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What Should I Do If I Think I Have A Concussion?

Updated on Jun 30, 2022 | Physical Therapy, Rehab Medicine, Your Health

Determined female soccer player playing with head during match

A concussion is type of brain injury usually caused by a blow to the head. Most of the time, the effects are minor and short term. But that’s not always the case. Immediate medical care may be necessary to prevent long-lasting neurological symptoms such as problems with concentration and memory.

Jenna Tosto Mancuso, PT, DPT, NCS, clinical specialist in neurologic physical therapy and physical therapist at the Abilities Research Center at The Mount Sinai Hospital, explains what a concussion does to the brain and what to do if you or someone you know may have sustained the injury.

What happens to the brain during a concussion?

Concussions are different than other head or brain injuries because there isn’t just one injured spot—the injury damages the whole brain. Concussions are often caused by a jolt to the head, which can cause the brain to bounce around in the skull, either back and forth or side to side. This rapid movement, and then the stopping, is what usually causes the injury. It also leads to changes in the chemical messengers—called neurotransmitters— which affects the communication pathways in the brain, leading to a variety of symptoms.

How might someone get a concussion?

Concussions usually result from rapid movement or changes in head and neck positioning. For instance, if you are playing a contact sport—like football—and get tackled, this can cause a concussion. It can also happen in soccer if you are hit in the head with the ball. But not all concussions happen while playing sports.

Does a concussion cause you to lose consciousness?

When we think about concussions, we often assume that the person loses consciousness, but that’s usually not the case. While you may lose consciousness briefly, it rarely lasts very long. Years ago, we might not have taken a blow to the head seriously if someone didn’t lose consciousness. We might have called it a stinger or a head hit. But researchers have realized that if you have sustained a head injury, it’s not a good idea to just walk it off and get back on the field.

What are the symptoms of a concussion?

Most symptoms of concussions appear pretty quickly. A headache, nausea, or blurry/ double vision are very common. Often, a concussed person may appear disoriented, confused, or not like themselves. They may lose their sense of balance or move oddly. They may seem unaware of their surroundings or lose track of time. If the concussion was sustained during a sporting event, a good way to find out is to ask, “What quarter are we in?” or “Which was the last team to make a play?”

What should I do if I think I have a concussion?

Immediately go to the emergency department. The medical teams there are trained and experienced in evaluating concussion symptoms and ruling out any other diagnoses. They will provide the best and most appropriate care. It’s also important to follow up with care after the head injury. For instance, if your child sustained a concussion, check in with their pediatrician to make sure there isn’t anything serious going on and to make sure your child recovers as quickly as possible.

What happens if you can’t get to the emergency department immediately?

Research shows that those who sustain a concussion do best if they get rehabilitation as soon as possible. If concussion symptoms aren’t addressed early, within two to three weeks, you may develop what we call post-concussive syndrome. These longer-term symptoms can become more serious concerns such as problems with memory, concentration, and impulse control.

What type of health care professionals can diagnose and treat a concussion?

Research and care of concussions has improved over the last 20 years. More health systems are developing comprehensive concussion care teams, which include specialists in rehabilitation medicine/physiatry, sports medicine, and neurology. Some teams also have physical therapists, occupational therapists, and speech and language pathologists and therapists. If you are experiencing changes in vision—such as double vision—the team might also include a neuro-ophthalmologist, which is a specialty that combines expertise with vision and neurology. The concussion care team might also refer you to a vision therapist, which is a subspecialty of occupational and physical therapy. If there might be an injury to the spine, the team might include an orthopedist. To best treat a concussion, we need a multi-disciplinary team to create a comprehensive plan of care for recovery.

Mount Sinai operates a post-concussion program through the Charles Lazarus Children’s Ability Center, located at Union Square, which has satellite programs throughout the city. We also operate a concussion clinic for adolescents and adults. For more information on that program, call 212-241-2221.

Learn more about the Mount Sinai Abilities Research Center

Building Physician Skills and Competencies in the Care of People with Disabilities

Mar 16, 2022 | Community, Diversity and Inclusion, Rehab Medicine

Eliana Cardozo, DO, Assistant Professor of Rehabilitation and Human Performance, with a patient. Photo taken before the pandemic.

While it is important for physicians to skillfully and compassionately care for patients, specific competencies may improve the experience for patients with disabilities, said Jenny Lieberman, PhD, Senior Occupational Therapy Rehabilitation Specialist at the Department of Rehabilitation, Medicine, and Human Performance, who was the featured speaker for a virtual talk hosted by the Office for Diversity and Inclusion (ODI) at Mount Sinai. The session, “Building Physician Skills and Competencies in the Care of People with Disabilities,” may be viewed here.

