31:43

Oh, I'm glad you raised that point that people are squinting their eyes, because then you have a lot of face tension from that and exactly you come in like that and how great is it if we can work on that before we start working on other things yeah, yeah, absolutely.

Dr. Ayla Wolf: 32:02

And then in terms of the, the manual therapy, um are there for kind of people who are maybe interested in pursuing it? You talked a little bit about the difference between kind of craniosacral therapy versus osteopathic and kind of manual manipulation from an osteopathic perspective. Are there any limitations or contraindications or things that people should be aware of?

Melissa Biscardi: 32:25

One important thing to note is if someone has a lot of autonomic symptoms, like placing pressure on the eyes sometimes can cause a negative response. So I would say, especially if you're trying this at home or just trying it with your patients for the first time, to sort of work around the eyes or make sure that, like I would say for POTS probably not the greatest thing or other people that are having just their nervous system up and down, heart issues we don't want to put a lot of pressure on the eyes, so just safely working around those tissues. That would be the major contraindication.

Dr. Ayla Wolf: 33:10

Let's go back to the research that you did on women and concussions and a specific hormone, the anti-malarian hormone or AMH, and talk a little bit about why you decided to focus on that particular hormone. What was the study design? What did you find? What did you discover?

Melissa Biscardi: 33:31

Sure. So when I started my master's I didn't come up with this idea. I came in to this research lab and my supervisor, dr Cole Antonio, she had the idea to look at. Okay, we know women have disruptions in their periods, or some women do after concussion, and sometimes this lasts for years, sometimes they don't have their period for years or months. Could this actually be affecting time to menopause? Which we didn't know and we still kind of don't know.

Melissa Biscardi: 34:06

But how we wanted to test that then with an objective marker was with anti-malarian hormone, which is ovarian reserve or time to menopause. So we recruited people from the same hospital that I'm recruiting from now, but a different area, and we did one blood, blood test to measure their levels. And I mean, my sample was only 10 people, so we can't say too much Um, but there were definitely changes, I want to say, versus the norms for the, the women, like the women's age, and in those 10 people, definitely everyone was having some sort of um menstrual irregularities since their injury. So I want to say it's, it's a possibility that it's related. Um, what I've seen clinically is that women who are close to menopausal age and tell me if you've seen this as well sometimes the injury can push them into menopause, or that's what it looks like from the clinical perspective.

Dr. Ayla Wolf: 35:23

I think it's worth keeping an eye on. Did you also look at FSH levels?

Melissa Biscardi: 35:29

We didn't. I know I wish we did actually. So if I had unlimited funding I would actually. So the only reason I didn't do that study on a bigger scale for my PhD, or not the only reason but one is that I can't as a practitioner, translate that into my clinical practice, like I can't order blood tests or do any sort of interventions related to those findings. So I thought, clinically the other research I was interested in and also made more sense, but I really wish someone would finish that study or do it with a fully powered sample.

Dr. Ayla Wolf: 36:07

Right. I mean because if you're finding abnormalities even in that one particular hormone in just 10 people that have symptoms, that really seems like somebody does need to pick up that mantle and keep running with it and doing more research and figuring this out, because there are lots of women of childbearing age that probably want to have more children and need to know if a concussion could potentially interfere with that, yeah yeah, and the mean age for concussion in women is 31.

Melissa Biscardi: 36:39

So it's like right when many are trying to conceive, are planning to. So maybe when I'm done my PhD, maybe I'll pick that up for a postdoc.

Dr. Ayla Wolf: 36:52

Yeah, yeah, well, okay, so one of the fascinating things that I noticed kind of at the intersection of fascinating things that I noticed, um, kind of at the intersection of, you know, I was working in fertility for a long time. Then I started studying neurology and when I started learning about primitive reflexes, I started to recognize that a lot of my, uh, female patients that were having trouble getting pregnant still had primitive reflexes, like a spinal gallant, and I was like, well, this makes perfect sense. If somebody still has a primitive reflex, it means a part of their brain is stuck, it hasn't fully developed. So of course their brain is like I'm not ready to have babies, I'm still stuck in this primitive reflex pattern. Wow, yeah, so I think that's a whole nother avenue that needs to be explored. And so how?

