The Most Common Physical Effects of Brain Injury

After a brain injury – particularly a traumatic brain injury (TBI) – the brain’s nerve cells may not send signals between each other as they used to. As a result – aside from a range of possible behavioral and cognitive issues – there will often be physical effects, which might get better quickly during recovery while others might take time or become a lasting problem. The more traumatic a brain injury, the more widespread and longer-lasting the effects will likely be. At the Mount Sinai Department of Rehabilitation Medicine we take brain injury and its effects on directly to help our patients resume active, healthy and independent lives. Our rehabilitation program is a made to suit the individual needs of each patient with a combination of cognitive, physical, occupational, neuropsychologicaland speech therapy. Our brain injury rehabilitation program is one of only two CARF-accredited programs in New York City and patients can also access our CARF-accredited outpatient services once they have been discharged from hospital. 

Below we will discuss the most common physical effects of brain injury and give tips to help manage them.

Headaches

Headaches are very common following a brain injury – thankfully they usually improve over time. For some the pain comes and goes; for others it is a constant. Headaches are often exacerbated by fatigue and stress. Ways to manage include mitigating your stress, resting in a dark and quiet place when the pain is at its worst and avoiding bright sunlight, alcohol and foods that might trigger a headache such as cold items, aged cheese and chocolate.

Poor Sleep

Changed sleeping patterns and poor quality sleep are both very common after a brain injury. It is usual at its worst in the early stages of recovery and will generally tend to get better as time progresses. Many patients will sleep during the day and be awake at night; napping is also common. To help manage poor sleep, do not use your bed for anything besides sleep and sex (e.g. watching TV), ideally have dinner four hours before bedtime and avoid caffeine and exercise once the morning has ended. 

Fatigue

For those who have suffered anything from a mild to a traumatic brain injury, fatigue will be extremely common. Patients will find that their stamina might be dramatically less than what it once was, with even small tasks like getting dressed or walking around the house becoming exhausting. To manage, take regular rest periods during the day, avoid overly taxing social and familial activities and when appropriate have your physical therapist create a safe exercise program to build up stamina. 

Balance and Mobility

Following a brain injury one’s sense of balance can be affected which can make basic mobility an issue. This is a common effect in the early stages of recovery, but it can go away over time with physical therapy. It is important to be aware of this issue and to lie down and rest when a dizzy spell occurs as falls are the leading cause of non-combat TBI. Ways to manage while working with your physical therapist include using a cane or other walking aid and making your home fall-proof by removing rugs, electrical cords and other items on which one could slip, fall and possibly cause another brain injury.

Sensory Impairment

As the brain controls all five of our senses, when brain injury occurs each is at risk of changing. Not much can be done about sensory impairment in the first year of recovery and a ‘wait and see’ approach is often taken in the hope that the patient’s senses will return on their own. The sensation of touch may be reduced, lost or exaggerated; eyesight may be affected and unable to be improved through glasses, taste and smell might go away completely, be altered or replaced with a metallic flavor and one might have muffled hearing or a ringing in the ears (one or both). The best tip is to be patient, know that sensory changes often improve or revert to pre-injury levels and to trust in the medical professionals looking after your rehabilitation.

If you, a friend or family member has suffered a brain injury and you would like to discuss the ways in which the Mount Sinai Department of Rehabilitation Medicine can help, please get in touch with us at (212) 241-6321.

Behavioral Effects of Brain Injury

People who have sustained a brain injury can experience a range of physical and emotional issues that can affect their identity and personality, relationships and their independence. The more severe or traumatic a brain injury, the more likely it is that the effects will be more pronounced and longer lasting. The way in which a brain injury might affect someone is complex, varied and unpredictable: sometimes a patient may display exaggerated manifestations of pre-injury personality traits whereas others might act in a fashion that is completely out of character. Indeed, often we see a mixture of the two. At the Mount Sinai Department of Rehabilitation Medicine we offer a dynamic and structured rehabilitation program to those who have experienced brain injury, Traumatic Brain Injury (TBI) or a stroke. This includes our TBI peer mentoring program, our Stroke Club, evaluation and treatment of vestibular and visual impairment as well opportunities to participate in TBI research studies.  Our brain injury rehabilitation program is an integral part of Mount Sinai’s Traumatic Brain Injury Model System of care and is one of only two CARF-accredited programs in New York City. Our brain injury patients can also access our CARF-accredited outpatient services available once they have been discharged from hospital. 