The talk was part of the third annual Raising Disability Awareness Virtual Talk Series, launched by ODI for Disability Awareness Month. The series featured speakers from the Mount Sinai Health System and the community to raise awareness and promote an inclusive and equitable workplace and health care environment for people with disabilities.

Patients with disabilities may face a wide range of neurological, orthopedic, or medical challenges, said Dr. Lieberman, who is an occupational therapist, researcher, and educator. “There are a varying range of diagnoses,” she said. “But many times the presentation will be similar when it comes to their disability. The worst thing that we could possibly do to any patient that comes through our doors is to make them feel invisible. This is their life. This is what they’re living on the day to day. So it’s really important to recognize them so they feel they are heard, and not invisible.”

Jenny Lieberman, PhD, Senior Occupational Therapy Rehabilitation Specialist.

The first key is knowledge, Dr. Lieberman said. Having awareness of specific secondary diagnoses that develop is key to providing good care—for example, knowing that a person with a spinal injury also could develop urinary tract infections, skin irritation, or autonomic dysreflexia, a sudden increase in heart rate blood pressure. Assessments and evaluations often differ for people with disabilities during medical appointments. For example, only 5 percent of people who use wheelchairs are weighed during their visits, which affects proper dosage of medication and management of their health, Dr. Lieberman said. The solution may be using a lift or an assessment table with a scale. Even if you cannot weigh them during the visit, you can validate their concerns by acknowledging your awareness that this is a problem that needs a solution.

Tasks like weighing patients, conducting secondary diagnoses, and administering medication might require different equipment and accommodations. Dr. Lieberman recommends to “be aware if someone is coming to you with a disability,” she said “The support services, access, and requirements should be in place beforehand to ensure that they get the treatment they need.”

People with disabilities often feel invisible or viewed as incompetent during their health care experiences. They also do not receive adequate information about treatments and interventions, often have access limitations, have to advocate for themselves, and may have trouble getting the financial or insurance support they need. Dr. Lieberman said clinicians can address these important issues if they are culturally competent and understand this population’s experiences.

Dr. Lieberman also discussed ways clinicians can ensure that patients with disabilities are heard: “Do a thorough chart review before you see the patient. Introduce yourself. Acknowledge their history, ask them if they’re still experienced the symptoms they were previously experiencing, and validate their concerns and symptoms,” she said. “While all of this seems very obvious to do, it doesn’t translate to our patients. They often don’t realize that we have looked into their chart and we actually have some backstory on them.”

In the end, Dr. Lieberman suggested that physicians and other providers always be empathetic and patient. They should create an environment that makes everyone feel safe and comfortable and speak to a person with a disability in language they are able understand so they can actively participate in their care plan.

Mount Sinai's Office for Diversity and Inclusion offers more disabilities-related resources

What Do I Do If I Sprain My Ankle?

Oct 1, 2021 | Rehab Medicine, Your Health

There’s a good chance you—or someone you know—has had a sprained ankle. This very common condition comprises about 30 percent of injuries seen at sports medicine clinics. And not just athletes are affected, more than 23,000 people each day seek care for a sprained ankle and half of all sprains seen in the emergency room are unrelated to sports.

Mariam Zakhary, DO, Assistant Professor, Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, and Attending Physician at Mount Sinai-Union Square, explains how to treat this common injury and what to do if you have chronic ankle instability.

What happens when you sprain an ankle?

Ankle sprains happen when you turn, twist, or roll the joint in a way that causes you to stretch or tear one or more of the three thick bands of tissue (called ligaments) that keep our ankles stable. Sprains occur when we misstep and put pressure on the ankle while it is out of its normal position. Often, we sprain our ankle when we walk on an uneven surface, such as a city street, or when we’re running and changing direction. Most sprains affect the ligaments on the outer side of the ankle.

Doctors typically put sprained ankles into one of three categories:

Grade one: You have stretched at least one of your ligaments but there is no tear.
Grade two: You have stretched at least one of your ligaments and have a partial tear in another.
Grade three: You have a full tear in one or more ligaments. You’ve probably also stretched your ligaments. Your ankle will most likely feel unstable with this injury, and will require immobilization with a boot.

What should I do if I sprain my ankle?

It depends on the severity of the sprain. If you can put weight on your ankle, you should be able to do some self-care at home and walk it off. But if it hurts to stand on your ankle, you should be checked out by a doctor as this might indicate that you have done serious damage to your ligaments and ankle, or even broken a bone.

What kind of self-care can I do?