Melissa Biscardi: 37:40

did you yes, when you're working with those patients, what kind of outcomes did you see on the other?

Dr. Ayla Wolf: 37:47

end. You know there's like the traditional classical spinal gallant test. What I would find because as an acupuncturist you're often palpating people's backs and you're inserting needles so what I would see is that a lot of these women had incredibly ticklish backs where so as soon as you touched them, they had kind of a startle response and they'd would call kind of a functional finding of like more of this, like subtle response in terms of just having somebody, you know, lightly palpate your low back. But I definitely would see that kind of hip hike, you know spinal gallant type pattern and I found over time, you know, just with doing the acupuncture, that that would go away, and then I did have really good outcomes. You know, doing a combination of acupuncture, that that would go away, and then I did have really good outcomes. You know, doing a combination of acupuncture, herbal medicine.

Dr. Ayla Wolf: 38:43

Many of these women were also, you know, seeking out reproductive medicine at different fertility clinics too. So there were many different scenarios, whether they were doing it just, you know, like working on things in my clinic or also doing IUIs or IVF. So lots of different scenarios. But that concept of finding these primitive reflexes or some subtle variation of it felt to me like it was important and needed to be explored.

Melissa Biscardi: 39:13

Absolutely, and that's Lord, absolutely, and that's it's really fascinating, because we know that IVF is not 100% or any of the uh, let's say medical approaches, and so I feel like in combination that's so much more powerful. Right, you're finding something that actually might be the reason why things are not being so successful on the other end, but together, yeah, you might have some babies, absolutely, absolutely Well.

Dr. Ayla Wolf: 39:50

So switching gears, cause I know you have a black belt in jujitsu, and is that how you got your concussion? Cause I know you also had a concussion.

Melissa Biscardi: 39:55

Is that how you got your concussion? Because I know you also had a concussion. So I actually this is a very how I got into concussion work is I had a concussion, but that's not why, like what led me to being interested in the brain. Can I tell that story? Tell that story, yeah, okay, I think people will be interested. Um, so I well, I've had sleep issues forever, and then actually, when I was in osteo school, I while I needed to sleep and so I started to take sleep ease, which in Canada is the same as Benadryl over the counter, and at first I just took a sprinkle, cut the pill, you know, in four, and then I had half.

Melissa Biscardi: 40:39

Then I don't know if I ever went to a hole, but I was doing it every night. And then I was losing my memory, or my started to lose my memory. How old were you at this time? Okay, so I would have been, let's say, 30 ish, yes, 30, 31. And I, I, yeah, so I'm losing my memory. So I started slowly, but then it was very noticeable to me Like I was well not remembering things that I learned, but not because I wasn't paying attention, like I would just have no recollection of learning something, or even seeing it, and then I started to get facial blindness, where I just wouldn't recognize people, and everyone was just like, oh it's nothing, oh it's stress.

Melissa Biscardi: 41:28

You know the whole invisible injury thing, um, and I'm a medical practitioner, so I was able to access everyone. You know, I had MRI, I had the great sports doctor look at me and no one was asking the right questions. That's really what it came down to. Um, and I just happened to be chatting Actually it relates to jujitsu because I was chatting with and no one was asking the right questions. That's really what it came down to. And I just happened to be chatting Actually it relates to jujitsu because I was chatting with a teammate about sleep and then he said oh, did you hear about that study that showed that Benadryl is associated with Alzheimer's? And I was like, no, I haven't seen that study actually. And then I was like, holy crap, this is what is happening in my brain.

