Programs of
the Sandra and Malcolm Berman Brain & Spine Institute
- The Epilepsy Center
- The Spine Center
- The Brain Injury Programs
- The Center for Memory and Brain Health
- The Adult Hydrocephalus Center
- The Headache Center
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- Center for Balance, Dizziness & Vertigo
- The Stroke Center
- Parkinson Disease Program
- Traumatic Brain Injury and Neuro-Rehabilitation programs
- Neurodiagnostic Lab
- Neuro-Psychiatry
- Pain Management Program
- Neuro-Ophthalmology
- Neuro-Otology
Brain injuries are generally divided by severity into two main types: traumatic brain injury (also called intracranial injury) and mild brain injury (also known as mild head injury, mild traumatic brain injury, minor head trauma, and concussion).
TRAUMATIC BRAIN INJURY
Traumatic brain injury occurs when an outside force injures the brain; it can be classified according to severity (mild, moderate, or severe), mechanism (closed or penetrating head injury), or other features (e.g., occurring in a specific location or over a widespread area). It is a major cause of death and disability worldwide, especially in young people, and causes include explosions, violence, falls, and vehicle, construction, and sports accidents.
SYMPTOMS
Symptoms depend on the type of injury (diffuse or focal), the area of the brain that is affected, and on the severity of the injury.
Symptoms include:
- Decreasing level of consciousness
- Paralysis or weakness on one side of the body
- Pupils (the black part in the middle of the eye) of unequal size
- A pupil that fails to constrict in response to light or is slow to do so
- Headaches that get worse or do not go away
- Abnormal posturing
- Slow heart rate with high blood pressure and depressed respiration
- Repeated vomiting or nausea
- Convulsions
- Inability to awaken
- Slurred speech
- Weakness or numbness in the limbs
- Loss of coordination, and increased confusion
- Restlessness or agitation
Over time, the following symptoms may develop or persist.
- Sleep disturbance
- Fatigue
- Short-term memory loss
- Loss of balance or dizziness
- Blurred vision/trouble reading
- Confusion
- Loss of sense of taste or smell
- Ringing in the ears
- Increased sensitivity to sound, light, distractions
- Weakness, numbness, or decreased coordination
- Reduced attention/concentration
- Difficulty making decisions
- Anxiety/depression or mood changes
- Irritability
An adult who has experienced a head injury should be taken to the emergency department immediately if he/she:
- Cannot be awakened
- Has one pupil larger than the other
- Has convulsions or seizures
- Has slurred speech
- Is getting increasingly confused, restless, or agitated
A child who has experienced a head injury should be taken to the emergency department immediately if he/she:
- Has any of the danger signs for adults (above)
- Will not stop crying
- Cannot be consoled
- Will not nurse or eat
DIAGNOSIS
The severity of brain injury must be determined by an expert in the field of brain injury through neurologic and neuropsychologic examinations and supported by other tests such as neuroimaging (CT, MRI, etc.). At the Sandra and Malcolm Berman Brain & Spine Institute, a multidisciplinary team of healthcare professionals provides the clinical evaluation and excellent care necessary to evaluate, diagnose, and treat head injury. This team includes:
- Physical medicine and rehabilitation physicians (physiatrists)
- Neurologists
- Neuropsychologists
- Case managers/educators
- Speech language pathologists
- Physical therapists
- Occupational therapists
- Psychotherapists
- Pain management physicians
- Vocational specialists
- Driver evaluation and training specialists
Patients may be referred to other specialists, including neuro-psychiatrists, neuro-ophthalmologists, and neuro-otologists.
TREATMENT
Healthcare experts at the Sandra and Malcolm Berman Brain & Spine Institute conduct neurologic and neuropsychologic evaluations to assess the severity of a brain injury by testing brain functions that are vulnerable to the injury, including mental processing speed, attention/concentration, and other executive functions (e.g., working memory, behavior regulation, task initiation, and planning and organization). The evaluators make appropriate referrals for patients to individually tailored partial or comprehensive treatment programs that promote healthy recovery (including after-injury plans for accommodations at home, school, or work).
The Brain Injury Programs at Sinai
The Brain Injury Programs at Sinai Hospital provide an unmatched continuum of neuro-rehabilitation services to patients who are recovering from a brain injury. They are designed to help restore an individual to the maximum level of thinking, physical, emotional, and behavioral abilities. Experience, empathy and expertise combine to create a competent, caring atmosphere in which a patient's progress and adjustment to injury are primary concerns. Our 20-plus years of service, along with a strong commitment to family education and support, produce significant functional outcomes and high rates of satisfaction.
