Introducing Dr Joseph E. Herrera

This month we have taken an in-depth look at how sports injuries can affect your life and highlighted preventative steps to avoid sports injuries. This week we would like to introduce you to a sports-specialist at Mount Sinai’s Department of Rehabilitative Medicine – Dr Joseph E Herrera. During sports seasons it is important that players look after themselves off the field as well as on. If you are looking at rehab to get back into shape or fighting off a hamstring tear - wherever you are on your journey to recovery (or the MBA), Dr Joseph Herrera can give you some coaching tips.

Dr Joseph E. Herrera is a Board-Certified Physician who joined Mount Sinai after the completion of an Interventional Spine and Sports Medicine Fellowship at the renown Beth Israel Medical Center, New York. He then completed his residency and served as Chief Resident in Physical Medicine and Rehabilitation through a combined program of Columbia Presbyterian Medical Center and Weill Cornel Medical Center. He finished his academic career before joining us by completing a fellowship at Beth Israel Medical Center and has been named an American Pain Scholar by the American Pain Society.

His literary works extend to authoring and editing textbooks such as the “Manual to Musculoskeletal Medicine” and “Essential Sports Medicine and he is the chief editor of the medical journal “Current Reviews in Musculoskeletal Medicine.”

He is currently researching Wii Shoulder Injuries – which are injuries obtained during using the Nintendo Wii Sports devices. His past accomplishment was in adding to the cutting edge of Lumbar Discography Study – and he anticipates beginning work in adding to the literature on Plasma Rich Protein for the Elbow.

Dr Herrera is also the New York State Athletic Commission and Chief Team Physician for USA Boxing Metro which has allowed him to regularly treat and evaluate professional athletes. His in-depth understanding of his field has awarded him the Rocky Marciano Physician of the Year Award for excellence in Sports Medicine.

Dr Herrera comes highly recommended. He was selected as one of the Best Doctors in America and has won an abundant of awards and comes highly recommended by his patients. He maintains an excellent rating on our website – averaging at 4.7/5 rating. His top-rated categories are in the following:

·        He explains in a way you understand

·        He listens carefully

·        They will recommend him to a friend

If you are looking for a sports physician that can help you through rehab or someone to create a bespoke plan of action.

If you have suffered a sports-related injury, please contact us at Mount Sinai Department of Rehabilitative Medicine for a bespoke rehab plan and request Dr Herrera. Contact our switchboard on: (212) 241-6321

Regaining Language in Aphasia Patients

 The outcome of aphasiac brain damage can seem debilitating to patients as their range of communication abilities is reduced. Depending on the extent of damage, and the area affected, there are treatments that can be employed to restore language abilities, either partially or completely.

The most commonly employed treatment process is speech and language therapy (SLT) and involves the patient working with a therapist on a series of exercises specially tailored to the type of aphasia damage. For patients who struggle to understand the meaning of words, activities, such as pairing words to pictures, or sorting words into groups based on their meaning, may be suggested, to redevelop word association knowledge and definition memory. If the trouble stems from a difficulty in expressing oneself coherently, a therapist may employ tasks in which the patient must name what they see in a picture, or judge whether or not words rhyme with one another. On top of working in one-on-one sessions with a speech therapist, often specially-designed computer programmes are used, alongside group speech sessions in order to improve conversational abilities.

Under circumstances where speech abilities are not restored to a functional level, speech therapists may work with the patient to develop alternative methods of communication. These may be in the form of gestural language, drawing or writing, or communication charts, where the patient has a grid of words or letters and can point to them to convey what they want to say.

While SLT is the most common form of therapy, research is also ongoing into medications and brain stimulation therapies. Certain drugs are being analyzed for their affects on aphasia symptoms, such as bifemelane, which has been noted for its abilities to increase circulation of blood in the brain, while others are being tested for increasing the brain's ability to recover and repair itself, and to help raise levels of depleted chemicals in the brain. Transcranial magnetic stimulation also holds promise, a technique that involves placing an electromagnet on the scalp and briefly sending an electromagnetic current through it to affected areas of the brain to re-stimulate activity in them.

Many of these alternative theories are still in the trial phase and so, currently, SLT is the most effective and widely used treatment. The prognosis of aphasia treatments can be difficult to predict, as it is heavily influenced by how severe the damage was, and also how healthy the brain was pre-injury. Recovery attempts are more likely to be successful in younger patients and are more effective the sooner they are started. Improvements in language and communication are most prominent in the first six months after the injury, however, this does not mean that recovery is impossible after this stage, with improvements still possible after several years in some cases.  

Relearning the Activities of Daily Living

 For patients who are recovering from a recent stroke, or similar brain injury, one of the struggles they face is the loss of independence in everyday life. The basics of self-care – eating, bathing, dressing, toileting, transferring (walking), and continence – which we usually take for granted, become activities that cannot be done without assistance. These activities of daily living (ADL) are tasks that must be relearned.

Regaining the ability to care for oneself is synonymous with returning to living an independent life. This is achieved through a process of occupational therapy which involves both relearning the muscular movements necessary to carry out tasks as well as increasing confidence levels in one's abilities in order to achieve a full recovery.

Task-specific Training

In order to relearn the processes needed to carry out the ADLs patients must undergo a regimen of exercises to regain coordination and strength, and to improve motor skills. These exercises are task-specific and tailored to the patient depending on which components they are missing. They focus around using repetition to build up muscle strength and memory.

A variety of techniques are used to retrain the muscles. For example, mirror therapy in which a mirror is placed on a table so that it covers the affected arm and reflects the unaffected one. This triggers mirror neurons, which are in the same area of the brain as motor neurons, making the patient think both arms are carrying out the same action. Recovery can also be aided through brain stimulation. Wires are placed on the scalp through which current stimulation is sent to the brain. This excites damaged areas of the brain, helping to increase the chances of them recovering.

The tasks do produce improvements in function and also cortical reorganization, however, these improvements do not generalize and transfer beyond the targeted activity or area. As such a range of exercises is required to improve motor activity in several areas.

Cognitive Strategy Training

While task-specific training is the only way to help patients recover their previous coordination and muscle power, this can be supplemented by cognitive strategy training. This involves utilizing the brain's ability to reorganize and create new pathways to improve cognitive skills such as attention, working memory, logical thinking, reading, and occasionally psychosocial functioning. This can be used in tandem with the physical exercises to increase self-esteem, and problem-solving strategies, as well as regulating training frustration.

Recovery can be a long and discouraging process. In order for the combination of these training techniques to have any lasting effect on motor improvement consistency is crucial. However, with time these exercises can enable stroke rehabilitation patients to live independently again.