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Jan 29 24

Spinal Cord Injury: A Personal Rehabilitation Journey

by John Weiss

Your recovery from a spinal cord injury (SCI) is unique. That’s because each injury is different, based on the location and extent of damage to the spinal cord.

Most people with SCI experience changes to strength, sensation and automatic function below the injury site. It can also impact your physical, mental, emotional and social well-being.  But despite these challenges, you can move forward with a fulfilling life and improved functionality with a personalized rehabilitation plan.

To unleash your full potential following an SCI, all aspects of your physical and emotional well-being must be considered. That’s why SCI rehabilitation with a specialized team is so important.

Complete and incomplete SCIs

There are two categories of SCIs: complete or incomplete, referring to the ability of the nerves to send messages between your brain and body below the level of your spinal injury.

  • If you’ve lost all sensation and strength below the injury site, it is a complete SCI.
  • If you have any sensation or motor function below the injury site, your SCI is incomplete.

Types of SCIs: Either can be complete or incomplete

Traumatic: These injuries occur from a physical trauma, for example, a blow to the spine or a gunshot injury.

Non-Traumatic. These injuries occur from non-traumatic causes, for example, a tumor, autoimmune disease and others. Their onset may be less obvious, with symptoms gradually worsening.

Symptoms of an SCI can vary tremendously and may include:

  • Loss of movement, coordination, balance and/or strength
  • Difficulty walking
  • Loss or diminished sensation or hypersensitivity to touch, heat or cold
  • Loss of bowel or bladder control
  • Exaggerated reflexes
  • Muscle spasms
  • Pain, including numbness or intense stinging sensations
  • Changes in sexual function or sensitivity
  • Difficulty coughing, breathing or clearing secretions from your lungs

If you notice any of these symptoms, whether immediately or gradually, don’t wait to consult your physician for a diagnosis and proper medical treatment.

How are spinal cord injuries treated?

Regardless of the type of SCI, specialized medical treatment and rehabilitation can help.

After a SCI, you may benefit from specialized inpatient rehabilitation to support your medical, physical, neurological and psychological needs. While recovery is different for everyone, rehabilitation will help you improve overall well-being.

Rehabilitation will likely continue after discharge until you can safely and confidently manage your care at home. You may receive home care, including physical, occupational and/or speech therapy, or therapy may be scheduled at an outpatient location specializing in SCI.

Inpatient and outpatient SCI rehabilitation may include:

  • Physical therapy: Improves muscle strength, range of motion, and improving mobility- whether walking or in a wheelchair
  • Occupational therapy: Supports your ability to care for yourself, including adaptive dressing, bathing, eating, going to the bathroom and transferring. Focuses on strength, fine motor skills and assistive devices
  • Recreational therapy: Includes adaptive sports, social activities and leisure pursuits
  • Nutrition education: Helps you follow a healthy diet

Who will be on my SCI rehabilitation team?

Your Good Shepherd Penn Partners physiatrist (physical medicine and rehabilitation doctor) will design and manage your SCI rehabilitation program based on your injury and goals. In addition to your physiatrist, your team may include:

  • Physical therapists (PT)
  • Occupational therapists (OT)
  • Speech & language therapists (SLP)
  • Case managers
  • Social workers
  • Neuropsychologists
  • Nurses with specialized training in treating spinal cord injuries
  • Nutritionists
  • Respiratory therapists (RT)

Your medical and rehabilitation team can guide you throughout your recovery journey, so do your best to keep any appointments with them.

For help with your SCI rehabilitation journey or for more information on treating spinal cord injuries, see the Good Shepherd Penn Partners spinal cord injury rehabilitation page or call 1.877.969.7342.

Dec 19 23

Post-Concussion Rehabilitation

by sciasulli

Customized Post-Concussion Rehabilitation

If you are a football or soccer fan, you regularly hear about athletes undergoing concussion protocol. Sports collisions alone are responsible for up to 3.8 million concussions each year.1 A concussion, the result of a hit to the head or a whiplash-like action that shakes the brain, can result from car crashes, bicycle accidents, fall, etc. 

