http://www.cnn.com/2011/HEALTH/02/26/duerson.brain.exam/
Concussions are an accepted part of many contact sports. Their symptoms are often quiet and usually ignored. It has only recently come to light the long-term damage that can occur from repeated concussions and hits to the head. The human brain is comprised of delicate tissue that, when forcefully and repeatedly slammed against a hard surface (such as the skull), can become injured. The brain is very resilient, but for those whose brains experience years of such repetitive contact, long term damage and progressive deterioration can occur.
Chronic Traumatic Encephalopathy (defined as disease of the brain caused by repeated traumatic events) has for many years been known to occur in fighters. The Parkinsonianism seen in Muhammad Ali is often considered to be related to his boxing career. In 2007 Chris Benoit, a well known professional wrestler, murdered his wife and child and took his own life. Later analysis of his brain showed CTE (http://www.sciencedaily.com/releases/2007/09/070905224343.htm).
Stories of increased dementia and erratic behavior have been reported in former professional football, hockey, and rugby players. The Boston University Center for the Study of Traumatic Encephalopathy is conducting a major analysis of the brains of deceased athletes and has had over 200 athletes commit to donating their brains for future study. Former NFL player Dave Duerson committed suicide on February 17, 2011 after months of language change and concerning behavior that he suspected was related to possible encephalopathy. He elected to take his life by a gunshot to the chest to preserve his brain for testing for the disease.
The Boston University studies help researchers better understand the incidence of CTE, but they do not provide ways to prevent or cure it. As awareness of CTE and other sports related brain injuries (such as concussions, post-concussive syndrome, and mild traumatic brain injury, among others) increases, so must community, social and parental response to it. Programs have been developed to provide pre and post concussive analysis for students and professional athletes. One such program used at the neurological institute at my hospital is called ImPACT ( http://www.impacttest.com/ ). According to their website, “ImPACT is a 20-minute test that has become a standard tool used in comprehensive clinical management of concussions for athletes of all ages.” It is a testing program to give baseline neurological/neuropsychological measurements to determine the level of injury exhibited by an athlete after a blow to the head. It is quickly and easily administered by an “athletic trainer, school nurse, athletic director, team coach, team doctor, etc" and can help to shed light on an injury that may otherwise go undetected.
Programs such as ImPACT can help coaches and athletes understand the severity of an injury and help physicians determine appropriate recovery. Parents can encourage these programs in their children’s schools and educate coaches about the severity of concussion. Concussions can no longer be accepted as a normal part of sports. Their effects, though they may not be immediately apparent, are long lasting, and can be devastating.
Wednesday, March 2, 2011
Tuesday, February 15, 2011
Serene Branson & The Warning Signs of Stroke
http://news.yahoo.com/video/health-15749655/24186960#video=24197100
This video footage comes from the 2011 Grammy Awards. Serene Branson, a news anchor from California, starts to discuss the excitement of the event, but then suddenly begins to slur her words and speak nonsense. Social media was abuzz. Why did she mess up? Was she confused? Did she speak another language? A lot of people had a lot of theories but very few recognized the confused language as a neurological symptom, possibly a symptom of stroke.
Though the press release issued by her news station denies a stroke, Serene’s speech was characteristic of the “confused, jumbled speech” seen during a stroke. The purpose of pointing this out and watching this video is not to analyze this particular situation, but to help identify signs of stroke when they occur. Strokes can happen to anyone at any time. It is imperative to know these signs and to immediately seek help if they happen to you or someone you know.
The American Heart Association has done extensive marketing to teach Americans the signs and symptoms of a heart attack. Most adults could name the common signs – chest pain, discomfort in the upper body (particularly in the left arm), and shortness of breath. But could most adults name the symptoms of stroke?
New education programs have been developed to further educate Americans about the symptoms of stroke and what to do if a person does have these symptoms. Stroke is the third leading cause of death of Americans according to the Center for Disease Control (http://www.cdc.gov/nchs/fastats/lcod.htm). It is also a leading cause of long-term injury. In my practice as a speech pathologist, I have seen strokes in patients ranging from 27 years to 92 years. No matter your age or current health condition, it is imperative to know the signs and symptoms of stroke. If you or someone in your environment shows any of these symptoms, DON’T WAIT – CALL 911 immediately. According to the American Heart Association, the following are signs of stroke:
SUDDEN:
- NUMBNESS OR WEAKNESS OF THE FACE, ARM OR LEG, ESPECIALLY ON ONE SIDE OF THE BODY.
