Advising Brown Bag – Dr. Gayda-Chelder – Concussions

Advising Brown Bag – Dr. Gayda-Chelder – Concussions


Hello and welcome to another in Stockton’s series of Brown Bag Advising Colloquia today we welcome Dr. Christine Gayda-Chelder Assistant Professor of Psychology at Stockton University she’s also a Licensed Clinical Psychologist with a sub-specialty in Neuropsychology she’ll be speaking today on unique issues and advising the student with Post-Concussive Syndrome so we welcome Dr. Chelder today thank you thank you very much I want to first acknowledge Dr. Mark J. Chelder who really brought about the idea for this I was at a NACADA Conference a couple of years ago with the academic advising team and Dr. Mark Chelder was with me yes I’m related to him and he noticed that there didn’t seem to be a lot of literature about advising the student post-concussion so I have to thank him for his really push to get this presentation and paper together that is being written Gabriella Navarro is one of our graduates right now applying to graduate school she graduated last spring and she has contributed greatly and a very important that you know my background I would say to my students you pay a lot of money to listen to me what gives me the right to tell you what I’m telling you what is my background so my undergraduate work was at Marywood University in Scranton PA and it was Dr. Raymond Martinetti who taught me physiological psychology and developed my passion for the brain and the impetus to volunteer at a neuro Med unit where individuals were living who had a very severe brain injury people most of them in a persistent vegetative state I started that work when I was about 20 and then decided to specialize in Neuropsychology and Dr. Frank Mrykalo was very instrumental as well and I feel the need to mention this because those of you out there who are advisors you are mentors you help weave who all the students become we have mentors never forget faculty we had mentors who have inspired us so being a part of an academic advising Brown Bag I think it’s so important to mention this and I have the future of Neuropsychology here with me today five students from my clinical Neuropsych classes this semester who will be helping I want to thank them and also Darice who works with Dr. John White who helped today with some editing of my talk she is wonderful so first and foremost we’re talking about concussion and I want you to remember that the New Jersey Brain Injury Association years ago had a billboard Bones Heal Brains Don’t you’ve got about a hundred billion neurons specialized nerve cells in your brain you’ve got four lobes we’ll go over briefly and many many other structures I could talk for years about the brain yes you may have heard of neurogenesis and rehabilitation people can get better from a brain injury but once you have severe permanent loss of neurons they don’t come back we’re learning more about how that might happen but for right now please know your brain can improve to a point and that’s what’s critical that’s why we have to have children wear bicycle helmets real quick parts of the human brain there again so many but I like to quickly talk about the four main lobes and the hindbrain the cerebellum which you see the bottom controls your balance movement coordination occipital lobes visual processing parietal lobe sensory processing temporal lobe memory your frontal lobe is the seat of executive control helps hold back impulses frontal lobes are often really the lobes that are most injured in a brain injury they’re right here behind your forehead imagine this here’s your skull here’s your frontal lobe you’re doing a hundred on the Garden State Parkway and all of a sudden you realize oh boy I better stop your brain is going to pound thank you Anthony Anthony is nodding he knows he works in healthcare your brain is pounding on the skull contusions bruising and this is what makes us distinctly human initiation planning remember that it’s going to come up again with concussion your frontal lobes help you focus hold back impulses you know that impulse to yell at your professor students hopefully your frontal lobes work well and you hold back these are all incredibly important areas of your brain and again I hate to rush through this and not give the brain it’s do but it is just amazing and many of you may know that it controls everything heart rate respiration in the medulla oblongata your attention your expressive language your understanding of language executive control which I mentioned which includes problem-solving impulse control my students in neuropsych just covered the fascinating topic of memory and they took a memory test very challenging one memory is complex you must attend encode learn be able to get it out and there’s verbal and visual memory how many of you know which side of the brain mediates more verbal memory like remembering words and prose passages who knows which side of the brain is more verbal functioning language anyone know my students just learned this the other day left correct right is more visual visual spatial so we assess visual memory we have people learn and remember faces designs verbal memory is more wordlists prose passages things like that sensory motor functioning right side of the brain controls left side of the body left side of the brain controls right side of the body so if you have a stroke let’s say in the left side of your brain right side maybe weak emotional functioning personality is controlled by the brain drives for hunger thirst and sex Dr. John White is here today who does amazing work with those who are sex offenders he’s writing a textbook the neuropsychology of sex crimes correct violent crimes something like that he this is cutting-edge information we now have about how the brain affects those behaviors