Melissa Biscardi: 42:09

So then of course, I had to change a few things and then, slowly, my memory started. You know, now I want to say it's fine, but who knows? But it's definitely back to, I want to say, a functioning normal. Um, so that's how I got interested in invisible injury, for sure. And then I wanted to say, maybe two or three years later then I got a concussion. I was already in the concussion world for lack of better language, so I went right to the best in the city. I feel like I had a good start on it, but I also feel like I had an unremarkable concussion. So I got foot in the face or whatever, a heel on the head. I had some symptoms, but within a few weeks I was, I was, I was back to jujitsu and life Got it.

Dr. Ayla Wolf: 42:58

So, going back to the Ben and Jill thing, when I was writing the sleep chapter in my book, I was doing a lot of research to see what the more recent research was saying, because I remember back in like 2016, 2017, that was when those headlines were coming out If I'm remembering the dates correctly. For sure, that's around the same time.

Dr. Ayla Wolf: 43:19

And yeah, and so I felt like for a moment there that was in the spotlight, and then it was like nothing happened. Nothing happened, there weren't I mean, there wasn't any new like laws or rules or anything Funny how that happens.

Dr. Ayla Wolf: 43:38

And so it's like, oh hey, by the way, benadryl can like really cause dementia and, you know, affects your brain if you take it every night. And then all of a sudden everything went quiet, never heard about it again, people went on with their lives. So as I'm writing my book, I was like, well, let me just see if there's new research out and in fact there was, and there was this really large study that took place in france and they looked at people's use of benadryl and they categorized it as like no use, low use, moderate use and high use, and they were actually able to show that like the people who were using Benadryl more frequently had indeed, you know, like more risk of having dementia, and so they even showed this like dose dependent nature to using it.

Melissa Biscardi: 44:21

But I'm like, but now nobody's talking about it anymore and I was like this makes me so mad. I'm like I try and mention it to my patients because it comes up especially around allergy season. So I'm pretty adamant about it because even when patients come in and they'll be having memory loss but or issues, and their brain is in a like that blood-brain barrier is more permeable. So it's even, I want to say, worse to take it when you have a concussion and then also, people don't know Benadryl is sleepies, right, like we have the same chemical that is put in different boxes with different names. So, yeah, I feel like we have a big responsibility to educate as much as we can. Yep, absolutely. And so tell me about you and your martial arts life.

Dr. Ayla Wolf: 45:22

Okay, well, I started out doing kickboxing and taekwondo when I was 15. And my very first concussion was when I was 18. I got kicked in the head, and I would say that I recovered from that very quickly, to my best of recollection, um, minus what I would say was like permanent change in my hearing. Um, so when I'm in loud environments, I can't hear the people in front of me very well, I can't make out what what the people are saying, and that's been there ever since that particular injury. Um, but the really sad thing was that that so I got my black belt in taekwondo and I immediately had major imposter syndrome where I just felt like I have this black belt and I don't deserve it, and even though I can do 20 tornado kicks in a row, if somebody like got me on the ground I'd be totally useless, yep.

Dr. Ayla Wolf: 46:25

And so I was like, okay, I got to go learn jujitsu. And so I started training jujitsu, but that was during my master's program and I had the opportunity at the jujitsu school to teach the kickboxing classes. And so, as a broke master's student, I was like, do I make money or do I spend money? And I didn't have time to do both, so I ended up stopping the jujitsu, which in hindsight I wish I hadn't. So then I taught kickboxing for a while, and then in my 30s at this point I was living in Oregon I decided to start training again. Only I went from. So when I was younger I did gi, and when I started back up I did nogi. So I trained nogi for a long time, pretty consistently.

Dr. Ayla Wolf: 47:15

but that was also at the peak of my kind of post-concussion syndrome, and so the sad piece of it was that I was showing up to class every day and I wasn't remembering anything like you were saying before Right and and so I was really struggling and I also was in a really bad training environment where I was like the only female and a lot of the guys were younger than me and they were bigger and stronger and they just lock me up into a body triangle for four minutes. Oh my gosh, that's the worst I know. I'm like I'm not learning anything, trying to struggle out of your 200 pound body triangle and so you're not learning anything either right, yeah silly it is, yeah.