If you have a minor, grade one sprain, there are a few things you can do to heal at home. Try these for a day or two and, if your ankle does not improve by the third day, you should probably see a doctor.

Rest your ankle. The rule of thumb is: if it hurts, don’t do it.
Elevate it. Raise your ankle above your heart, especially at night. This allows you to enlist the help of gravity to drain any excess fluid.
Apply ice. I recommend icing for 20 minutes, every two or three hours for at least the first 48 hours. Then, continue to ice for pain relief as needed.
Use a brace. If your ankle feels unstable, use a brace to hold it in place.
Try compression. Wrap your ankle with an elastic bandage. The wrapping should be snug but not so tight that it hinders circulation.
Take a pain reliever. Use an over-the-counter anti-inflammatory, such as ibuprofen.

How long do I need to stay off my injured foot?

It depends on how bad a sprain you’ve got. As soon as your ankle can bear weight with minimal pain, you can walk on it. But respect the pain; it is your body’s way of communicating with you. If it hurts to walk, don’t. You may find you need to use a walking boot, crutches, or even a wheelchair for a while. If you find it hard to walk after a day or two, make an appointment with a doctor.

How long will it take to fully recover from an ankle sprain?

While a minor sprain can take about two weeks to heal, a severe sprain can take as long as three months. Listen to your body. If you try a new activity and it increases pain, that is your body’s way of telling you that you might be making the condition worse.

When should I see a doctor about my injury?

It’s never a bad idea to see a doctor about a sprained ankle—and the sooner you see one, the better. If you have a minor sprain, a doctor can tell you how to treat it and cope with the pain. If your pain is more severe, the doctor may order an X-ray to get a better idea of what is going on and see if you’ve fractured your ankle or done other damage.

I keep injuring my ankle. What can I do?

When you sprain your ankle, you stretch the ligaments, and these bands of tissue don’t recover their pre-injury tightness even after your ankle has healed. This may lead to chronic ankle instability—a tendency to turn, twist, or roll your ankle with the slightest provocation. Each time you re-sprain your ankle, you stretch the ligaments just a little more. Unfortunately, you can’t strengthen your ligaments, but you can strengthen your secondary stabilizers, which are the muscles around the ankle such as your lower leg and calf muscles.

Also, because repeated sprains may cause even more sprains, it’s not a bad idea to use an elastic bandage, tape, or an ankle brace to keep the joint stable. Many athletes with chronic ankle instability wear braces or use medical or therapeutic tape for increased stability, but the best treatment is to work on the muscles around the ankle.

How do I strengthen the muscles around the ankle?

The key is to strengthen the muscles both on the outside and inside of the ankle. Some of these muscles go all the way up to the knee. You’ll also want to strengthen the muscles in your feet.

One easy thing to do at home is to spell the alphabet out with your foot while seated. This activates the muscles in the ankle and works on conditioning them. When the ankle is more stable, you can start doing single leg exercises. An example of this is standing on one foot and hinging forward to touch an object out in front of you, close to the ground. This forces your ankle to use the surrounding muscles to remain stable. You can also do this single leg exercise as a preventative.

However, the best way to learn the right exercises is to work with a physical therapist.

Make an appointment with Dr. Zakhary

Learn more about Rehabilitation Medicine at Mount Sinai

I Have Long COVID. How Do I Get Back to Physical Activity?

May 19, 2021 | COVID-19, Rehab Medicine, Your Health

Older woman on work out bench lifting free weights

Millions of people across the United States have contracted and overcome a COVID-19 diagnosis. However, for some, the road to recovery has been difficult. Known as ‘long COVID,’ some patients continue to experience symptoms of COVID-19 weeks to months after their initial diagnosis.

While experts are unsure of its prevalence, the number of people with long COVID is significant and has prompted the creation of programs like the Mount Sinai Center for Post-COVID Care where patients are treated and researchers investigate the condition. Joseph Herrera, DO, Chair of Rehabilitation and Human Performance for the Mount Sinai Health System, and cardiology fellow Saman Setareh-Shenas, MD, explain what it means to be a COVID-19 long hauler and how the Mount Sinai Health System is working to get these patients back to physical activity.

What is long COVID patient?

Saman Setareh-Shenas, MD: This is a patient with Post-COVID Syndrome, which is a series of symptoms ranging from shortness of breath, chest pain, heart palpitations, heart racing, the inability to return to pre-COVID level of physical activity, and brain fog. These symptoms are present for weeks after their initial COVID-19 symptoms have resolved. We have seen patients experiencing these symptoms for six months, or even longer.