and the brain always strives to maintain homeostasis a balance so we can all function now I want to elaborate on this my point to you today is to have sensitivity in advising our students who may have lost that balance due to a concussion so as you’ll see there’s been a long history of thinking a concussion no big deal we now know better we now know more so what exactly is a concussion again the old stereotype as I was saying it’s a ding you’re seeing stars you’re playing football so you saw stars back on the field that was the thinking for a very long time however now the US Department of Health and Human Services Centers for Disease Control and Prevention acknowledges a concussion is indeed a brain injury it is commonly called a mild traumatic brain injury so if you see in the literature MTBI mild brain injuries also concussion I’m going to talk more about this but we have stretching of neurons going on again the brain slams against the skull it alters the overall balance of functioning stretching and straining of brain tissue this also leads to reduced cerebral energy so what we now know is and even if you don’t lose consciousness you can have a concussion there’s a lot going on and there’s a recent article just published in the Journal of Head Trauma Rehabilitation I think that says it best and this is why concussion was ignored for so long that the structures ok the MRI looks good you’re fine listen to this quote the changes in the brain associated with mild traumatic brain injury are believed to effect the neurochemical software more so than the brain structural hardware so please be mindful if one of your students reports they’ve had a concussion they may have clear findings on brain imaging studies because we’re looking at the software you may have heard the term diffuse axonal injury the neurons the axons have been torn apart you don’t see that on an MRI as great as MRI is PET SPECT EEG it can easily be missed in fact and this is a beautiful neuron you can see it is beautiful neurons are amazing we need them only a neuropsychologist in which is in love with neurons but it really is a great picture if you’ll see where the axon is oops I didn’t mean to do that the axon up at the top that’s what’s often torn diffuse axonal injury Lee right now is going to come up and read some statistics about brain injury some statistics a traumatic brain injury TBI which is a bump or blow to the head accounts for about thirty percent of all injury deaths in the United States however not all head injuries results in TBI’s TBI’s can range in the severity from mild the most common to severe as previously noted mild TBI is commonly known as a concussion defining a concussion as a mild TBI has increased our understanding of the recovery process and has facilitated programs to support awareness and prevention of concussions however Love is now going to follow up with some statistics in 2009 about 248,418 children which were the ages of 19 or younger were treated at emergency departments for sports-related TBI between the years 2001 and 2009 the amount of children diagnosed with a concussion or TBI do from a sports and recreation injury rose 57% thank you great job our future and now I will ask my other students helping today to hand out the two handouts we have one is Heads Up Preventing Concussion and the other is Recovering so my students will be handing these out as I begin to review this with you what is so challenging about a concussion is you have I call it the devastating triad it really is devastating cognitive physical and emotional functioning is effected I acknowledge if you break your arm and you are limited you may have emotional distress correct if it’s happened to any of you you will be frustrated the difference is when it’s the brain it’s more innate it’s within its not an emotional response your emotions are effected your thinking is effected so if you all have the handout right now Heads Up Preventing Concussion on the back are signs and symptoms and I ask you to please keep this in your office if you ever have a student who reports they’ve had a concussion you can review and remind yourself what they may be going through and I really like this handout because it is from the CDC it’s valid it’s reliable it’s trustworthy I always remind my students be careful of googling there’s a lot of fluff and stuff I don’t want fluff and stuff in your papers so if we look at signs and symptoms starting to the left difficulty thinking clearly feeling slowed down concentrating remembering think about a student in a classroom having these experiences then to the right more physical headache nausea or vomiting clumsiness balance problems dizziness vision can be effected sensitivity to light and noise do the classrooms get noisy do the hallways of Stockton University get noisy absolutely just feeling tired all the time numbness or tingling more emotional irritability sadness nervousness anxiety sleeping more often than usual or sleeping less trouble falling asleep drowsiness is again big pause button lets stop here this is a lot in every single person who has a concussion will have a unique presentation of symptoms I can’t tell you after a concussion exactly how someone will present I can’t tell you how long it will take them individually to get better but our research tells us in weeks and coming months we should see improvement there is wonderful research out there emerging and sometimes the research says give it six months sometimes a year it’s very individual so please remember that this is where the medical team has to work with the education team as you will see so what happens when a student has a concussion well hopefully they’re going to have a medical assessment and it’s going to be an interdisciplinary treatment team and I’m thrilled to see some folks here from