Should I be alarmed?
By Rob Traister, Director of Communications, Brain Injury Association of America, Inc.
A concussion is a type of traumatic brain injury (TBI). Each year, more than 2.5 million people in the U.S. sustain TBIs, and nearly 119,000 people are treated for TBIs in emergency departments in New York State.
When you hear the term concussion or TBI, images of athletes or soldiers come to mind since many injuries are sustained on the playing field and the battlefield. But falls are the leading cause of brain injury and car crashes are the leading cause of TBI-related hospitalization and death.
As 56-year-old Ralph climbed the ladder to remove holiday decorations, he stumbled and fell about five feet, knocking his head against the ground. His wife, Janis, wasn’t too concerned. “Ralph was a little dazed, but he never lost consciousness so I assumed he was okay,” she said.
That evening Ralph went to bed early and slept almost 16 hours. A few days later he complained of headaches at work and feeling too tired to enjoy his grandchildren over the weekend. As the weeks passed, Ralph grew sensitive to light and noise. He withdrew from regular social activities and became easily irritated. And yet, Ralph looked fine.
With mounting frustration and concern, Janis took to the Internet where she found the Brain Injury Association of America and its web site (www.biausa.org), which contains a wealth of information on concussion. She also called the toll-free number: 1.800.444.6443. Janis spoke to an information and resource specialist in New York and got connected to doctors and therapists who could help.
Janis and Kevin’s story is not uncommon. A recent Harris Poll found that 87 percent of those polled could not define what a concussion is, and 78 percent did not know the symptoms of a concussion. Nearly 40 percent of those surveyed said they would not know what to do in the event a loved one sustained a concussion.
Tell me more
TBI is caused by a bump, blow, or jolt to the head or by a hit to the body that causes the brain to bounce or twist inside the skull, stretching and damaging brain cells and causing chemical changes in the brain. This movement can result in either a temporary alteration in consciousness (feeling dazed, stunned, or confused) or a loss of consciousness.
TBIs can happen at any time, anywhere and to anyone. They can happen at home, at school, at work, or on the playing field, and they happen to the elderly, middle-aged, young adults, teens, and infants. No one is immune.
What are the symptoms?
No two brain injuries are alike, and different people may exhibit different symptoms after an injury. Common symptoms include:
• Amnesia (loss of memory)
• Appearing dazed or stunned
• Lack of coordination
• Loss of consciousness for any length of time
• Changes in mood, behavior, or personality
• Sensitivity to light or sound
What should I do if someone has a TBI?
If you suspect someone has a TBI – even a mild TBI such as concussion – seek evaluation by a qualified medical professional. Go to the emergency room or to your primary care provider as soon as possible.
Your doctor will likely prescribe rest and gradual return to activity. Care should be taken to avoid self-medication with caffeine, alcohol, or recreational drugs. There is no scientific evidence to support claims that supplements or vitamin regimens provide therapeutic benefit.
For those individuals whose symptoms do not resolve, treatment may involve rehabilitative therapy and medication.
Most people who sustain concussions recover after a few days or weeks, but for some people – about 15 percent – the concussion results in a chronic condition that can cause or accelerate a broad range of physical, cognitive, and behavioral diseases and disorders. People experiencing these issues may need accommodations for symptoms at school, work, and home.
What does the future hold?
Researchers are working to determine why some people have a better recovery after TBI than others. In the meantime, it is a good idea to practice common-sense prevention techniques.
In the car, use seat belts and infant/child safety seats, adhere to the speed limit, and never drink and drive or text and drive.
At home, add lighting to dark areas, add a second railing to stairways, and tape down throw rugs.
In workplaces (including home kitchens), place heavy objectives on lower shelves, keep floors dry, avoid tall ladders, and wear head protection as needed.
To decide whether or not to let your child play contact sports, evaluate the people responsible for safety during practice and games, examine the concussion protocols for your state, and find out if the protocols are being followed. No matter what, be sure to wear properly-fitted helmets that meet current standards when engaging in any sports or recreational activity.
Where can I get more information?
