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The NERD model: reflex circuit dysfunction as a systems-level driver of persistent post-concussion symptoms.

Matthew M Antonucci1,2, Kenneth Jay1,3,4,5

  • 1Department of Functional Neurology, Carrick Institute, Cape Canaveral, FL, United States.

Frontiers in Systems Neuroscience
|February 12, 2026
PubMed
Summary

Persistent post-concussive symptoms may stem from network dysfunction, not just cortical issues. This model highlights reflex disintegration as a key, actionable mechanism in brain injury recovery.

Keywords:
cortical entrapmentfunctional neurologygain modulationnetwork rigidityneurorehabilitationpost-concussion symptomsreflex circuitssensorimotor integration

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Area of Science:

  • Neuroscience
  • Systems Biology
  • Clinical Neurology

Background:

  • Persistent post-concussive symptoms are traditionally linked to widespread cortical dysfunction.
  • This view may neglect crucial systems-level interactions within the brain.

Purpose of the Study:

  • To propose a novel conceptual framework for understanding persistent post-concussive symptoms.
  • To reframe post-concussive dysfunction as a network-level disorder with reflex disintegration as a central mechanism.

Main Methods:

  • Development of a conceptual framework based on clinical observation and systems-level dynamic modeling.
  • Modeling the brain as a time-evolving control network with five interconnected functional nodes.
  • Analysis of the interplay between sensory input, reflex circuits, and higher-order brain regions.

Main Results:

  • Dysfunction arises from the dynamic interplay among five functional nodes: sensory interface, reflex-brain stem hub, cerebellar module, basal ganglia-thalamic modulator, and cerebral cortex.
  • Injury to nodes or connections disrupts reflex control, signaling, and thalamocortical integration.
  • The framework emphasizes the roles of the cerebellum in timing/coordination and basal ganglia-thalamic complex in gain/gating.

Conclusions:

  • Post-concussive dysfunction can be viewed as a network-level disorder.
  • Reflex disintegration is identified as a central, actionable mechanism in the recovery process.
  • The proposed model offers a new perspective for guiding early intervention strategies.