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Reconnecting After Concussion

Interactive Metronome
Interactive Metronome

This document discusses using interactive metronome (IM) therapy to address cognitive issues associated with post-concussive syndrome. It begins by defining concussions and post-concussive syndrome, then outlines various cognitive domains that can be impaired such as attention, memory, processing speed, and executive function. It describes how IM training can help improve synchronization between brain networks to enhance cognition. Specific cognitive exercises are provided that can be combined with IM tasks to target areas like attention, memory, processing, and more. The document emphasizes how IM therapy can help rewire the brain for more efficient functioning after concussion.

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RECONNECTING AFTER CONCUSSION: ADDRESSING PCS WITH IM Heather Barr MS CCC-SLP
LEARNING OBJECTIVES Identify key symptoms of post-concussive syndrome (PCS) Identify application for use of IM in this patient population Learn new treatment activities to incorporate into successful therapy sessions
CONCUSSION A concussion is a type of traumatic brain injury that is caused by a blow to the head or body, a fall, or another injury that jars or shakes the brain inside the skull. It creates a traumatically induced physiological disruption of brain function, as manifested by at least one of the following: w撃 Period of loss of consciousness (brief or extended) w撃 Any loss of memory for events immediately before or after the accident w撃 Any alteration in mental state w撃 Any period after the injury in which one is unable to form new memories
IMAGING TO ASSESS THE BRAIN If an MRI/CT scan is normal and there was no loss of consciousness you should NOT assume there is no disruption to the brain. Neuro-imaging techniques are insensitive to the metabolic effects of concussion. Neuro-imaging rules out more severe injury, but does not confirm or deny the presence of concussion.
CONCUSSION (cont.) Mechanism of Concussion May or may not persist, for varying lengths of time May exhibit persistent emotional, cognitive, behavioral and physical symptoms alone or in combination, which may produce a functional impairment. Some may not become aware of, or admit, the extent of their symptoms, until they attempt to return to normal functioning. Symptoms may also be overlooked in the face of more dramatic physical injury (e.g. orthopedic or spinal cord injury). Signs & Symptoms
PERSISTANT SYMPTOMS 80 % improve within 3 weeks; however, some of the following symptoms may linger. COGNITIVE COMPONENTS PHYSICAL COMPONENTS EMOTIONAL/MOOD COMPONENTS q奄 Difficulty thinking clearly q奄 Need more time to think q奄 Difficulty with attention/ concentration q奄 Difficulty remembering q奄 Difficulty doing two things at once q奄 Headache q奄 Nausea/ vomiting q奄 Balance problems/ Dizziness q奄 Fuzzy/blurry vision q奄 Fatigue q奄 Sensitivity to noise or light q奄 Feeling foggy or groggy q奄 Irritability q奄 Impatience q奄 Sadness q奄 Reduced tolerance for stress q奄 Nervousness/ anxiety q奄 Lack of initiative, apathy q奄 Sleep more/less than usual
POST-CONCUSSIVE SYNDROME Post-Concussive Syndrome (PCS) term to describe a constellation of symptoms that persist after the injury. w撃 If symptoms persist more than 4-6 weeks w撃 If symptoms are not improving and are impacting daily function w撃 Failure to return to baseline w撃 Inability to demonstrate improvement with ImPACT testing w撃 Academic/Vocational/Sports Impact ≒ Affecting independent home management ≒ Affecting academics/grades ≒ Affecting work performance ≒ Unable to return to play
MANAGEMENT OF SYMPTOMS Rest Education (Symptoms & Expected Positive Recovery) Stress management interventions w撃 Sleep w撃 Relaxation Techniques (minimize stressors) w撃 Minimize use of stimulants (alcohol, caffeine, tobacco) Graded/Modified return to activities (work, school, activities, sports) w撃 Modified schedules with additional time for task completion w撃 Environmental modifications Monitoring recovery w撃 Physician follow-up w撃 ImPACT Testing w撃 What if the person is not progressing??
