WESTBOROUGH, MA April 21, 2017 There has been a great deal of research published recently about the cumulative impact of concussion. Every athlete who experiences a concussion has a unique trajectory toward recovery. It is well-known that athlete’s who experience a second or third concussion may be at risk for long-term cognitive symptoms unless they rest until the symptoms are fully resolved. It is now expected that each recovery is different and should be tailored for the presenting symptom profile and the athlete’s medical history. A combination of rest and controlled exertion seems to work best for recovery. Balance and vestibular changes from concussion require physical therapy in the days after injury. We offer these services at Whittier Rehabilitation Hospital. In cases of second or third concussion the recovery can be very different and often prolonged.
There are dozens of You Tube videos that I have posted in these pages illustrating the brain as it becomes concussed. On my first website nearly 20 years ago I purchased a .gif program to illustrate the movement of the brain during a concussion – like the one below. It cost me nearly $100 to download and post on my website. Now they are available free of cost and easily posted to social media.
A concussion is a traumatic brain injury resulting from force causing energy to pass through the brain resulting in the brain shaking within the skull. A study published in January 2016 in the Journal of Pediatrics suggests that preadolescent boys are at higher risk of concussion when playing on varsity ice hockey teams. The study at Hasbro Children’s Hospital in Providence, RI also suggested that girls playing ice hockey who are heavier may be at greater risk for concussion. On average, the preadolescent boys in the study took 54 days to become symptom free.
Here is a link to another very useful video produced by a Canadian physician Dr. Mike Evans. I often have families watch this 10 minute video before initiating our conversation. The point is that the brain is seriously impacted by energy pulsating through the skull from whatever cause. I have seen several snow boarders this winter. Spring sports usually see an uptick of concussions in lacrosse and girl’s softball. Concussion can be expected to effect all cognitive functioning including concentration, speed of mental processing, problem solving, memory, and behavior.
WESTBOROUGH, MA January 31, 2017 There is no way to avoid a stressful life it seems. Some people are better than others at reducing the impact of stress. Excercise, healthy eating, regular sleep, and mindfulness reduce the impact of the stress and tension we all experience in our lives. These behaviors are being taught to children who experience stress just like their parents in many schools. Meanwhile, concussion and more serious brain injuries result in changes in the autonomic nervous system that are sometimes life threatening. The behavioral response of these afflictions include marked restlessness, anxiety, changes in sleep hygiene, abnormal pain response, and pervasive tension.
In cases of severe brain injury one might see autonomic storming as described in a prior blog. Autonomic storming results from trauma to regions of the brain that control primitive bodily functions like respiration, heart rate, and emotional regulation. This includes profuse sweating, elevated heart rate, rapid changes in body temperature and motor restlessness. These functions are comprised in the autonomic nervous system and are known as the fight-flight mechanism. The sympathetic nervous system elevates blood pressure, respiratory drive, and gets us ready to fight or run. Meanwhile, the parasympathetic system puts the brakes on these functions allowing the body to return to its normal resting rate.
“Eventually, chronic stress could be treated as an important risk factor for cardiovascular disease, which is routinely screened for and effectively managed like other major cardiovascular disease risk factors.” Ahmed Tawakol, Harvard Medical School
Ostensibly, stress has the capacity to change this normal resting heart rate and slowly raise our levels making it difficult to truly relax. In the long term, external stress can change our heart functioning including hypertension and cardiac arrhythmia and put us at risk for cardiovascular illness including heart attack and stroke. Lifestyle changes are necessary to avoid long-term health problems from stress. Mindfulness includes deep, regular breathing, guided imagery, and progressive relaxation. It is being introduced in some public schools so that it may become part of the coping mechanisms used by kids when stress sets them off – as it undeniably will do.
Sefton, M. (2015). Heart rate variability: Biofeedback options for post-concussion syndrome, https://concussionassessment.wordpress.com/2015/08/03/heart-rate-variability-biofeedback-options-for-post-concussion-syndrome/
WebMD (2017) Brain ‘stress ball’ may be key to heart risks. http://www.webmd.com/brain/news/20170111/stress-ball-in-your-brain-may-be-key-to-heart-risks#2, taken January 14, 2017
WESTBOROUGH, MA November 10, 2016 You may be interested in the Clock of the week on this day after the presidential election of Donald J. Trump. It was drawn by a male with obvious cognitive dysfunction. The task is simple – draw a clock and set the hands for 11:10. In this case the patient became stuck. He asked me “how do I do it” and I replied start with the circle. As you may notice the man drew the large circle quite well. I thought to myself “hmm, not bad”. Next he drew one small circle after another. Finally he was able to approximate the minute hand only – as you can plainly see it is set juxtapose where the 2 might be.
Dementia is an insidious neurological disease that robs patients of their mental functioning – including memory, problem solving and the capacity to think with critical acumen. The late president Ronald Reagan succumbed to dementia of the Alzheimer’s type in 2004 after a decade of declining cognitive prowess. He was 69 when he entered the White House. It has grown more prevalent in the past decade. Neuropsychologists are uniquely qualified to manage the cognitive and behavioral changes associated with dementia. There is no cure for dementia at the present time. Exercise and mental activity are two components of maintaining a healthy mind and body into one’s old age. My practice is filled with older patients many of whom do not believe in the adage about old age being “the golden years”. In fact, many older patients are lonely and demoralized. Many are afraid of what the next president may do to their healthcare, housing and social security pensions.
Let us hope that our next president will maintain his mental faculties well into old age. His somewhat unbridled behavior is not unlike that of patients suffering with some forms of dementia that negatively impacts judgment, planning and decision-making. Mr. Trump will be 70 years old when he enters the White House in January 2017. The oldest man to ever be elected to the office of the president.
WESTBOROUGH, MA September 28, 2016 There will be a free seminar offered at Whittier Rehabilitation Hospital in Westborough on Wednesday September 28, 2016 on Sports-related Concussion along with updated information about post concussion syndrome and its treatment. The program is presented by Michael Sefton, Ph.D., director of neuropsychology and psychological services at Whittier Rehabilitation Hospital and certified brain injury specialist. The program begins at 5:30 with a dinner being served. Call WRH at 508-870-2222 to reserve your spot.