A Trusted Referral Center for Complex Concussion and Autonomic Cases

NeuroSport provides structured, system-based evaluation for patients not improving with standard care, including concussion, POTS, and dysautonomia. Our approach is multidisciplinary, evidence-based, and centered on identifying the underlying causes of persistent symptoms following mild traumatic brain injury and related conditions.

Patients are commonly referred by medical providers, including emergency departments, primary care, cardiology, neurology, physical therapy, and other specialists. Evaluation is focused on identifying the drivers of persistent symptoms and developing targeted, progression-based care strategies guided by objective clinical findings.

A Referral Destination for Patients Not Improving with Standard Care

Many patients with concussion, POTS, or dysautonomia recover with appropriate initial management. However, a subset of patients do not follow an expected clinical course. In these cases, persistent symptoms often reflect dysfunction across multiple neurological and autonomic systems rather than a single isolated diagnosis.

NeuroSport provides a structured, system-based evaluation designed to identify the underlying drivers of persistent symptoms and clarify the clinical picture in complex cases.

Role of Referral

Referral to NeuroSport is intended for specialized evaluation of neurological and autonomic function, not routine musculoskeletal care.

The goal of referral is to:

  • Identify the physiological systems contributing to persistent symptoms

  • Objectively assess neurological and autonomic function

  • Clarify diagnosis in complex or overlapping presentations

  • Guide targeted, progression-based management strategies

Clinical Context

Patients referred to NeuroSport are often already under the care of multiple providers. Referral is not intended to replace ongoing care, but to provide additional diagnostic clarity and support more effective, coordinated management.

When standard care does not result in expected improvement, a more advanced and structured evaluation is often necessary to identify the underlying cause.

When Standard Care Is Not Enough: Indications for Advanced Evaluation

Most patients with concussion, POTS, or dysautonomia improve with appropriate initial management. However, a subset of patients do not follow an expected recovery trajectory. In these cases, persistent symptoms often reflect dysfunction across multiple neurological and autonomic systems rather than a single, isolated diagnosis.

Standard treatment approaches may address individual symptoms, but do not always identify the underlying physiological drivers responsible for ongoing dysfunction.

Purpose of Advanced Evaluation

Referral to NeuroSport is intended for structured evaluation of complex neurological and autonomic presentations, not routine musculoskeletal treatment.

Advanced evaluation is designed to:

  • Identify the underlying drivers of persistent symptoms

  • Objectively assess neurological and autonomic system function

  • Differentiate between overlapping or coexisting conditions

  • Establish a clear clinical baseline for progression and recovery

Clinical Relevance

This approach is particularly valuable in patients who:

  • Have not responded as expected to standard care

  • Present with symptoms that do not align with a single diagnosis

  • Demonstrate features of both neurological and autonomic dysfunction

  • Require greater clinical clarity to guide next steps in management

The following clinical patterns commonly indicate when a more advanced evaluation may be appropriate.

Clinical Patterns That Warrant Advanced Evaluation

Primary Clinical Indicators

Refer for advanced evaluation when patients present with:

  • Symptoms persisting beyond expected recovery timelines

  • Limited or no improvement despite appropriate care

  • Symptom exacerbation with physical or cognitive activity

  • Exercise intolerance or early fatigue with exertion

  • Dizziness, lightheadedness, or symptoms with positional change

  • Elevated heart rate or suspected orthostatic intolerance

  • Cognitive symptoms impacting work, school, or daily function

  • Recurrent or unpredictable symptom flare-ups

  • Multi-system presentations without a clear unifying diagnosis

Condition-Specific Clinical Patterns

Concussion / Post-Concussion Syndrome

  • Symptoms persisting beyond 2–4 weeks

  • Ongoing headache, dizziness, or cognitive dysfunction

  • Difficulty progressing with return-to-activity

  • Persistent symptom provocation with exertion

POTS and Dysautonomia

  • Tachycardia or lightheadedness with standing

  • Fatigue, brain fog, or reduced activity tolerance

  • Symptoms worsened by heat, prolonged standing, or exertion

  • Suspected autonomic dysfunction without clear diagnostic direction

Complex or Overlapping Presentations

  • Concussion with autonomic features

  • Persistent dizziness without a clear vestibular cause

  • Chronic fatigue with neurological features

  • Patients evaluated by multiple providers without resolution

Clinical Context

These patients are often already under the care of multiple providers. Referral is not intended to replace ongoing care, but to provide additional diagnostic clarity and guide more targeted management.

