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Frequently Asked Questions

01. What is MedTrak Diagnostic’s technology?
  • Videonystagmography (VNG) manufactured by its sister company, MedTrak VNG, Inc.
  • Posturography (aka FallTrak II) trade-marked and distributed by MedTrak VNG, Inc.
  • Computerized Neurocognitive testing distributed by MedTrak’s affiliate Braincheck, Inc.
02. What is the VNG + testing battery?
VNG, posturography, computerized neurocognitive objective testing and several other special screening tests.
03. What are the special screening tests in the VNG+ battery?
  • The Romberg balance test (always included)
  • The Fukuda marching test (always included)
  • Near point convergence testing (always included)
  • Eye disconjugacy testing (always included)
  • Weber Rinne hearing testing (occasionally included)
  • University of Pennsylvania smell testing (occasionally included)
04. Will the patient experience any side effects as a result of undergoing VNG+ testing battery?
  • No. there are no permanent side effects from any of the testing battery

  • During the test, we attempt to recreate dizziness, so the patient may experience some dizziness for about 15-60 seconds
05. What is videonystagmography (VNG)?
  • VNG is an FDA 510K Class II medical device that is non-invasive and non-pharmaceutical

  • For VNG testing, a patient wears an infrared goggle system which monitors both voluntary and involuntary movements of the eye (such as nystagmus), without interference from ambient light, during various types of stimulation such as visual, positional and inner ear calorics

  • Stated simply, the computerized VNG goggle system camera locks onto the pupil of the eye so that any movement can be detected, measured and recorded (no matter how small). The goggle shines infrared light on the eye which is undetectable so that the brain perceives that the eye is in the dark. This eliminates ambient light induced distractions and eliminates the ability of the brain to utilize ambient light in order to suppress any involuntary movements that may be elicited during the testing stimulations, including nystagmus.

  • The VNG computerized testing protocols are more commonly known as oculomotor, vestibulo-ocular reflex, Dix-Hallpike, positional and caloric irrigation trials

  • VNG test results objectively measure and record specific locations of brain dysfunction, and the extent of injury for the central vestibular nervous system (brain) and the peripheral nervous system (inner ear)

  • VNG test results provide clinicians with the ability to make objective assessments and finalize the diagnosis of a patient’s brain and peripheral vestibular injury
06. Does the Medicare Physician Fee Schedule have CPT codes for VNG?
  • Yes

  • VNG and ENG (VNG’s predecessor) CPT codes have been are part of CMS’s fee schedule for decades
07. What is nystagmus?

Nystagmus is an involuntary and uncontrolled repeating oscillation of the eyes which contain a continuous slow component movement in one direction and fast component movement in the opposite direction. Depending upon which trial of the VNG test is being performed, the presence, absence and/or ability to suppress nystagmus can be indicative of an injury and/or dysfunction of the central vestibular nervous system (brain) and/or the peripheral nervous system (inner ear)

08. Can a VNG test show a false positive?
  • No

  • The eye movements being monitored and measured by computer analysis are involuntary and CANNOT BE FAKED
09. Can VNG technology determine if a patient is putting forth their best effort or malingering?
  • Yes 

  • During VNG testing, the patient’s eye is monitored by computer and a printable graph recording is created measuring the distance, slope and time required for any eye movements, whether voluntary or involuntary. 

  • Involuntary eye movements, such as nystagmus, are absolutely impossible to “reproduce or fake” because of the extreme consistency of the slow and fast component eye fasciculation which repeats over-and-over in micro rotational graph slopes.

  • Voluntary eye movements, analyzed during the oculomotor section of the VNG trials, are measured and recorded by computerized graphing. The patient must put forth their best effort in order for the graph recording to consistently repeat over-and-over during a 30 second period. An example would be that the time lag (known as latency) of the voluntary eye movement known as saccades would be exactly the same time lag, measured in hundredths of seconds, repeating over-and-over (such as .35, .35, .35 seconds) during the entire test trial. Humans are absolutely incapable of this type of time lag accuracy
10. How long has VNG technology been around?