The Traumatic Brain Injury and Neuro-Rehabilitation Units
The Traumatic Brain Injury and Neuro-Rehabilitation units provide medical recovery and improve patients' quality of life. The focus is on enhancing self-care, educating patients and families, and preparing patients for the transition to the next level of care, whether it be home and/or continued rehabilitation at a subacute facility, home care, outpatient, or day treatment setting. The multidisciplinary team works closely with families to support, educate, and assist them every step of the way. The treatment team provides individualized and group treatment to improve communication, cognition, swallowing, functional activities of daily living, and physical abilities, and places a strong emphasis on psychosocial, behavioral, and emotional well-being.
RETURN! Brain Injury Community Re-entry Program
The RETURN! Brain Injury Program at Sinai offers comprehensive day treatment services to brain-injured adults in a structured, supervised setting. RETURN! is designed to improve quality of life, enhance self-care, and prepare clients for transition to the home, community, and work. RETURN! provides individualized and group treatment to remediate communication, cognition, functional activities of daily living ,and psycho-emotional concerns. Clients are assisted in creating a realistic, sustainable aftercare plan for their future.
The RETURN!—To Work Vocational Program at Sinai Rehabilitation Center
The RETURN!—To Work Vocational Program at Sinai Rehabilitation Center is designed to successfully rehabilitate, train, and competitively place individuals with acquired brain injuries back into the workforce. Using a supported employment model, the program provides both neuro-rehabilitation and case coordination for individuals who seek work in the community. When the person is ready, job development, placement and coaching are provided to ensure the best vocational match and successful adjustment to the work setting. Job coaching and case coordination are provided long-term in this model of treatment.
MILD BRAIN INJURY (CONCUSSION)
Concussion is the most common type of traumatic brain injury. Common causes include sports injuries, bicycle accidents, car accidents, and falls, as well as blows to the head or acceleration or deceleration forces without a direct impact.
Repeated concussions can cause cumulative brain damage (e.g., dementia pugilistica) or severe complications (e.g., second-impact syndrome). Someone who has sustained an initial brain injury and then sustains a second brain injury before symptoms associated with the first injury have fully cleared is at risk for second-impact syndrome which is a very serious condition that may lead to permanent brain damage or death.
Concussion in school-aged athletes is an under-recognized health risk; those who experience concussion are at long-term risk of persistent health problems and diminishment of life-long potential. Although one in ten athletes reports suffering a concussion during the athletic season, no clinically derived guidelines exist for when it is safe for the young athlete to return to competition, and a too-early return will place him or her at increased risk of permanent brain damage.
SYMPTOMS
Frequently defined as a brain injury with or without a transient loss of brain function, concussion can cause a variety of physical, cognitive, and emotional symptoms that usually go away entirely within three weeks but may persist, or complications may occur.
A concussion may cause moderate changes in a person’s thinking, emotional, or physical abilities, and these changes can significantly impact everyday life.
Typical symptoms of mild brain injury include:
- Sleep disturbance
- Fatigue
- Headaches that get worse
- Short-term memory loss
- Loss of balance or dizziness
- Blurred vision
- Confusion
- Loss of sense of taste or smell
- Ringing in the ears
- Increased sensitivity to sound, light, distractions
- Weakness, numbness, or decreased coordination
- Reduced attention/concentration
- Difficulty organizing daily tasks
- Difficulty making decisions
- Anxiety/depression or mood changes
- Irritability
An adult who has experienced a head injury should be taken to the emergency department immediately if he/she:
- Cannot be awakened
- Has one pupil (the black part in the middle of the eye) larger than the other
- Has convulsions or seizures
- Has slurred speech
- Is getting increasingly confused, restless, or agitated
A child who has experienced a head injury should be taken to the emergency department immediately if he/she:
- Has any of the danger signs for adults (above)
- Will not stop crying
- Cannot be consoled
- Will not nurse or eat
DIAGNOSTICS
At the Sandra and Malcolm Berman Brain & Spine Institute, a multidisciplinary team of physicians provides the clinical evaluation and excellent care necessary to evaluate, diagnose, and treat concussion. This team includes:
- Physical medicine and rehabilitation physicians (physiatrists)
- Neurologists
- Neurosurgeons
- Neuropsychologists
- Case managers/educators
- Speech language pathologists
- Physical therapists
- Occupational therapists
- Psychotherapists
- Pain management physicians
- Vocational specialists
- Driver evaluation and training specialists
Patients may be referred to other specialists, including neuro-psychiatrists, neuro-ophthalmologists, and neuro-otologists.