SPEECH THERAPY Cognitive areas addressed: Attention Skills Memory Function Problem-Solving Reasoning Abilities Processing (Accuracy/Speed) Word Retrieval Skills Mental Endurance Executive Function Skills Speech therapy evaluation: History of symptoms Clinical Interview Cognitive assessment w撃 Standardized/Non-standardized assessments w撃 Task/Skill Simulation w撃 Effects of cognitive demands on physical performance w撃 Effects of physical demands on cognitive performance
SCIENCE OF THE BRAIN Our brains read, think, remember and process information all day, every day, which is why functioning with any cognitive weakness at all can be exhausting. Brain training rewires the brain so that it can function faster and more efficiently. Traditional cortical parcellation schemes have emphasized the presence of sharply defined visual, auditory, and somatosensory domains populated exclusively by modality-specific neurons (i.e., neurons responsive to sensory stimuli from a single sensory modality). Contemporary neuroscience research suggests that cognition is the result of a number of large scale brain networks that require efficient brain rhythm or synchronization.
THE BRAIN PRIMARY NETWORKS OF THE BRAIN: Default mode network w撃 What your brain does when not engaged in specific tasks. (REST) w撃 The unquiet or noisy mind Salience network w撃 The controller or network switcher w撃 Requires efficient neural timing Central-executive network w撃 Engaged in higher-order cognitive and attentional control - THINKING NEURALTIMING OF BRAIN NETWORKS: Synchronization between the three major brain networks Synchronized milli-second based communication between and within these networks If compromised, efficient and normal cognition and motor behavior can be compromised
BRAIN TRAINING Effectiveness directly and indirectly facilitates the synchronization between the brain networks Strengthens the ability to invoke the salience network (controller) w撃 Learning to suppress/inhibit/silence the REST-producing brain network to exert more controlled attention and thinking SCIENCE OF IM & WHY IT WORKS Rhythm based brain timing therapies help repair or develop efficient neural pathways Sensory Stimulation increases cortical reorganization Brain timing changes your capacity to think and learn
ATTENTION Attention Skills: w撃 Sustained Attention is the ability to stay focused and on- task for a period of time. ≒ Vigilance - defined as the ability to maintain attention and alertness over prolonged periods of time. w撃 Selective Attention is the ability to quickly sort through incoming information and stay focused on one thing in spite of distractions. w撃 Divided Attention is the ability to multi-task.
ATTENTION TRAINING Therapy activities w撃 Recite sequences w撃 Specific listening w撃 Integrate pieces of information integrated spelling w撃 Mental Manipulation Complexities/Demands w撃 Information w撃 Duration w撃 Environmental distractions w撃 In conjunction with IM Integrating IM with Attention tasks w撃 Simultaneous completion of IM timing tasks with attention task ≒ Present/exchange information in time ≒ Present/exchange information off time w撃 Auditory Stimuli ≒ Spoken information w撃 Visual Stimuli ≒ Written information ≒ Visual organization component
IMMEDIATE / WORKING MEMORY This skill handles the dynamic job of keeping the information you need to complete immediate and short-term tasks at the forefront of your mind. Working memory can be thought of as the equivalent of being mentally online, our search engine. It refers to the temporary workspace where we manipulate and process information.
IMMEDIATE / WORKING MEMORY TRAINING Therapy activities w撃 Repetition of digits spans, word lists, info ≒ Straight repetition, reverse, alphabetical, order, ranked, sequenced ≒ Alternate orders w撃 Mental math ≒ Math Tree w撃 Alpha-Numerical Sequences w撃 Mental Manipulation Complexities/Demands w撃 Information w撃 Duration w撃 Environmental distractions w撃 In conjunction with IM Integrating IM with Memory tasks w撃 Simultaneous completion of IM timing tasks with memory task ≒ Present/exchange information in time ≒ Present/exchange information off time w撃 Auditory Stimuli ≒ Spoken information w撃 Visual Stimuli ≒ Written information ≒ Visual organization component
PROCESSING Processing (Speed): This is the accuracy and speed at which your brain processes information. Faster processing speed means more efficient thinking and learning. w撃 Auditory Processing:This is the ability to analyze, blend and segment sounds. Auditory processing is crucial not just for speaking, but also for reading and spelling.This is because when you read, you need to be able to identify the individual and blended sounds that make each word unique and recognizable. w撃 Visual Processing:This is the ability to perceive, analyze and think in visual images. Visual processing is imperative for reading, remembering, walking, driving, playing sports and literally thousands of other tasks you do every day.