NeuroSport’s evaluation process is designed to move beyond symptom-based care and identify the specific systems contributing to persistent dysfunction.

What We Evaluate and How NeuroSport Is Different

NeuroSport’s approach is centered on structured, system-based evaluation of neurological and autonomic function. The objective is not simply to describe symptoms, but to identify the specific physiological systems contributing to persistent dysfunction and guide targeted management.

Comprehensive, System-Based Evaluation

Evaluation is tailored to the individual presentation and may include:

  • Detailed clinical history with emphasis on symptom behavior and triggers

  • Neurological screening, including cognitive and oculomotor assessment

  • Autonomic evaluation, including orthostatic response and heart rate dynamics

  • Exercise tolerance assessment to evaluate physiologic response to exertion

  • Balance and coordination assessment when clinically indicated

Objective, Measurable Findings

Assessment is based on objective clinical measures and reproducible patterns rather than symptom description alone. This allows for:

  • Identification of underlying contributors to persistent symptoms

  • Differentiation between overlapping or coexisting conditions

  • Establishment of a clear clinical baseline

  • Monitoring of response to intervention over time

Targeted, Progression-Based Management

Management is guided by objective findings and focuses on progressive restoration of function. This may include:

  • Structured autonomic rehabilitation strategies

  • Gradual progression of exercise tolerance based on physiologic response

  • Integration of cervical spine and neuromuscular factors when indicated

  • Patient-specific pacing and recovery strategies

Integration of the Moreau POTS Protocol (MPPâ„¢)

For patients with autonomic dysfunction, care may incorporate the Moreau POTS Protocol, a structured approach that uses carefully monitored exercise to challenge and restore autonomic regulation.

This protocol is designed to improve control of heart rate and cardiovascular response through progressive exposure to dynamic and static physiologic demand.

Collaborative Care Model

This approach is not intended to replace ongoing care, but to provide additional diagnostic clarity and guide more targeted, effective management within the broader care team.

Clear identification of the underlying drivers of symptoms allows for more efficient care and improved clinical decision-making across the treatment team.

Clinical Experience and Referral Confidence

NeuroSport’s clinical approach is informed by experience in high-performance and complex care environments, including Olympic sports medicine, professional athletics, and multidisciplinary medical systems.

Dr. Moreau has served in leadership and clinical roles within the United States Olympic Committee and has worked in collaboration with physicians, athletic trainers, and medical specialists in the management of complex neurological and musculoskeletal conditions. He is a published researcher in the fields of concussion and post-concussion syndrome. Additional details regarding clinical experience and qualifications are available upon request or can be reviewed on the NeuroSport credentials page.

Evidence-Guided, Collaborative Care

Evaluation and management are grounded in current evidence and guided by objective clinical findings. Care is structured to align with accepted medical standards and integrates appropriate referral to medical specialists when indicated.

Patients are not managed in isolation. Findings are used to support coordinated care, ensuring that coordination with primary and specialty providers occurs when additional evaluation or intervention is needed.

Referral with Confidence

Referral to NeuroSport can be made with confidence that patients will undergo a structured, clinically grounded evaluation focused on identifying the underlying drivers of persistent symptoms.

The goal is to provide clinical clarity, support decision-making, and enhance the effectiveness of the overall care plan.

Referral Process

Download Referral Form (PDF)

Referral to NeuroSport is designed to be simple and efficient, allowing patients to access evaluation without unnecessary barriers.

How Referral Typically Occurs

In most cases, providers direct the patient to contact NeuroSport to schedule an evaluation. This allows timely access to care without delay.

Clinical Coordination

If additional context is helpful, providers may contact the clinic directly to discuss the case or coordinate evaluation. This is particularly useful in complex or multi-system presentations.

Referral Support

A one-page referral handout is available for your use. This can be provided to the patient at the time of referral to ensure a clear and consistent next step.

What the Patient Receives

  • A structured, system-based evaluation

  • Identification of contributing neurological and autonomic factors

  • A targeted, progression-based management plan

  • Clear clinical direction to support ongoing care

Contact Information

NeuroSport Spine and Concussion Center
Vancouver, Washington
360-326-2121