Health Sciences who can back me up it does take a village I’m pointing Hillary Clinton right her book it takes an interdisciplinary treatment team to help this person may include physicians hopefully it does first and foremost primary-care a neurologist who specializes in the brain the physiatrist many people have never heard of a physiatrist they are physicians who specialize in physical medicine and rehabilitation so if you were at Bacharach Institute for rehabilitation or Health South you would have a physiatrist who plans your care for in-patient or out-patient rehabilitation a psychiatrist may be onboard clinical psychologist neuropsychologist to do testing more and more but not always we are seeing folks who had a concussion have a physical therapists occupational therapists speech therapists social worker now my favorite part ideally in the perfect world that I fantasize about every single person on this planet who has a concussion would have a comprehensive neuropsychological assessment but this may not be covered by health insurance and maybe too costly for some students and their families it can be a few thousand dollars to have a true comprehensive neuropsych so many students may be getting a brief eval things may be missed just please note that it is important to ask the student what medical care have you received now it’s up to them as we’ll talk about to share that with you but it would be great if they could have all this you may have heard of this program ImPACT which we have at Stockton University it is a model for our student-athletes where they have preseason baseline testing if a concussion is suspected they have post-injury testing and treatment and then it is determined if the athlete is ready for non-contact activity and is it safe to return to play not everyone has this in place but it is important if they have it now HIPAA I know many of you are probably familiar with this it’s the Health Insurance Portability and Accountability Act of 1996 a student has to sign a release for you to see their medical records now can they obtaine a copy let’s say of their neuropsych eval verifying a concussion can they get a copy themselves and then do what they want with it yeah they can you may not understand it all I work with the neuropsychologists who write eloquently and in a fashion that is understandable to all but some speak medical jargon please know the student does have the right to restrict your access but what I’m finding happening at Stockton which is positive most students know now to bring their medical information to Learning Access Program and get services through learning access in the Counseling Center that’s the perfect world but I’m seeing it happen more and more and of course parental involvement will vary as you all know faculty sometimes parents show up on academic advising day they just pop in Rick is nodding have you had that I’ve never had that but I hear it can happen you may have parents come in who are all about this is what my son or daughter needs again you may have some though who are surprisingly unsupportive of the recommendations of the medical the medical team has again or on the flip overly cautious I’ve seen parents disagree i’ve had students tell me you know I had a concussion and my mom is like get back get back to the game get back to academics were paying a fortune for Stockton and dad is you know on the other side take a break so there can be a disconnect there can also be a disconnect between the healthcare system and the educational system and I have not seen this as much right now my practice I pretty much work with older adults with dementia my husband who’s a neuropsychologist encounters this a lot the situation in which it may be hard for educators to understand again a neuropsych report or what the physician is saying just open your mind and listen you’re now well educated and informed about concussion have an open mind trust the expertise I think that’s the best I can say as the healthcare professional needs to trust you that you’re sensing the student really does need to take the semester off and it is a challenging call to make a very tough call so I think this handout you should all have Recovery you handed that one out as well recovery from concussion and hold onto this but please please know ah this is geared more toward children and teens but it still is relevant for university students this is a very general overview we hope again that every student has a personalized plan by their health practitioners the issue for us as advisors and instructors in the classroom if the student comes back is really making sure there’s compliance especially if there are specific issues lack of social support so this is where it should all start to come together first remember for most students this is the first time they’re needing assistance it maybe frightening and overwhelming you may have a student in front of you you’re advising I’m an A plus plus plus student I can’t take a break yes I have headaches but I can’t stop please again hopefully you have the healthcare information in front of you make sure they’re going to the Counseling Center to deal with feeling overwhelmed and scared students many of my students have opened up in my clinical neuropsych class about how scary it is to have a concussion this bizarre feeling just not being right and you’re trying to concentrate in a classroom choose your classes for next semester it can be very overwhelming let them talk again ultimately they may need the Counseling Center but please give them a neutral safe environment to talk about what’s happened to them it’s very overwhelming however some students may have a past history of learning disability attention deficit disorder prior concussion again they still may feel certainly overwhelmed but there’s a different