PROCESSING TRAINING Therapy activities w撃 Generate words from letter given ≒ Letter before/after the letter given, two letters before/after ≒ Timed tasks (all letters of alphabet) ≒ Visual selective attention/processing activities Complexities/Demands w撃 Information: familiar, unfamiliar, related, unrelated w撃 Duration w撃 Environmental distractions w撃 In conjunction with IM Integrating IM with Processing tasks w撃 Simultaneous completion of IM timing tasks with memory task ≒ Present/exchange information in time ≒ Present/exchange information off time w撃 Auditory Stimuli ≒ Spoken information w撃 Visual Stimuli ≒ Written information ≒ Visual organization component
WORD RETRIEVAL / FLUENCY Word Retrieval difficulties may be associated with storage, retrieval, or a combination of storage and retrieval of words. w撃 Difficulties with storage can be related to storage of the word meaning or storage of the phonological representation (i.e. syllable and sound structure) of the word. w撃 Difficulties with retrieval can be related to retrieval of the word meaning or retrieval of the phonological representation of the word.
WORD RETRIEVAL / FLUENCY TRAINING Therapy activities w撃 Word ladder (auditory or written) w撃 Synonyms, antonyms w撃 Multiple meaning words w撃 Word scrambles Complexities/Demands w撃 Information: familiar, unfamiliar, related, unrelated w撃 Duration w撃 Environmental distractions w撃 In conjunction with IM Integrating IM with Word Retrieval tasks w撃 Simultaneous completion of IM timing tasks with memory task ≒ Present/exchange information in time ≒ Present/exchange information off time w撃 Auditory Stimuli ≒ Spoken information w撃 Visual Stimuli ≒ Written information ≒ Visual organization component
PROBLEM SOLVING & REASONING Logic and Reasoning: This is the ability to reason, form concepts, and solve problems using unfamiliar information or new procedures. It enables you to create correlations, solve problems, plan ahead and draw conclusions.
EXECUTIVE FUNCTION SKILLS The term executive function describes a set of cognitive abilities that control and regulate other abilities and behaviors. Executive functions are necessary for goal- directed behavior. They include the ability to initiate and stop actions, to monitor and change behavior as needed, and to plan future behavior when faced with novel tasks and situations. Executive functions allow us to anticipate outcomes and adapt to changing situations. The ability to form concepts and think abstractly are often considered components of executive function.
REACTION TIME Brain timing - related to the integration between the two hemispheres of the brain Slower brain processing speed is manifested in motor skill deficiencies The greater the balance requirements, the faster the brain must process When we observe movement, we can indirectly observe the efficiency of brain processing w撃 Smooth, coordinated movements are the result of precise timing and good integration between the two sides of the brain w撃 Rigidity, and uncoordinated movements are the result of bad timing and faulty integration and are indicative of poor brain processing The inefficiencies that result from poor brain timing or slow reaction time are improved by performing activities that refine and repair the timing processes in the brain.
COGNITIVE THERAPY WITH IM Your brain needs just as much exercise as your body You can use IM with anything and everything! When in doubt, try it out!
BUT WAIT, THERES MORE Want to earn CEUs for a FREE course on Reconnecting After Concussions? For this course, visit https://secure.interactivemetronome.com/NetSite/IM/CEU/ SimpleRegistration.aspx?course_id=1838. While youre there, be sure to check out our catalog of 90+ webinars. Want more courses for about brain injuries? Great! Weve got you covered. Autism? Reading? Using IM in Schools? Sports Rehab? Weve got those too! Our catalog is divided into specialized bundles that let you tailor IM to your practice. Now, it is easy to get the information you wantand fast!