So, what happens to the brain when you get a concussion?

When your head is hit hard, the brain moves against the skull and damages brain tissue, causing a mild traumatic brain injury (mTBI) that can result in temporary loss of some brain functions. Concussion symptoms may appear immediately after the injury or days or weeks later, with the most common being headache, dizziness (a sense of disequilibrium and imbalance more often than vertigo) and nausea.2   It’s important to remember you don’t need to have a loss of consciousness to sustain a concussion. 

Every concussion is a serious injury, so the sooner you are evaluated by a healthcare provider and begin rehabilitation, the sooner your symptoms may resolve with no lasting damage. Most patients will make significant progress with a concussion rehabilitation program, and concussions usually resolve within 1 to 3 months with a personalized rehabilitation program. However, some patients experience long-term physical, cognitive and emotional effects and need a longer-term, specialized plan to treat those symptoms.

Post-concussion syndrome (PCS)

If concussion symptoms persist longer than three months, you may have PCS. Your risk of PCS increases with every subsequent concussion, number of concussion symptoms or a history of behavioral or certain brain-related conditions. If left untreated, PCS symptoms may last years or decades. 

Symptoms of PCS include many typical concussion symptoms but these may also be present:

  • Body temperature irregularities
  • Heart rate issues
  • Gastrointestinal difficulties
  • Blood pressure changes
  • Chest pain
  • Sexual dysfunction
  • Reduced alcohol tolerance

Concussion Rehabilitation

Every concussion’s symptoms are unique, so your post-concussion rehabilitation is customized to treat your specific symptoms. Your health-care team will evaluate your vision, balance and eye movements. They will ask questions about your symptoms and about the event that caused your concussion. If your doctor suspects you have a serious concussion, a CT scan or MRI of your brain may be ordered.

Post-concussion, your brain needs at least a few days to rest, with no intense thinking or physical activity during this time. In fact, resting your brain and giving it a chance to heal is important for any level of concussion. 

After the initial resting period, your concussion rehabilitation will begin and continue until you are symptom-free.

Your post-concussion rehabilitation may include:

  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Vision therapy
  • Balance & Vestibular therapy
  • Headache management
  • Neuropsychology
  • Nutrition counseling

Your health-care team will work with you through the dynamic changes that happen during concussion rehabilitation, to get you back to school, work, exercise, sports and other activities as quickly as possible.

For more information about concussion therapy at Penn Therapy & Fitness, call 877-969-7342 or visit our concussion therapy page.

1. Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil.

2. Physiopedia, Post-Concussion Syndrome.

Aug 8 23

Brain Injury Rehabilitation: What is the best therapy for brain injury?

by Jon Brannan
What is the best therapy for brain injury

A football tackle. A stroke. A combat injury. A car accident. Any of these events can cause a brain injury.  And just as each cause of brain injury is different, so will be its symptoms and the specific therapies needed to resolve them.

What is a brain injury?

Traumatic brain injuries may be caused by a blow or bump to the head, an object piercing the skull, a violent shaking of the head (such as whiplash) or a fall. Non-traumatic brain injuries may be caused by an infection, cancer or an abnormality in one of the blood vessels of within your brain. The symptoms of your brain injury are directly related to the part of your brain that is impacted by the traumatic or non-traumatic event.

What types of therapy are available for brain injuries?

No two brain injuries are alike, each person’s therapy plan is designed to treat their unique symptoms and restore as much physical and cognitive function as possible.

