The Path Back To Work After a Concussion with Nate Pope (Part 2) | E47

This is Part 2 of my conversation with Nate Pope from NCX Brain Recovery. Recovery stalls when life gets smaller. We’ve all seen it: light hurts, noise overwhelms, screens drain, so routines narrow and the brain doubles down on workarounds. We open up a different route—structured, supportive challenges that reengage vision, balance, attention, and memory together. Instead of chasing one symptom at a time, we train the whole system to find easier, more efficient pathways.

We talk through the surprising number of career pivots after concussion and the practical ways others adapt their existing roles: short movement breaks, fresh air, and task rhythms that reset the nervous system. We also explore where AI can actually help—offloading busywork and cognitive clutter so people can focus on the tasks that matter. Along the way, we address a common pitfall: labeling new attention problems as ADHD. True ADHD starts in childhood; post-concussion attention issues are different, and stimulants can amplify anxiety and dysautonomia. By coordinating with prescribers, prioritizing sleep, nutrition, and targeted cardio, and using intensive therapy, many patients regain focus without medication.

The heart of our approach is multi-sensory integration and cognitive flexibility. We layer eye movements, vestibular input, executive tasks, and conversation, then change the rules to build adaptability. That steady stream of achievable wins releases dopamine, rebuilds confidence, and breaks rigid patterns. Sound exposure enters when ready: mechanic shop clatter, playground chaos, crying infants—whatever mirrors real life. It’s not about flooding; it’s about training selective attention under realistic stress. fMRI findings back it up: underactive regions normalize after two weeks, and memory improves as the brain stops detouring.

If you’ve been dealing with symptoms for months or years, there’s real hope. We offer free virtual consults to map your history, goals, and fit for our two‑week intensives and eight weeks of aftercare. Subscribe, share with someone who needs a path forward, and leave a review to help others find these tools. Your brain can do this—one smart step at a time.

Nate Pope and NCX Brain Recovery: https://www.ncxbrainrecovery.com/

REGISTER for the online global Love Your Brain Summit on March 20th-22th 2026: https://www.loveyourbrain.com/summit

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Chapters

• 0:00 Welcome And Recovery Philosophy
• 2:59 Career Shifts After Concussion
• 4:48 Adapting Work And Movement Breaks
• 5:38 AI As A Tool For Cognitive Load
• 6:18 Stimulants, Misdiagnosis, And Withdrawal
• 10:02 Multi‑Sensory Training For Memory
• 12:45 Cognitive Flexibility And Rule Changes
• 15:32 Sound Exposure And Real‑Life Stressors
• 22:11 Free Consults And Outcomes
• 26:46 Closing Remarks And Medical Disclaimer

Transcript

Nate Pope: 0:38

And so they get in some really pretty rigid, you know, patterns that they can develop over the years. And and when they come to us, we're like, it's okay. You're in you're you're in good company, but we're gonna change that. You you're going to avoid avoiding from here on out. And we're going to embrace change and and challenge, but we're going to do it in baby steps so that you know you can do it. So, and we'll hold your hand through the whole thing, you know, but we're going to make sure that you're constantly being challenged and things are constantly being changed up. And and we want you smiling while you're doing that.

Dr. Ayla Wolf: 1:20

Welcome to Life After Impact, the Concussion Recovery Podcast. I'm Dr. Ayla Wolf, 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. How often do you see people choose to change jobs or change careers as a result of having a pretty heavy symptom burden or just struggling to go back to their previous job?

Nate Pope: 2:33

Yeah, actually more frequent than than I would have guessed when I when I started doing this, because they sometimes it's not a great fit anymore. Um and or they discover that we do so many things in the clin in our clinic. I mean, if you're with a therapist for seven hours a day, you know, for two weeks in a row, you learn quite a bit. And um and we start realizing you're really good at this and you love this. Have you thought about this? And you know, we're we're occupational therapists, and so we also feel pretty um adept at helping people navigate and explore, you know, um things that they might be good at or they might be interested in. And um and so we we do have a lot of career switches.