Let us go through some of the most common behavioral effects of brain injury, including what they are, what to look out for and ways to help. 

Disinhibition

A common behavioral change in early recovery is disinhibition, or an inability to control or manage socially inappropriate behavior. This might manifest itself through unpredictable anger or rage, divulging secrets to others too freely, inappropriate remarks and even exhibitionism or making unwanted sexual advances. This might be difficult for family and friends to handle, but the best advice is to try to be calm as appearing shocked or distressed might make the sufferer feel there is something wrong with them. It is also wise to discuss the inappropriate behavior with the patient – always in a non-judgement way – and to set firm boundaries as well as discovering appropriate ways for them to express themselves, their personality and their sexuality. 

Impulsiveness

Another common behavioral effect of brain injury is an inclination to speak or act without thinking about the possible consequences. Aside from a range of embarrassing, awkward or even threatening social situations, there are some practical implications that may affect one’s ability to manage their own life independently. One of the most salient issues is the ability to manage one’s finances as patients might impulsively spend money quickly, rashly and above and beyond what is affordable. In helping patients manage their finances it is important to have a situation that allows a guardian to help compensate for their inability to manage money while also allowing for the least restrictive solution possible. A common practice is to have the patient agree to not have access to credit cards and finances while not being supervised, but to allow them a credit card with a modest maximum a well as some spending cash for everyday needs. Depending on the situation and your relationship with the patient, it might be necessary to seek legal advice from a lawyer or local court’s guardianship office to obtain information about how to create a suitable and legal guardianship over a brain injury patient’s finances.

Apathy and Disaffection

After a brain injury a patient may become passive, unresponsive, apathetic, emotionless and lacking the capacity for initiative. In the early stages of recovery, a patient will often appear unaware or unconcerned with their injury and resulting inabilities. Others may demonstrate a will to be active and to connect with others, but are often unable to follow through. For the patient with a brain injury, this apathetic and disaffected state is not just the result of depression, but also from the physical damage endured by the brain. As such, it is essential that friends and family are extremely sensitive to the patient’s needs and emotions or inability to express emotion. Often the best way to help someone showing these signs of brain injury is to support, love and accept them, along with offering plenty of affection and practical help to make their lives easier.

If you, a friend or family member has suffered a brain injury and you would like to discuss the ways in which the Mount Sinai Department of Rehabilitation Medicine can help, please get in touch with us at (212) 241-6321.

Neuroplasticity – The Brain's Repairing Mechanism

 Injuries to the head can result in long term damage to areas of the brain, varying depending on where on the head the injury was sustained. While a variety of therapeutic services can be employed to regain a certain level of functionality the brain also has a unique response to regional damage – neuroplasticity.

Neuroplasticity is the brain's ability to reorganize itself through lifetime creation of new neuron pathways. From birth developmental plasticity begins, as neuron branches and synapses form to process new sensory information. At the age of two or three, a child's brain has around 15,000 synapses per neuron. This is around twice as many as in the adult brain as neurons strengthen, weaken, and are eliminated with age. While this process slows down, the brain retains the ability to grow new neurons throughout life in response to new stimuli. One such circumstance under which the brain may begin to regenerate in this way is when a certain area of it is damaged.

Known as functional plasticity, in response to an area of the brain loosing functionality, often the surrounding healthy areas will take over those processes, restoring former abilities. Neurons which remain undamaged will grow new nerve endings to create new connections where the original links were broken due to injury. As well as restoring connections, undamaged neuron axons can create entirely new pathways, developing nerve endings that connect with other undamaged neurons, to carry out necessary functions. Especially in children, when damage is sustained in one hemisphere of the brain, the corresponding area in the other half of the brain may take on functions traditionally performed in the initial hemisphere.