Brain injury treatment at Good Shepherd Penn Partners is managed by a team of professionals trained in brain injury rehabilitation. Your team may include:

  • A physiatrist to oversee your treatment, prescribe medication and manage medical problems.
  • A neuropsychologist to assess your impairment and help you learn coping strategies.
  • Physical therapy to restore sensory deficits and regain strength, coordination, flexibility, range of movement, posture, balance and gait.
  • Occupational therapy to help you relearn daily tasks, such as eating, getting dressed, bathing and grooming.
  • Speech and language therapy to help you regain communication skills that may be diminished and strategies to compensate for those that are lost.
  • Recreational therapy to improve physical, emotional and cognitive function.
  • Psychological counseling to improve your well-being.
  • Cognitive therapy to help improve your memory and attention.
  • Vocational counseling to help you return to work.
  • A social worker to facilitate access to outside service agencies, assist with care decisions and help with communication between care providers.

What is the best therapy for brain injuries?

There is no singular “best” therapy for a brain injury. The best therapy is the therapy that’s right for you, that addresses your unique set of symptoms.

Recovery can be a matter of days or years. However, if it is recommended, it’s crucial to begin inpatient therapy at an inpatient rehabilitation facility such as Penn Medicine Rehabilitation as soon as medically possible. Starting as soon as possible after the injury takes advantage of your brain’s plasticity and its capacity to reorganize its neural networks in response to your injury. After you’re medically stable, outpatient care will help you continue to improve over the subsequent months and if necessary, years.

The ultimate goal of brain injury rehabilitation is to enable you to do what you love and need to do daily (activities of daily living) so that you can return home and live independently and safely.

If you or a loved one have experienced a brain injury, please visit our Brain Injury Rehabilitation Program page or call 1-877-969-7342.

Jun 23 23

What is the Role of Speech Therapy in Brain Injury Recovery?

by Jon Brannan
Senior Couple Relaxing In Autumn Landscape

A brain injury can be a life-changing event. There are two types of brain injury: traumatic and non-traumatic.  Traumatic is caused by an external event such as a car accident or a fall, while non-traumatic brain injuries occur as a result of an event inside your body, like a stroke.

Regardless of the type, when a brain injury occurs, your ability to speak, think, chew or swallow may be affected. Speech therapy is critical in restoring these skills and learning strategies to compensate for any deficits.

What speech disorders occur after a brain injury?

The most common disorders accompanying a brain injury are Dysarthia, Dysphagia, Cognitive-Linguistic Disorder, Aphasia and Apraxia.

Dysarthria

Dysarthria occurs when you have difficulty controlling the muscles used for speech. The inability to control these muscles may cause reduced movement of your lips, tongue and soft palate and problems managing the airflow from your lungs when speaking. Symptoms of dysarthria include slurred or slowed speech that is difficult to understand or difficulty producing varied patterns in tone when speaking.

Dysphagia

Dysphagia occurs when there is weakness in the muscle used in swallowing and/or when the natural timing and coordination of swallowing is impaired.

Cognitive-Linguistic Disorder

Cognition refers to thinking processes that include attention, memory, and executive functioning. A cognitive linguistic disorder may affect your ability to remember important information, reason, or problem solve.

Aphasia

Aphasia is impaired ability to express or understand language. It may also affect your ability to read or write. Aphasia occurs when the left-side portions of your brain responsible for language are damaged.

Apraxia of Speech

Apraxia of Speech is a motor speech disorder caused by the brain’s inability to control the muscles used to speak or the muscles of the lips or tongue. Symptoms of apraxia of speech include an impaired ability to say sounds correctly.

How does speech therapy treat brain injury?

The good news is that speech therapy can treat brain injury and help your recovery in two ways:

1) Restorative therapy: the goal of restoration is to improve the strength of the muscles and coordination needed for speech and swallowing or improve the neuronal connections needed for cognitive linguistic tasks.

2) Compensatory therapy: the goal of compensation is to support speaking, swallowing, and language through implementation of strategies that improve daily life.

A speech-language pathologist (SLP) at Penn Therapy & Fitness will design a therapy program to help improve your abilities impacted by brain injury.  We work to help you regain speaking, swallowing, communication, and cognitive skills that will support your goals in your home environment.