Dr. Ayla Wolf: 3:21

Aaron Powell I see that in my population of people that I work with too is the desire to find a different job that maybe doesn't involve sitting in front of a computer for eight hours a day. Um yeah, and I've seen people who have switched from one job to another where maybe they can be outside more or just doing a wider variety of different things. And um, you kind of just see them thrive in a different type of career choice.

Nate Pope: 3:50

Yes, yeah, for sure. Yeah, we we're moving all the time in our clinic. We're almost on our feet the entire time doing stuff and getting outside and um and and they just start feeling better and and then they understandably start getting nervous about going back and sitting in front of a computer and doing and not moving anymore. And they've they've they've already figured out this is what's helped me get to where I'm at. I don't want to go back to sitting and and doing that. And so some of them don't have a choice, and we and I'm saying, okay, for you, you're gonna pause and get out of off that computer and you're gonna go for a little walk, you're gonna take a little brain break, you're gonna get some exercise and fresh air, maybe, and you're gonna work with your employer hopefully to be able to do this. And then you're gonna come back and be more effective when you do sit down in front of the computer. So some of them have had to kind of navigate that sort of a adapted way of working. Um and and then others will do the whole career switch, you know, like you say. And so Yeah, yeah.

Dr. Ayla Wolf: 4:58

Yeah, absolutely. And it will be interesting too, just to maybe see how AI can help people in terms of taking some of the like busy work off their plate and um maybe free up their time to to do other things.

Nate Pope: 5:13

I know. We've we've wondered if we should do a little in our intensive part of our two weeks, um, help them figure out how to use AI a little bit. And for some things that might be helpful that way. I really believe that.

Dr. Ayla Wolf: 5:28

Yeah. Well, and that's the thing with like the type of work that we do. We have to constantly be staying on top of all of the new things that are coming out that could potentially make people's lives easier.

Nate Pope: 5:38

Yep, for sure.

Dr. Ayla Wolf: 5:40

So let's talk a little bit about ADHD. And then you mentioned that briefly. You also mentioned that in the fMRI research that some parts of the brain are kind of offline, other parts of the brain may be compensating and overactive. One of my concerns has always been if you give somebody a stimulant, an ADHD medication that improves metabolism, is it maybe also improving metabolism in an area that's hyperactive in addition to trying to improve metabolism in an area that's underactive? And are you just still promoting an imbalance in the brain by using stimulants? So uh what are your thoughts on that?

Nate Pope: 6:23

Yeah, well, for sure. Um, first of all, it's it's usually a misdiagnosis. If they have not had a history and they hit their head and now they have focus and attention issues, that is not ADHD. And you can go, you know, the DSM five criteria even would spell that out. So they shouldn't have been diagnosed with that. But it's so similar that it does get diagnosed. And often they're like, well, they may not diagnose it, but they say, let's give a prescription for it because it's so similar. So um it is brain-altering chemicals you're introducing into the brain. And so when patients come to us, they'll ask us, should I stay on my sleep meds and my headache meds and my ADHD meds and my anxiety meds and my depression meds? They come in with uh quite an assortment of meds sometimes. And um we mostly have them go get approval from your doctor because we're not we're not gonna undo what any doctor's saying. So we got to kind of play it safe that way. But I would request if all of them could agree and and be okay with you getting off all as many of these um brain altering substances as possible while you're doing our two-week of intensive and hopefully and preferably a few weeks before they come in. Most patients are scheduling about a month out or so, and so there's some time to kind of get off of all those drugs. And um, and when they come in, most of our patients that were on all of those drugs, we get the brain to do what it's supposed to do. We want them eating healthy and and getting good sleep and and we're doing exercise. We do cardio like three times a day for little chunks of what we do throughout our seven-hour days, and then we're just doing the right things for the brain, and some good things start happening and and they don't end up needing to go back on those on those drugs. Most of them are like, oh, I'm so much better. My brain's actually doing what I want it to do. I no longer have focus issues, and so I'm not going back on that. You know, they don't need to.

