Tag Archives: Board Certified Vestibular Physical Therapist

A Parent’s Nightmare: Teenage Concussion

ON THE LEVEL FALL 2015
A Quarterly Newsletter of the Vestibular Disorders Association
TherasportPhysicalTherapy
          Concussion Therapy

By Dr. Jennifer Liss (with Sherron Laurrell)

Corinne Santana, age 13, is the picture of what makes a parent proud. Her parents, Jennifer MacDermott and Eric Santana, have watched with love and awe as their daughter has handled a medical emergency that introduced the family to the overwhelming topic of teenage concussion.

Corinne is an 8th grader and a cheerleader. On September 20, 2014, she was participating in a cheerleading stunt where she was in the second tier lifting another cheerleader to the top of a pyramid. The girl on the bottom lost her hold because of a weakened wrist that was wrapped in a brace. As the top girl fell, Corinne was clobbered in the back of the head. A few minutes later, Corinne hit her chin on another girl’s forehead. Both Corinne’s mom and her coach knew quickly that something was wrong. She was acting strangely and was unresponsive to questions. Her head was bobbing.

Her mom rushed her to the ER. After a CT scan, she was admitted to the hospital and eventually taken by ambulance to the Regional Trauma Center in Atlantic City, New Jersey. Suffering with intense head and neck pain, the doctors prescribed medications that required heart monitoring. For more than a week, Corinne zoned in and out. She remembers nothing of the accident or the days after. The on-call doctor at their family practice, although very sympathetic, did not have much knowledge about concussion. She recommended Corinne be seen by a Sports Medicine Specialist.

Corinne’s school was even less informed about concussions than the family doctor. The middle school just didn’t know what to do, including the school nurse. On October 2, 2014, Corinne was evaluated by a Rothman Institute Sports Medicine Specialist. Although Corinne’s specialist gave her a 504 (academic) Accommodation Plan, some of her teachers would not cooperate. A few were openly critical of her, saying that she was ”exaggerating” and ” faking” her symptoms. Corinne was depressed, full of anxiety, mentally confused, dizzy and in pain. She first came to see me on October 13th.

As a Certified Specialist in Vestibular Rehabilitation I had begun getting numerous referrals to treat postconcussive syndrome. When I initially started treating these patients four years ago I quickly realized they were different from the Traumatic Brain Injury (TBI)/ neurological and vestibular populations. They often have a combination of central and peripheral abnormalities. VOR (vestibulo-ocular reflex) retraining, even with extensive modification, did not progress the way my vestibular patients progressed. Many times the patients seemed to have trouble focusing on a target even with their heads still.

After spending extensive amounts of time with concussion specialists, vision therapists, and attending as much continuing education in this area that I could find, I realized that in order to normalize impaired vestibular reflexes, concussion patients first had to be able to clearly focus on a target.

Corinne’s main symptoms upon examination included headache, dizziness, fatigue, and neck pain. Her symptoms increased with reading, copying from the board, math class (always her hardest) and exertion. Instead of beginning my clinical concussion exam with the standard oculomotor exam, I began with monocular accommodative focus (the ability of an individual eye to focus clearly on a target) and found a significant difference between her two eyes. I then assessed for a convergence insufficiency (normal is 4-6 cm) and found that the same eye that had weaker accommodative focus had more difficulty moving medially and maintaining convergence on a target. This affected saccadic eye movement speed, and endurance strongly impacts reading ability. Copying from the board was even more difficult because it involves repetitive head movement combined with visual accommodation between near and far targets.

I treated Corinne twice a week for five months. Her recovery was slow but consistent. 13-year old girls are the slowest youth population to recover from concussion due to their dramatic hormonal changes. However, thanks to Corinne’s consistent efforts in therapy, she successfully graduated on February 5, 2015. She has returned to her middle school life and her cheerleading!

When Corinne’s mom was asked what she has learned from this experience she was very clear. “Speak up if you see something that looks out of place.” After the fact, she remembers seeing the wrist brace on the girl who was supporting her daughter in the pyramid and wondering why she was performing a cheerleading stunt if her wrist was injured. She also feels residual frustration about the lack of school system knowledge about concussions and how to treat patients. She tries hard to strike a balance between letting Corinne be independent and overprotecting her. This is an understandable reaction from a mom who has seen her daughter through such a powerful event. Corinne’s mom plans to educate those around them about the importance of treating teenage concussions seriously and immediately.
Sports Medicine

Jennifer Liss is certified in Vestibular Rehabilitation. She is an Adjunct Professor of Kinesiology at Rowan University in Glassboro, NJ. TheraSport Physical Therapy offices are located in New Jersey, where she has practiced for 16 years. She can be reached at JenLiss@Therasport.org. Sherron Laurrell is a vestibular patient who has been treated by Dr.Liss. They now collaborate on case studies to educate and help others.

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Are you a Fall Risk? Contact TheraSport Physical Therapy Today!