Depending on your diagnosis, your SLP may use exercises to:

  • Help you speak louder
  • Strengthen or coordinate your mouth, tongue, jaw and throat muscles
  • Improve your memory
  • Improve organization and problem-solving
  • Retrain your swallowing function
  • Help you say words clearly
  • Enhance your word choice and tone
  • Integrate augmentative communication like text-to-speech apps
  • Incorporate low-tech communication tools like a whiteboard, images or pen and paper

If you or a loved one has speech, language, swallowing, or cognitive changes due to a brain injury, visit our speech therapy page or call 877-969-7342.

Jun 13 23

Meet the Expert: Jeremy Yves Charles, MD

by Jon Brannan

Brain Injury Rehabilitation Program Director
Penn Medicine Rehabilitation
An inpatient rehabilitation unit of the Hospital of the University of Pennsylvania

“Working with someone to achieve their full potential is a priceless experience.”

Jeremy Yves Charles, MD

After experiencing a brain injury, it can be difficult to find the right resources to help you or a loved one recover. As Director of the Brain Injury Program at Penn Medicine Rehabilitation, Jeremy Yves Charles, MD, oversees the Brain Injury Recovery Center, a program dedicated to the holistic recovery of brain injury patients.  From their Rittenhouse location in Philadelphia, he and a team of therapists, rehabilitation nurses and neuropsychologists help hundreds of patients learn the skills they need to lead productive, fulfilling lives.

Here we learn more about Dr. Charles’ background and why his work is so important to him.

Q. Can you tell us a little about your role?

A. My primary role is to connect patients with the care and resources they need. I spend a lot of time with new patients and their families so I can understand their needs and how to best support them. Those observations allow me and the treatment team to coordinate the best plan of care for each patient and family.

Q. What is a brain injury?

A. There are two primary types of brain injury – traumatic and non-traumatic.  Traumatic injuries occur as the result of an external force like car accidents, falls and sports injuries, while non-traumatic injuries occur as a result of internal conditions such as strokes, vascular malformations (such as aneurysms) and brain tumors

Q. How does brain injury impact patients?

A.  Both traumatic and non-traumatic brain injury can cause debilitation. Sometimes patients have milder symptoms and improve their function quickly. Sometimes patients have severe symptoms and have longer-term issues with cognition, motor and/or sensory deficits and personality changes.

Q. What motivates you?

A. It is really a privilege to do the job I do.  Inpatient rehabilitation can truly make miracles happen. Every day, I get to witness patients get better. Seeing a patient achieve their potential – something as simple as speaking their first words – makes me grateful for the opportunity to play a role in their recovery.

Q. What role can families and caregivers play in recovery?

A. The patient’s caregiver is truly one of the most important parts of the team. We work very hard to educate them about what to expect and how they can support the patient.  The more they understand, the better the outcome.  Caring for someone with a brain injury is definitely an adjustment, so we want to make sure we do everything possible to support that person.

Q. What advice would you offer someone who’s experienced a brain injury?

A. Be patient with yourself and the recovery process. The brain is a complex and amazing organ that can and does recover. Don’t be afraid to ask for help – it’s why we’re here.

Q. What is on the horizon in treating brain injuries?

A. Technology (via new imaging techniques) is helping us better identify the specific pathways involved in brain injuries. As we learn more, we can further target our approaches to optimize outcomes. Technology (i.e. non-invasive brain stimulation) is also key to new therapeutic opportunities. We work closely with the University of Pennsylvania research teams to evaluate the potential of new treatments to help our brain-injured patients.

Jeremy Yves Charles, MD

  • Undergraduate: Cornell University
  • Medical School: SUNY Downstate College of Medicine
  • PM&R Residency: Penn Medicine
  • Neurorehabilitation Fellowship: Brain Injury Medicine: Hackensack Meridian Health JFK Johnson Rehabilitation Institute
  • Professional Memberships: Association of Academic Physiatrists, the American Academy of Physical Medicine and Rehabilitation and the American Board of Physical Medicine and Rehabilitation

To learn more about the Brain Injury Program at Penn Medicine Rehabilitation, visit our web page.

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