The first FDA 510 was granted to the company that is now MedTrak VNG, Inc. in 1984

11. Who interprets the VNG data?

Board certified neurologists

12. How long have MedTrak’s expert consultants been interpreting VNG data?

Since 2004 through MedTrak’s sister company Interpra, Inc. (reporting software system)

13. How many VNG test results has the MedTrak team interpreted through Interpra?

Hundreds of thousands of patients

14. Does MedTrak’s Interpra system have the largest repository of VNG data in the world?

Yes

15. Are VNG age-matched normative values well-established and peer reviewed?
  • Yes 

  • In fact, recent studies conducted by major universities, medical schools, and the United States military have concluded that the normative values are so accurate that it is not necessary to do baseline testing prior to the injury.
16. Is VNG a well-established and peer reviewed medical technology?
  • Yes 

  • VNG has been studied, researched, and the subject of thousands of peer-reviewed publications for decades. VNG testing is considered the “gold standard” for testing the central vestibular nervous system (brain) and the peripheral nervous system (inner ear)
17. Have court precedents, including Daubert, been established for using VNG+ technology for providing testimony in brain injuries cases?
  • Yes 

  • State and Federal courts began allowing VNG+ medical experts to testify in brain injuries cases several years ago

  • Administrative Law Judge decisions are being published which provide for the acceptance of VNG+ test results to stand alone (without the need for other types of testing) as proof of the existence of brain injury
18. How many law firms are currently using MedTrak’s VNG+ brain injury testing and reporting?

Hundreds of law firms in multiple states

19. Has VNG+ testing been successful in settling and/or litigating brain injuries cases?
  • Yes

  • MedTrak provides a list of legal, medical and university references for attorneys who would like to hear about the success of VNG+ in brain injury settlements and litigation
20. Estimated dollar figure for settlements made for traumatic brain injury cases in which MedTrak has been involved for the last 2 years?

More than 50 million dollars ($50,000,000)

21. Can VNG results be used to assist rehabilitation professionals with treatment regimes?
  • Yes

  • VNG test results provide rehabilitation specialists with quantitative objective measurements which can be utilized to customize and modify treatment regimes for brain injured patients
22. How many clinicians use this technology in the United States?

Thousands of medical groups and private practitioners currently use the technology, sold to them by MedTrak

23. Do Hospitals and Universities use this technology?
  • Yes
     
  • MedTrak provides equipment, technical and clinical support to hospitals and universities
24. Does the United States military use this technology for brain injuries?
  • Yes
     
  • MedTrak provides equipment, technical and clinical support to the US military
25. How many states have practitioners who use MedTrak technology?
  • All 50 

  • Also, Washington DC, Puerto Rico, Canada, and military bases overseas
26. What is Posturography?
  • Posturography is a medical device that is non-invasive and non-pharmaceutical

  • For all Posturography testing, the patient stands on a “computerized” force plate with an electronic sensor monitoring system

  • The patient performs the static Posturography tests known as the modified Clinical Test of Sensory Interaction on Balance (mCTSIB) and the Limits of Stability (LOS) test

  • For the mCTSIB test, the patient is asked to try to hold their balance steady with eyes opened on a stable surface, then with eyes closed on a stable surface, then with eyes open on an unstable (perturbed) surface and finally with eyes closed on a perturbed surface 

  • The computerized mCTSIB test objectively measures and records all movements and the velocity of all movements and assists the clinician in determining any dysfunction within any of the three (3) systems of balance and equilibrium (visual, vestibular and proprioception- somatosensory) 

  • For the LOS test, the patient stands on a stable surface and the computer provides a systematic guide for the patient to move around their center of gravity

  • The computerized LOS test objectively measures and records a patient’s ability to move in terms of distance required, time required and velocity of the movements

  • Both the mCTSIB and LOS test accurately measure patient movements in distance (hundredths of an inch), time (hundredths of a second) and velocity (hundredths of inches/second) and the results are compared to age-matched normative values

  • Posturography test results provide a clinician with the ability to make a quantitative objective assessment of the patient’s balance and coordination dysfunction and differentiate between visual, vestibular and somatosensory pathology
27. Does the Medicare Physician Fee Schedule have CPT codes for Posturography?
  • Yes

  • Posturography CPT codes have been are part of CMS’s physician fee schedule for decades
28. Are the age-matched normative values for posturography well establish and peer reviewed?

