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

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

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
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How Can I Manage My Low Vision?

Updated on Jun 30, 2022 | Your Health


Visual impairment is a common condition that affects more than 12 million adults over age 40 in the United States. But low vision—a condition that affects one in six adults throughout the nation—is different. People with low vision have reduced visual acuity (the common clinical measure of eye function) that cannot be corrected by standard glasses, contacts, medication, or surgery.

Leannza Tang, OD, an optometrist and Director of Low Vision Services at New York Eye and Ear Infirmary of Mount Sinai, explains low vision rehabilitation and what patients can do to seek care.

What causes low vision? What are the symptoms?

Low vision can be caused by many different eye conditions. Some of the more common include glaucoma, macular degeneration, and diabetic retinopathy, but there are other  conditions that can lead to vision loss as well.

The most common symptom is blurry vision that cannot be corrected or improved with standard eyeglasses, contact lenses, or eye surgeries. This usually translates to difficulty seeing small print. Patients may have difficulty reading a book; seeing a sign from a distance that they used to be able to; or even watching television.

Some people have distorted or missing spots in their central vision. This might make seeing people’s faces a lot more difficult. Other times, patients report side vision loss, which is what we typically see in glaucoma patients. When someone has severe side vision loss, this can affect their mobility.  Walking around as well as navigating stairs and curbs can be very difficult. These patients are prone to bump or trip over things.

Leannza Tang, OD

Are all low vision patients considered legally blind?

This is a common misconception about low vision patients that may not be true. Legal blindness is defined as someone with a visual acuity of 20/200 or poorer and/or has a visual field of no more than 20 degrees in their better seeing eye. Therefore, not all low vision patients are considered legally blind.

Eye care providers can clarify if you meet the criteria for legal blindness during your eye exam.

What is the difference between a low vision exam and a routine eye exam?

My low vision exams can be very different from a routine eye exam. One of the first things I tell patients is that I’m focused more on how they’re functioning day-to-day. Typically, the results of different scans, side vision tests, eye pressure tests, and dilations are all being managed by their ophthalmologist or optometrist so therefore, it is still very important to follow up with them as instructed.

I am interested in finding out what the patient’s goals or complaints are in relation to their vision. Are they having difficulty reading small print? Are the issues apparent when looking at price and medication labels or when reading a book and watching television? Do they have problems seeing street signs or bus numbers? The list goes on. I typically meet with patients for about one hour in which we discuss how to manage the condition and what devices might make navigating day-to-day life easier.

How do I manage low vision? Will the condition get worse?

I recommend seeing a low vision specialist. Many people think that you need to wait until you have severe vision loss before seeing a specialist but that is not true. Low vision physicians see a range of patients, from profound to more mild vision loss.

Low vision specialists can discuss any additional services that may benefit a patient. This includes orientation and mobility training for those who are having difficulty walking around or traveling independently because of their vision loss. There is training for household tasks like cooking, doing laundry, housework, and so on. There is also training to more efficiently use your personal devices including computers, smartphones, and laptops. If patients already have these devices, a specialist can teach them how to use built in accessibility and other features that might benefit them.

I also show low vision devices to see if they’re suitable to help a patient with their day-to-day tasks. This includes:

  • A hand magnifier is probably the most common and familiar low vision device. Hand magnifiers make text bigger and are mostly for spot reading tasks like reading price labels or medication labels. Stand magnifiers are best for if you want to sit down and read a book for an extended period of time. To use it, you slide the device over your reading material while sitting at a desk or table. They come in different magnification powers, so I recommend a low vision evaluation to make sure that you are using the most appropriate device and power.
  • Digital magnifiers operate very similar to stand magnifiers. These magnifiers allow you to adjust how big you want the words to appear as well as the color of the text for ease of viewing and reading.
  • If patients are having issues seeing objects at a distance, like bus numbers or street signs, we can prescribe telescopes. We can do in-office training so that patients are able to use the device efficiently and comfortably.

It is very difficult to say whether someone’s vision will or will not get worse over time. It really depends on the person’s underlying condition that is causing their low vision. I will stress that it is important to follow up with the provider who is managing your eye condition and continue to take your prescribed medications and eye drops as instructed.

What resources are available for people with low vision?

