CONCUSSION AND BRAIN INJURY SERVICES
A child, adolescent and adult with a brain injury or concussion requires expert and comprehensive evaluation and treatment. We serve individuals immediately after brain injury and those who are years post-injury.
Our expert team meets with patients and their families to review the nature of the injury, medical history, previous evaluations, school performance, and home and community functioning. Depending on each individual case, our comprehensive assessment and diagnostic approach may include the following:
Neurological Evaluation: A board-certified pediatric neurologist and nurse practitioner will determine if there was a brain injury, concussion or other neurological/medical cause for your child’s symptoms.
Neurophysiological Testing: CNNH is the only center in the region providing clinical High Density EEG (HD-EEG) services. HD-EEG provides an electrical image of the brain providing information about areas of the brain that may not be functioning properly. CNNH also offers computerized assessments of attention and vigilance.
ImPACT Testing: ImPACT is a computer test developed to help clinicians evaluate an athlete’s recovery following concussion. ImPACT is a 20-minute neurocognitive test that has been scientifically validated to measure the effects of sports-related concussion. If a concussion is suspected, the test is administered. Follow-up tests can be administered over days or weeks so clinicians can continue to track the athlete’s recovery from the injury. Tests require a CNNH expert for proper interpretation.
Medical Evaluation and Treatment: Following a comprehensive medical evaluation, the physician will determine if additional testing, medication and/or non-medication treatment options are useful, as well as provide education about the neurological condition.
Neurorehabilitation: A brain injury typically affects cognitive functioning (mental processes of thinking, reasoning, learning, remembering, problem-solving and creativity). Neuropsychological assessment may test strengths and deficits in a variety of cognitive and behavioral areas. We design programs to help individuals compensate for their weaknesses, to maximize functioning in home, school, work, and community.
Psychological Assessment and Treatment: Many children and young adults experience significant psychological stress from their injuries. As a result, our team of experts provides Cognitive Behavior Therapy in addition to our Cognitive Rehabilitation services. This ensures that individuals who receive therapy have the most effective form of intervention tailored to their specific cognitive, emotional, and behavioral requirements.
Educational and Vocational
Educational and vocational evaluations may include Neurofunctional Assessment and a review of school and work records, individualized educational plans (IEP), individualized transition plans (ITP), and planning for supported employment. Educational, cognitive and behavioral supports and recommendations are provided to schools and employers, and CNNH provides Cognitive Rehabilitation Therapy to support these plans.
Allied Health Evaluations and Treatment: This may include evaluations and ongoing treatment with a speech and language, physical or occupational therapists, as needed.
Family Review and Home Evaluations: After evaluations and testing are completed, comprehensive reports are generated, and diagnostic findings, testing results and treatment recommendations are reviewed with families. When necessary, our behavioral specialists can conduct home or school evaluations, and work with families and schools to provide behavioral management and treatment reinforcement. Vocational and Independent Living Referral Services and Life Care Plan Development are offered as needed.
The links below provide more information and community resources on brain injury and concussion:
- Brain Injury Association of NJ
- Brain Injury Association of Pennsylvania
- Brain Injury Association of Delaware
- Brain Injury Association of New York State
- Lash and Associates Publishing/Training
- Brain Injury Association of America
- North American Brain Injury Society
About Brain Injuries
When there is an insult to the brain that causes structural or metabolic changes, it is referred to as a brain injury. The problems and complications of brain injury are dependent upon the area of the brain that is involved, and the capacity of the individual experiencing a brain injury to compensate. Thus, the manifestations and results of brain injury are unique to each person. Brain injuries can be classified as “developmental”, “acquired” or “traumatic”. However, these categories can overlap.
Developmental Brain Injuries
Developmental brain injury can occur from various mechanisms during fetal life, such as placental abnormalities, prenatal infections, or in utero exposure to toxic substances such as alcohol or drugs.
Acquired Brain Injuries (ABI)
Acquired brain injury (ABI) can be due to various causes, such as strokes, near drowning, infection (encephalitis, meningitis, and more), bleeding within the brain (from aneurysms and other causes), drug overdose, surgical complications, brain tumors, chemotherapy and/or radiation therapies, or metabolic disorders.
Traumatic Brain Injuries (TBI)
Traumatic brain injury (TBI) typically refers to an external force causing harm to the brain, such as a blow or jolt to the head, or a wound that penetrates the skull, as can occur from car accidents, gun shot wounds, or sports injuries (see also “concussion” section). There can also be destructive processes affecting the brain from genetic, hereditary, congenital or degenerative disorders. These processes are not typically classified as brain injury, although they have many of the same characteristics of acquired brain injury.
TBI is often further defined by the severity of the insult: ranging from “mild” if there is only a brief change in consciousness or awareness, to severe if there is prolonged loss of consciousness. However, even mild TBI, as can occur with concussion, can cause significant neuropsychological and other impairments, particularly if recurrent. In fact, TBI is often referred to as the “silent epidemic”, as there are often no obvious external signs that someone is suffering from the adverse effects of a brain injury. There are many people who suffer from the adverse effects of TBI, but have not been diagnosed properly as having had TBI. It is estimated that over 1.4 million people in the United States sustain TBI each year, and many of these individuals continue to suffer from the effects of TBI for the remainder of their lives.
Brain injury of all forms can cause physical problems, such as motor impairment, epilepsy (seizures), headaches, balance problems, and fatigue; emotional, behavioral and neuropsychiatric changes and disturbances, such as depression, mood swings, anxiety, impulsivity and agitation; cognitive impairments and neuropsychological dysfunction, such as memory loss, poor processing of information, trouble concentrating or paying attention, disorganization, poor judgment, and difficulties holding employment or maintaining relationships. In addition to the neurological and neuropsychiatric consequences of brain injury, other organ systems, such as the cardiovascular, hormonal, digestive and immune systems, can be directly or indirectly affected by brain injury.
Signs and Symptoms
A concussion is a disturbance in brain function that occurs following either a blow to the head or as a result of the violent shaking of the head. In the United States, the annual incidence of sports-related concussion is estimated at 300,000. Estimates regarding the likelihood of an athlete in a contact sport experiencing a concussion may be as high as 19% per season.
Signs of a Concussion may either be reported by the individual/athlete or may be observed by others, including:
- Appears Dazed / Stunned
- Confused about Assignments
- Forgets Plays
- Unsure of Game, Score or Athletic Opponent
- Moves Clumsily
- Answers Questions Slowly
- Loses Consciousness
- Behavior / Personality Change
- Forgets Events Before Impact (Retrograde Amnesia)
- Forgets Events After Impact (Anterograde Amnesia)
- Balance and Dizziness Problems
- Double or Blurry Vision
- Sensitivity to Light or Noise
- Feeling Sluggish or “Foggy”
- Changes in Sleep Patterns
- Concentration and Memory Problems
“They investigated my concerns with necessary testing and took time to consult with other doctors who would have vital input. They considered my concerns with a different perspective and started “connecting the dots”.”
— Bill R.