One example of when natural adult neurogenesis (formation of new neuron endings) can occur is following a stroke. Strokes are caused either when a blood clot prevents sufficient oxygen flow to the brain or when a blood vessel bursts leading to internal bleeding in the head. If left untreated, a stroke can cause certain areas of the brain to cease to function. Strokes can cause long-lasting physical and psychological problems, however, the brain may attempt to compensate for permanent localized damage by re-routing function pathways.

Head injuries can cause debilitating damage that leave the patient with reduced functionality. Therapeutic rehabilitation, such as physiotherapy, occupational therapy, and speech therapy can go some way to recovering a patient's abilities, however, the body's natural propensity to repair itself, many also contribute to patient recovery following a localized head injury.

Recovering from a Traumatic Brain Injury

Injuries to the head or brain can have a range of effects, depending on the form the injury takes and the level of severity. Following a traumatic brain injury (TBI) many patients may display several of the same symptoms as the brain attempts to repair itself, including disorientation, mood swings, and difficulty performing simple tasks. Often after injury swelling, bleeding, or changes in the chemistry of the brain can affect normal functioning of the healthy brain tissue. As swelling decreases, blood flow is able to return to a normal level, and the patient may regain their ability to function in everyday activities.

The most rapid recovery of brain activity is likely to happen in the first six months of recovery, with the patient showing steady signs of improving in function. After this period patients may show signs of further recovery up until two years after the accident, though at a slower rate, and after two years improvement will decrease substantially. During the first six month period there are a range of actions that can be taken to improve chances of a fuller recovery.

The first important step to take during the recovery period is to get plenty of rest, so that the brain has a chance to recover and regain function. While the brain cannot regenerate cells that have died, areas of the brain may be able to take over the activities of the damaged areas by creating new nerve pathways. Avoiding stressful situations is also recommended as these can illicit and amplify mood swings and personality changes that can follow TBI. Avoiding activities where you could sustain further damage to the head is also necessary. The brain cannot recover 100% from a traumatic injury, and participating in risky activities increases the likelihood of repeat injury. The effects of repeat injury build on the original damage in a cumulative manner, lessening the chances of recovery.

Taking medicines should be carefully regulated as many can inhibit the repair of the brain. Although head injuries can cause the patient trouble in falling asleep avoid taking sleeping pills, sedatives, or tranquillisers. Many over-the-counter sleep medications contain antihistamines which can disrupt memory retention and the ability to learn new information in those who have sustained a TBI. If the patient is suffering from headaches, Tylenol should be administered over non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin which can occasionally cause the site of injury to bleed.

Occupational, speech, and physiotherapists may be employed to aid the rehabilitation process, depending on the nature of the injury, but taking these initial precautions can encourage the brain to begin a process of restoration. 

Caring for an Aphasia Patient

 Around 1,000,000 individuals in America suffer from some form of aphasia, struggling to communicate as easily as they did pre-injury. The role of an aphasia patient's carer is to aid the recovery process in the hope that the patient will regain a level of normality to their speech. Throughout the recovery period there are a series of actions that a carer can take to aid in relearning language, or to help a patient to feel more confident in communicating.

Keeping it Simple

One key thing to remember when communicating with an aphasia patient is that, while they may understand everything you say it may take them longer to process it. Keeping background noise and distractions to a minimum can help their comprehension. Avoid talking to them like you would a child and use adult language, however, keep sentences shorter and simple so it is easier for them to reply. Instructions should be broken down into simple steps and, initially, questions should be yes-or-no ones. This will allow an aphasia patient to slowly regain their ability to retain information.

Learn to Listen

Depending on the manifestation of a patient's aphasia it may take them a longer time to respond to a question. In these circumstances it is important not to rush them to respond and simply to be patient until they have finished talking. Avoid putting words into their mouths otherwise they will not have the opportunity to relearn speech for themselves. If forming full sentences is a struggle for a patient try working out other ways of communicating, such as using hand gestures, picture charts, or writing. The inability to vocalize thoughts does not mean that they do not understand what you have said so ask them if they have and simply cannot say their response.