Dr. Ayla Wolf: 48:02

So I was in bad environment. It was not conducive to my own learning. My head injury was not conducive to my own learning and I but I mean I was like full on doing MMA, I was studying like takedowns, I was doing sparring, I was doing jujitsu no gi and I went to a couple of jujitsu tournaments and at one point one of my friends who taught jujitsu and had his own school, he just looked at me and he goes you don't want this as bad as these other people that you're competing against. And he was right, because I was 35 years old, I owned my own business, I was working full time. I wasn't out for blood like some of these 21-year-old females with a chip on their shoulder were at the time.

Dr. Ayla Wolf: 48:52

And so this, like a whole MMA scene back then, was very just cutthroat and some of these girls were, you know, a little nasty Like they. Just they didn't care if they injured you, they just wanted to win and prove themselves. And again, coming from a healthcare background, I didn't want to go in and give other people concussions, or you know. I just so he was right, you know, he just looked me dead in the eye and he said you don't want? Uh, so I, I kept training, but with a different attitude, right, um, I actually got out of the no gi and I started training gi again, um, at his school and it which was hilarious because no gi is so much faster, and so he just kept screaming at me slow down, slow down, slow it down. Um, yeah, so between all the back and forth of gi, no gi, mma, to just straight jujitsu, like I was just kind of all over the place, um, and then eventually I um had a back surgery. I had to have a fusion in my low back. I tried to go and at this point I'm now living in Dallas, texas, and I'm at a much more professional gym environment with great people but after my back surgery I think I tried to go back to jujitsu a little too soon.

Dr. Ayla Wolf: 50:17

It was about five months afterwards and I remember getting stacked up and twisted and my back just kind of went and I was like, oh, this is not, this is not good. And then a week later I got need in the head accidentally and a lot of my concussion symptoms came back, and so I was like, okay, between the back surgery and the low back issue and then getting like the concussion symptoms again. That was finally when I was like, okay, I'm just going to do kickboxing, but I'm not going to spar, I'm just going to train, like let me just take myself out of all of the potential head impact scenarios. But because I love it so much, fast forward 2018,. I'm like you know what? Let's go back, let's do this.

Dr. Ayla Wolf: 51:04

And so I started doing it. It is yeah. And so I started doing private MMA lessons with a MMA with a former UFC fighter. She had retired at the time, and so I was in a session with her and she was like giving me cues, just cue, cue, cue, cue, like justice and justice, and it was just like rapid fire cues. And all of a sudden my brain just went and it just paused for like half a second and in that half a second she clocked me right between the eyes and I all my concussion symptoms came back again.

Melissa Biscardi: 51:39

And so again it's like all right, okay.

Dr. Ayla Wolf: 51:41

How many times does the universe want to tell me Like I can't, I can't do this anymore. I have too much on the line with my career.

Melissa Biscardi: 51:50

It's tough though, when yeah, when you like something a lot and it makes you feel good in some ways, you get the endorphins, the physical activity. So I can see why you have going back.

Dr. Ayla Wolf: 52:05

Yeah, I mean when, when you do something for 20 years, you know it becomes part of your identity. And I think that's that's a big part of why it's hard for fighters to retire, or you know, it's like their whole identity is wrapped up in themselves as a, as a competitor, and I get that. I mean, how many concussions did it take until I was finally like okay let's do CrossFit instead.

Melissa Biscardi: 52:28

I didn't know we had so much in common and I actually have hearing loss, so, but that's a whole other episode. So, yeah, so we have. We're in busy places. Same thing I have trouble hearing people and I never realized how. I don't want to use the word severe, but I'll throw it in like how severe the loss was until COVID, because people would come in wearing masks. And then I realized, oh my gosh, I'm relying quite a bit on actually seeing people's lips move and I just didn't realize it.