Dealing with vision loss, whether sudden or gradual, can be very difficult. Some patients express feelings of sadness, frustration or anxiousness. A referral for behavioral health resources can be made to ensure a patient has the support they need.

Mount Sinai has excellent low vision resources. To learn more about low vision services at New York Eye and Ear Infirmary of Mount Sinai, please speak to your eye care provider or visit our website.

Learn more about low vision services at New York Eye and Ear Infirmary of Mount Sinai

What Are Sensory Processing Differences and How Do They Relate to Autism?

Updated on Dec 17, 2024 | Seaver Autism Center, Your Health


Autism spectrum disorder (ASD) is a developmental disorder. It often appears in the first three years of life and affects social communication and behavior.

Several different signs can prompt someone to seek out an autism evaluation. In this Q&A, Paige Siper, PhD, Chief Psychologist of the Seaver Autism Center for Research and Treatment at Mount Sinai, explains when you might want to seek an assessment, what that involves, and what a recent focus on sensory processing differences means.

What signs might prompt an evaluation for autism spectrum disorder (ASD)? 

Several signs may prompt an autism evaluation. Concerns are commonly raised by a parent, family member, pediatrician, or teacher. Autism-specific screening should occur at the 18- and 24- or 30-month well visits and whenever a concern is expressed.

Autism is a constellation of difficulties with communication and reciprocal social interaction as well as repetitive and restricted behaviors and interests. Early signs may include delays in language or motor skills, although some individuals with autism achieve milestones on time.

Social communication signs include limited use of nonverbal communication such as eye contact, facial expression, pointing and other gestures and limited social interaction; for example, lack of showing objects of interest, minimal interest in peers or lack of shared enjoyment with others. Difficulty with imitation and pretend play are also common early signs. Repetitive behavior signs include repetitive speech, an intense focus on certain topics or parts of objects, insistence on sameness, lining up objects or toys, motor mannerisms such as hand flapping or body rocking, and unusual sensory behaviors.

Paige Siper, PhD

What are sensory processing differences?

In 2013 when the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) came out, it was the first time sensory reactivity was included within the diagnostic criteria for autism. The DSM-5 describes three categories of sensory differences:

  • Sensory hyperreacitivty is an overresponsiveness to sensory stimuli that may take the form of individuals covering their ears in response to sounds, squinting or avoiding the sight of certain objects, resisting the feel of certain textures or discomfort when touched by others.
  • Sensory hyporeactivity is an underresponsiveness to sensory stimuli, which can result in significant safety concerns. For example, an individual who is hyporeactive may not respond to the sound of an alarm, the feel of pain or temperature, or the sight of a car passing by.
  • Sensory seeking is an excessive interest in sensory stimuli. Individuals who are sensory seeking may repeatedly seek out the sight, feel or sound of certain objects.

Each of these examples can affect daily living and quality of life. Research suggests up to 90 percent of individuals with autism display sensory differences compared with people who do not have autism.

How do I know if my child needs a sensory assessment and what is involved?

If your child is displaying sensory hyperreactivities, hyporeactivities, or seeking behaviors that are affecting their daily functioning, a sensory assessment may be warranted. The goal of a sensory assessment is to identify personal sensory preferences. We all have our own sensory preferences, and by determining those preferences we can modify environments accordingly.

Over the past several years, the Seaver Autism Center at Mount Sinai developed a novel sensory assessment called the Sensory Assessment for Neurodevelopmental Disorders (SAND). The SAND combines a semi-structured, clinician-administered observation and a corresponding caregiver interview. We want to see, within an exam setting, how a child responds to stimuli that prompt sensory responses, and we also want to capture information from caregivers about their child’s daily experiences.

Following an assessment, parents will learn about their child’s unique sensory preferences and sensitivities, and then an individualized treatment plan can be developed and implemented. Adjustments in an individual’s sensory experiences can have a profound impact on adaptive behavior, social engagement, and learning.

Since autism is a lifelong diagnosis, how can parents and caregivers support their child as they develop?

Parents are their child’s greatest advocate and the true experts. Parents can support their children by helping them develop the skills necessary to become as independent as possible. A variety of interventions are commonly used to help individuals on the autism spectrum gain skills. These include:

  • Applied behavior analysis, often referred to as ABA therapy, is one evidence-based treatment for core features of autism.
  • Speech and language therapy is important to develop both functional and pragmatic communication skills.
  • Occupational therapy can focus on sensory reactivity, fine motor skills, and activities of daily living.
  • Physical therapy can target challenges such as low muscle tone, which is commonly observed in autistic individuals.