Boost Their Confidence

An important aspect of the recovery process is the patient feels that they are living a normal life, so encourage them to to participate in every-day activities and decisions. Try to encourage them to carry out more daily tasks independently and avoid the urge to overprotect them. Although it may seem counter-intuitive to engage a patient in conversations with larger groups of people, it may be beneficial to their recovery. In a one-on-one setting there is a lot of pressure on the patient to respond to questions and engage in the conversation but in a small group they are able to join in when they feel ready and no one is waiting on them to reply. As their speech improves try taking the patient out into more public settings so that they can practice their communication skills in real life situations.

The most important thing to remember when aiding the recovery of an aphasia patient is that each case is different. Rehabilitation methods that may have worked for one patient may not work for another so work with them to find the best exercises for their situation.  

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.  

Stroke-Related Language Complications

 Conditions resulting from stroke damage can vary depending on which area of the brain was affected. Certain areas of the brain are responsible for the production, and synthesis, of language information and if these are damaged as a result of a stroke, the consequent communication problems are referred to as aphasia. There are four main types of aphasia – anomic aphasia, Broca's aphasia, Wernicke's aphasia, and global aphasia - each caused by damage to a different area of the brain.

Anomic Aphasia

Anomia is a condition in which a patient suffers a deficit of expressive language and is the most common, and also least severe form, of aphasia. While a patient with anomic aphasia may struggle to find the right word to describe something, especially nouns and verbs, they have no trouble understanding the speech of others and are able to read adequately, though writing may come with more difficulty.

Broca's Aphasia

Also known as expressive aphasia, this form is the result of damage in the frontal area of the left hemisphere of the brain. This area, known as Broca's area, is thought to be involved in the production of speech and damage to it can result in problems with forming full sentences. Though sufferers of expressive aphasia may be able to produce basic words to convey their message they struggle to form full sentences, often missing out important words, such as prepositions. As well as being unable to produce fluid speech they may also struggle to understand the speech of others.

Wernicke's Aphasia

On the other side of possible aphasic manifestations is Wernicke's, or receptive, aphasia. Occurring when the back section of the left brain hemisphere is affected, Wernicke's aphasia is characterized by difficulty understanding the meaning of written or spoken words. Patients still produce fluent, connected sentences, yet they unknowingly use nonsensical, made up words. They may still understand the flow of another person's speech and can work out from the rhythm of it whether they are asking a question or conveying an emotion, but have no understanding of the meaning of the words used. This is because the affected area, known as Wernicke's area, is thought to be the locus of human language comprehension.

Global Aphasia

Both Broca's and Wernicke's aphasias can vary in degree of severity but the most serious form, global aphasia, occurs when there is widespread language impairment. When both language areas of the left brain hemisphere are damaged, patients lose all language abilities, both in terms of comprehension and production and this form of aphasia most commonly occurs immediately after a stroke.

Often global aphasia is caused by swelling around the brain and may improve as this goes down. Similarly, area-specific language problems may decrease during the post-stroke recovery period. However, in instances where full language abilities are not regained speech and language therapies may be use to try and restore speech or, in extreme cases, to develop alternative ways of communicating.

Introducing Our Director of Brain Injury Research - Dr. Dams-O'Connor

 This week we are introducing Dr. Kristen Dams-O'Connor, the new director of the Brain Injury Research Center of Mount Sinai who specialises in traumatic brain injuries (TBI), and more specifically, the recovery process of TBI patients.

When beginning college at Colgate University, Dr. Dams-O'Connor intended to major in international relations; however, after taking an introductory course in neuroscience she was hooked, and chose instead to major in this field. Her research began in controlled laboratory experiments and she fell in love with the accuracy and certainty with which she could observe cause-and-effect relationships in her studies.

Following her undergraduate degree in neuroscience, Dr. Dams-O'Connor decided to do further studies in psychology so she could work more closely with patients who were living with neurological diseases. During her doctoral studies she worked at a clinical site for three years at the University at Albany , participating in programs that helped people with devastating brain diseases live more productive and meaningful lives.

