Our Occupational and Speech Therapists specialize in treatment for individuals who have sustained concussions. You may wonder why you would be treated by a speech therapist if you have no difficulty speaking. Speech-Language Pathologists treat thinking skills listed below.

The goals of the program include:

Helping clients develop a better understanding of the effects of their brain injury, their strengths and weaknesses, and the benefits of compensatory strategies as a tool for life-long success.

Teaching compensatory strategies and cognitive skills that will facilitate and sustain their ability to function independently, return to work, and /or participate in academic coursework.

Facilitating improvement in neurocognitive function through evidence-based graded activities in targeted areas of deficit.
The program is a multi-phase approach to retrain:

• Attention
• Memory
• Information processing
• Auditory Processing
• Executive function
• Time management
• Reasoning
• Problem-solving
• Higher-level language skill
• Visual Processing

What you should know about Mild TBI

Symptoms Checklist

Traumatic brain injury (TBI) is caused by an impact to the head from direct blows or sudden movements such as whiplash. TBI can result in physical, cognitive, behavioral, or emotional difficulties. Injuries can range from minor to extremely severe and call for various levels of intervention and treatment.

People with TBI may experience short-term memory loss, have difficulty concentrating or paying attention, become easily disoriented, have impaired judgment, experience headaches or migraines, have slurred speech, experience seizures, become fatigued, depressed, or easily agitated, or experience increased anxiety and impulsive behaviors.

Our team of Brain Injury Specialists at Neuro Rehab Associates can help people who have sustained a TBI. The type and duration of intervention depend on how severe the injury.

What can our team of therapists do?

• Evaluate the skills necessary for the client to engage in daily activities at home; at work; at school and during leisure activities, and facilitate the resumption of those activities.
• Educate the client so they understand their specific deficits and how to work around them and improve them
• Restore cognition, language, movement, coordination, balance, endurance and strength so that a person with TBI can be more independent.
• Help the client perform simple tasks that are meaningful to the person's life.
• Recommend equipment that can aid a person in performing daily life activities with greater independence, such as a tub or shower seat to allow bathing without standing when the client has poor balance and grab bars for greater safety when getting in or out of a tub or shower.
• Teach a person with TBI to compensate for problems with thinking, such as memory impairments, use of weekly checklists of household chores, minimizing over-stimulation and confusion in their environment.

Our occupational therapists (OT) have training and experience in assessing and improving functional visual skills. After they have completed their assessment, they may also refer you to a specialized optometrist to complete a thorough diagnostic exam. Our OTs use a variety of strategies and exercises to train specific aspects of the visual system, compensate for vision-related symptoms, and facilitate recovery of function visual skills after a concussion. They may work on the eye movement skills needed for reading such as pursuits (eye tracking) and saccades (eye jumps), shifting focus, scanning, and processing visual information. They will also work on visual perception, visual memory, and spatial awareness. The patient is assigned specific home exercises to practice these skills.

Common visual symptoms include:

• double vision
• blurred vision
• eye strain and fatigue
• headaches that intensify with the use of the eyes
• dizziness and nausea
• difficulty tracking moving objects or loss of place when reading
• light sensitivity
• motion sensitivity

The effects of a stroke on communication (speaking, understanding, reading, writing), memory, upper extremity function, self-care management, and independent living skills can vary greatly from one patient to another and the pace and progress of rehabilitation can vary, too. It is important to find a care provider that specializes in stroke rehabilitation as we do at Neuro Rehab Associates. We can help people to achieve the best outcomes possible through evidence-based treatment.

For more information please visit the National Stroke Website or this fact sheet on Post Stroke Fact Sheet

LSVT LOUD: Cathy Fisher and Tina Poncin, Speech-Language Pathologists, have been certified in the LSVT (Lee Silverman Voice Treatment) to treat the voice of people with Parkinson Disease as well as people with other neurological voice disorders.

Most patients with Parkinson's Disease experience decreased voice volume and decreased intelligibility of their speech as their disease progresses. The purpose of LSVT is to reverse that decline by focusing on the patient's attention on increasing voice volume through an intensive exercise program.

LSVT BIG: Darcy Peterson, Physical Therapist, is certified in LSVT BIG: an intensive, effective, one-on-one treatment created to help people with Parkinson's disease (PD) and other neurological conditions address walking, balance and other activities of daily living (for example, getting up from low chairs) or even job-related tasks.

For more information please go to the LSVT Global website.

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life.

Alzheimer's is a disease that attacks the brain. It is the most common form of dementia.

Dementia and Alzheimer's Disease affects not only the person with memory difficulty but also the family.

Once the initial assessment is completed, our treatment focuses on helping the individual, family and/or caregiver

• Understand specific information regarding the cognitive deficits
• Learn ways to set up the environment to maximize function
  
• Compensate for the deficits
• Maintain and sometimes improve the functioning

For more information please go to the Alzheimer's and Dementia Website

See 10 Early signs of Alzheimer's Disease vs. typical age-related memory loss (further down the same page).

Mild cognitive impairment (MCI) is a diagnostic category used to describe gradual cognitive decline associated with aging, but distinct from dementia. It can affect memory specifically or other areas of cognition, such as attention, executive function, language, and visuospatial skills.

In cases of MCI, it is often difficult to identify the specific starting point or the transition from asymptomatic phase to the symptomatic phase. Estimates of occurrence in the general population range from 3-17%. There is still a great deal of uncertainty regarding the likelihood of progression to dementia or Alzheimer’s Disease(AD), but it is generally thought to be around 10%. Many cases of MCI are stable over time.