Yes

29. Is Postuography a well-established and peer reviewed medical technology?
  • Yes

  • Posturography has been studied, researched and the subject of hundreds of peer-reviewed publications for decades. Computerized Posturography testing is considered the “gold standard” for testing balance and coordination
30. Have court precedents, including Daubert, been established for using Posturography technology for providing testimony in brain injuries cases?
  • Yes 

  • State and Federal courts began allowing VNG+ (which includes Posturography) medical experts to testify in brain injuries cases several years ago

  • Administrative Law Judge decisions are being published which provide for the acceptance of VNG+ test results to stand alone (without the need for other types of testing) as proof of the existence of brain injury
31. Can Posturography results be used to assist clinicians with treatment regimes?
  • Yes

  • Posturography test results provide rehabilitation specialists with quantitative objective measurements which can be utilized to customize and modify treatment regimes for brain injured patients
32. What is the Braincheck neurocognitive test?
  • Braincheck is an FDA registered, Class II medical device that is non-invasive and non-pharmaceutical

  • For testing, the patient is supervised and accesses Braincheck’s web-based portal to perform the neurocognitive trials
     
  • Braincheck is a computerized neurocognitive testing system that utilizes small tasks and standardized methods to directly and objectively measure and record brain function such as reaction time, eye-hand coordination, visual processing, visual attention and neural fatigue, cognitive interference, executive function, mental processing and memory
33. Does the Medicare Physician Fee Schedule have CPT codes for Computerized Neurocognitive testing?

Yes

34. Which major medical school developed the Braincheck neurocognitive test?

The Eagleman laboratories at Baylor Medical School has been researching brain injuries for decades and have provided this computerized neurocognitive exam in collaboration with Texas Medical Center

35. Are the age-matched normative values for Braincheck well establish and peer reviewed?
  • Yes

  • In fact, Baylor Medical School has been instrumental in creating the age-matched normative data for computerized neurocognitive testing
36. How specific are the Braincheck neurocognitive test results?

Braincheck’s computerized algorithms are so specific that they are able to determine whether a patient has put forth their best effort, thereby eliminating the potential for malingering

37. Can Braincheck results be used to assist clinicians with treatment regimes?
  • Braincheck results provide quantitative objective measurements and can therefore be used by rehabilitation professionals to customize and modify cognitive rehabilitation regimes
38. What kind of practitioner specialists are on the MedTrak’s team of expert consultants?

Board certified Neurology, Otology/ENT, Physiatry, Anesthesiology and Physical Therapy

39. Is MedTrak’s team of consultants available for depositions and court testimony?
  • Yes

  • All of the MedTrak experts are experienced at providing testimony and are available for both in-person appearances and/or tele-conferencing
40. What types of brain injuries can the VNG+ testing battery be used for?
  • Mild Traumatic Brain Injury (mTBI) also known as a concussion

  • Moderate and severe traumatic brain injuries

  • Anoxia

  • Noxious chemical exposure
41. What are the ten (10) most common uses for the VNG+ testing battery?
  • Motor vehicle collisions

  • Assaults cases

  • Premise cases

  • Blows to the head

  • No-head-contact Incidents involving violent movements to the neck and/or body

  • Exposure to blasts

  • Drowning

  • Suffocation

  • Exposure to noxious chemicals

  • Sports injuries
42. How many possible subjective complaints/symptoms can a brain injured patient experience?
  • 39

  • A full list can be found on the website at www.medtrakdx.com

  • On this website, just below “Traumatic Brain Injury (TBI) – the silent epidemic” click on the link that says: DOWNLOAD Case Manager Brain Injury Check List
43. Does every subjective complaint/symptom correlate directly to the objective test results?
  • Yes 

  • The VNG+ testing battery objectively identifies the specific brain lobe involvement. This allows medical practitioners to specifically correlate patient symptomatology directly to the damaged portion of the brain. This can be extremely useful in dispelling the notion that a patient might be inventing symptoms or malingering
44. Is a mild Traumatic Brain Injury – aka a Concussion a structural injury or a metabolic injury?

