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Early Initiation of Vestibular Therapy Following Sports-Related Concussions: A Retrospective Cohort Study

Summarized by Arielle Berkowitz, DO November 2023 When a player experiences a bump to the head during a sports game or practice, he/she may begin to experience headaches, dizziness, blurred vision, trouble concentrating, or a brief loss of consciousness known as a Sports Related Concussion (SRC). These symptoms are often troubling and may make it difficult to immediately return to school, work, and/or sports. SRC can occur at any age and at any level of athletic training. Recovery after a SRC is different for each individual. Athletes who are female, who have had prior concussions, learning disabilities, and/or psychiatric illness may have more trouble returning to their normal daily activities. During this tough time, it is important to follow with experts who can help with the recovery process and provide education, guidance, and encouragement. In the past, it was recommended that athletes who have sustained a SRC completely rest their minds and body- avoiding television, phones, computers, and school-work- so that their brains could fully heal. More recent guidelines advise light activity/work during this recovery period. In most states, athletes are required to progress through a daily exercise schedule with a trained professional for one whole week. During this time, the athlete must perform exercises with increasing intensity with close monitoring of symptoms. Vestibular therapy is a therapy that is often offered to patients who continue to experience symptoms such as dizziness and balance issues weeks after their injury. With vestibular therapy, patients work closely with physical therapists to improve things such as balance and vision. In a recent article, “Early Initiation of Vestibular Therapy Following Sport-Related Concussions: A Retrospective Cohort Study,” by Ferry et al., the authors wanted to determine whether or not starting vestibular therapy shortly after injury would result in a faster recovery. In this study, the researchers reviewed the medical charts of patients ages 12-25 years who had a SRC between January 2014-December 2019, were seen in the Sports Medicine Concussion Clinic at Duke University and were referred to PT for vestibular therapy. Results from this study suggested that waiting to start vestibular therapy could increase the time to recovery and return to sport. In other words, starting vestibular therapy early after injury could result in a quicker recovery. After SRC, it is important to seek appropriate care early. Although we still need more details regarding exactly how long a person should receive vestibular therapy, how frequently he/she should go for visits, and when to begin the therapy, it is noted that, overall, it is extremely helpful without any detrimental effects. For more information view the article https://doi.org/10.7759/cureus.39764

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Watch with BIANJ: Live Concussion Documentary Screening

In recognition of National Concussion Awareness Day, the Brain Injury Alliance of New Jersey will be livestreaming Bell Ringer: The Invisible Brain Injury on Friday, September 16 starting at 3 PM. Join us to watch this award-winning PBS documentary, which is approximately one hour long and will be streamed live via Zoom. A brief optional discussion will immediately follow. Seating is limited for this free screening. Reserve your spot today.

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Free Webinar: Back-to-School Update – A Comprehensive Approach to Athlete Brain Health and Concussion

With the start of a new school year, children across New Jersey will be resuming interscholastic sports participation. This webinar will provide an updated overview of the current best practices for diagnosis and management of concussion and post-concussion syndrome with an emphasis on overall athlete brain health. There will be a specific focus on what is most important to understand for school personnel (teachers, coaches, etc.) and parents of youth and high school athletes. This webinar will be held via Zoom. Click here to register today!

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WEBINAR: Back to School Update – A Comprehensive Approach to Athlete Brain Health and Concussion

With the start of a new school year, children across New Jersey will be resuming interscholastic sports participation. This webinar will provide an updated overview of the current best practices for diagnosis and management of concussion and post-concussion syndrome with an emphasis on overall athlete brain health. There will be a specific focus on what is most important to understand for school personnel (teachers, coaches, etc.) and parents of youth and high school athletes.