TREATMENT
Healthcare experts at the Sandra and Malcolm Berman Brain & Spine Institute conduct neurologic and neuropsychologic evaluations, which may be brief screenings or more comprehensive studies, to assess the brain functions that are vulnerable after a mild brain injury; these include mental processing speed, attention/concentration, and other executive functions (e.g., working memory, behavior regulation, task initiation, and planning and organization). The evaluators make appropriate referrals for patients to individually tailored partial or comprehensive treatment programs that promote healthy recovery (including after-injury plans for accommodations at home, school, or work). Patients may be referred to any of the following programs at LifeBridge Health.
Mild Brain Injury Rehabilitation Program
The Mild Brain Injury Program provides specialized medical management for those who have sustained a recent brain injury and for those with long-standing symptoms associated with mild brain injury that have not resolved. Best outcomes occur when mild brain injury is treated immediately, clear information is provided, and consistent follow-up services are offered. This holistic, comprehensive approach provides both the medical and mental health services necessary to resolve complex neurologic problems. A dedicated case manager is available to clients and families to provide education and resource coordination.
The RETURN!—To Work Vocational Program at Sinai Rehabilitation Center
The RETURN!—To Work Vocational Program at Sinai Rehabilitation Center is designed to successfully rehabilitate and train individuals with acquired brain injuries and return them to the workforce. Using a supported employment model, the program provides both neuro-rehabilitation and case coordination for individuals who seek work in the community. When the person is ready, job development, placement, and coaching are provided to ensure the best vocational match and successful adjustment to the work setting. Job coaching and case coordination are provided long-term in this model of treatment.
A TEAM APPROACH
The key to recovery for patients is their receiving care from healthcare providers who understand what causes the changes that occur as a result of concussion, and the team of professionals at the Sandra and Malcolm Berman Brain & Spine Institute is knowledgeable and skilled in the treatment of concussion.
Concussion Program
The Concussion Program of the LifeBridge Sandra and Malcolm Berman Brain & Spine Institute is a program in which neurology and rehabilitation experts collaborate to monitor and treat sports-related concussions in high school– and college-aged athletes to predict when it is safe for an athlete to resume participation in contact sports.
The Program is structured to medically manage those individuals who sustain a recent brain injury and to work with those with unresolved long-standing symptoms that relate to mild brain injury. Best outcomes occur when the injury is treated immediately, clear information is provided, and consistent follow-up services are offered. However, for those who have not received such care and for whom symptoms remain, much can be done to improve or eliminate the symptoms’ effects. Our comprehensive, coordinated programming ensures the best treatment.
Kevin Crutchfield, MD, is a stroke neurologist, with expertise in cranial blood flow and transcranial-Doppler sonology. He is board certified in psychiatry and neurology. Dr. Crutchfield earned his doctorate in medicine from Georgetown University, interned at Fitzsimmons Army Medical Center in Aurora, Colorado, and completed a residency in neurology at Walter Reed Army Medical Center. He was a senior staff fellow in metabolic neurology at the National Institutes of Health in Bethesda, Maryland, and trained in transcranial-Doppler sonology at Johns Hopkins Hospital. He holds a faculty appointment at the Uniformed Services University of Health Sciences and remains an active researcher and consultant to the US military regarding the long term effects of traumatic brain injuries.
Julie O’Reilly, PsyD, is a licensed psychologist and neuropsychologist who specializes in traumatic brain injury. She earned her doctorate in psychology from the Georgia School of Professional Psychology; interned at The University of Minnesota Medical School, Department of Neurology; and completed a two-year residency in neuropsychology at Johns Hopkins Hospital and the Kennedy Krieger Institute and Children’s Hospital. She received clinical and research appointments at Johns Hopkins School of Medicine during her residency through the Department of Psychiatry. Dr. O’Reilly serves as a Board Member of the Brain Injury Association of Maryland, a state affiliate of the national Brain Injury Association of America.
For more information about the treatment of concussion at the Sandra and Malcolm Berman Brain & Spine Institute, call 410-601-WELL (410-601-9355).