- CONFUSION, TROUBLE SPEAKING OR UNDERSTANDING
- TROUBLE SEEING IN ONE OR BOTH EYES
- TROUBLE WALKING, DIZZINESS, LOSS OF BALANCE OR COORDINATION
- SEVERE HEADACHE WITH NO KNOWN CAUSE
It is important to immediately get medical help if someone experiences any of these signs because certain medications can only be administered if the symptoms have occurred for less than 3 hours. The medications available in the emergency room can significantly decrease overall mortality and long term injury if given in the right amount of time. The new slogan of the American Stroke Association reminds us of the importance of knowing these symptoms and immediately obtaining care: “Learn to recognize a stroke. Because time lost is brain lost.”
For more information on stroke identification and prevention, the Veterans Association has a website with sources for patients and family members:
http://www.rorc.research.va.gov/rescue/stroke-information/about-stroke.cfm
The American Heart Association/American Stroke Association also has informative handouts:
http://www.strokeassociation.org/STROKEORG/General/Patient-Information-Sheets_UCM_310731_Article.jsp
This video footage comes from the 2011 Grammy Awards. Serene Branson, a news anchor from California, starts to discuss the excitement of the event, but then suddenly begins to slur her words and speak nonsense. Social media was abuzz. Why did she mess up? Was she confused? Did she speak another language? A lot of people had a lot of theories but very few recognized the confused language as a neurological symptom, possibly a symptom of stroke.
Though the press release issued by her news station denies a stroke, Serene’s speech was characteristic of the “confused, jumbled speech” seen during a stroke. The purpose of pointing this out and watching this video is not to analyze this particular situation, but to help identify signs of stroke when they occur. Strokes can happen to anyone at any time. It is imperative to know these signs and to immediately seek help if they happen to you or someone you know.
The American Heart Association has done extensive marketing to teach Americans the signs and symptoms of a heart attack. Most adults could name the common signs – chest pain, discomfort in the upper body (particularly in the left arm), and shortness of breath. But could most adults name the symptoms of stroke?
New education programs have been developed to further educate Americans about the symptoms of stroke and what to do if a person does have these symptoms. Stroke is the third leading cause of death of Americans according to the Center for Disease Control (http://www.cdc.gov/nchs/fastats/lcod.htm). It is also a leading cause of long-term injury. In my practice as a speech pathologist, I have seen strokes in patients ranging from 27 years to 92 years. No matter your age or current health condition, it is imperative to know the signs and symptoms of stroke. If you or someone in your environment shows any of these symptoms, DON’T WAIT – CALL 911 immediately. According to the American Heart Association, the following are signs of stroke:
SUDDEN:
- NUMBNESS OR WEAKNESS OF THE FACE, ARM OR LEG, ESPECIALLY ON ONE SIDE OF THE BODY.
- CONFUSION, TROUBLE SPEAKING OR UNDERSTANDING
- TROUBLE SEEING IN ONE OR BOTH EYES
- TROUBLE WALKING, DIZZINESS, LOSS OF BALANCE OR COORDINATION
- SEVERE HEADACHE WITH NO KNOWN CAUSE
It is important to immediately get medical help if someone experiences any of these signs because certain medications can only be administered if the symptoms have occurred for less than 3 hours. The medications available in the emergency room can significantly decrease overall mortality and long term injury if given in the right amount of time. The new slogan of the American Stroke Association reminds us of the importance of knowing these symptoms and immediately obtaining care: “Learn to recognize a stroke. Because time lost is brain lost.”
For more information on stroke identification and prevention, the Veterans Association has a website with sources for patients and family members:
http://www.rorc.research.va.gov/rescue/stroke-information/about-stroke.cfm
The American Heart Association/American Stroke Association also has informative handouts:
http://www.strokeassociation.org/STROKEORG/General/Patient-Information-Sheets_UCM_310731_Article.jsp
Tuesday, February 8, 2011
Representative Gabrielle Giffords & Traumatic Brain Injury
http://www.msnbc.msn.com/id/41266830/ns/us_news-life/
Rep. Gabrielle Giffords and her family are going through the rehabilitation and recovery process in the eyes of the country. As a victim of a gunshot wound to the head, Rep. Giffords has suffered a traumatic brain injury (TBI). TBI’s result in different problems based upon the location in the brain where the injury occurred. You can find a good map of the brain and its functions here: http://www.msnbc.msn.com/id/10401930. Some of the areas that can be affected after a TBI are speech, language, swallowing, cognition, breathing, and movement on one or both sides of the body.