Moving to New York, she carried out an internship in neurorehabilitation at the Rusk Institute of Rehabilitation Medicine at New York University Medical Center. On completion of the internship she progressed to a fellowship in Clinical Neuropsychology at Mount Sinai. During this Dr. Dams-O'Connor began to focus her research more on TBI, taking an interest in the heterogeneous nature of these injuries, with no two cases being alike. This variability allowed her to apply her knowledge of empirically supported neurobehavioral interventions to unique individual cases.

Today, as well as being a director, Dr. Dams-O'Connor is also an Associate Professor in the Department of Rehabilitation Medicine at the Icahn School of Medicine, and the Director of Research. She is PI of two grants from the National Institutes of Health and Co-Project Director of the New York Traumatic Brain Injury Model System which, as well as carrying out research on brain trauma, also provides emergency medical services, acute care, rehabilitation services, and long-term outpatient care. In her career to date she has published over 60 peer-reviewed manuscripts and chapters on traumatic brain injuries, their treatments, and outcomes and her work is internationally recognised. In her current research Dr. Dams-O'Connor works primarily on studying the long-term outcomes of brain injuries including clinicopathological signatures of TBI. A key interest of hers is understanding why some patients display a full recovery after their injuries while others partially recover before regressing later in life.

You can read more about the Brain Injury Research Center here - www.tbicentral.org

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.  

The Long-Term Effects of Sports-Related Head Trauma

 At least 300,000 sports-related head injuries occur in the United States every year. The short-term effects of sports head injuries have long been known. Concussions, as the result of a blow to the head can cause headaches, dizziness, and nausea in the short term. More recently it has been discovered that head injuries can cause problems long after the initial incident.

Post-Concussion Syndrome (PCS)

Around 15% of people who have suffered a single concussion develop persistent, injury-related symptoms. These can last anywhere from a couple of weeks, to a few months, up to a year. While the immediate symptoms of concussion are fairly mild, PCS can manifest itself in the form of noise sensitivity, concentration and memory problems, depression, and anxiety. It is thought that this condition can be exacerbated by pre-existing psychological conditions, being female, and being an older individual. While PCS cannot be treated as a whole, medications can be administered to alleviate certain symptoms, while psychotherapy and neurotherapy can be carried out to improve mental health and brainwave activity.

Chronic Traumatic Encephalopathy (CTE)

Another, more extreme consequence of repeat head injuries is CTE. This syndrome only manifests itself around 8 to 10 years after injury, and is most prevalent in professional athletes in sports such as football, boxing, wrestling, and ice hockey.

Symptoms develop in four stages- the first stage is characterized by a deterioration in attention, increased disorientation, headaches and dizziness. Later this condition develops to cause memory loss, social instability, erratic behaviour, and poor judgement. In the final two stages, patients may suffer from progressive dementia, reduction in muscle activity and control, vertigo, deafness, and, in extreme cases, suicidal tendencies.

The reasons behind why this happens are largely unknown and currently the only method of diagnosis is through post-mortem direct tissue examination. Treatments may include the use of speech and language therapists, and occupational therapists, however, as there is currently no cure, most treatment revolves around supporting the patient, and making him or her comfortable.

There is presently little conclusive research on the prevention of CTE, however, it is thought that immobilizing the head during a blow may prevent the future memory loss and learning difficulties associated with CTE. Of course, the best preventative action is to reduce the risk of head injuries, and to allow time to fully recover following any concussion which, for 85% of cases is up to three weeks.

Everything You Need to Know About Strokes

This week we tell you everything you need to know about strokes: how they are caused, how you can recognise one, and how they are treated.

Causes

Strokes are caused when the brain does not receive enough oxygen. There are two ways in which this can occur. An ishemic stroke, the more common form, is caused by clots in the blood vessels which supply the brain which stop the blood flow. The second, rarer form is the hemorrhagic stroke, which is caused by ruptured blood vessels bleeding into, or around, the brain.