ARE YOU A FALL RISK?
Help TheraSport Physical Therapy Celebrate National Physical Therapy Month by taking advantage of our FREE Balance Screening by appointment only throughout the month of October.  CALL NOW!

Balance Screening Will Include:

• An evidence-based functional outcome
assessment tool used to assess fall risk

• A brief customized home exercise program
with pictures and written instructions

• A FREE fall prevention giveaway item

• An educational magnet to reduce fall risk

• Educational handouts & brochures will
be available for various conditions

Screenings will be provided by Doctors
of Physical Therapy who Specialize in:

• Vestibular Rehabilitation

• Orthopedics

• Mechanical Diagnosis and Treatment of the Spine

• Sports Medicine

(Certified Specialists in Vestibular, Orthopedics and Spine)

WASHINGTON TOWNSHIP, NJ
P.856.256.8393
14 Parke Place Blvd.  #D
Sewell,  NJ  08080
info@therasport.org

MERCHANTVILLE, NJ
P.856.661.0200
30 W. Maple Ave.
Merchantville,  NJ 08109
info@therasport.org

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TheraSport Physical Therapy

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If you’re a fitness advocate, active adult or professional athlete with a sports-related injury, the expert team of TheraSport Physical Therapy can help.

As one of the premier South Jersey sports medicine facilities, we are dedicated to diagnosing and treating sports-related injuries, from stress fractures to runner’s knee and tennis elbow, as well as sprains and more complex injuries that result from athletic activities.

Our Board Certified Physical Therapists have extensive experience in adolescent through adult, amateur or professional sports medicine. At TSPT, we also treat public and private school athletes and numerous collegiate and professional sports teams.

We offer ImPACT testing to all athletic school programs. ImPACT is the abbreviation for Immediate Post-Concussion Assessment and Cognitive Testing. It is a computerized test which takes approximately 20 minutes to administer. The ImPACT test measures verbal and visual memory, processing speed and reaction time.

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Be out on the links all season long…

TheraSport Physical Therapy Sports Medicine

Summer is right around the corner, and if you love golf as much as Brad in our Merchantville office, you’ll be out on the links all season long.

Golfers are susceptible to overuse injuries, such as tennis/golfers elbow, carpal tunnel syndrome, and chronic back pain. These injuries can occur due to repetitive motions such as gripping the golf club, bending over to putt, or setting up for a shot.

If you suffer from any of these chronic issues, make an appointment with Maryann in our Merchantville, NJ TheraSport Physical Therapy office. She can set you up with a consultation with, Dr. Jennifer Perno, who is a board-certified sports injury specialist, and can help get you back into the swing of things.

Keep track of us and what is new on our TheraSport Physical Therapy Facebook page!

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Vestibular Neuritis: Navigating the Real World – A Case Study

On The Level – A Quarterly newsletter of the Vestibular Disorders Association
Vestibular Neuritis: Navigating the Real World – A Case Study
By Jennifer Liss, DPT (Editor: Sherron Laurrell, vestibular patient)

This case study outlines challenges facing clinicians when treating vestibular neuritis in patients who continue to work full-time in highly stimulating vestibular environments.

Jen Beasley, a 37-year old first grade teacher, was referred to me by her ENT in December, 2014. She had awakened a month earlier with severe dizziness and nausea. After attempting to push through, holding on to the walls at school as she went through her day, she was diagnosed with vertigo by her family doctor and sent home with anti-nausea medication. Two weeks later, Jen saw an Urgent Care doctor who saw fluid in her ears and attributed it to allergies. Jen eventually ended up in bed as the dizziness and nausea exhausted her. Her ENT referred her to me with a diagnosis of BPPV.

During our first meeting, we spent time talking about her symptoms and situation. I suspected Jen was not dealing with “simple” BPPV and was likely suffering with either vestibular neuritis or labyrinthitis.

The most important component of any patient evaluation is getting a good history.

Key subjective elements a clinician should look for to differentially diagnose vestibular neuritis include:
•    Onset – 2 to 4 days extreme nausea, vertigo, and imbalance. By the time they see the physical therapist they should be  SLOWLY improving. Episodes usually follow a cold/flu or sinus infection.

•    Hearing loss distinguishes labyrinthitis from vestibular neuritis. Treatment plans from a PT perspective are the same. An    ENT/ audiologist should be consulted about the hearing loss.

•    Increased symptoms with movement in visual fields, such as computer use, crowded places, TV.

•    Balance – impaired stability with gait especially with un-level or darkened environments.

•    Motion sensitivity – increased symptoms with position changes, quick turns. THIS IS USUALLY THE ONLY SYMPTOM WITH A BPPV PATIENT.

•    Dizziness Handicap Inventory (DHI) – usually in the moderate disability range.

Key objective elements include:

•    Most important tests are Head Thrust and Dynamic Visual Acuity (DVA). If these 2 tests are positive and you have normal oculomotor & neurological exams; this is usually a peripheral vestibular insult verses a central insult such as stroke.

•    Frenzel goggles to rule out BPPV with Hallpike maneuver, performing the test at slow to medium speed. Hallpike test is negative if there is no sign of a torsional nystagmus.