Dr. Ayla Wolf: 53:02

So, yeah, that clued you into like the severity of it.

Melissa Biscardi: 53:06

Oh interesting.

Dr. Ayla Wolf: 53:08

And was your hearing loss from a concussion or something different? No, I think so.

Melissa Biscardi: 53:14

It happened in the beginning. I didn't really even notice it. It was. It's kind of similar to the, to the memory thing like asking people to repeat themselves, or is that actually loud or not? But I think it was from antibiotic use, okay, because I had lots of strep and basically just strep, but multiple times a year when I was growing up. So I feel like it might've been that.

Dr. Ayla Wolf: 53:40

Sure, just an ototoxic antibiotic that killed some hair cells.

Melissa Biscardi: 53:45

All the medications are getting me basically yeah, on the other side, like that's good to know, right, because often we take things and don't look at the fine print or maybe are not as informed as we could be.

Dr. Ayla Wolf: 54:03

Right. And it's so hard when you're like okay, well, this is a known side effect, but it's not a common one. And so it's like how do I even weigh the pros and cons of do I take this or not? Based on what I know, it's not an easy decision for anybody, For sure, For sure. Oh gosh. Well, is there anything else we haven't talked about that you want to cover?

Melissa Biscardi: 54:26

well, actually, yes, the fact that, just to remind people that we're both talking at, we shine, yes september 1st.

Dr. Ayla Wolf: 54:38

So the we shine is a virtual symposium that is all female, female led and female, all female speakers. So, yeah, I'll put a link to the show notes to the conference. Yeah, awesome. And so I'm curious so what are you doing on a daily basis for your brain health?

Melissa Biscardi: 55:00

That's a good question. So I always get movement in, like now I like to run, that's how I get my endorphins that I don't get from jujitsu. And I use the red light, maybe not every day, but a few days a week, and I try and do some mindfulness. But I would say for me, right, mindfulness, oh yeah, nevermind, I just started a big gratitude poster, so not every day.

Dr. Ayla Wolf: 55:27

Is that what's in the background there?

Melissa Biscardi: 55:29

That's a different thing that I do, but it's almost the same. It's like things that I want to remember that happened through the year, and this is like my third year of doing it and it's really cool because then you just have a stack of post-it notes and yeah, so there's that stack of post-it notes and, um, yeah, so there's that a lot of gratitude and reframing things as um on either the positive, or I get to do this, or wouldn't it be fun if this happens, or if I could do this instead of like, oh my God, I can't believe I have to write my thesis. Yeah, and I try and eat healthy, but I'm definitely not perfect. Oh, and sleep, yes, I make sure I get as much, you know, eight hours sleep, if I can.

Dr. Ayla Wolf: 56:16

Absolutely Awesome. Movement, sleep, gratitude, yeah, goes a long way. Absolutely Well. Thank you so much for coming on the show. Do you want to let people know where they can find you? I mean, I'll put the link in the show notes too. But what are the best ways to contact you or reach out to you?

Melissa Biscardi: 56:35

I would say all the fun stuff happens on instagram, which is easy to remember. It's conrehabca is my little handle and, yes, find me there and if you have questions, comments. I love to talk to people and it's going to make me live longer.

Dr. Ayla Wolf: 56:56

Perfect, okay, good. Well, I'll put all that in the show notes and thank you again, and maybe once you wrap up your research we'll have you back on the show. We can talk about that too, once you get all your participants through and crunch some numbers.

Melissa Biscardi: 57:11

Awesome, I'd love that.

Dr. Ayla Wolf: 57:12

Cool. All right Well have a good night, you, too. Medical Disclaimer this video or podcast is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No doctor patient relationship is formed. The use of this information and materials included not intended to be a substitute for medical advice, diagnosis or treatment, and consumers of this information should seek the advice of a medical professional for any and all health related issues. A link to our full medical disclaimer is available in the notes.