Dr. Ayla Wolf: 8:42

So Yeah, yeah. And that's a really good point. You know, my understanding is that ADHD is a, you know, it's a neurobiological condition. There are these very specific sets of diagnostic criteria, and it usually starts in childhood. And so a lot of people who don't have a history of ADHD, like you said, they get a concussion, they have that trouble of focus and attention. And I think maybe because ADHD does have kind of this easy prescription treatment out there, it's easy to then just say, well, let's just use this and see, you know, we have this drug that's supposed to increase focus and attention. So let's just try it in this patient population as well. But I agree that there may be some side effects to that, especially if people do have anxiety and and autonomic nervous system dysregulation and they're already dealing with a certain amount of kind of hyperactivity in certain pathways, there might be some some side effects to then kind of revv those pathways up as well.

Nate Pope: 9:43

Yeah, I agree. I think that definitely is happening. We can't see everything that's going on in the brain. But um, I do know the ones that are on medication for ADHD and it's not really ADHD because I had a concussion or whatever. Uh usually those meds are nowhere near as effective for them, anyways, because it's treating it in the wrong way. It's treating the wrong problem. And and it's really um, so most of them it's pretty easy to to sell on just stop taking them.

Dr. Ayla Wolf: 10:16

Right, because they're not quite sure if it's helpful in the first place.

Nate Pope: 10:19

They're already like, I don't think this is working very good. So yeah.

Dr. Ayla Wolf: 10:23

Yeah, yeah. And then let's talk a little bit about memory because that's also again, like some of the I would say many people concussions, they say I have difficulty with focus and attention and memory. So can you talk a little bit about how you're doing um multi-sensory activities that then can actually support these pathways that involved in focus, attention, and memory?

Nate Pope: 10:47

Sure. Yeah. Well, um, kind of going back to the example of your pathways or your roads having roadblocks. Um, and we're essentially we want to just take the roadblock signs down because there's no damage behind the roadblock sign. But prior to that, they're having delayed a lot of delayed and slow responses to everything that they do. A lot more energy goes into it, and memory gets affected in the in the mix because retrieving information is slower. Sometimes it's it's not that they just can't remember, it just takes them a longer time to remember. So it definitely comes up as like a memory issue. And so um basically when we when we take those roadblocks off the road and they're able to do what they were always able to do prior to getting the concussion, then memory comes back. And so to get that to happen, we try to engage in the multi-sensory approach. We try to engage the brain in a way that uh doesn't allow it to take these detours to take to compensate. The brain will is a creature of habit and it's also a path of least resistance. Those are kind of its two main rules. And so when you can show it that working the right way is easier, even if it takes a lot of engaging the brain and challenging them, eventually the brain will engage those areas that are inactive when you do a multi-sensor integration approach. Because it it just can't compensate. It can't continue to compensate when you're doing hour, hour after hour engaging multiple areas of the brain simultaneously, it doesn't leave it a lot of option to continue in its bad patterns. So it makes it so hard for the brain to keep doing what it's been doing that it eventually engages those areas that are less active. And we when I was with uh the research uh-based clinic that um was doing the functional MRI, we would do it before treatment and then after the two weeks of treatment. And we could easily see all the areas that were disengaged, getting less blood flow, now right, we're right in the normal range. And their symptoms had gotten better too. So they knew that they had gotten better, but it was nice to see it on the scan too, and say, look, it's this is working. And the main thing in between those two scans was getting multiple areas of their brain to engage and engage at the same time. And memory was just one of those bonuses that would improve and get better again once the whole brain starts started functioning.

Dr. Ayla Wolf: 14:15

Yeah. So it you're so you're not necessarily just trying to give people memory tasks to improve their memory. You're trying to engage their visual system, their vestibular system, their frontal lobes, uh, their conversational abilities uh kind of all at the same time. And a byproduct of that is then their branch is working better in in all areas, including memory.