The Brain Injury Association of America has a brochure about concussions, Brain Injury: Dispelling Myths and Misconceptions About Concussion, available through its online marketplace. Information about brain injuries can be found on the organization’s web site at www.biausa.org. People with questions about brain injury can also contact BIAA’s National Brain Injury Information Center at 1.800.444.6443.
Making the right choice in traumatic brain injury rehabilitation
By Ken Shapiro, MD, Medical Director, Brain Injury Services, and Paul Novak, MS, OTR, Program Director, Neuro-Rehabilitation Institute Sunnyview Rehabilitation Hospital
When an individual experiences a serious medical event like a brain injury, it can be a stressful and overwhelming time for both the patient and the family. Everyone wants the best possible care for their loved one; however, selecting a high quality rehabilitation program can be a challenging task. Unfortunately, people often must decide where to go for rehabilitation when they have very limited time to adequately research their options to make an informed decision. Here are some considerations.
It is important for the family to be proactive in interactions with physicians and other healthcare professionals when a loved one is in an acute care hospital following a brain injury. If specialized brain injury rehabilitation is recommended, it is critical that the family work closely with the hospital social worker to learn about all available inpatient and outpatient options so that they can make the best choice for the loved one’s optimal recovery.
Specialized brain injury rehabilitation requires a carefully planned and individualized program to help the person to improve his/her level of functioning at home, work, school and in the community.
There is a range of rehabilitation programs that differ in terms of:
• The types of services they provide
• How often services are provided
• The setting where these services are offered
• Who provides the services
The most intensive level of brain injury rehabilitation for patients with moderate to severe injuries is found in an inpatient acute rehabilitation hospital where patients receive 24-hour medical care and a minimum of three hours of therapy a day for five or more days per week. The next level of care is in a sub-acute rehabilitation program, which is typically housed in a skilled nursing facility and where patients receive one to three hours of therapy a day for one to six days per week. At the other end of the spectrum are services offered on an outpatient basis or in the person’s home. Outpatient programs are for individuals who have their medical problems under control enough to live in their own homes and can travel to get their treatment. Outpatient brain injury programs typically offer one to three hours of therapy a day for two to three days per week. Home care programs—for persons who are living at home but are unable to travel to get their treatment—typically offer nursing care as needed and therapy services one to three days per week.
Regardless of the level of rehabilitation required, to achieve the best possible outcome, it is important that your treatment be supervised by a physiatrist, a physician specializing in rehabilitation medicine, and that your care be delivered by a specialized interdisciplinary team with extensive experience treating individuals with a brain injury.
Another important consideration for finding superior quality rehabilitation services is to select a program that is certified by the Commission on Accreditation of Healthcare Facilities (CARF), an international, not-for-profit organization that promotes quality rehabilitation services by establishing standards for quality and surveying those organizations to assure the standards are being met. CARF accreditation means that the services that a program provides meet the highest standards of quality.
Many brain injury rehabilitation programs offer opportunities for patients and family members to tour the program prior to making their decision. This is an excellent chance to see the facility, meet the staff, and get a feel for how the program operates to help determine if this would be a good match for their family member with a brain injury.
Some important questions to ask to determine an excellent brain injury rehabilitation program:
• How long has the program been in existence?
• How many persons with your diagnosis are admitted each year?
• Does the program have a formal system for evaluating the effectiveness of its services? (i.e., what percentage of inpatients return home after discharge and how satisfied are patients and family members with program services?)
• What is the program’s average length of stay for persons with your condition?
• Does the program provide a wide range of therapy and other rehabilitative services? (i.e., occupational therapy, physical therapy, speech and language pathology, neuropsychology, therapeutic recreation, rehabilitation nurses, social workers/case managers)
• How many hours of therapy do patients receive per day, per week?
• Does the program have a support group or offer peer mentor services?
• Does the program offer assistance with discharge? How does it work?
• Is training offered for family members/caregivers?
• Will my insurance plan cover all or part of the cost for rehabilitation?
• Will program staff help with insurance-related questions?
Several studies have shown a direct relationship between intensive specialized rehabilitation and the person’s ability to achieve his/her highest level of functioning after a brain injury. When choosing a brain injury rehabilitation program, it is important that individuals and their families make informed decisions to maximize the potential for recovery.