Symptoms

There are various physiological indicators that a stroke has occurred. It is often signalled by a sudden numbness in the face, arm, or leg, and especially on a single side of the body. This may be accompanied by sudden confusion, and the inability to speak or understand others' speech.

Trouble seeing in one, or both, eyes can result from a stroke, as can having difficulty walking, and losing balance and coordination. The final symptom of a stroke is a sudden, and severe headache.

The sooner a stroke is identified and treated, the less permanent damage it is likely to do. This is because, the sooner treatment is administered, the more of the brain can be saved.

Cures and Therapies

Accute stroke therapies are administered to try and stop the stroke while it is happening, either to stop the bleeding or to dissolve the clot. If the cause of the stroke is ischemic aspirin is given, as this has the effect of thinning the blood, preventing further clots. With hemorrhagic strokes it it a little less straight forward as the patient must be monitored to ascertain what the cause of the bleeding is. It may be as a result of blood thinning medicines, high blood pressure, head trauma, or blood vessel malformation. Once the cause is identified tre

atment can then be tailored to the patient's need. Immediate emergency care for hemorrhagic strokes is concerned with controlling the bleeding, and medications may be given to reduce blood pressure or to slow the blood flow.

In the case of quickly identified and treated strokes there may be very little lasting damage, however, for some, there may be a need for a range of therapies to relearn certain skills. Strokes can cause paralysis or movement control problems, pain, difficulties using or understanding language, memory and thinking problems, and emotional disturbances, depending on which area of the brain is affected. Rehabilitation therapy involves the input of a range of specialists including physiotherapists, psychologists, occupational therapists, speech and language therapists, dietitians, specialist nurses and doctors, all of whom work to help patients relearn skills to make them as independent as possible.

Strokes can be damaging but the key to full recovery is knowing and recognising the signs and taking early action to get medical help.  

A man who started as an athlete and became a Physical Medicine specialist. An interview with Dr. Herrera. 

We sat down with Dr. Joseph Herrera, a Rehabilitation and Physical Medicine specialist at Mount Sinai, to learn more about his specialism, career, passions and hobbies. Hope you enjoy!

Q: Why did you decide to become a doctor?

A: My overall purpose and why I get up in the morning is to help others get back to life. I love problem-solving and developing strategies for patients to overcome disabilities.  Whether it's knee pain and developing a plan to get back on the field to play soccer or if it is shoulder pain and developing a plan to put on a shirt, getting a patient back to their maximal function is my ultimate goal.

Q:  Could you tell us a little more about your specialties?

A: Physical medicine rehabilitation is such a broad field that covers all aspects of disability. Physiatrists can practice in several different subspecialties such as pediatrics, spinal cord injury, traumatic brain injury, sports medicine, pain management, and neuromuscular diseases to name a few.  The overall goal of the field is to maximize function and minimize disability. It is one of the most rewarding fields to be in. 

Q:  Where did your interest in fluroscopy/electrodiagnostic testing/sports injuries etc. begin?

A: I have always been active playing both recreational and competitive sports. I was a college athlete that suffered an injury and was treated. The process of return to play intrigued me. 

 My interest in electrodiagnostics and fluroscopic procedures occurred during residency.  I became especially intrigued in the ability to help people with pain through injections. 

Q: What is it that interests you in rehabilitation medicine specifically?

A: The ability to get people back to living their life is what interested me in rehabilitation medicine.

Q: How did you get into this field?

A: I was  introduced to the field in medical school. 

Q: Why Sports injuries?

A: Prior to medical school I was a crew coach and an athlete. Having the knowledge of biomechanics and knowing the mechanism of injury has helped me diagnose and treat various athletic injuries. 

Q: Favourite sport?

A: I love a number of sports rowing, baseball, football, basketball.

Q:   Favourite team?

A: Yankees, Giants, Knicks, Rangers and, of course, Rutgers University sports.

Q:  Favourite thing to do in New York City?

A: The Restaurants scene!

Q: Fun Fact about yourself.

A: I was a coach before going to Med school.