Nate Pope: 14:41

Yes, exactly. It's like they they come in with light sensitivity and noise sensitivity, is another example. You're not going to work directly on challenging their sensitivity to light or noise as much. I mean, there's a little bit of that. And we do turn it, we take make them take their sunglasses off, because some of them have that everywhere they go. And we we do challenge that, those areas a little bit. But it's usually just um a byproduct of getting the whole brain working better, that a lot of those um secondary symptoms or issues just start getting better. And it's fun when they start improving. They're like, oh, we haven't been working on that, but I I've noticed that I don't have this anymore. Like, yeah, it's just because uh all the neural connections are being re-established and it makes everything work better. And you don't, in fact, targeting just cognitive stuff when they have memory and problem solving and organizational issues. When you just target those areas, it tends to really just overwork the areas that are trying to compensate in those areas. It's not doing what you want to do. And so um it almost has the opposite effect when you target too much the area that that is a cognitive deficit or the memory or whatever it is. Um and so it tends to improve when you work, the get the whole brain working.

Dr. Ayla Wolf: 16:16

So And do you also include elements of uh promoting cognitive flexibility and doing things where again, like maybe the rule set changes, or you know, people have to be able to like do one thing and then do a different thing?

Nate Pope: 16:30

Yeah, yeah. Yeah, in fact almost every one of our multi-sensory integration activities that we do has an element. Uh, first of all, there's an element of grading up and down for challenge so that we're trying to hit the just right challenge all the time. But part of that is as they start to get it and they're like, okay, I'm getting it. And we always want success because we get that extra dopamine and and it's really good, you know, for them to keep wanting to go. And you want the general mindset of like, oh, that was hard, but I I did it. Oh, that was also a little bit hard, but I did it. And that you want that to build on those experiences. Um but um what was your question?

Dr. Ayla Wolf: 17:15

Oh, we're talking about how you're incorporating like aspects of cognitive flexibility.

Nate Pope: 17:19

Oh, yeah. And so the other element that we have with each of those multi-sensory activities is that we're not only grading up and down for the difficulty level, but we're trying to build in flexibility elements to all of those tasks. So, okay, we did this this way, but now we're doing it this way, and we're changing the rules of how we do that activity constantly. Um, because that's life is is kind of that way, and we we need to prepare them for that as well. But it also really helps to engage the brain if if we mix it up constantly.

Dr. Ayla Wolf: 17:57

So in a uh safe and positive environment.

Nate Pope: 18:02

Yeah, and it's nice to do that in the clinic because uh prior to coming, and I'm sure you know this because you've worked with these patients, but the go-to is don't do any of those risky things. Just do the things that you're comfortable with. Um other things may may even trigger or cause symptoms, so they have an added um reason to not, you know, challenge their brain too much or step out of the the norm. And so they get in some really pretty rigid, you know, patterns that they can develop over the years. And and when they come to us, we're like, it's okay, you're in you're you're in good company, but we're gonna change that. You you're going to avoid avoiding from here on out. And we're going to embrace change and and challenge, but we're going to do it in baby steps so that you know you can do it. So, and we'll hold your hand through the whole thing, you know, but we're going to make sure that you're constantly being challenged and things are constantly being changed up. And and we want you smiling while you're doing that.

Dr. Ayla Wolf: 19:13

So Yeah, I love it. And how much are you incorporating sound elements into this multi-sensory, because you mentioned people have sound sensitivity. So are you kind of intentionally introducing a um sound element to to either a distracting sound or people having to like ignore something while doing something else?

Nate Pope: 19:35

Yeah, we do. Um it drives them crazy at first. And but we we ease into that one as well. Um, if someone works, so yeah, one example, we had a mechanic that had had a concussion um and had was post-concussion syndrome, and he came in and he's like, I just, you know, I can't handle the noise, you know, and there's so much noise machinery and and stuff like that. And it's amazing what you can find on YouTube in terms of like sound stuff.

Dr. Ayla Wolf: 20:06

So annoying sounds.

Nate Pope: 20:08

Yeah, yeah, noise. Um noise of a mechanic shop, you know, and and we funneled that in while we were doing other things and he had to think on his feet and and engage. So yeah, we'll introduce those are that's usually in our second week. Our first week usually don't get to that much challenge. Um, but in the in the second week, um, we like to start introducing elements of what they're going to have when they go back into real life. Um, and that's one of the elements is helping them.

Dr. Ayla Wolf: 20:38

A soundtrack of 20 screaming children on a playground.