Joseph Herrera, DO: We are seeing some patients that have not even been hospitalized with COVID-19 who are having difficulty progressing their activity to pre-COVID-19 infection levels. They will have good days and bad days, and will try to push themselves physically. But, instead of taking two steps forward, they take 10 steps back. That is a common theme with our long haulers.

How do you guide a patient back to physical activity?

Dr. Herrera: Important for a patient’s physical and cognitive activity is understanding their submaximal exercise limits. This is a measure of a patient’s aerobic fitness and maximum oxygen uptake while doing rigorous—but not overly strenuous—activity like jogging on a treadmill or using an exercise bike. Some patients who have difficulty with physical exertion may also benefit from a formal breath work program that helps patients understand breathing techniques. At Mount Sinai, we progress patients using the rule of tens. This means that every 10 days we increase the intensity duration of the exercise by 10 percent. So, it does take some time to get ‘back to normal.’ But we advise our patients that their body needs that time to heal and rest. The symptoms resolve, but it does take a prolonged period for those symptoms to get better.

What advice do you have for long haulers who are trying to get back into exercise?

Dr. Herrera: If you have long COVID, you have to respect the symptoms you are experiencing and understand that your body is in the process of healing. I advise patients to create a diary of what they are experiencing and work with a physical therapist to address their concerns. Slowly working toward a gradual return to activity is the goal. You can’t rush this. Anytime our patients try to rush the process, they end up taking 10 steps back instead of three steps forward.

Dr. Setareh-Shenas: COVID-19 comes with a lot of inflammation and the body needs time to heal. Give yourself that time; go slowly, and gradually you can get back to your baseline. Normal household stuff is important, like walking and grocery shopping. Then, once you are comfortable, move on to exercising and boosting your exercise capacity.

Dr. Herrera: I think the most important message is, if you’re experiencing any symptoms of long COVID, don’t push yourself too hard but do see a specialist. Get evaluated to see if you qualify for any of the programs that we offer at Mount Sinai.

Get more COVID-19 information from Mount Sinai

I Recovered From COVID-19. How Do I Get Back In Shape?

May 17, 2021 | COVID-19, Rehab Medicine, Your Health

If you are one of the millions who contracted COVID-19 in the past year, you may still be in the process of regaining the physical fitness lost from when the virus forced you to slow down and heal.

Joseph Herrera, DO, Chair of Rehabilitation and Human Performance for the Mount Sinai Health System, and cardiology fellow Saman Setareh-Shenas, MD, explain how those who have recovered from COVID-19 can get back into their pre-illness shape and how the Mount Sinai Post-COVID Care Center can assist them on their road to recovery. Two key takeaways: Take it slow and consider seeing a specialist if you encounter any hurdles along the way.

How does the effect of COVID-19 on the body influence my recovery?

Joseph Herrera, DO: We are seeing a range of symptoms, from mild to severe, in patients after being infected with COVID-19. The virus affects them both physically and cognitively, everything from increased fatigue, shortness of breath, and tachycardia, a medical term of a rapid heartbeat, and difficulty concentrating, also known as brain fog. Because of this, some patients find it difficult to get back to their pre-COVID level of physical activity.

What about athletes? Does COVID-19 affect them differently?

Dr. Herrera: We’ve seen a range of people who have been impacted by COVID-19, from recreational athletes to marathon runners and professional athletes. I would say that they, similar to the general population, have a range of symptoms, some very mild all the way to severe. Overall, I don’t think your pre-infection conditioning really prevents anything.

Saman Setareh-Shenas, MD: COVID-19 doesn’t discriminate between athletes and non-athletes. We have seen major effects from the virus as well as post-COVID syndrome in very healthy athletes.

When is it safe to resume physical activity after recovering from COVID-19?

Dr. Herrera: We’ve been advising symptom-free patients to resume activity as tolerated. If they’ve been hospitalized due to COVID-19 or have spent a prolonged time in bed while recovering, whether in an intensive care unit bed or in their home, we want to make sure that they can return to normal activity before progressing to exercise.

Dr. Setareh-Shenas: Early on in the pandemic as the initial wave of patients were recovering, we started noticing a lot of our patients were not immediately able to go back to their baseline exercise level.

At the Mount Sinai Post-COVID Care Center, we help patients regain their pre-COVID strength and conditioning by using recommendations based on guidelines by the Leadership Council of the Sports and Exercise Cardiology Section of the American College of Cardiology and findings by British researchers. These guidelines advise those in recovery to return to exercise very gradually. Don’t go back to where your baseline was. Wait at least seven to 10 days, and then take it slowly from there.

