Instructions for Concussion and Traumatic Brain Injury Patients

Medical Journal Article

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Designs for Strong Minds; Cognitive Rehabilitation for Mild or Moderate Posttraumatic Head Injuries
Physical Medicine and Rehabilitation Clinics of North America, February 2007, Volume 18, Issue 1, Pages 109-131
D. Markus

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List of steps to follow post-concussion:

  • See your primary care physician first and if needed meet with a doctor trained in treating concussions if you find that your have symptoms do not resolve within 4-6 weeks (see symptoms list above). 

  • Limit visual input wear sunglasses outside and indoors (Solar Shields or FL41 sunglasses to block sunlight, LED and fluorescent lights); Darkness is your friend.

  • Avoid TV, cell phone screen time.

  • Rest! Limit all physical activity.

  • Wear a baseball cap outside and in stores, at school, and in offices. Fluorescent lighting taxes your nervous system.

  • Wear musician’s earplugs (Earasers, found online or at Guitar Center, work well)

  • Avoid loud environments like auditoriums and sports events

  • Ask for accommodations at work or school. 

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My Story 

By Cathy Grochowski, May 2019

Brain injury can lead to a real roller coaster of emotions. As one of Dr. Markus’ many clients who sought out her expertise following having read The Ghost in My Brain book by Dr. Clark Elliott, I was asked to share my story, some thoughts, and potential steps that might come in handy for you or your loved one moving forward.

My mild traumatic brain injury/concussion took the better part of two years to resolve. It was indeed a long journey, and I commend you and your loved ones for seeking as much knowledge as you can to do your best to beat TBI. TBI survivors are a strong bunch, and they need to be their own best advocates.

NEVER GIVE UP, you have the neuroplasticity of the brain on your side! According to medicinenet.com, neuroplasticity is “the brain's ability to reorganize itself by forming new neural connections throughout life. Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment.” If one provider fails to encourage healing, whatever the techniques and tools used, move on to other alternatives. During the first year of my journey, I learned it took a village to heal my hurting brain. 

A concussion, even a mild one, is a traumatic brain injury. I wince every time I hear someone state “Oh, it’s just a concussion, she’ll be fine. I had many concussions and they are no big deal.” Argh! Here’s a little-known stat to ponder. Approximately 80% of concussions will resolve within the usual suggested timeframe of 4-8+ weeks. That’s great news! However, that leaves 20% of us (a whopping 500,000 people annually in the U.S. alone) whose symptoms may not fully resolve so quickly or easily. For these individuals, quite often things get worse in the weeks following the initial insult to the head. 

The following is a list of head injury symptoms I endured either immediately or soon after sustaining my injury. Yes, it’s a lengthy list, and no, not every symptom was present from day one. That’s a key understanding that all should be aware of, symptoms come and go and quite often they arrive well beyond the initial date of injury. I think in my own case, part of my not noticing certain symptoms immediately was that I had other stronger symptoms that took my complete undivided attention. In hindsight, I’d say I was “putting out fires” symptom by symptom as I sought relief. 

Head Injury Symptoms:

  • Nausea

  • Vertigo or dizziness; loss of balance

  • Sound sensitivity (hyperacusis) 

  • Light sensitivity, especially to fluorescent lighting

  • Feeling overloaded/overwhelmed

  • Difficulty with emergency vehicle lights and sound

  • Problems walking in wide open areas; on shiny floors; on “busy” rugs/carpeting; in crowds

  • Blurred vision/Double vision

  • Constant fatigue, long naps, sleep difficulties at night

  • Failure to initiate movement

  • Depression; mood swings; low motivation

  • Anxiety, frustration, anger

  • Hypervigilance, exaggerated startle response

  • Limited attention or concentration

  • Inability to follow directions

  • Poor reading comprehension (rereading the same paragraphs); memory loss; short attention span

  • Poor spatial judgement

  • Impaired depth perception

  • Visual midline shift (sensation of pulling to the left or right)

  • “super market syndrome” (difficulty walking down the isles in a supermarket or other store)

  • “Unsteady-non-specific spatial disorientation”

  • Feeling of “walking in my own silent movie” (a phrase often used to describe the disconnect between the individual and the environment)

  • Inability to watch TV – any fast movement leads to head pain

  • Cannot watch commercials (scenes are switched quickly)

  • Word-finding difficulties

  • Inability to multi-task or work in transition

  • A feeling of “Electrical storms” in the brain

  • Poor adaptation to visually complex environments (patterns on the floor, high ceilings)

  • Post-injury amnesia (no recollection of specific events/activities not connected to original injury)

OFFICE POLICIES

It is difficult to estimate how many appointments a patient might need for cognitive restructuring.

First appointment consists of an interview, review of records and formulation of a
treatment plan: 1.5hrs
Please bring copies of pertinent medical reports and neuropsychologic evaluation if performed.

3 to 4 additional appointments (1 appointment is 2/50 Minute Sessions) with Dr. Markus are recommended.
Many patients elect to return for additional treatment after several weeks.


FEE SCHEDULE:

Interview, review of records and formulation of a treatment plan: $950.00  
50% deposit required to confirm your appointment time, balance is due upon completion of appointments. 

Cancellation Policy for initial consultations and multiple appointments fully refunded 2 week prior to appointment. 

If an appointment is canceled less than two weeks prior to appointment there will be a $750.00 charge. 

Private Cognitive Restructuring Sessions
(includes take-home materials)  
This includes two 50 minute individualized cognitive restructuring sessions and customized cognitive materials for at home rehearsal.
Session rate: $750 per 2/50 Minute private session
7 Days is required to change or cancel an appointment without charge. There will be a $375 cancellation charge. 

FORM OF PAYMENTS ACCEPTED: credit card, check or cash 


PHONE CONSULTATIONS

Dr. Markus offers phone consultations, which are particularly useful for out-of-town patients. 

If you want Dr. Markus to review any neuropsychological testing or other reports prior to your phone consultation, please send this material via email or snail mail. Review of these materials usually takes an additional hour. 

Phone consultations and advance review of material cost $375.00 per 50 minute session. 
Payment is required when the appointment is scheduled. 
7 Days is required to change or cancel a phone consultation appointment without charge. There will be a $375 cancellation charge. 
Appointments are scheduled with Margit Nikitas / Office Coordinator 847-433-7878