COPD is the third most common group of illnesses in the United States and it is the only illness whose frequency is increasing. COPD includes a bunch of diagnoses that include chronic bronchitis, emphysema, asthma and bronchiectasis. Recent studies show that 26 million Americans, or 8.4% of the U.S. population, have COPD. So you are not alone.

Watch the video to learn about the other half of Burke Rehab’s cardiopulmonary rehab program: cardiac rehab.

The first thoughts that come to mind when you are told you have COPD are usually quite negative.  This is understandable.  But COPD stands for Chronic Obstructive Pulmonary Disease. The first word is chronic which means a long time.  So your job is to do whatever you can do to live the best life possible with the most confidence. And the first step you can take to living a healthier life is to quit smoking.

Of all the COPD cases, 95 percent are related to cigarette smoking. Cigarette smoking causes a type of lung damage that mimics the natural aging process of the lung. Therefore, if you smoke, you may experience the symptoms of COPD even if you gave up cigarettes a long time ago. That being said, the most important thing you can do when diagnosed with lung disease is to give up smoking as soon as possible.

Stopping smoking is much more powerful than any treatment a doctor can offer you.

When your lung is damaged, you need as much of your normal/healthy lung as possible so even just one more cigarette is detrimental. In addition, smoking is actually worse for your heart than your lung, and most patients with COPD have both heart and lung problems.

My message to you is to stop smoking and arm yourself with knowledge and a plan so you can live the best life possible.

A stroke occurs when vital blood flow and oxygen to the brain is cut off. It is a medical emergency and one of the ways to learn how to recognize a stroke is to remember to act F.A.S.T.

F – Face: Ask the person to smile and check if the face droops.
A – Arms: Ask the person to raise both arms. Check if one drifts downwards.
S – Speech: Ask the person to repeat a simple phrase and see if speech is slurred or strange.
T – Time: If you observe any of these signs, call 9-1-1 immediately.

Other stroke symptoms to be aware of also include:

• - Sudden numbness or weakness of face, arm or leg—especially on one side of the body.
• - Sudden confusion, trouble speaking or understanding.
• - Sudden trouble seeing in one or both eyes.
• - Sudden trouble walking, dizziness, loss of balance or coordination.
• - Sudden severe headache with no known cause.

The National Stroke Association also advises to note the time these symptoms are first seen as this information is vital to healthcare providers and can affect treatment decisions. There also is an FDA-approved clot-busting medication that may help reduce long-term disability post ischemic strokes if given within three hours of the first symptom.

Post Stroke Recovery

After stabilizing in an acute care hospital, post-stroke patients and their caretakers should advocate to be transferred to an acute rehabilitation hospital where they will receive the therapy and medical management needed to ensure maximum recovery.

Watch our video to learn the difference between acute and sub-acute rehabilitation.

Unlike at a sub-acute facility, post-stroke patients in acute rehabilitation hospitals will receive a minimum of three hours of therapy per day, including physical, occupational and speech therapy, up to six days a week.  Therapy is provided on both a one-to-one and group basis, depending on the needs of the individual patient. Patients are medically managed by specially-trained physicians 24-hours a day. Sub-acute care is less intensive than acute rehabilitation and patient generally only receive between one and two hours of therapy per day. This may not be enough therapy to allow for maximum recovery.

For more information about stroke and stroke rehabilitation, attend Burke’s upcoming annual Stroke Awareness Day on May 22. For more information about the event contact Lisa Edelstein, OT; Program Director of Burke’s inpatient stroke program at (914) 597-2256. Additionally, Burke is involved in several post stroke research studies. Interested patients should visit www.burke.org/research/clinicalresearch.

—Michael Reding, M.D.
Director, Stroke Rehabilitation Program

Learn about Burke’s Stroke Rehabilitation program.

Since the last consensus conference four years ago, the recommendation for treating concussion has been rest. This practice was re-addressed at the 2012 conference and it was determined that perhaps relative rest—not bed rest—along with some low level activity and therapy before symptoms have completely disappeared, would be a better solution. It was also suggested that patients take part in more low level activities, physiotherapy and have a neuropsychological consult one month after the trauma.

The Sport Concussion Assessment Tool (SCAT2), which outlines the standardized method for evaluating athletes 10 years and older for concussions, was also discussed at the conference. It will be refined this year and updated with the SCAT3. Among other changes, the new SCAT would exclude neck injuries from the assessment. What won’t change are the present guidelines for youth athletes that ban heading in soccer, tackling in football and body checking in ice hockey until the athlete is 14 years old.

There needs to be continued research, however, on the types and magnitudes of head forces for specific ages and sports to better understand the threshold of concussion. The consensus found no evidence that helmets or mouth guards protect against concussions as they are caused by the acceleration/deceleration of the head, though helmets do have their place in protecting people from other types of brain injuries.

