Category Archives: Rehab

Sports Medicine Expert on Concussion Symptoms and Dangers

Posted on: October 14, 2014

Concussion Management. Assessing the Symptoms.

By Dr. Eric Small

While a headache is among the best-known and first symptoms of a concussion, there are often delayed symptoms that indicate ongoing mild brain damage and require treatment. Ten percent of symptoms don’t present for a week or more.

For this reason, it is essential that parents and teachers as well as emergency room physicians and pediatricians recognize the need to monitor a young injured athlete for the full spectrum of possible symptoms. In my experience, when the athlete gets over the initial headache, or perhaps never experiences this symptom, parents and youngster often push for a quick return to all activities. But that can put a young person at serious risk.

Today’s best concussion management involves assessing all symptoms – early and late, including many that can seem unrelated to the injury — to determine the proper timing of an athlete’s return to play and also to learning, that is, the resumption of a full academic load.

Often-overlooked symptoms of a concussion include sleep disturbances and personality changes, in which, for example, a very sociable teen becomes quiet. It’s also important to know that post-injury cognitive impairment often causes academic difficulties to emerge over time. For example, an A student in math becomes, two or three months later, a B student. I particularly advise parents to keep an eye on their child’s performance in math and foreign language. As both subjects require doing multiple mental tasks simultaneously, and rely heavily on memory, they are usually the most affected. When I see a young athlete who appears fine after a concussion, I ask two targeted questions: First, “How are you sleeping?” And always – “Are you having problems with math?”

Be aware that cognitive symptoms may not surface until triggered by a heavy cognitive stress, such as back-to-back tests in school – and that this delay in symptoms can lead to dangerously delayed treatment. A little-known fact about this type of injury is that an untreated concussion can keep getting worse.

Another surprising fact to most people is that a broken nose or broken tooth suffered during sports can also cause head trauma, causing the same set of often-delayed symptoms. This is why I strongly advise that even a symptom-free child see a doctor within 48 hours of the injury, and that visits continue as the child is watched for late-arriving symptoms.

It is now recognized that proper concussion rehabilitation often involves not only physical rest and rehabilitative therapies – but rest and rehab for the brain. Ideally, a physician prescribes personalized guidelines for modifying physical and mental activities. The guidelines typically encompass texting and computer screen time, both of which can add visual over-stimulation to the stress of cognitive processing.

For day one post-concussion, I typically recommend that the student go to school a few hours late. If they tolerate that, day two is a full day. But during non-core classes, such as gym and music, I recommend they rest in the nurse’s office. And no tests. Similarly, a return to play might start the student off with a little jogging, then add push-ups. What you don’t want is the old method of rehab where the athlete stays out of school for a period of time and then returns to a full regimen. A gradual progression is a must.

Editor’s Note: Dr. Eric Small is a past chairman of the AAP committee on Sports Medicine and is active in creating national policy regarding children and sports. He has been named Sports Medicine Best Doctor in New York Magazine and Westchester Magazine  since 2007, and has over 20 years of experience with athletes.

For more information on concussions, visit www.cdc.gov/concussion

 

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Pulmonary Medicine Expert Discusses Asthma and the Flu

Posted on: January 17, 2014

Take Steps to Avoid the Flu, Especially if You Have Asthma

By Harlan Weinberg, MD Medical Director, Pulmonary Medicine & Critical Care Medicine, Northern Westchester Hospital

Patients who have a diagnosis of asthma, as well as other clinical conditions, such as COPD, Cystic Fibrosis, Congestive Heart Failure, Diabetes Mellitus, and Cancer, are all at increased risk of developing flu-related complications.

Asthma is a disorder of the lungs characterized by chronic inflammation of the airways. Acute influenza may lead to worsening of asthma/asthmatic exacerbation, pneumonia and ultimately, respiratory failure, for both children and adults.

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Take the COPD Quiz

Posted on: November 12, 2013

 

1. True or False: It’s easy for patients to recognize the symptoms of COPD.

2. True or False: More than 12 million American adults have COPD.

3. True or False: Genetics are the top reason people develop COPD.

4. True or False: COPD is common in younger people.

5. True or False: People with COPD should get flu and pneumococcal vaccines.

For answers…

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Westchester Pulmonologist Gives COPD Caregivers Support

Posted on: November 12, 2013

What Caregivers Need to Know About COPD

By Dr. Harlan Weinberg, Medical Director of Pulmonary Medicine, Northern Westchester Hospital
Weinberg, (Harlan Weinberg, MD)Living with someone who has COPD can be very challenging. Not only are there challenges in helping the patient with treatment and preventing exacerbations of COPD, but the condition can really limit the caregiver’s lifestyle as well. Good communication between the caregiver, the patient and the doctor is extremely important. You have to keep an open three-way channel. This will help you figure out when you can manage a situation at home or when you might need to make a trip to the emergency room. Continue reading

New York Pulmonary Specialist Discusses Asthma

Posted on: June 20, 2013

Are Asthma Attacks Rising With the Temperature This Summer?

By Dr. Harlan Weinberg, Medical Director of Pulmonary Medicine, Northern Westchester Hospital

Asthma If it seems like asthma is on the rise, it is. The Centers for Disease Control and Prevention report that doctors diagnosed 4.3 million more Americans with the condition over the last ten years. Unfortunately, no one really knows why asthma is increasing. In spring and summer, the increase in temperature, pollen, and humidity can make asthma attacks more likely. Luckily, there are plenty of ways to protect yourself or loved ones.

Asthma is characterized by inflammation in the airways. This inflammation can lead to shortness of breath, a tight feeling in the chest, and wheezing. The condition can limit your ability to exercise or partake in activities of daily living. The inflammation can be caused by a number of triggers, such as allergies, dust mites, pollen, infections, certain foods, and environmental factors like pollution or mold. The full list is substantial, which means it may take a while to find a patient’s trigger. Blood tests for allergies can help narrow down the candidates. Patients may also want to keep a journal to jot down the places and times when breathing gets worse. Continue reading