It is important for each child to have a personalized treatment plan that is reviewed and updated regularly to ensure individuals reach their optimal potential.

What programs and services does Mount Sinai offer at the Seaver Autism Center?  

The Seaver Autism Center is a multidisciplinary program with a large research focus ranging from natural history studies that track change over time to clinical trials that test new treatments. All individuals participating in research at the Center receive an autism-focused research evaluation. We also offer neuropsychological and psychoeducational evaluations, individual psychotherapy for those on the autism spectrum and their siblings, parent training, and medication management through Mount Sinai’s Faculty Practice Associates. The Seaver Autism Center has a large community outreach program that offers social skills groups and training for both families and professionals. We have a variety of collaborations with local cultural institutions such as the American Museum of Natural History and the Guggenheim Museum. Finally, our training program is committed to training the next generation of autism experts.

What is the Seaver Autism Center at Mount Sinai doing to support patients’ sensory needs?  

Over the past year, we made it a priority to improve care and better support individuals on the autism spectrum’s sensory needs within the Mount Sinai community. We developed Sensory Toolkits that are now available within our pediatric emergency departments. We are starting to disseminate the toolkits to other specialized practices within and outside of the Health System with the goal of improving the patient experience. Each kit has several sensory tools, as well as an information sheet that explains the intended use of each tool to satisfy sensory needs and ultimately to make each person’s experience more comfortable. Families get to take the kits home with them to continue using beyond their visit to Mount Sinai.  Our team also developed a learning module, now available across the Mount Sinai Health System, to train physicians, clinicians, and staff members within different disciplines on how to best support neurodiverse patients. We are actively collecting data on both of these initiatives to ensure these new programs are serving their intended purpose. Finally, we are surveying caregivers of children on the autism spectrum to determine which sensory interventions and supports have and have not worked for their child. You can learn more here.

Read more about the Seaver Autism Center for Research and Treatment at Mount Sinai

Center of Excellence for Pancreatic Cancer Multidisciplinary Team at Mount Sinai West Provides Customized and Comprehensive Treatment Plan in One Day

Updated on Jun 30, 2022 | Mount Sinai West, Your Health

Members of Mount Sinai’s Center of Excellence for Pancreatic Cancer Multidisciplinary Team, from left: Deirdre Cohen, MD, Aimee Lucas, MD, Daniel M. Labow, MD, and Karyn A. Goodman, MD.

A diagnosis of pancreatic cancer can be scary and overwhelming. And, it can be daunting and time-consuming for patients to figure out which physicians to see and arrange for all the needed diagnostic testing.

Mount Sinai’s Center of Excellence for Pancreatic Cancer Multidisciplinary Team is a “one-stop shop” that can help patients get everything they need, from expert opinions on cancer treatments to advice on nutrition. Located at Mount Sinai West, the team provides a comprehensive workup by a multidisciplinary team of leading experts, all in one day.

The full-day assessment includes any necessary diagnostic tests, physical exams, and consultations in one place—a comfortable, patient-centered setting. At the end of the day, patients receive a personalized treatment plan and understand the prescribed course of action.

“At the end of their visits, patients walk out with an easy-to-understand-and-follow treatment plan, put together by some of the best minds for treating and researching pancreatic cancer,” said Karyn A. Goodman, MD, Professor and Vice Chair for Research and Quality in the Department of Radiation Oncology at the Icahn School of Medicine at Mount Sinai, and Associate Director for Clinical Research at The Tisch Cancer Institute. “It can take several weeks for a patient to get a treatment plan for a complicated cancer. We do it in one day.”

“Our team is available to all patients whether they are newly diagnosed, looking for a second opinion, or about to begin treatment,” Dr. Goodman added.

Patients benefit from the expertise of a full array of pancreatic cancer specialists including medical oncologists, radiation oncologists, surgical oncologists, gastroenterologists, pathologists, radiologists, genetics counselors, oncology nurse practitioners, and pain management specialists.