A mild traumatic brain injury (mTBI) which is also known as a concussion is a METABOLIC INJURY. It rarely involves damage to the structures of the brain. The injury occurs directly to the neurons, axons and dendrites in the brain and it can also involve the inner ear peripheral vestibular system

45. Why don’t MRI’s, Scans, Ultrasounds, X-rays or Tomography usually help with mild traumatic brain injury diagnostics?

All of these devices were created to analyze structural deficits. A mild traumatic brain injury rarely involves damage to the brain structures

46. How long after a brain injury can a patient undergo the VNG+ testing battery?
  • Patients should wait at least 3 days after sustaining a brain injury

  • There is no post-incident time limit. Brain injuries are permanent and the VNG+ testing battery will identify the area and extent of the injury at any time frame post-injury
47. Can the testing verify permanent impairment and disability?
  • Yes

  • Once a brain injury has been objectively identified, the determination of permanent impairment and disability has been established. Workers compensation board rules vary between states; however, this testing has been utilized to finalize percentage-disability determinations

  • For personal injury claims, once the determination of brain injury has been established, the patient will not recover certain motor and/or cognitive functions (permanent disability) and the only rehabilitation techniques available are those of compensation and coping. The brain injured patient should anticipate an impending downgrade in their lifestyle and future fall injuries associated with the expected vestibular, motor and/or cognitive declines
48. How can the VNG+ battery determine causation if there was a previous brain injury?
  • The VNG+ testing battery accurately and objectively identifies the areas and extent of any brain damage

  • The VNG+ testing battery accurately correlates a patient’s subjective complaints directly to the objective findings

  • A patient who has sustained a brain injury will have continuous or returning symptomatology on a regular basis during the 6-12 month period post-injury and will require regular medical and rehabilitation intervention on a continuous basis

  • A patient who has sustained a brain injury will have continuous or returning physical and/or cognitive deficits on a regular basis during the 6-12 month period post-injury and will require regular medical and rehabilitation intervention on a continuous basis

  • Conclusion: If the patient was performing their usual daily activities and routines over the previous 12 month period prior to the current incident and in the absence of their seeking out regular medical and/or rehabilitation interventions over the previous 12 month period prior to the incident for symptom relief, functional incapacity and/or cognitive deficits, a direct causal relationship of the current incident to the current brain injury symptoms and physical and/or cognitive deficits can be claimed, within the bounds of reasonable medical probability
49. How long does the testing battery take to perform?

75-90 minutes

50. Are follow up exams required?

The rehabilitation specialists or referring physicians typically request follow up testing in order to guide the treatment regimes

51. How extensive is the MedTrak Diagnostics report?

The full report is approximately 30 pages

52. Who signs the 30 page report?

At minimum there are two signatures from MedTrak’s team of experts which include one board certified neurologist and one physical therapist

53. What does the full report include?
  • Test result raw data

  • Test result narrative reports 

  • Subjective complaint to objective finding correlations

  • Impressions

  • Recommendations

  • Immediate plan of care

  • Long term plan of care

  • A Future Rehabilitation Care Cost Report
54. What is the immediate treatment plan of care?
  • Based upon the brain damage incurred, this report provides generalized treatment program recommendations
     
  • It also provides the expected six (6) month cost, stated in exact dollar amount projections, for this recommended short term rehabilitation program
55. What is the long term Future Rehabilitation Care Cost Report?

This report provides the expected “present-day” long term costs, stated in exact dollar amount projections, for the expected long term rehabilitation and follow up testing procedure MINIMUMS based upon the patients expected life expectancy and the brain damage incurred

56. Why do MedTrak’s reports look similar for brain injury patients?
  • Each MedTrak report is partitioned into the same specific sections for each patient (listed in the next question). This gives the reports a similar look from patient to patient

  • Many brain injured patients experience a similar mechanism of injury which leads to similar types of damage to specific lobes of the brain. This leads to similar types of symptomatology

  • The MedTrak report is a generalized (not specific) rehabilitation program recommendation. By targeting the identified brain injury, the treating practitioner utilizes the MedTrak report to specifically guide the complex rehabilitation program, which varies greatly from patient-to-patient
57. What are the specific sections of the MedTrak report?
  • Incident/Injury information

  • Summary of testing

  • Summary of test result

  • Summary of patient complaints

  • Correlation of results

  • Impressions

  • Immediate treatment plan (generalized)