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Sports Concussion

What is sports concussion? Sports concussions often occur in contact sports such as football, ice hockey, soccer and lacrosse, but they also occur in non-contact sports such as baseball, golf, and cheerleading. Most sports concussions don’t involve a loss or consciousness or a blow to the head, and many times, are overlooked by coaches and parents as they can be focused on the play. For most athletes, symptoms will resolve within two to four weeks, however for some, symptoms can persist for several months. Safe Return to Play If an impact or blow to the head is observed or suspected, and an athlete displays any of the above symptoms, they should follow the steps for a safe return to play. LEARN THE STEPS What are the signs and symptoms? What's the Difference?Signs of Sports ConcussionSymptoms Reported by AthleteWhat's the Difference? What makes a sport concussion different from other concussions? Athletes want to get back to play as soon as possible and may disregard other symptoms. The risk for a second concussion is higher when young athletes return to practice or competition too soon. The NJ Concussion Law has certain requirements before a student athlete can return to practice or competition. Signs of Sports Concussion Feel dazed or stunned Confusion Forgets plays or coaches instruction Uncertainty about opponents, time (e.g., which half, quarter), or score Alterations in coordination or clumsiness Gait or balance problems Shows personality, mood, or behavior change Forgets events prior to or after the impact Loss of consciousness Symptoms Reported by Athlete Headache or pressure in the head Dizziness Balance Problems Nausea or Vomiting Sensitivity to light Sensitivity to noise Lethargy or fatigue Problems remembering Poor attention/concentration Not feeling right Slowed processing Numbness or tingling Sleep problems How to manage a sports concussion How a sports concussion is diagnosed A sports concussion is a medical diagnosis and should be evaluated and diagnosed by a physician. Athletes may report symptoms during the game or after, and sometimes days later. These symptoms should be taken as seriously as those reported on the day of the impact, and the athlete should be evaluated by a physician. A doctor will review how the impact occurred, signs and symptoms, and medical history. They will also conduct a neurological examination which assesses vision, hearing, balance, coordination, and cognitive functions. Concussions should be managed by medical physicians and licensed healthcare providers who have specialized training in the management and treatment of concussion. Recovery from sports related concussion Cognitive and physical rest The standard of care following a diagnosis of concussion is physical and cognitive rest. During the first few days of recovery, athletes who have sustained concussion should restrict physical AND cognitive activities that require attention and concentration, as they may exacerbate and possibly prolong overall recovery. It is expected that athletes who have sustained concussion who limit relevant physical and cognitive activities will not require further intervention and will recover spontaneously. What limiting cognitive and physical rest looks like Student Athletes should be provided with a return to learn plan and a set of personalized academic accommodations to assist in their recovery. Some athletes may be [...]
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Concussion

What is a concussion? A concussion is often referred to as a mild traumatic brain injury (mTBI) caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, stretching and damaging brain cells and creating chemical changes in the brain. There may be signs of injury to the head, such as bruising or cuts, or there may be no visible injury. A person does not necessarily lose consciousness after a concussion. Concussions are usually not life-threatening but, they should be taken seriously. Remember: A concussion/mTBI is an injury to the brain, not just ‘seeing stars’. Most people will recover completely within 2-3 weeks if given the proper periods of rest and a gradual return to activities. Repeated concussions occurring over an extended period can result in cumulative neurological and cognitive effects. Repeated concussions occurring within a short period of time can be catastrophic. Request a Workshop BIANJ offers customizable workshops for parents, teachers, and coaches. Contact us today to get your school up to speed on concussion prevention, recognition, and treatment. REQUEST A WORKSHOP Symptoms of Concussion Symptoms of concussion can vary, but common signs include: Dizziness Headaches Blurred Vision Nausea Vomiting Slurred Speech Appearing Dazed, Confused Ringing in the Ears Delayed Response to Questions What If I Have a Sports Concussion? LEARN THE SIGNS When to Seek Medical Attention Healthcare professionals recommend individuals contact their physician, call 911 , or go to the nearest emergency department immediately if someone sustains a bump, blow, or jolt to the head and has these symptoms: A headache that gets worse and does not go away Weakness, numbness, or decreased coordination Repeated vomiting or nausea Slurred speech Drowsiness or cannot be awakened Pupil asymmetry Convulsions or seizures Does not recognize people or places Increased confusion, restlessness, and agitation Unusual behavior Loss of consciousness Treatment Many people who have a concussion will experience initial symptoms such as headaches, dizziness, thinking difficulties, and changes in behavior. Symptoms typically diminish after two to three weeks. If symptoms continue beyond two weeks, it is important to consult with a healthcare professional trained in concussion management. Evaluation by healthcare professionals trained in the care of concussion is important After sustaining a concussion, it is very important to avoid any activity that places the individual at risk of sustaining another concussion Assure the individual that symptoms will subside if a recovery plan that balances rest and activity is followed Since most people will recover completely, accommodations will be temporary Healthcare professionals who are trained in concussion management will also take into consideration the stressors in the person’s life and how those may impact the recovery process. All factors need to be considered and addressed as a part of the recovery plan. The good news is that research shows that early identification, education, and management of symptoms can prevent long-term symptoms. Managing the symptoms through a balance of rest and activity is the key to recovery. Post [...]
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Regional Seminar