Nate Pope: 20:43

Yeah, we have yeah, we have moms that are, you know, are like, I just I kind of love it here. And I don't know how I want I when I go home, I love my kids, but I don't know how I'm gonna deal with it, you know? And and so we we have to sometimes it's crying children.

Dr. Ayla Wolf: 21:00

So Yeah, yeah. That's what I just absolutely love about that creative element in the recovery process is like, okay, what is your job? Or, you know, what is your life like at home? What are the challenges for each individual person? And then introducing The soundtrack of the screaming kids or the the mechanic ship or last Thanksgiving, my two nephews came over and my dog has a couple different soccer balls. And so my two nephews were like bouncing these soccer balls asynchronistically for about four hours straight. And I almost just lost my mind. And so this year I I said um to my boyfriend, I go, we need to hide those soccer balls this year.

Nate Pope: 21:46

I thought you were gonna tell me about a story about how after that you decided you would intentionally expose yourself to that so that next time happened, you'd be good. Yeah.

Dr. Ayla Wolf: 22:01

Well, gosh, thank you so much for giving us kind of a window into your clinic. Why don't you let us know where people can find you, what resources you have, your website, all that good stuff.

Nate Pope: 22:12

Sure. Yeah, um, you can find us at ncxbrainrecovery.com. So um, yeah, so we do free consultations. Um, that's probably the best starting point. And like I said, most mostly that's what we do as virtual consults. Um, we'll even do a symptoms checklist if someone has enough time. I'll even dig deep and and figure out, usually it's like what happened, um, how many concussions have you had, and and what were they, and what are the symptoms that it left you with, and then how severe are each one of those. And we'll go into that. That can take a little while if someone wants a shorter consult. That's uh a lot easier to do, and we can just, you know, um get the basics. But some are really loving the free consult, you know, advice and and assessment, you know, it's not an official assessment, but it is kind of giving us an idea as to what's going on, and mostly I'm filtering to see are you a good fit for what we can help someone with? Um and we really want every single person that comes into our clinic to go out feeling like they had an amazing recovery. So it's in our best interest as a clinic, but especially in the patient's best interest that it's a good fit. And so the consult is it's a free consult to figure that out. You know, where are you at? What's going on? I think we can help you, or maybe I send them in a different direction if I don't think we can help them. Yeah, that's the best starting point. Um, and there's they can ask any and all questions. And it's just it's nice to talk to an actual person who has dealt with this. And um it's worth it to us, even if people don't come or decide to do our treatment. Many of them will, and and so it's worth it to us, though, to just provide that free service for someone to come in and get a touch point with. Okay, I've been dealing with this for years. I have these symptoms, you know, or maybe it's months, but a lot of times it's years they've been dealing with this. And to hear the hope and realize, oh, this is I don't have to continue with this. People are getting better from this all the time. And most of our patients, I think last time we tracked the data for our symptoms reporting from patients. Um, 91% of our patients report 75% reduction in symptoms in the first two weeks, which is before we start the eight weeks of aftercare. And that's targeting, trying to get them to that 100%. And usually we get there or we're really close to it. And so it's been awesome. It's uh kind of a therapist dream job because people are getting better. And um, yeah, so we'd love to see anyone if they if you've been having any symptoms post one month from when you hit your head, most of those um don't have to continue. So it's there's a lot of hope with post-concussion syndrome um if you do the right things.

Dr. Ayla Wolf: 25:22

Yeah, at the right frequency.

Nate Pope: 25:25

Yeah, exactly.

Dr. Ayla Wolf: 25:27

Well, thank you so much. I'll include all that in the show notes and uh love to just stay in touch on everything you have happening. I I love that you're doing these two-week intensives. I think that makes such a huge difference when you have the right amount of repetition and then novelty and challenge and the multi-sensory approach. It's unique to concussion recovery, but so important.

Nate Pope: 25:50

Yeah, yeah. Thank you.

Dr. Ayla Wolf: 25:53

Yeah, have a great day.

Nate Pope: 25:54

All right, we'll see ya.

Dr. Ayla Wolf: 26:00

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