  • Recommendations

  • Disclaimers

  • Long term plan of care (generalized)

  • Future rehabilitation care costs
58. How are law firms trained by MedTrak to recognize brain injuries?
  • MedTrak Diagnostic’s long-time experience with managing and training referring physicians, rehabilitation specialists and legal offices, helps to insure that the patients being sent for the VNG+ testing battery have most-likely sustained a brain injury

  • MedTrak provides in-person training and tele-conference training for attorneys and case managers. MedTrak provides law offices with a “Brain Injury Symptoms Check List” pad and a two-step brain injury vetting system
59. How are brain injury rehabilitation specialists and referring physicians trained by MedTrak?
  • MedTrak provides a continuing education (CEU) training course for rehabilitation specialists in the area of concussion management and vestibular and cognitive therapies. This course has been running for decades and is sponsored by accredited Universities in the US and Canada. The course is also approved by every physical therapy state board in the United States

  • This course also includes a physician training component, instructed by MedTrak’s board certified neurology consultants
60. Does MedTrak provide the actual vestibular and cognitive rehabilitation treatments?
  • No

  • MedTrak’s rehabilitations consultants have decades of experience in treating and teaching the specialties of vestibular rehab and concussion management, however, MedTrak’s consultants now concentrate on providing the extensive reports, teaching and consulting for the rehabilitation specialists who will provide the actual treatments
61. Does MedTrak have a wide network of rehabilitation specialists possessing the expertise required to handle brain injury treatment regimes?
  • Yes 

  • MedTrak can provide recommendations for quality facilities that have the expertise in providing the necessary treatment programs recommended in the MedTrak report
62. How is the VNG+ testing battery technician trained?

MedTrak has been running a formal training course for the VNG+ technicians for decades. The course work includes:
 

  • A full video training library series

  • Two full training manuals

  • In-office personalized training

  • In-person access to the MedTrak technician training center in Nevada

  • Telephone support

  • Tele-conferencing access with MedTrak’s technician training experts
63. How is the quality assurance of the VNG+ technician maintained?
  • MedTrak’s consultants monitor testing results for every VNG+ technician on a daily basis

  • MedTrak provides constant refresher and update tele-conferencing programs for all technicians
64. How are the VNG+ technicians supervised?

All technicians are supervised by a licensed medical professional (MD, DC and PT)

65. Does a patient need a physician/clinician referral to be tested?
  • No, but most law firms prefer to have the patient referred by a physician for testing

  • Every MedTrak testing center is located in a licensed professional office and every test is supervised by a licensed professional

  • Patients have direct access to these health care professional offices so an actual written referral is not necessarily required
66. Who receives the finalized MedTrak report?
  • The referring physician

  • The attorney of record

  • The treating rehabilitation specialist
67. How are finalized reports, invoices and other important documents retrieved?

The MedTrak Concussion Detection Testing System (MedTrak CDT) provides a web portal with 24/7 access for retrieval of any reports, invoices, lien agreements or pertinent medical or legal documents. This is a HIPAA compliant secure site requiring a user name and password and managed and monitored exclusively by MedTrak Diagnostics

69. Are all of the MedTrak testing locations available on the MedTrak CDT web portal?

Yes

70. Are all of the MedTrak testing center schedule availabilities on the MedTrak CDT web portal?

Yes

71. Can a patient fill out forms on the MedTrak CDT web portal?

Yes

72. Can a law firm or medical practitioner upload information to the MedTrak CDT web portal?
  • Yes

  • Law offices and medical practitioners can use the MedTrak CDT to UPLOAD important documents for review by MedTrak’s consultants
73. Are all of the MedTrak testing locations available on the MedTrak Diagnostics web site?
74. How many states currently have MedTrak brain injury testing centers?
  • MedTrak Diagnostics has 28 brain injury testing centers in 7 states: NV, CA, TX, CO, AZ, NM, KY

  • MedTrak Diagnostics intends to expand to all 50 states within the next 2-3 years

  • MedTrak VNG provides technical and clinical support to all 50 states
75. What is MedTrak Diagnostics contact information?
  • Website: www.medtrakdx.com

  • Office Phone: 702-820-5230

  • Office Fax: 702-819-7835

  • Main Office Email: refer@medtrakvng.com
76. What is MedTrak Diagnostics toll free phone number?

