1.4 Million Americans Experience Traumatic Brain Injury Each Year

Brain Injury Awareness Month

Studies show that 1.4 million Americans will experience a traumatic brain injury (TBI) this year, leading to 275,000 hospitalizations and 52,000 deaths each year in the United States alone. These injuries may be mild to serious, and can lead to permanent mental damage and even death.

March is Brain Injury Awareness Month, and Frazier Rehab Institute is working to increase awareness across the Commonwealth of the signs and symptoms of a brain injury.

“Traumatic brain injuries result from a bump, blow or jolt to the head that disrupts the normal function of the brain,” said Darryl Kaelin, MD, Frazier Rehab Institute Medical Director, and Physical Medical and Rehabilitation Division Chief at University of Louisville Physicians. “They have become increasingly common in adults and children, so it’s important to understand how to determine if a person is at risk for, or suffering from, a head injury.”

There are many causes of TBI, with falls proving to be the most common. Falls disproportionately affect the youngest and oldest age groups. Other leading causes include an unintentional blunt trauma, like being hit by an object, and motor vehicle accidents.

TBIs are classified as mild, moderate or severe. Victims can display a wide variety of physical, cognitive and sensory symptoms, which can help classify the severity of the injury. About 75 percent of TBIs that occur each year are concussions or other forms of mild traumatic brain injury (MTBI). Concussions can appear right away or days or months after the injury.

Adults or children experiencing a concussion typically display loss of consciousness for seconds to a few minutes, a state of being dazed or confused, headache, nausea or vomiting, drowsiness or difficulty sleeping, dizziness and loss of balance. These victims may also experience blurred vision, ringing in the ears, a bad taste in the mouth or changes in the ability to smell. They can show signs of mood swings, depression or anxious behavior.

Severe to moderate brain injuries include symptoms such as loss of consciousness for several minutes to hours, severe headaches, repeated vomiting, convulsions or seizures, pupil dilation, fluids draining from the nose and eyes, weakness or numbness in fingers and toes and loss of coordination. Victims may display profound confusion, slurred speech, agitation or combativeness, and in extreme cases, they will become comatose.

Individuals with severe TBIs will likely require hospitalization. Severe TBIs can result in coma or amnesia after injury. These injuries can lead to death or lasting brain damage. Approximately 5.3 million Americans live with a TBI-related disability.

“Traumatic brain injuries can affect all aspects of the patient’s life, and the lives of their friends and family,” said Dr. Kaelin. “Disabilities that develop from traumatic brain injuries can inhibit the victim’s ability to drive, complete household tasks, maintain employment and even uphold relationships. Our goal is to provide customized treatment and help restore patients to their fullest potential of independence.”  

If you or someone in your care experiences a blow to the head, it is important to see a doctor right away. Do not wait for traumatic brain injury symptoms to occur.

If you or a loved one has a concussion or think you may, call the Frazier Rehab Brain Injury Program at 502.582.7476.

Low back pain: A physical therapist’s perspective

Low back pain: A physical therapist's perspective

Low back pain: A physical therapist’s perspective

When patients who are suffering from low back pain come to physical therapy for the first time, the two most frequently asked questions are, “Why was I referred to physical therapy when my MRI shows joint or disc abnormalities?” and “Don’t I need an MRI so you know what is going on?”

Both questions are very reasonable. After an MRI reveals a disc bulge or protrusion, many patients feel that a referral to a physical therapist is the equivalent of having your mechanic tell you to continue to drive your car and see if your flat tire improves. Frankly, both scenarios can feel ridiculous.

Thankfully, the human body is not like a car. Multiple studies in the last few years have shown that the farther a disc extrudes or protrudes, the more likely your body is to reabsorb the disc with time.(1,2) In other words, disc healing is a very real and normal occurrence.

MRI and X-ray Abnormalities

As we age, we can develop abnormalities that can be seen on MRI and X-ray. For example, in studies of patients without low back or neck complaints, about 30 percent of patients in their 20’s have disc bulging and degeneration.

The percent of abnormalities increases with age and by the time an individual is in his or her 80’s the prevalence of these abnormalities is greater than 80 percent.(3) Remember, these abnormalities are in patients without pain.

While there are times when surgery is needed to address low back pain, outcomes are significantly improved when abnormalities in imaging correspond with the expected complaints of the patient and positive clinical findings.

Watch the video below to learn more about how physical therapists can often treat lower back pain without surgery.