context now they may have a history with Learning Access Programs so they feel more comfortable going but they’re scared again so you’ve got to refer i’m going to be talking more in weeks to come with Bob Ross over in the Counseling Center and Learning Access because he would also like me to work more with his staff about how to best manage concussion but we have great services here in Counseling Center and Learning Access and my students know the first day of class it’s in the syllabus you need help the door is open and advising should focus on reinforcing compliance with the recovery recommendations inform yourself again about what your student has been told you can have a powerful effect on the recovery realistic expectations again that may mean something more we’ll talk about withdrawing from a class you we all hate to disappoint students and we have students here students we don’t want to disappoint you but sometimes we have to be assertive and say you know with that GPA you may want to not apply to grad school just yet we need to be honest with you we want you to succeed in life so to the advisors here the faculty it can be some tough love so what are issues that there’s a lot of literature on the kiddies and the teens in high school but what about higher-ed college university level scheduling may need to change increased rest periods maybe after a concussion this student can return to class in a couple weeks but the schedule they have is back-to-back you as an advisor may be helping the student work out instructors about redesigning the schedule so there are rest breaks or maybe one class needs to be dropped again it’s hard for me to be specific every person who has a concussion is unique but these are pretty typical themes may need to withdraw from the current semester or classes some of you have talked to me about interesting situations where the student decides I’m going to withdraw from every class except yours professor because I know you and I’m gonna make it we can’t make it they’re nauseous in the classroom just be open-minded and maybe realize that may or may not work again time of classes may be altered related to scheduling I mean scheduling can mean work schedule and academic and here I mean more the academic classroom times but again there may be intense pressure to keep up remind your student alcohol use illicit drug use is always bad but can certainly exacerbate symptoms living arrangement some of our students may need to get out of where they are because it’s not low stimulation I have encountered this with many of my students where after a concussion they need to go home for a while or to a friend who lives off campus where it’s quieter there has to be excellent communication with instructors online hybrid see my little caution sign I have an opinion about this as a neuropsychologist and a faculty member proceed with extreme caution my experience is any online or hybrid course requires an extremely high level of initiation and executive control students would you agree if you’ve done online you have to be very self-motivated one of the biggest issues after a concussion is you may not be as self motivated again headaches tired exhausted you may be having problems with balance and coordination with dizziness the last thing you want to do at the end of the day is log on to Blackboard I don’t think it’s a good idea just proceed with caution really have a good conversation with the student and of course enlist as much support as possible as we’ve talked about when I used to teach health psychology every student learned the first wealth is health this is a quote by poet philosopher Ralph Waldo Emerson be a role model if they are feeling pushed and trying to do too much it’s not worth it years ago two students here taught me the value of telling little tidbits of my story I feel we live in a TMI society too much information but when I told a couple of my students Kate and Jamie years ago how I struggled doing this in that grad school it was as though I opened a new world to them they admitted to me they thought my academic career was easy you just got into grad school and everything fell into place oh no not when I was being yelled at in grad school by my supervisor nearly made me cry when I was denied my most hopeful wonderful postdoctoral fellowship and all worked out in the end I wound up where I had to be but we’ve had disappointment I was delayed getting my license as a psychologist by a couple years I was caregiving for a family member my students know my thing well the earth didn’t open and suck me in I’m alive it was okay that I needed more time this is the struggle of many of our students with a concussion but I’m going to lose a semester we must advise well if the physicians and the medical team are saying you need a break the first wealth is health maybe you have a little light-hearted story you can share with them to inspire them really Kate and Jamie just got their masters degrees there working in the field of psychology they taught me so much because just that little bit of information I don’t know is this true students you look at us like robots like everything’s easy we never had the pain of applying to grad school we never shed tears and again I’ve already mentioned this recovery from concussion varies several weeks or months however I must mention malingering is the intentional feigning or exaggerating of symptoms for secondary gain you must be alert to this can we prove it no but a neuropsych eval may indicate a student is exaggerating symptoms we are seeing more and more of this in the clinical world we are in tough economic times if you’ve had a concussion and you pursue litigation there are attorneys who will coach you how to perform on a neuropsych test to fake an injury this is real we’re seeing more of it the stats are