800-TBi-TEST

77. Does MedTrak supply a reference list of law firms, practitioners and official entities?
78. Does MedTrak or its sister company web sites post “peer reviewed research articles?”
79. Who can get tested at a MedTrak testing center?

Anyone is welcome to be tested

80. Why are personal injury law firms utilizing MedTrak?
  • In the past, personal injury law firms had very few tools for assisting their cases in making the determination of mild traumatic brain injury. Imaging and neuropsychologist testing were among the few tools which are now being shown to be out dated and ineffective

  • 21st century objective testing technology has caught up to assisting clinicians with making the clinical diagnosis of mild traumatic brain injury

  • MedTrak’s objective testing battery and symptomatology correlation provides that 21st century reporting

  • Currently, our statistics are showing that the defense has little to no room to negotiate cases where brain injury has been objectively confirmed. Law firms known for litigation are being offered policy limits without “bad faith” dealings based on MedTrak’s involvement
81. Why should law firms avoid the substandard MedTrak “copy cats?”
  • Opportunistic copy cats companies have no access to MedTrak’s long time expert consultants and no access to the data, research and knowledge that MedTrak has compiled over the last 30+ years of testing and treatment for mTBI patients

  • Firms that use MedTrak copy cats will be subjected to receiving substandard reports and ultimately substandard testimony
82. What current University research projects are underway in the US regarding the use of objective VNG testing for patients suspected of having mild traumatic brain injury?

The City University of New York is currently investigating the high prevalence of   microsaccades, found exclusively in VNG testing results, for humans who have sustained mild traumatic brain injuries. This would provide clinicians with a  “biomarker” which would assist in the clinical diagnosis of mTBI

83. Why is computerized neurocognitive testing beginning to be chosen over a neuropsychologist’s exam?
  • Neuropsychologist testing is now being thought of as a subjective examination which requires scoring by a human. This fact brings into play the chance for biases, prejudices or economic influences

  • Computerized neurocognitive testing has been perfected by Baylor medical school and Texas Medical Center and therefore provides an objective, nonbiased assessment of a patient’s neurocognitive status

  • The computer algorithms are so sophisticated in recording patient reaction times (in hundredths of seconds) that it can identify, and subsequently weed out, malingering attempts instantly
84. What is the cost for the entire MedTrak testing battery and the MedTrak reports?

$10,000.00

85. Why does MedTrak only accept liens (or cash) and NOT accept medical insurance?

MedTrak’s consultants are among the most knowledgeable and experienced in the industry and choose not to be bound by the undervalued pricing conditions in the current medical insurance marketplace

86. Who is responsible for payment to MedTrak?

The patient who is tested

87. Why MedTrak NEVER sells its liens:

MedTrak does not want a third party, with any sort of financial interest, negotiating on its behalf

88. What is the treatment for patients who test positive for brain injury?
  • Brain injured patients have sustained a permanent disability which is very complex. Proper rehabilitative treatment requires skilled therapists and constant attention

  • The rehabilitative techniques employed by these skilled therapists entail compensation and coping techniques which attempt to provide patients with temporary symptom relief and a measure of functional ability

  • Areas of focus include visual cortex, vestibulo-ocular reflex, cervico-ocular reflex, optokinetic reflex, rehabituation techniques, balance and coordination techniques, positional transfer retraining,  eye-hand coordination, center of gravity retraining, neuromuscular reeducation, headache management, dizziness management, muscle spasm care, cognitive therapies, memory retraining, sleep pattern retraining, emotional support including anxiety, mood swing and depression support, reaction time retraining, assistance with diminished hearing or tinnitus, assistance with diminished reading abilities, training and retraining regarding the stimuli which bring on a return of symptomologies and more…
89. How can a patient find a skilled rehabilitation specialist to help treat their brain injury?
  • MedTrak’s expert consultants have been teaching and training therapists around the US for many years [and recently Canada] and can recommend an appropriate clinical specialist

  • Additionally, MedTrak has created another sister company to handle brain injured patients by “Tele-Physical Therapy”
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