Low Back Pain Treatment

When developing a treatment plan for low back pain, it is important to realize that a one-size-fits-all approach is not appropriate. In other words, some movements and treatments that help one patient may not be effective for treating your low back pain.

Research has shown that subgrouping patients based on their history and clinical findings improves outcomes.(4) We do this first by getting a good history of the patient’s symptoms, screening for potential red flags, assessing neurologic involvement (how is his or her sensation and strength), and then determining movement or directional preference.

Movement preference is part of a spine examination where you complete range-of-motion exercises in particular planes of movement to determine how these motions affect your pain sensitivity or symptom location. Once movement preference has been determined, evidence-based therapeutic exercise and manual therapy are used to reduce pain sensitivity and restore previous mobility.

After the first visit to physical therapy, you should have a better understanding of what movements or postures are affecting your pain and what you can do immediately to improve symptoms. In each subsequent visit, response to treatment is reassessed and joint mobilizations, manipulation, soft tissue mobilization, and other various manual techniques along with progressive therapeutic exercises are utilized to further decrease pain sensitivity and movement limitation.

While the time it takes for symptoms to resolve varies, most patients should be able to see a benefit in their pain with physical therapy after the first few visits.


Nelson Caudill

Nelson Caudill is a physical therapist with KentuckyOne Health.

  1. Zhong M, Liu JT, Jiang H, et al. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Pain Physician. 2017;20(1):E45-E52.
  2. Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil. 2015;29(2):184-95.
  3. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol 2015;36:811–6
  4. Fritz JM, Cleland JA, Childs JD. Subgrouping patients with low back pain: evolution of a classification approach to physical therapy. J Orthop Sports Phys Ther. 2007;37(6):290-302.

Fuzzy, Feel-good Therapy

Fuzzy, Feel-good Therapy

Fuzzy, Feel-good Therapy

Dogs specially trained to provide patients with inspiration and love are key players in the healing process at several KentuckyOne Health facilities.

There’s nothing like a wet nose and kind eyes to warm the heart and revive the spirit. But animals can offer more than companionship. Pets who have been specially trained to provide certain types of support to individuals facing health challenges can help people recover.

The canine companions at Frazier Rehab Institute, part of KentuckyOne Health, are certified to deliver Animal Assisted Therapy services, and dogs at the Saint Joseph Cancer Center, Saint Joseph Hospital, Saint Joseph East and Saint Joseph East Cancer Center, all part of KentuckyOne Health, socialize with patients and visitors, helping keep smiles on their faces even when they’re dealing with medical concerns.

“Interacting with pets is soothing to many people,” said Jamine Hamner, director of Volunteer Services with KentuckyOne Health. “These animals can help lift spirits and calm people down when they are anxious. Our patients’ moods change when an animal is in the room — it’s amazing to see.”

A Tradition of Wagging Tails

 

Dogs began visiting patients at the Frazier Rehab Institute more than 15 years ago as part of a Pet Therapy Visitation program. Volunteer pet owners and certified therapy dogs visited patients on a weekly basis. The visits were a hit, and the staff decided to add a dog to the team permanently to interact with patients and families, as well as be involved in therapy interventions.

“Animal Assisted Therapy is a goal-directed program in which specially trained animals are an integral part of the treatment process,” said Jill Farmer, CTRS, manager of recreation therapy and adapted sports programs with Frazier Rehab Institute. “The therapy promotes improved physical, social, emotional and cognitive function. We saw real value in officially making dogs part of the work we do.”

Watch the video to hear Jill Farmer, CTRS discuss Animal Assisted Therapy and Animal Assisted Activity.

 

A dog named Madison was the first four-legged staffer to join the KentuckyOne Health canine collaboration in 2006. The Paws with Purpose Organization placed her with the Frazier Rehab Institute, where she served solo until 2014, when she was joined by another facility dog named Charlie.

A breeder in Deer Park, Washington, donated Charlie to Frazier Rehab Institute. Like Madison, he was trained as a service animal. In December 2016, thanks to donations to the Jewish Hospital & St. Mary’s Foundation, Frazier Rehab Institute welcomed a new therapy dog named Stanley.

These three four-legged pioneers forged ahead on a mission to help patients facing a variety of conditions, including working with patients who have had a:

  • Stroke — The facility dogs help encourage individuals to talk, walk, or use an affected arm or leg for grooming or petting.
  • Traumatic brain injury — Trained facility dogs can help improve a patient’s communication and thinking skills. For example, a therapist may ask the individual to identify or recall the dog’s age, color and name or to complete basic tasks, such as petting the dog.