Patients also have access to social workers, nutritionists, exercise therapists, and palliative care specialists. A nurse practitioner coordinates the care prescribed in the treatment plan and educates each patient about what to expect.

“Our multidisciplinary group reviews all of the patient’s information from examination and diagnostic testing,” said Deirdre Cohen, MD, Associate Professor, Icahn School of Medicine and Director of GI Oncology Program at Mount Sinai. “This close collaboration among specialists helps ensure that all elements of each patient’s treatment plan will work in harmony for optimal outcomes. It is an ideal setting where we can assess eligibility for clinical trials— we offer the latest treatment options to every patient we see, and we also make sure that every patient is treated as a whole person, taking into account each unique individual’s needs and preferences.”

“Pancreatic cancer is complex. It requires the integration of specialists from many medical and surgical disciplines,” said Daniel M. Labow, MD, Professor of Surgery at Icahn Mount Sinai. “Our approach allows us to quickly and efficiently design a personalized treatment plan for each pancreatic cancer patient.”

He added, “Importantly, we make time for patients to be heard—we listen, answer questions, and provide support. We make the overwhelming and daunting manageable.”

 

Learn more about the Pancreatic Multidisciplinary Team

Expert Advice on Diagnosing and Treating Aphasia

Updated on Jun 30, 2022 | Featured, Your Health

Aphasia is loss of the ability to understand or express spoken or written language. It commonly occurs after strokes or traumatic brain injuries. It can also occur in people with brain tumors or degenerative diseases that affect the language areas of the brain.

According to the National Aphasia Association, this disorder affects about two million people in the United States, and is more common than Parkinson’s disease, cerebral palsy, or muscular dystrophy, yet most people have never heard about it. That changed after the family of actor Bruce Willis announced he will step away from acting following a recent diagnosis of aphasia.

Laura Stein, MD, MPH

In this Q&A, Laura Stein, MD, MPH, Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai and attending physician at the Mount Sinai and Mount Sinai Queens Stroke Centers, discusses how aphasia is diagnosed, the potential burdens for families and caregivers, and some treatment options, notably treatments by speech-language pathologists.

What is aphasia?

Aphasia is a term doctors use to describe the loss of one’s ability to use their language function, or communicate with the world around them. It’s due to damage in the brain. It’s easy to lose sight of how all-encompassing language function is. It’s what we say with our words. It’s understanding others. It’s our ability to read, our ability to write, our ability to do everything in between. We have to remember that aphasia represents a symptom that patients experience or a sign doctors look for on their exams. It’s really just a term describing these problems with language and communication. It tells us nothing about why someone is having problems with their language and communication. I also want to acknowledge that aphasia can be profoundly difficult and frustrating for patients and their families. Our ability to communicate with the world around us is paramount to the human experience.

What are the signs and symptoms of aphasia?

The signs and symptoms of aphasia are actually quite varied, depending on the individual. Aphasia can be so mild that someone talking to an individual with an aphasia might not even know that they have it. In such a case, someone with a mild aphasia might have trouble coming up with words or the names of objects. At times, their speech may sound broken and fragmented, but they may still be able to communicate what they want to communicate and understand what people are saying, what they’re reading around them. Unfortunately, aphasia can be very debilitating at times, and some people have a difficult time making their needs known or understanding what’s going on around them. These can be very troubling and frustrating symptoms for patients and their families to live with.

How is aphasia diagnosed?

Aphasia is diagnosed with a detailed examination of one’s language function, and might be performed by a neurologist like myself, or a speech-language pathologist. It’s really important to assess every component of language function. We listen to what somebody says, whether spontaneously or with various prompts. We assess what they understand when they’re spoken to. We assess their ability to read, their ability to write, their ability to name everyday objects around them, their ability to repeat sentences that are spoken to them.

What causes aphasia?

The causes of aphasia can be quite varied. Anytime language function is abnormal, we worry about damage to specific locations of the brain where the language centers are located. In a majority of people, the language centers are on the left side of the brain, but in a small minority they may be on the right. Aphasia is more common in older individuals, and stroke is the most common cause  because of how many people have strokes in our society at older ages. However, there are many causes, like a degenerative disease that might cause dementia, a tumor, infection, or head trauma. But it’s really all about figuring out what part of the brain is not working normally, and why

What are the types of aphasia, and how do they differ?