Often at the time of a severe TBI or other accident a patient is given a tracheotomy - a hole in the throat through which mechanical ventilation (breathing) can be given. A tracheotomy (trach) tube must then be placed in the hole to keep the hole open and clean. Based on this report, Rep. Giffords was given a tracheotomy and now can breathe independently. They cannot immediately remove the tracheotomy tube and must now place a speaking valve to begin a “weaning” process.
The following is information about the weaning process of a tracheotomy tube. I am not involved in the care of Rep. Giffords, so I am describing the traditional process and what I hypothesize may occur with Rep. Giffords. The weaning process is common with all tracheotomies, and the amount of time required to complete the weaning process differs significantly between patients. Because the body has become used to breathing in and out through the hole in the throat, the patient may not be able to take enough oxygen into the body if the doctors closed the hole off immediately. Instead, the speech pathologist and respiratory therapist start with placing a one-way speaking valve over the tube so that the patient can breathe in through the tube and out through the mouth. After the patient is able to tolerate breathing this way for long periods of time, the speech pathologist and respiratory therapist will begin trials of “capping” the tube entirely. This will force the patient to breathe only with the nose and mouth and not through the hole in the neck. They will monitor oxygen saturation (quantities) in the blood, and work toward tolerating closing the hole off permanently.
You may be wondering why this valve is called a “speaking valve” and why speech has not been mentioned yet. The weaning process is important to patient independence and progress, but one of the main benefits of beginning this process is that this valve will also allow a patient to produce voice. When the patient is breathing in and out through the hole in the neck, the patient is not able to speak. No air is passing through their vocal folds (they are located above the tracheotomy site) and therefore speech is not possible unless a speaking valve is added. When the valve is placed, a person is capable of using their vocal folds to make noise (cough, say “ahh,” or speak words). A person may be able to immediately begin speaking after placement of the valve (if they have no injury to the part of the brain that controls speech production) or they may require further speech therapy to begin to speak again. I suspect that, based on reports of where Rep. Giffords was shot, she will have to undergo speech therapy to learn to speak again.
Thankfully Rep. Giffords has a wonderful team of speech pathologists, physical therapists, occupational therapists and doctors working to help in her recovery (I should know – I completed an externship at TIRR in the spring of 2009 and it is a wonderful place!). It appears that she is no longer in the acute (very seriously injured) stage and now can tolerate 3+ hours of therapy a day. As more information comes out regarding Rep. Giffords rehabilitation and recovery, I will try to comment upon it. Here is an earlier article with information about her injury and recovery process - http://www.huffingtonpost.com/2011/01/21/gabrielle-giffords-rehab-houston_n_812313.html.
Rep. Gabrielle Giffords and her family are going through the rehabilitation and recovery process in the eyes of the country. As a victim of a gunshot wound to the head, Rep. Giffords has suffered a traumatic brain injury (TBI). TBI’s result in different problems based upon the location in the brain where the injury occurred. You can find a good map of the brain and its functions here: http://www.msnbc.msn.com/id/10401930. Some of the areas that can be affected after a TBI are speech, language, swallowing, cognition, breathing, and movement on one or both sides of the body.
Often at the time of a severe TBI or other accident a patient is given a tracheotomy - a hole in the throat through which mechanical ventilation (breathing) can be given. A tracheotomy (trach) tube must then be placed in the hole to keep the hole open and clean. Based on this report, Rep. Giffords was given a tracheotomy and now can breathe independently. They cannot immediately remove the tracheotomy tube and must now place a speaking valve to begin a “weaning” process.
The following is information about the weaning process of a tracheotomy tube. I am not involved in the care of Rep. Giffords, so I am describing the traditional process and what I hypothesize may occur with Rep. Giffords. The weaning process is common with all tracheotomies, and the amount of time required to complete the weaning process differs significantly between patients. Because the body has become used to breathing in and out through the hole in the throat, the patient may not be able to take enough oxygen into the body if the doctors closed the hole off immediately. Instead, the speech pathologist and respiratory therapist start with placing a one-way speaking valve over the tube so that the patient can breathe in through the tube and out through the mouth. After the patient is able to tolerate breathing this way for long periods of time, the speech pathologist and respiratory therapist will begin trials of “capping” the tube entirely. This will force the patient to breathe only with the nose and mouth and not through the hole in the neck. They will monitor oxygen saturation (quantities) in the blood, and work toward tolerating closing the hole off permanently.