Along with the SCAT, the consensus also releases an official consensus statement that provides concussion treatment guidelines. The new official consensus statement won’t be published until later this month or the next, but here are some of the other key points the conference panel agreed upon:

• - No return to play on the same day;
• - A potential revision of the pocket SCAT for non-health care personnel;
• - Creation of a Child SCAT for children under 10;
• - Removal of baseline testing from the post-concussion evaluation of patients; and
• - Computerized neuropsychological testing only for athletes whose concussions persist.

The consensus also suggested that those involved in sports:

• - Have zero tolerance for head checking and maximize rule enforcement for other unsafe behaviors that put players at risk for the head injuries;
• - Teach proper techniques and fundamentals for their respective sports;
• - Learn how to recognize concussions and provide an appropriate response; and
• - Reduce unnecessary contact in youth sports.

The conference also highlighted the need to implement a multi-faceted approach to tackling concussions and the need for various experts to come together and find the best way to manage and prevent sports concussions. What we do next can and will affect the lives of all athletes so this dialogue must be continued for the betterment and safety of sports.

**Update**

The new SCAT 3 and Child-SCAT 3 have been released. Download the SCAT 3 and Child-SCAT 3 for your reference.

—Barry Jordan, M.D., M.P.H.
Assistant Medical Director

Learn about Burke’s Brain Injury Rehabilitation program.

The number of spinal cord injuries per year has remained fairly stable over the last two decades, with nearly 12,000 occurring each year mostly from sports injuries, car accidents and other forms of traumatic injury. Currently in the United States there are approximately 200,000 people are living with spinal cord injuries or spinal dysfunction. With today’s advanced medical treatments, more spinal cord injury patients survive the trauma compared to just a few decades ago. This positive shift in mortality rate underlines the great importance of initial acute treatment and follow up rehabilitation.

Treatment for spinal cord injuries can be divided into to two stages: acute and rehabilitation. The acute phase takes place immediate following the injury and is conducted at a hospital with an appropriate trauma center. During this time, the patient is immobilized to ensure that the damage to the spinal cord is minimized and any other injuries can be treated. This phase may also include surgery to reinforce the damaged area of the spine to prevent further injury. The acute phase will conclude when the patient is stabilized and ready to begin the next step towards recovery—rehabilitation therapy.

Spinal cord injury patient learns to walk with the ReWalk exoskeleton robot.

The rehabilitation phase will provide the tools necessary to begin working toward independence. This is a critical time for recovery because many of the gains the patient will make in movement happen during this time. This is why acute rehabilitation, as opposed to rehab done in sub-acute facilities, is so important after such an injury. Improvements made during this period can set the stage for the patient’s recovery afterwards.

While all spinal cord injury patients require rigorous physical and occupational therapy, the injuries and pace of recovery are unique to each person. An individualized plan should be designed to help the patient maximize their recovery. In addition, spinal cord injury patients should receive ongoing education from various disciplines as their injuries and resulting conditions are life-changing and permanent. This education should focus on coping, additional resources and the need for lifelong follow up to deal with changing needs, laying the groundwork for a lifetime of work and improvement.

Once acute rehabilitation concludes, the real work comes next as patients need to continually strive to maintain muscle mass and flexibility through exercise therapy. This can be done at outpatient rehabilitation therapy clinics or at other facilities.

Patients must work on sustaining physical integrity until there is a cure so when the time comes, they will be ready for it.

— Argyrios Stampas, M.D.
Director, Spinal Cord Injury Program

Learn more about Burke’s Spinal Cord Injury Rehabilitation program.

As we welcome in 2013, Burke Rehabilitation Center continues to explore new ways to reach and educate patients. We are at an unprecedented time in history; one that allows for instant communication and information sharing. With this in mind, Burke is introducing our first Rehab Insights blog. This new monthly feature on our website will allow community members, students and prospective patients to access important medical insights from our renowned medical staff.

Rehab Insights is a new platform that allows our experts to share their medical insights and foster conversations about rehabilitation. From spinal cord injury, to traumatic brain injury, to stroke, to orthopedics, our respected Burke staff is eager to share pertinent information with you. The goal is to help you gain a better understanding of the role of rehabilitation in medicine today.

In the coming months, our medical staff will introduce you to the latest technology and the most current treatment options for those who experience a life changing illness or injury. Burke strives to deliver the most optimal, customized care because our mission is to help each patient reach maximum recovery. The new Rehab Insights blog is another way of achieving our goal of bettering the lives of the patients we serve.

Next month Rehab Insights will feature Argy Stampas, M.D., director of Burke’s Spinal Cord Injury Program, who will discuss spinal cord injury rehabilitation during the acute injury stage and beyond. A recognized leader in spinal cord rehabilitation, Dr. Stampas will cover the current approach to treatment as well as a hopeful future for patients with paralysis.

We hope you find our new blog both helpful and enjoyable.

— Mary Beth Walsh, M.D.
Executive Medical Director and CEO