Sign Up Now! Learn about the affects of brain injury on children and adolescents at our annual seminar. Attend workshops, hear from professionals, make connections, and more. Don't miss out! Register Today Workshops Developmental Outcomes of Pediatric Brain Injury Supporting Youth and College Students Impacted by Brain Injury Understanding Concussion and Prevention in Youth Panel Discussion NJ State Services for People with Brain Injury
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Perspective: Cognitive Behavioral Therapy for Insomnia Is a Promising Intervention for Mild Traumatic Brain Injury

Summarized by Dan Zhou, MD October 2023 Insomnia is one of the most common complaints after traumatic brain injury. It occurs in almost half of patients and is more common in those with mild injuries, also known as concussions. People with insomnia have difficulty falling and staying asleep at night. This can negatively affect day-to-day routines due to tiredness and difficulty concentrating. A recent article titled “Perspective: Cognitive Behavioral Therapy for Insomnia Is a Promising Intervention for Mild Traumatic Brain Injury” was published in Frontiers in Neurology which reviews cognitive-behavioral therapy for insomnia (CBT-I) in concussion patients. CBT-I uses a combined cognitive and behavioral approach to treatment. Some examples include concepts such as limiting stimulation at bedtime, relaxation training, cognitive therapy, and sleep hygiene training. The overall goal is to promote sleep at bedtime, improve the sleep/wake cycle, and address negative thoughts surrounding sleep which would decrease sleep-related anxiety and arousal. In treatment trials, CBT-I has emerged as the preferred treatment for insomnia. The article mentions that 70-80% of patients with insomnia experience lasting benefit from CBT-I and about half have complete resolution. Similar to treating insomnia in general, CBT-I is also preferred as the main treatment for insomnia in concussion patients. Compared to taking prescription medications or self-treating, CBT-I does not have the side effects that all medications may carry and can provide lasting benefits. To understand why CBT-I is most appropriate for insomnia after concussion, we need to understand the connection between the two. The leading theory of why insomnia happens frequently after concussion is discussed in the article. First some people are at risk be it through their genetics or personalities. This is followed by a trigger which would be the head injury. The last factor is the perpetuating loop that keeps the sleep issues going. This loop is due to changes in behavior and attitudes. For instance, some people may attempt to sleep longer by taking more naps during the day which can mess up normal sleep patterns. Additionally, having negative thoughts like “lack of sleep will negatively affect my recovery” causes a cycle of anxiety associated with sleep. It is specifically this perpetuating loop phase with all of its behavioral and emotional factors where CBT-I may have the greatest benefit. Improving sleep after concussion is important as it is shown to improve mental functioning, pain, depression, and anxiety. These are some of the reasons that CBT-I has been and remains promising for the treatment of insomnia in mild traumatic brain injury patients.   For more information, view the article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575746/  
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Workshops