More Related Content

Reconnecting After Concussion

  • 1. RECONNECTING AFTER CONCUSSION: ADDRESSING PCS WITH IM Heather Barr MS CCC-SLP
  • 2. LEARNING OBJECTIVES Identify key symptoms of post-concussive syndrome (PCS) Identify application for use of IM in this patient population Learn new treatment activities to incorporate into successful therapy sessions
  • 3. CONCUSSION A concussion is a type of traumatic brain injury that is caused by a blow to the head or body, a fall, or another injury that jars or shakes the brain inside the skull. It creates a traumatically induced physiological disruption of brain function, as manifested by at least one of the following: w撃 Period of loss of consciousness (brief or extended) w撃 Any loss of memory for events immediately before or after the accident w撃 Any alteration in mental state w撃 Any period after the injury in which one is unable to form new memories
  • 4. IMAGING TO ASSESS THE BRAIN If an MRI/CT scan is normal and there was no loss of consciousness you should NOT assume there is no disruption to the brain. Neuro-imaging techniques are insensitive to the metabolic effects of concussion. Neuro-imaging rules out more severe injury, but does not confirm or deny the presence of concussion.
  • 5. CONCUSSION (cont.) Mechanism of Concussion May or may not persist, for varying lengths of time May exhibit persistent emotional, cognitive, behavioral and physical symptoms alone or in combination, which may produce a functional impairment. Some may not become aware of, or admit, the extent of their symptoms, until they attempt to return to normal functioning. Symptoms may also be overlooked in the face of more dramatic physical injury (e.g. orthopedic or spinal cord injury). Signs & Symptoms
  • 6. PERSISTANT SYMPTOMS 80 % improve within 3 weeks; however, some of the following symptoms may linger. COGNITIVE COMPONENTS PHYSICAL COMPONENTS EMOTIONAL/MOOD COMPONENTS q奄 Difficulty thinking clearly q奄 Need more time to think q奄 Difficulty with attention/ concentration q奄 Difficulty remembering q奄 Difficulty doing two things at once q奄 Headache q奄 Nausea/ vomiting q奄 Balance problems/ Dizziness q奄 Fuzzy/blurry vision q奄 Fatigue q奄 Sensitivity to noise or light q奄 Feeling foggy or groggy q奄 Irritability q奄 Impatience q奄 Sadness q奄 Reduced tolerance for stress q奄 Nervousness/ anxiety q奄 Lack of initiative, apathy q奄 Sleep more/less than usual
  • 7. POST-CONCUSSIVE SYNDROME Post-Concussive Syndrome (PCS) term to describe a constellation of symptoms that persist after the injury. w撃 If symptoms persist more than 4-6 weeks w撃 If symptoms are not improving and are impacting daily function w撃 Failure to return to baseline w撃 Inability to demonstrate improvement with ImPACT testing w撃 Academic/Vocational/Sports Impact ≒ Affecting independent home management ≒ Affecting academics/grades ≒ Affecting work performance ≒ Unable to return to play
  • 8. MANAGEMENT OF SYMPTOMS Rest Education (Symptoms & Expected Positive Recovery) Stress management interventions w撃 Sleep w撃 Relaxation Techniques (minimize stressors) w撃 Minimize use of stimulants (alcohol, caffeine, tobacco) Graded/Modified return to activities (work, school, activities, sports) w撃 Modified schedules with additional time for task completion w撃 Environmental modifications Monitoring recovery w撃 Physician follow-up w撃 ImPACT Testing w撃 What if the person is not progressing??