You may be wondering why this valve is called a “speaking valve” and why speech has not been mentioned yet. The weaning process is important to patient independence and progress, but one of the main benefits of beginning this process is that this valve will also allow a patient to produce voice. When the patient is breathing in and out through the hole in the neck, the patient is not able to speak. No air is passing through their vocal folds (they are located above the tracheotomy site) and therefore speech is not possible unless a speaking valve is added. When the valve is placed, a person is capable of using their vocal folds to make noise (cough, say “ahh,” or speak words). A person may be able to immediately begin speaking after placement of the valve (if they have no injury to the part of the brain that controls speech production) or they may require further speech therapy to begin to speak again. I suspect that, based on reports of where Rep. Giffords was shot, she will have to undergo speech therapy to learn to speak again.
Thankfully Rep. Giffords has a wonderful team of speech pathologists, physical therapists, occupational therapists and doctors working to help in her recovery (I should know – I completed an externship at TIRR in the spring of 2009 and it is a wonderful place!). It appears that she is no longer in the acute (very seriously injured) stage and now can tolerate 3+ hours of therapy a day. As more information comes out regarding Rep. Giffords rehabilitation and recovery, I will try to comment upon it. Here is an earlier article with information about her injury and recovery process - http://www.huffingtonpost.com/2011/01/21/gabrielle-giffords-rehab-houston_n_812313.html.
Wednesday, February 2, 2011
A few definitions
What’s the difference between “speech” and “language”? Aren’t those just two words that mean the same thing?
When we talk we use both speech and language.
Language refers to the message we send. We can send messages with body language or with verbal language. Some people can talk in a variety of languages (Spanish, French, Vietnamese). A change in language will mean that what someone says comes out clearly, but does not make sense. It would sound like they are talking in a different language or that their English is jumbled (incorrect use or ordering of words). Difficulty comprehending language can also occur after stroke or brain injury. The word for a change in language after a stroke or traumatic brain injury is aphasia (pronounced “ah-fay-shaa”).
Speech refers to how we send the message. It is done using the mouth with help from the lungs and the vocal folds (found in your voicebox, or larynx, in your throat). To speak, a person takes a breath, vibrates their vocal folds, and uses their tongue, teeth and lips to make sounds (to articulate sounds). A change in speech would mean that one part of the speech system has been changed due to weakness or injury. Any damage to the tongue, lips, throat, or lungs can cause a change in speech. This can sound many different ways. It may be slurred or slushy, it may be imprecise, or the wrong sounds may come out, but if the problem is only related to speech, then the language (or message) should be correct. That won’t always mean that you will understand everything, but the difficulty understanding stems from HOW it is said, not WHAT is said. The word for a change in speech (can occur for many reasons) is dysarthria (pronounced “dis-arth-ree-a”). Another word for a certain kind of change in speech after a stroke or traumatic brain injury is apraxia (pronounced “a-prax-ee-a”).
Other definitions:
Voice – The noise that comes from our vocal folds. You can know how your voice sounds by saying “ahhhhhhhhhhhhhhh.” Voice is often grouped with speech, but a person could certainly have problems with only the sound of their voice (Rachael Ray). The word for a change in voice is dysphonia (pronounced “dis-fon-ee-aa”).
Swallowing –Swallowing happens in three stages: oral, pharyngeal (throat), and esophageal. Problems with swallowing can happen for many reasons and due to disruptions in one or all stages of the swallow. Weakness or injury to the tongue, lips or palate (roof of mouth) can cause oral stage swallowing problems. Pharyngeal stage swallowing problems can occur with neurological diseases (stroke, Parkinson disease, Multiple Sclerosis), injury, and/or weakness. Gastroenterologists (GI doctors) are the pros for esophageal stage problems and problems in the stomach. The word for difficulty swallowing is dysphagia (pronounced “dis-fay-sha” or “dis-faa-sha”).
Cognition – Cognition encompasses how we think and process information. General cognition (for the purposes of this blog/speech therapy) includes problem solving, memory, attention, reasoning and a variety of other areas of brain use.