Dr. Herrera: We guide patients using the ‘rule of tens.’ For example, if a patient were lifting a hundred pounds prior to getting infected with COVID-19, we have them cut everything in half—or even a quarter—of the weight they previously lifted. Then we apply the ‘rule of tens,’ by increasing either the intensity or the duration of exercise by 10 percent every 10 days. This way, they have a gradual increase in activity.

What precautions should post-COVID patients take when getting back to physical activity?

Dr. Setareh-Shenas: In the past year, we have seen a number of patients in our post-COVID population who are experiencing heart racing, palpitations, or a new arrhythmia. So, as a precaution, I would say that patients recovering from COVID-19 who have chest pains or shortness of breath, should be evaluated by their physician or by an expert cardiologist at a Post-COVID Center.

For example, in our Cardiology Clinic within the Post-COVID Care Center at Mount Sinai, we evaluate patients who have complaints of chest pain or shortness of breath and conduct exercise testing to see their maximal exercise capacity and evaluate for any arrythmia during exercise. We want to know: Do they have any symptoms when exercising on the treadmill? Does their heart go under strain that’s not equivalent for their age group and their risk factors? So, patients should be mindful of this, especially if they have a history of cardiac issues.

Dr. Herrera: Most importantly, don’t push yourself too hard but do see a specialist. Get evaluated to see if you qualify for any of the programs that we offer at Mount Sinai.

Get more COVID-19 information from Mount Sinai

Access-A-Ride Paratransit Services Adjusting to the COVID-19 Pandemic

Updated on Jun 30, 2022 | Community, Diversity and Inclusion, Rehab Medicine

Donna Fredericksen, Deputy Director of the MTA’s Transit Access-A-Ride (AAR) Paratransit Outreach, with Kevin Funney, Operator, Maggies Paratransit Corp.

The COVID-19 pandemic has affected many parts of city life, including the safe access of New Yorkers with disabilities to services and care. During a talk hosted by the Mount Sinai Office for Diversity and Inclusion (ODI), Donna Fredericksen, Deputy Director of the MTA’s Access-A-Ride (AAR) Paratransit Outreach, described how the program has adjusted to the pandemic and continued to safely provide paratransit service to New Yorkers. The virtual talk can be viewed here.

The session, “Proactive Measures During COVID-19 and Beyond,” was the second in the new Raising Disability Awareness Virtual Talk Series, featuring speakers from around the Mount Sinai Health System as well as the community, in honor of Disability Awareness Month in October. During this time, ODI hosted events to educate, raise awareness and promote an inclusive and equitable health care environment for people with disabilities.

“Access-A-Ride trips are available—24-7 and 365 days a year—for people with disabilities who cannot use the subway or the bus,” Ms. Fredericksen said. “This could be a temporary setback, perhaps a new knee or a new hip, or it might be something more long term.”

Talk on Disability Awareness

During the COVID-19 pandemic, AAR has adjusted its procedures: Riders and drivers must wear masks. All dedicated vehicles are disinfected, and temperature checks are required for drivers. And to allow for social distancing, shared rides are discontinued—though people with disabilities can be accompanied by a personal care attendant (PCA). Applicants are still required to go to an assessment center as part of the eligibility determination process. The sites are open at 25 percent capacity, with COVID-19 safety protocols in place. For many months during the pandemic, fares were suspended, but they resumed on Tuesday, January 19.

The AAR fare for most eligible riders is $2.75, the same as subway or bus fare. If they have a PCA, that person travels free, and AAR customers who are enrolled in the Fair Fares program, which aids lower income New Yorkers, pay $1.35.

AAR is the largest paratransit service in the country, with 160,000 riders. Pre-COVID, it made 24,000 trips a day, Ms. Fredericksen said. Now the weekday trips remain steady at about 70 percent of that level.

Meeting Essential Travel Needs

Ms. Fredericksen and two team members outlined how to apply for eligibility—the required first step—and how to schedule a ride, access language and interpretation services, navigate through the AAR web page, and access the MYmta app, which is available at the Apple App Store and Google Play. Access-A-Ride answers to “a higher authority,” Ms. Fredericksen said, in this case, being in compliance with the FTA (Federal Transit Administration) and the ADA (Americans with Disabilities Act) and prioritizing the needs of people with disabilities. “We want to focus on essential travel, such as taking you to dialysis or chemotherapy appointments, or if you are an essential worker, or you need service immediately,” she said.

“If you have any questions about AAR, please call. Someone is there Monday through Friday from 9 to 5 to help you out.” For the latest information, including a guide to AAR and the AAR newsletter, visit https://new.mta.info/accessibility/paratransit. Or call 1-877-337-2017.

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