  • 9. SPEECH THERAPY Cognitive areas addressed: Attention Skills Memory Function Problem-Solving Reasoning Abilities Processing (Accuracy/Speed) Word Retrieval Skills Mental Endurance Executive Function Skills Speech therapy evaluation: History of symptoms Clinical Interview Cognitive assessment w撃 Standardized/Non-standardized assessments w撃 Task/Skill Simulation w撃 Effects of cognitive demands on physical performance w撃 Effects of physical demands on cognitive performance
  • 10. SCIENCE OF THE BRAIN Our brains read, think, remember and process information all day, every day, which is why functioning with any cognitive weakness at all can be exhausting. Brain training rewires the brain so that it can function faster and more efficiently. Traditional cortical parcellation schemes have emphasized the presence of sharply defined visual, auditory, and somatosensory domains populated exclusively by modality-specific neurons (i.e., neurons responsive to sensory stimuli from a single sensory modality). Contemporary neuroscience research suggests that cognition is the result of a number of large scale brain networks that require efficient brain rhythm or synchronization.
  • 11. THE BRAIN PRIMARY NETWORKS OF THE BRAIN: Default mode network w撃 What your brain does when not engaged in specific tasks. (REST) w撃 The unquiet or noisy mind Salience network w撃 The controller or network switcher w撃 Requires efficient neural timing Central-executive network w撃 Engaged in higher-order cognitive and attentional control - THINKING NEURALTIMING OF BRAIN NETWORKS: Synchronization between the three major brain networks Synchronized milli-second based communication between and within these networks If compromised, efficient and normal cognition and motor behavior can be compromised
  • 12. BRAIN TRAINING Effectiveness directly and indirectly facilitates the synchronization between the brain networks Strengthens the ability to invoke the salience network (controller) w撃 Learning to suppress/inhibit/silence the REST-producing brain network to exert more controlled attention and thinking SCIENCE OF IM & WHY IT WORKS Rhythm based brain timing therapies help repair or develop efficient neural pathways Sensory Stimulation increases cortical reorganization Brain timing changes your capacity to think and learn
  • 13. ATTENTION Attention Skills: w撃 Sustained Attention is the ability to stay focused and on- task for a period of time. ≒ Vigilance - defined as the ability to maintain attention and alertness over prolonged periods of time. w撃 Selective Attention is the ability to quickly sort through incoming information and stay focused on one thing in spite of distractions. w撃 Divided Attention is the ability to multi-task.
  • 14. ATTENTION TRAINING Therapy activities w撃 Recite sequences w撃 Specific listening w撃 Integrate pieces of information integrated spelling w撃 Mental Manipulation Complexities/Demands w撃 Information w撃 Duration w撃 Environmental distractions w撃 In conjunction with IM Integrating IM with Attention tasks w撃 Simultaneous completion of IM timing tasks with attention task ≒ Present/exchange information in time ≒ Present/exchange information off time w撃 Auditory Stimuli ≒ Spoken information w撃 Visual Stimuli ≒ Written information ≒ Visual organization component
  • 15. IMMEDIATE / WORKING MEMORY This skill handles the dynamic job of keeping the information you need to complete immediate and short-term tasks at the forefront of your mind. Working memory can be thought of as the equivalent of being mentally online, our search engine. It refers to the temporary workspace where we manipulate and process information.
  • 16. IMMEDIATE / WORKING MEMORY TRAINING Therapy activities w撃 Repetition of digits spans, word lists, info ≒ Straight repetition, reverse, alphabetical, order, ranked, sequenced ≒ Alternate orders w撃 Mental math ≒ Math Tree w撃 Alpha-Numerical Sequences w撃 Mental Manipulation Complexities/Demands w撃 Information w撃 Duration w撃 Environmental distractions w撃 In conjunction with IM Integrating IM with Memory tasks w撃 Simultaneous completion of IM timing tasks with memory task ≒ Present/exchange information in time ≒ Present/exchange information off time w撃 Auditory Stimuli ≒ Spoken information w撃 Visual Stimuli ≒ Written information ≒ Visual organization component
  • 17. PROCESSING Processing (Speed): This is the accuracy and speed at which your brain processes information. Faster processing speed means more efficient thinking and learning. w撃 Auditory Processing:This is the ability to analyze, blend and segment sounds. Auditory processing is crucial not just for speaking, but also for reading and spelling.This is because when you read, you need to be able to identify the individual and blended sounds that make each word unique and recognizable. w撃 Visual Processing:This is the ability to perceive, analyze and think in visual images. Visual processing is imperative for reading, remembering, walking, driving, playing sports and literally thousands of other tasks you do every day.