The main clinical criteria for MCI diagnosis include concern about a change in cognition (memory or non-memory), impairment in one or more cognitive domains that are corroborated by family, generally preserved independence in functional abilities and no significant impairment in social or occupational functioning.

Speech therapy can be beneficial for those diagnosed with MCI. The primary focus would be on education regarding diagnosis and residual strengths, the teaching of compensatory strategies, training family members in the use of supportive strategies for home carryover, and strengthening the existing “strengths”.

Our speech-language pathologists specialize in diagnosing and treating conditions that affect memory and thinking. We can create a plan to help you mange and cope with chemo brain symptoms. Doctors sometimes refer to this as cognitive rehabilitation or cognitive remediation.

Signs and symptoms of chemo brain may include the following:

• Being unusually disorganized
• Confusion
• Difficulty concentrating
• Difficulty finding the right word
• Difficulty learning new skills
• Difficulty multitasking
• Feeling of mental fogginess
• Short attention span
• Short-term memory problems
• Taking longer than usual to complete routine tasks
• Trouble with verbal memory, such as remembering a conversation
• Trouble with visual memory, such as recalling an image or list of words

Following an initial assessment, a treatment plan focused on learning to adapt and cope with memory changes may involve:

• Repetitive exercises to train your brain. Memory and thinking exercises may help your brain repair broken circuits that may contribute to chemo brain.
• Tracking and understanding what influences memory problems. Carefully tracking your memory problems may reveal ways to cope. For instance, if you become more easily distracted when you're hungry or tired, you could schedule difficult tasks that require extra concentration for the time of day when you feel your best.
• Using coping strategies. You may learn new ways of doing everyday tasks to help you concentrate. For instance, you may learn to take notes or make an outline of written material as you read. Or a therapist may help you learn ways of speaking that help you commit conversations to memory and then retrieve those memories later.
• Stress-relief techniques. Stressful situations can make memory problems more likely. And having memory problems can be stressful. To end the cycle, you may learn relaxation techniques. These techniques, such as progressive muscle relaxation or mindfulness practices, may help you identify stress and help you cope.

Mayo Clinic web pages regarding Chemo Brain

Individualized therapy to develop and implement practical solutions to the challenges of everyday living with MS.

The goal of the program is to help people with MS stay active in daily life by facilitating participation in the activities that are valuable and meaningful to them. This includes productive, self-care, and leisure activities.

Comprehensive focus includes but is not limited to:

• Fatigue management
• Activity Modifications
• Adaptive equipment use
• Memory compensation techniques
• Visual changes
• Fine motor coordination
• Upper extremity strength and range of motion
• Home modifications.

Multiple Sclerosis Program at Neuro Rehab and Fatigue Management

For more information on Multiple Sclerosis please visit the National MS Society web page.

IM has been shown to improve:

• Attention & Concentration
• Motor Planning & Sequencing
• Language Processing
• Behavior (Aggression & Impulsivity)
• Balance and Gait
• Endurance Strength
• Motor Skills

Cathy Fisher and Michelle Rosen have training in this treatment approach and uses IM to enhance traditional therapy approaches to achieve measurably improved outcomes.

The IM program provides a structured, goal-oriented process that challenges the patient to synchronize a range of hand and foot exercises to a precise computer-generated reference tone heard through headphones. The patient attempts to match the rhythmic beat with repetitive motor actions.

A patented audio or audio and visual guidance system provide immediate feedback measured in milliseconds, and a score is provided.

For more information, please visit the Interactive Metronome Web page.

Michelle Rosen, OTR at Neuro Rehab Associates is NDT certified. The NDT (Neuro Dynamic Treatment) Approach is used for the management and treatment of individuals with central nervous system (CNS) pathophysiology and used with adults who have suffered a stroke or other neurological deficits. The individual's strengths and impairments are identified and addressed in relation to functional abilities and limitations. The NDT Approach continues to evolve with the emergence of new theories, models, research, and information in the movement sciences. NDT is a hands-on, problem-solving approach. An intervention involves direct handling and guidance to optimize function. The approach is guided by the client's reactions throughout every treatment session. An NDT Trained or NDT Certified™ therapist's education in neurology, physiology, and current research is translated into daily practice. They work collaboratively with patients, families, caregivers, and other healthcare professionals to develop individualized comprehensive treatment programs based on NDT theory and philosophy.

The goal of this treatment is to improve executive functioning skills and problem-solving by using an integrative problem solving/emotional regulation approach. This treatment was designed for people who have mild to moderate cognitive deficits related to Stroke, Acquired Brain Injury (ABI), M.S., Parkinson’s Disease. The program is client-centered and wellness-focused. In our experience, the clients we treat with the diagnosis listed above improve in many areas but often get to a level where their executive functioning and problem-solving skills seem to get stuck and what they have learned in treatment does not carry over into their daily lives. Often poor emotional regulation sabotages problem-solving and executive functioning skills.

This approach is concrete and gives the client a step-by-step concrete approach to regulate their emotions by being more aware of the emotion, triggers that caused the emotion, sensations they feel, behaviors they exhibit and their self talk and then gives them specific strategies to use to regulate these. They also learn an acronym to use to go through the steps of problem-solving where they identify when a problem is occurring, determine/define the problem, brainstorm alternatives, develop a plan and determine how and when to implement the plan and then self-evaluate how to effect the plan was and make changes as necessary. In the group setting, the participants not only learn the techniques but they also, help each other brainstorm and work through the techniques while they are all practicing the techniques. Once their emotions are regulated, they are able to problem-solve more effectively.

If you would like more information, please feel free to contact us or look up more information about the program on the Mount Sinai Hospital website or the Archives Physical Medicine Rehabilitation.