There are multiple types of aphasia. The networks that underlie language function are complicated and interconnected. We’ll break it down in broad senses: There are expressive and receptive aphasias. With expressive aphasia, an individual has difficulty expressing themselves—speaking in sentences, coming up with words, writing; their speech may sound broken and fragmented. With receptive aphasia, an individual has more trouble understanding language, what people are saying, what they are reading. Someone may have a mixed aphasia, with expressive and receptive components. The most profound aphasia is a global aphasia, where all aspects of language function are impaired, and it is incredibly difficult to communicate with the world around you.

How is aphasia treated?

First and foremost, we have to understand what the cause of the aphasia is. Once we identify a cause, such as a stroke, we can think about treatments and if we can prevent the aphasia from getting worse. Beyond that, we think about how can we help the individual rehabilitate. We have outstanding speech-language pathologists who are specially trained in optimizing one’s language function and their ability to communicate with the world around them, despite their aphasia.

Learn more about speech-language pathology services at Mount Sinai
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Could My Hair Loss Be Alopecia?

Mar 29, 2022 | Skin Health, Your Health


Hair loss—called alopecia areata—can be upsetting. If it affects you, you may feel as if you’re the only one, but it’s more common than you think. About seven million Americans have alopecia areata, including men, women, and children of all ethnic groups.

In this Q&A, Emma Guttman-Yassky, MD, PhD, Waldman Professor and Health System Chair of Dermatology at the Icahn School of Medicine at Mount in New York and Director of the Alopecia Areata Center of Excellence at Mount Sinai, explains the condition, its risk factors, and who to contact for treatment.

What is alopecia areata?

Alopecia areata is an autoimmune disease that causes you to lose your hair, mostly on the scalp. An autoimmune condition means your body’s own immune system is attacking a certain part of your body. In this case, the system attacks healthy hair follicles. Alopecia areata often starts with one or more circular patches about the size of a quarter. Hair may disappear suddenly, over just a few days, or it may fall out slowly, over weeks or months. This condition can spread to other parts of the body, such as the eyebrows, eyelashes, beard, and extremities. The condition is not linked to food. There’s nothing you should eat—or avoid—to prevent it. If you are an alopecia patient, you can eat whatever you want.

What causes the condition? Who is most at risk?

This condition does not discriminate. It affects people of all ages, genders, and backgrounds. It often starts in childhood or adolescence but can affect those well into adulthood.

Alopecia areata can be triggered by a significant event, such as an illness or trauma, or it can arise due to genetics or a family history of eczema or another allergy. We see more alopecia areata in families of patients who have had the condition. We also see it in families that have eczema. While some people think it can be caused by stress, there is no scientific data to back that up. Alopecia is not contagious.

Can hair loss affect you emotionally?

If you’re feeling anxious or depressed over your hair loss, that’s not unusual. Hair can be an important part of our identity. And baldness—in patches or all over your head—can be devastating. It can make you feel self-conscious and unhappy about your appearance. According to the National Institute of Mental Health, people with long-term alopecia areata are at a higher risk of depression. So, if you’re feeling sad or uncomfortable about the condition, you are not alone.

Should I see a doctor if I think I have alopecia?

You should see a doctor as soon as you notice a problem. Some mild forms of the disease improve on their own, but most people need medical intervention. I recommend seeing a specialist, because many primary care physicians don’t know how to treat alopecia. At the Alopecia Areata Center of Excellence at Mount Sinai, we have special expertise in diagnosing and treating alopecia areata and cicatricial alopecia.

We have found that patients with alopecia have more systemic inflammation than patients with other skin conditions, such as psoriasis or eczema. Over a long period,  inflammation that is systemic—affecting many or all parts of the body—can cause a number of problems including heart disease, arthritis, Alzheimer’s disease, and cancer. Getting treatment early can help prevent alopecia from developing into these conditions.

How is the condition treated?

The first step is to evaluate your symptoms and the type of cells that are causing the inflammation. Dermatologists will then use a variety of treatments, including systemic (oral or biologic), topical, and injected anti-inflammatory medications. In addition, at Mount Sinai’s Alopecia Areata Center of Excellence, we are researching new treatments for the conditions, so we may be able to include you in a clinical trial.

Learn more about the Alopecia Areata Center of Excellence at Mount Sinai

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