Free, customizable education for the community. The Brain Injury Alliance of New Jersey provides free interactive workshops on a variety of brain injury related topics. Workshops can be customized for the audience and adapted for different ages. To request a workshop please fill out the form. If you have any questions, contact Barbara Chabner, Director of Education and Outreach at bchabner@bianj.org. Brain Injury EducationTransportation SafetyBrain Injury Prevention & OtherBrain Injury Education Introduction to Brain Injury –This workshop provides an overview of the different types of brain injuries, common causes, symptoms and changes that result from brain injury, as well as strategies for assisting brain injury survivors.   Adjustment to Brain Injury – Designed for brain injury survivors and caregivers to discuss the challenges of adjusting to life after brain injury. The workshop reviews the various changes that can result from brain injury, common responses to these changes, and strategies for developing support throughout one’s journey.   Brain Injury in Students – Designed to teach educators and school staff how to support students with brain injury, this presentation reviews the different types of brain injury, the effect of brain injury on students, and accommodations and strategies for assisting students.   Brain Injury & Substance Abuse –This workshop provides an introduction to brain injury, highlights the bidirectional relationship between brain injury and substance abuse, and offers strategies for working with individuals impacted by brain injury.   Brain Injury & Domestic Violence –Designed to provide an introduction to brain injury, explore the connection and barriers associated with brain injury and intimate partner violence, and offers strategies for working with survivors of brain injury and domestic violence.   Brain Injury & Mental Health –This workshop provides an introduction to brain injury, explores mental health concerns that are common after brain injury, and offers strategies for working with survivors of brain injury.   Return to Work After Brain Injury –Designed for brain injury survivors and caregivers this workshop highlights common barriers to employment after brain injury and reviews the resources and accommodations that are available to assist survivors on their vocational journey. Transportation Safety Helmet & Wheeled Sport Safety – Focuses on wheeled sport safety (bike, scooter, skateboard), including the importance of wearing a helmet and rules of the road.   Distracted Driving – Designed to teach how to be aware of distractions and demonstrates how everyone can share the road. Strategies for drivers to prevent crashes and to understand pedestrian safety will be included.   Pedestrian Safety – Focuses on safety tips for walking and crossing the road.   Teen Safe Driving – Designed to educate teens about the GDL laws, pedestrian safety and how to be aware of distractions. Strategies for new drivers to prevent crashes and to learn how everyone can share the road will be included.   Child Passenger Safety – Designed to help families understand which car seat is right for their child and to learn when car seats need to be switched.  We also offer a workshop for K-1 grade students designed to teach them the importance of sitting in a booster seat.   School Bus/School Zone Safety- A workshop for students discusses [...]
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42nd Annual Seminar for Professionals

Wednesday, May 1, 2024 The Palace, Somerset, NJ Save the Date! May 1, 2024 The Annual Seminar offers an educational and networking opportunity for professionals to gain knowledge of the latest research, best practices and effective strategies for working with individuals affected by brain injury. The knowledge level of the audience varies, including both new and experienced professionals. The Seminar is a full day conference consisting of a keynote presentation followed by three workshop blocks with three presentations in each block. Lunch will be served and organization exhibitors and student poster presentations will also be included. Student Poster Proposals We invite you to submit a poster proposal. Posters typically focus on research, prevention, treatment, rehabilitation and public health issues related to individuals affected by brain injury. Accepted posters will be displayed at the Seminar. Submit your proposal today! Award Nominations Each year the Alliance recognizes outstanding individuals for their dedication to our mission through their professional contributions, personal achievements, strength of character, and relentless work to support our constituency. Submit a NominationMimi Goldman Positive Achievement Award Mimi Goldman, who was pivotal in the development of the Council for the Head-Injured Community (CHIC, now known as VOICES), passed away in 1997. She was the first person with a brain injury to serve on the Board of Trustees for the Brain Injury Alliance of New Jersey. Mimi served as a role model for the brain injury community, sharing her talents and experiences on numerous committees and events, and always with a characteristic smile. The Brain Injury Alliance of New Jersey established the Miriam (Mimi) Goldman Positive Achievement Award in the spring of 1997 to commemorate Mimi Goldman. This award is presented each year to an individual with a brain injury to honor his or her accomplishments. 2022 Recipient: Christopher Mueller Click here to nominate someone for this award.  Trooper Scales Memorial Award Trooper Christopher S. Scales was a front-line partner in the Brain Injury Alliance of New Jersey’s brain injury prevention efforts. Trooper Scales was struck and killed on December 3, 2002 while conducting a seatbelt enforcement detail on the New Jersey Turnpike. The Brain Injury Alliance of New Jersey honored State Trooper Christopher Scales posthumously in May 2003 by introducing the Trooper Christopher Scales Memorial Award. This award is presented each year to a member of the law enforcement community who has demonstrated exemplary efforts in promoting public safety and brain injury prevention. 2022 Recipient: Sgt. Jefferey Delbuono Click here to nominate someone for this award.  Jill Schulman Community Pillar Award The Jill Schulman Community Pillar Award recognizes individuals, employed in the brain injury field, who significantly contribute to the quality of life for people with brain injury and their caregivers and promote brain health through their volunteer service and support of the mission of the Brain Injury Alliance of New Jersey. The Award was renamed to honor Jill Schulman who passed away in May of 2011. During her 21 year tenure with the Alliance, Jill’s contributions, character, and unending passion embodied the spirit in which the Community Pillar Award was established. 2022 Recipient: Dr. Dustin Gordon Click here to nominate someone [...]
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