•    Dynamic Gait Index (DGI) After a comprehensive work up we concluded that
Jen’s diagnosis was vestibular neuritis.

As we put together the plan for her vestibular rehabilitation, the biggest challenge was limiting stimulation in her work environment. Jen’s job responsibilities involve constant head movement, frequent turning and excessive visual & auditory stimulation.

Early on, she had to modify her work duties as much as possible. One of her “extra” responsibilities was supervising children during bus duty. A medical excuse note eliminated this from her daily schedule. Because her work environment was heavily loaded with vestibular stimulation, it was difficult to progressively load her vestibular system during therapy as I would normally recommend. I had to be careful with her home program. Visual retraining is essential to recovery of normal function but it has to be progressed more slowly for active patients like Jen than for patients who are retired or in less stimulating work environments. I taught Jen strategies such as limiting head movement and focusing her eyes when she felt “overloaded.”

It is essential to teach patients that vestibular exercises should increase dizziness for 5-10 minutes but if the symptom increase lasts, they are overloading an impaired system.

Jen needed to accept that this would not be a smooth recovery because of her work environment. She hit her first setback at week 4, which is common. Many patients are driven to see steady weekly progress. At about week 4, they increase their home exercise program and try to do more at work because they are feeling better. Consequently, they will have a 2+ day spike in symptoms from doing too much. This is when we have “emotional chat” days for encouragement and counseling to accept that the road to recovery isn’t always easy and modifications need to be made along the way.

Jen has learned to modify her activities while continuing her VRT exercises in my office and at home. She has seen overall improvements and is feeling hopeful. Although it may take longer than she would like, I expect Jen to make a full recovery of normal vestibular function.

I want to emphasize that patient education is essential for ALL vestibular patients. They need to know the reasoning behind what they are doing, be warned about pitfalls that may happen along the way, and most importantly, that compliance is key to vestibular success!

Editor’s Note: Jennifer Liss is certified in vestibular rehabilitation by Susan Herdman’s VRT certification course at Emory University. TheraSport Physical Therapy offices are located in New Jersey, where Jennifer has practiced for 16 years. Jennifer can be reached at JLiss@Therasport.org

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March Madness at TheraSport Physical Therapy!

March Madness at TheraSport Physical Therapy

March Madness is in full effect at TheraSport Physical Therapy!

March Madness 2015 is NCAA basketball’s prestigious championship tournament, and now it is in full swing!

Basketball players are susceptible to Achilles injuries. The Achilles is the strongest and longest tendon in the body. It attaches to the heel bone, and causes the foot to push off the ground when the calf muscles tighten. When overused, your Achilles can become inflamed and cause tendinitis.

Make an appointment at TheraSport today to find out what preventative measures you can take to avoid tendinitis and other injuries!

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Knowlegde. Experience. Results. Let Our Expertise Expedite Your Recovery!

What is Physical Therapy?

Physical therapy is a form of treatment for when health issues make it hard to move around and do everyday tasks. Physical Therapy regularly helps you move better and may relieve pain that you have from an injury or illness. It also helps improve or restore your physical function and your fitness level to get back to your daily activities.

The goal of physical therapy is to make daily activities easier after surgery or ease the issues of a chronic illness. For example, physical therapy may help with walking, going up stairs, or getting in and out of bed.

Physical therapy can help with recovery after some surgeries. Your doctor may suggest physical therapy for injuries or long-term health problems such as:

•  Back pain or injuries/illnesses of the Back such as a herniated disc.
•  Tendon or ligament problems, an example would be an anterior cruciate
ligament (ACL) injury, a meniscus tear, or plantar fasciitis.
•  Arthritis conditions such as Osteoarthritis and rheumatoid arthritis.
•  Injuries of the spine such as Spinal stenosis
•  Neurological disorders such as Parkinson’s disease
•  Vestibular issues such as vertigo or post concussion syndrome

What does a physical therapist do?

At TheraSport Physical Therapy, our highly skilled physical therapists will examine you and create a treatment plan. Depending on your health and condition, your therapist will help you with flexibility, strength, endurance, coordination, and/or balance.

If you have an injury or complication from an illness, your therapist will first reduce your pain and swelling if you have any. Then he or she will work with you to increase your flexibility, strength, and endurance.

Physical therapy almost always includes some form of exercise. Stretching, core exercises, moderated weight lifting, and walking are some physical therapy methods we use at our facilities. Your physical therapist will also construct an individual exercise program so you can keep up with your therapy at home.

Our therapists may use manual therapy, and techniques such as heat, cold, massage, ultrasound, and electrical stimulation during your therapy program.

Contact TheraSport Physical Therapy for a consultation at one of our two New Jersey locations.

TSPT WASHINGTON TWP.
14 Parke Place Blvd Ste D
Sewell, NJ 08080
(856) 256-8393

TSPT MERCHANTVILLE
30 W Maple Ave
Merchantville, NJ 08109
(856) 661-0200

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