  • 18. PROCESSING TRAINING Therapy activities w撃 Generate words from letter given ≒ Letter before/after the letter given, two letters before/after ≒ Timed tasks (all letters of alphabet) ≒ Visual selective attention/processing activities Complexities/Demands w撃 Information: familiar, unfamiliar, related, unrelated w撃 Duration w撃 Environmental distractions w撃 In conjunction with IM Integrating IM with Processing tasks w撃 Simultaneous completion of IM timing tasks with memory task ≒ Present/exchange information in time ≒ Present/exchange information off time w撃 Auditory Stimuli ≒ Spoken information w撃 Visual Stimuli ≒ Written information ≒ Visual organization component
  • 19. WORD RETRIEVAL / FLUENCY Word Retrieval difficulties may be associated with storage, retrieval, or a combination of storage and retrieval of words. w撃 Difficulties with storage can be related to storage of the word meaning or storage of the phonological representation (i.e. syllable and sound structure) of the word. w撃 Difficulties with retrieval can be related to retrieval of the word meaning or retrieval of the phonological representation of the word.
  • 20. WORD RETRIEVAL / FLUENCY TRAINING Therapy activities w撃 Word ladder (auditory or written) w撃 Synonyms, antonyms w撃 Multiple meaning words w撃 Word scrambles Complexities/Demands w撃 Information: familiar, unfamiliar, related, unrelated w撃 Duration w撃 Environmental distractions w撃 In conjunction with IM Integrating IM with Word Retrieval tasks w撃 Simultaneous completion of IM timing tasks with memory task ≒ Present/exchange information in time ≒ Present/exchange information off time w撃 Auditory Stimuli ≒ Spoken information w撃 Visual Stimuli ≒ Written information ≒ Visual organization component
  • 21. PROBLEM SOLVING & REASONING Logic and Reasoning: This is the ability to reason, form concepts, and solve problems using unfamiliar information or new procedures. It enables you to create correlations, solve problems, plan ahead and draw conclusions.
  • 22. EXECUTIVE FUNCTION SKILLS The term executive function describes a set of cognitive abilities that control and regulate other abilities and behaviors. Executive functions are necessary for goal- directed behavior. They include the ability to initiate and stop actions, to monitor and change behavior as needed, and to plan future behavior when faced with novel tasks and situations. Executive functions allow us to anticipate outcomes and adapt to changing situations. The ability to form concepts and think abstractly are often considered components of executive function.
  • 23. REACTION TIME Brain timing - related to the integration between the two hemispheres of the brain Slower brain processing speed is manifested in motor skill deficiencies The greater the balance requirements, the faster the brain must process When we observe movement, we can indirectly observe the efficiency of brain processing w撃 Smooth, coordinated movements are the result of precise timing and good integration between the two sides of the brain w撃 Rigidity, and uncoordinated movements are the result of bad timing and faulty integration and are indicative of poor brain processing The inefficiencies that result from poor brain timing or slow reaction time are improved by performing activities that refine and repair the timing processes in the brain.
  • 24. COGNITIVE THERAPY WITH IM Your brain needs just as much exercise as your body You can use IM with anything and everything! When in doubt, try it out!
  • 25. BUT WAIT, THERES MORE Want to earn CEUs for a FREE course on Reconnecting After Concussions? For this course, visit https://secure.interactivemetronome.com/NetSite/IM/CEU/ SimpleRegistration.aspx?course_id=1838. While youre there, be sure to check out our catalog of 90+ webinars. Want more courses for about brain injuries? Great! Weve got you covered. Autism? Reading? Using IM in Schools? Sports Rehab? Weve got those too! Our catalog is divided into specialized bundles that let you tailor IM to your practice. Now, it is easy to get the information you wantand fast!