The dogs can be especially helpful in pediatric cases, encouraging children to crawl, stand or speak.

“The dogs can motivate individuals to continue working rather than giving up,” Farmer said. “And receiving a service animal for personal use once they have been discharged home can open up a world of independence for a person. The animal can help with opening doors, pulling off shoes and socks, and retrieving dropped items.”

Patients need an order from a physician to work with a facility therapy animal. If a patient has a compromised immune system, this kind of treatment may not be recommended.

Helpful Volunteers

 

Dogs who visit patients at Saint Joseph facilities serve a purpose that is a little less clinical than the dogs at Frazier Rehab Institute. But their work is just as important.

“These dogs are volunteers, and their human parents are volunteers,” Hamner said. “They show up at the hospital according to a self-determined schedule and then walk around to cheer people up as requested. It’s an awesome experience.”

Volunteer dogs who visit Saint Joseph facilities must already be trained therapy dogs. Pet owners may sign up to volunteer online, and when a dog has been approved, the owner can use the same online system to set up visits. These dogs receive special therapy badges, clock in when they are ready for work and visit patients in need of furry companionship.

Partners in Puppy Love

 

KentuckyOne Health partners with community organizations Paws with Purpose, Pet Partners for Independence, Wonderful Animals Giving Support (WAGS), Central Kentucky Love on a Leash and Alliance of Therapy Dogs.

Paws with Purpose puppies in training visit Frazier Rehab Institute patients on the weekends. Pet Partners for Independence offers facility and therapy dog training. And volunteers with WAGS bring in trained therapy dogs to visit patients during the week.

Together, these organizations brighten the days and improve the health of patients.

Funding for the pet therapy program at Frazier Rehab Institute was provided by a generous gift from June and Stanley Atlas.

More Than Man’s Best Friend

 

While it can be tempting to pet and cuddle the doggy helpers, remember that facility dogs who are working as service animals have to keep their focus on their work when they are on the clock.

“Facility dogs like the ones at Frazier Rehab Institute are highly trained dogs who must go through a minimum two years of continuous training,” said Farmer. “They are not pets. They are allowed to be typical dogs when they are not at work but are required to follow specific commands when they are on the job.”

Charlie, a goldendoodleCharlie, a goldendoodle, celebrated his fifth birthday in April.

Teddy Stapleton, a cocker spanielTeddy Stapleton, a cocker spaniel, is one of the many therapy dogs helping KentuckyOne Health patients.

Stanley, a yellow Labrador retrieverStanley, a yellow Labrador retriever, joined the pet therapy program in 2016.

This article originally appeared in the 2017 Fall edition of One Health Magazine. Sign up for your free subscription.

The Right Route to Recovery

The Right Route to Recovery

The Right Route to Recovery

All stroke rehabilitation is the same, right? Wrong. Here’s why.

A stroke doesn’t just come and go. The repercussions of the event can stay with a person both mentally and physically for a lifetime. Each year, roughly 800,000 Americans experience a stroke, and many of those must then begin the recovery process.

Darryl Kaelin, MD

“Stroke is one of the most common causes for disability in America and is certainly a leading reason for needing rehab,” said Darryl Kaelin, MD, medical director at Frazier Rehab Institute, part of KentuckyOne Health and associate professor of the division of physical medicine and rehabilitation at the University of Louisville. “After a stroke, survivors can lose a lot of physical and mental function and must work to get back what they can. That’s where rehab comes in.”

In or Out?

The primary mission of all rehabilitation facilities is to help patients improve their quality of life by working on:

  • Skills such as walking, talking and eating
  • Physical strength and flexibility
  • Living an independent lifestyle

“Stroke patients must carefully consider where they will seek rehab,” Dr. Kaelin said. “Not all hospitals and clinics offer the same services.”

Recently the American Stroke Association recommended stroke survivors utilize acute, inpatient rehab instead of skilled nursing facilities. This decision was based on several studies that revealed numerous advantages to inpatient rehabilitation programs compared with those in skilled nursing facilities.

Some of the most notable benefits of inpatient rehabilitation include:

  • Daily visits from a rehab doctor
  • Longer therapy sessions
  • Higher nurse-to-patient ratios

These added benefits can lead to quicker recovery times as well as longer life expectancy for those who participate in acute inpatient rehab.

This article originally appeared in the Fall 2016 edition of One Health Magazine. Want more health and rehabilitation news like this? Subscribe to One Health Magazine and receive the latest news straight to your inbox.