That covers the basics of terms you may hear on this blog or in regards to medical speech-language pathology. There are many more words related to speech-language pathology and audiology, but this should give you a start. I have not cited any sources here as these definitions come from topics that I discuss with patients everyday and come from a variety of sources throughout my training. More information on the diagnoses discussed can be found at www.asha.org.
When we talk we use both speech and language.
Language refers to the message we send. We can send messages with body language or with verbal language. Some people can talk in a variety of languages (Spanish, French, Vietnamese). A change in language will mean that what someone says comes out clearly, but does not make sense. It would sound like they are talking in a different language or that their English is jumbled (incorrect use or ordering of words). Difficulty comprehending language can also occur after stroke or brain injury. The word for a change in language after a stroke or traumatic brain injury is aphasia (pronounced “ah-fay-shaa”).
Speech refers to how we send the message. It is done using the mouth with help from the lungs and the vocal folds (found in your voicebox, or larynx, in your throat). To speak, a person takes a breath, vibrates their vocal folds, and uses their tongue, teeth and lips to make sounds (to articulate sounds). A change in speech would mean that one part of the speech system has been changed due to weakness or injury. Any damage to the tongue, lips, throat, or lungs can cause a change in speech. This can sound many different ways. It may be slurred or slushy, it may be imprecise, or the wrong sounds may come out, but if the problem is only related to speech, then the language (or message) should be correct. That won’t always mean that you will understand everything, but the difficulty understanding stems from HOW it is said, not WHAT is said. The word for a change in speech (can occur for many reasons) is dysarthria (pronounced “dis-arth-ree-a”). Another word for a certain kind of change in speech after a stroke or traumatic brain injury is apraxia (pronounced “a-prax-ee-a”).
Other definitions:
Voice – The noise that comes from our vocal folds. You can know how your voice sounds by saying “ahhhhhhhhhhhhhhh.” Voice is often grouped with speech, but a person could certainly have problems with only the sound of their voice (Rachael Ray). The word for a change in voice is dysphonia (pronounced “dis-fon-ee-aa”).
Swallowing –Swallowing happens in three stages: oral, pharyngeal (throat), and esophageal. Problems with swallowing can happen for many reasons and due to disruptions in one or all stages of the swallow. Weakness or injury to the tongue, lips or palate (roof of mouth) can cause oral stage swallowing problems. Pharyngeal stage swallowing problems can occur with neurological diseases (stroke, Parkinson disease, Multiple Sclerosis), injury, and/or weakness. Gastroenterologists (GI doctors) are the pros for esophageal stage problems and problems in the stomach. The word for difficulty swallowing is dysphagia (pronounced “dis-fay-sha” or “dis-faa-sha”).
Cognition – Cognition encompasses how we think and process information. General cognition (for the purposes of this blog/speech therapy) includes problem solving, memory, attention, reasoning and a variety of other areas of brain use.
That covers the basics of terms you may hear on this blog or in regards to medical speech-language pathology. There are many more words related to speech-language pathology and audiology, but this should give you a start. I have not cited any sources here as these definitions come from topics that I discuss with patients everyday and come from a variety of sources throughout my training. More information on the diagnoses discussed can be found at www.asha.org.
Wednesday, January 5, 2011
My goal
Speaking, hearing and swallowing are some of life's most basic and fundamental gifts. It isn't until one of these gifts is lost that we appreciate the intricacies in them. When a person or family member does experience a change in their speech, language, hearing, or swallowing, they often feel outcast and alone. The goal of this site is to highlight headlines in mainstream media to help patients, families, and medical practitioners better understand topics in speech-language pathology and audiology. Whether it is current research, cinema, or celebrity encounters, I hope to provide tangible information and human faces to often misunderstood subjects. Featured on this site will be stories from mainstream media sources about those who have had changes in their speech, language, hearing or swallowing.
To survivors and family of survivors: I hope that by reading the stories on this blog you will learn, grow, and realize that in this trying time you are not alone. Rehabilitation is possible for many of the topics covered on this site. Speech-language pathologists and audiologists are available in most medical centers to help when you have encountered a change in your speech, hearing, or swallowing. Contact your primary care provider for more information.
So...let's talk about speech.
Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs.
To survivors and family of survivors: I hope that by reading the stories on this blog you will learn, grow, and realize that in this trying time you are not alone. Rehabilitation is possible for many of the topics covered on this site. Speech-language pathologists and audiologists are available in most medical centers to help when you have encountered a change in your speech, hearing, or swallowing. Contact your primary care provider for more information.
So...let's talk about speech.
Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs.
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