Functional Neurology Explains Why Concussion Symptoms Spiral
- Ayla Wolf
- 2 days ago
- 4 min read
One of the most frustrating experiences for people with persistent post-concussion syndrome is being told:
"Your CT scan is normal."
"Your MRI is normal."
"Everything looks fine."
And yet, they still can't tolerate busy environments. They still get dizzy in grocery stores. They still struggle with headaches, brain fog, light sensitivity, fatigue, anxiety, and cognitive overload - and it's not getting better with time.
If everything is normal, why do they still feel broken? Dr. Matt Antonucci and Dr. Kenneth Jay published a paper in the scientific journal Frontiers in Systems Neuroscience (Jan 2026) that outlines a model to explain this exact question.
The Problem With Traditional Models
Modern neurology excels at identifying structural problems.
A tumor. A stroke. A hemorrhage. Multiple sclerosis.
These conditions produce visible changes on imaging.
But what about the millions of people whose symptoms are clearly neurological, yet whose imaging appears normal?
Dr. Antonucci estimates that as many as 1.3 billion people worldwide may fall into this gap—individuals with neurological dysfunction that cannot be adequately explained by structural imaging alone.
This includes many people with:
Concussion
Migraine
ADHD
Autism
Dysautonomia
Persistent dizziness
Sensory processing disorders
Functional neurology attempts to bridge this gap by focusing not only on brain structure, but on how neural networks function.
The Brain Is a Network, Not a Collection of Parts
Traditional neuroanatomy often teaches the brain in isolated regions.
The frontal lobe does executive function.
The occipital lobe processes vision.
The temporal lobe processes sound.
While this is useful, it doesn't reflect how the brain actually works.
The brain functions more like a network.
Every experience depends upon communication between multiple regions simultaneously. Vision is not simply an occipital lobe activity. Balance is not simply a vestibular activity. Attention, emotion, movement, and cognition all emerge from communication between interconnected neural networks.
When those networks become disrupted, symptoms emerge—even when the structures themselves remain intact.
Why Concussion Symptoms Can Spiral
One of the most fascinating concepts discussed in the episode is the idea that concussion symptoms don't simply persist—they can evolve.
Dr. Antonucci describes concussion as a disorder of maladaptive feedback loops.
The brain receives sensory information.
It processes that information.
It generates a response.
Then it receives feedback about that response.
When the brain is functioning normally, this cycle allows for constant adjustment and optimization.
After a concussion, however, the processing may become distorted.
Normal sensory information can produce abnormal outputs.
Those abnormal outputs generate abnormal feedback.
The abnormal feedback is then fed back into the system, creating a self-reinforcing cycle.
Over time, the nervous system can become trapped in these loops, causing symptoms to intensify, spread, and become increasingly complex.
Neuroplasticity Is Not Always Your Friend
Most discussions of neuroplasticity are overwhelmingly positive.
And often, that's true.
Neuroplasticity allows us to learn new skills, recover from injury, and adapt to change.
But neuroplasticity itself is neutral.
The brain will strengthen whatever pathways are repeatedly used.
That can be beneficial.
It can also reinforce dysfunctional patterns.
Dr. Antonucci compares this process to an airport closure.
If one route becomes unavailable, traffic gets rerouted elsewhere.
Initially, this adaptation is helpful.
But over time, the alternative route becomes the new normal.
The original pathway weakens, while compensatory pathways become deeply entrenched.
This may help explain why some patients develop chronic symptoms long after the initial injury has resolved.
The Cerebellum: The Brain's Master Coordinator
One of the key nodes in the NERD model is the cerebellum.
Most people think of the cerebellum as a structure involved in balance and movement.
But modern neuroscience has revealed that its role is far broader.
The cerebellum acts as a predictive calibration system.
It constantly compares incoming information with expected outcomes and helps coordinate:
Movement
Balance
Emotion
Attention
Cognition
Speech
Autonomic regulation
When cerebellar processing becomes disrupted, patients often describe feeling disorganized rather than incapable.
They can still think.
They can still move.
But everything feels harder, slower, less coordinated, and less automatic.
Why Grocery Stores Are So Difficult
Many concussion patients describe a common experience:
"I'm fine at home."
"But the moment I go into a grocery store, everything falls apart."
This is where the concept of load becomes extremely important to understand.
When demands on the nervous system increase, hidden vulnerabilities become exposed.
Bright lights.
Crowded aisles.
Moving people.
Visual complexity.
Decision-making.
Background noise.
All of these increase processing demands.
A nervous system operating near capacity may appear functional under minimal load but begin to fail when demands increase.
This explains why many patients can manage basic activities at home but struggle significantly in busy environments.
Neck Pain, Dizziness, and Sensory Compensation
One particularly interesting discussion centered around neck pain.
Many people assume chronic neck tightness is the primary problem.
But what if it's actually a compensation?
Dysfunctional vestibular integration may cause the nervous system to tighten neck musculature as a protective stabilization strategy.
The tight neck then becomes part of the feedback loop.
The result?
Chronic tension
Headaches
Dizziness
Increased sensory sensitivity
Treating the neck alone may temporarily reduce symptoms while failing to address the deeper dysfunction driving the compensation.
A New Way to Think About Recovery
One of the most powerful statements from the episode was this:
"The nervous system does not descend into chaos. It reorganizes into new, often less efficient but stable configurations."
That sentence may fundamentally change how we think about persistent post-concussion syndrome.
Patients are not broken.
Their brains are adapting.
The problem is that the adaptations may no longer be serving them.
Recovery may not require simply reducing symptoms.
It may require helping the nervous system reorganize itself again—this time toward more efficient and resilient patterns.
The Future of Functional Neurology
The NERD model is still a theoretical framework, but Dr. Antonucci and his colleagues have already completed a randomized controlled trial comparing the model against standard concussion care, with publication expected soon.
If validated, this work could represent an important step toward a more comprehensive understanding of concussion, neuroplasticity, and functional neurological disorders.
More importantly, it offers something many patients desperately need:
A framework that explains why symptoms persist—and a roadmap for how recovery may still be possible. I'm honored to call Dr. Antonucci one of my mentors and teachers, and his work has greatly influenced how I approch patient care in my clinic.
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