exploding all I can tell you is to always what do they say little kids have eyes behind the back your head if you’re getting a feeling it doesn’t make sense and the student’s not getting better it really again that’s up to the medical team but you may want to ask them why aren’t you getting better one of my colleagues had a situation last semester that was fascinating student had a concussion got all the supports in place never used the supports of Stockton missing class two months later I want to pass no can do I don’t like that that’s a red flag to me you had your chance why didn’t you well it it was fishy so just be alert to this I hate to be negative but the intentional faking a brain injury is so on the rise again my husband does a lot of this work and it’s the client who comes in they they were able to find the office from an hour away they drove themselves there you asked them to draw a clock oh I just can’t oh I can’t deal with this let me lay down I don’t know how to draw a clock and they’ll have a panic attack that doesn’t seem quite real Anthony’s nodding yeah you see this stuff yeah we’ll discuss at the end we’re almost done to wrap things up there is something now that Dr. White and Darice have researched very well gave a talk on Chronic Traumatic Encephalopathy this results from repetitive trauma to the brain and there are young people as young as 17 who have been diagnosed with it am I right or even younger think that was the youngest case what we now know is when you’ve had repetitive multiple concussions it’s an issue you may have heard about this the movie Concussion with Will Smith what started our understanding of Chronic Traumatic Encephalopathy is well documented in this PBS special and and I’m gonna show you a snippet of the first football player who tragically died at the age of 50 Mike Webster he died in 1990 at the age of 50 he was he played for a couple different teams and lastly the the Pittsburgh Steelers it is sad tragic yet fascinating for me as a neuropsychologist to see that it’s really only on autopsy you can see this and again research is now moving toward Pop Warner there was a recent study last year I shared with my neuro psych class they are starting to study Pop Warner football players and over one season the brains of these little children on FMRI they’re different because there’s concussion and there’s something called sub concussive hits has anyone heard of this you don’t see the concussion happen it’s not like the player bangs his head and falls down it’s just throughout the game movement of the brain so I’m going to ask Zach to come forward before we watch a video clip for the record I am a Dallas Cowboys fan this belongs to my son go Cowboys next year Dak Prescott here’s the issue so all of our football players wear these wonderful helmets they are improving but again we put the brain in there the brain isn’t is surrounded by cerebrospinal fluid the skull the sub-concussive hits happen it’s going to move did you see in the Super Bowl helmets fly off yeah yeah so you know we put our brain in here but it’s limited in what is going to prevent makes sense thank you again do I have any Dallas Cowboys fans briefly I want to show you a clip from League of Denial the NFL’s Concussion Crisis my students watch it neuropsych it may forever change how you watch football I am a die-hard football fan I was taken to a Rutgers football game when I was three years old and I fell in love my dad was one of those guys who believed in college football because they don’t get paid he said I feel more for the quarterback playing for the spirit of Rutgers then the guy making a few million so very briefly i’m just going to show you a little bit about Mike Webster you’re actually going to see him speak and how he was impaired cognitively from Chronic Traumatic Encephalopathy and I’ll start wrapping things up good morning in 1991 Mike Webster left football soon he and his family would come to believe those hits to the head had taken a devastating toll Mike wasn’t Mike he was angrier quicker than before and didn’t have the patience to have you know the kids on his lap or take a walk with the kids like he didn’t have that stamina physically over the years he became increasingly confused he would forget you know which way the grocery store was which way it was to go home he was he would actually he broke down in tears in front me a couple times because he couldn’t get his thoughts together and he couldn’t keep them in order at home there were bouts of rage he took a knife and slashed all his football pictures they were all destroyed and gone and broken glass and they were all down you know and it it wasn’t Mike they’d been college sweethearts but 27 years and four children later Mike and Pam Webster’s marriage ended we didn’t understand what was happening you’re just trying to get by in this storm I mean your money’s gone your prides gone our bills are all over due our house is getting foreclosed all the security is gone all those parameters are removed so everything’s crumbling once one of Pittsburgh’s greatest football heroes Webster began living out of a pickup truck I come outside sometimes and just see him you know sitting in the truck and it would be freezing and he just be sitting there just looking miserable said you know the the worst thing is I’m actually getting to the point where sometimes or if I don’t have my medicine he said I’m I’m cold and I don’t realize that I can fix it by putting a jacket on Webster was often unable to sleep he had a lot of pain and he and he hasn’t slept for days so he asked me he said Sonny can you taze me I’m like what does that mean so he pulls out this stun gun and zzzz zzzz I’m like Mike that’s not healthy he said but I haven’t slept and all you gotta do is taze me right here and I’m like okay uh huh yeah he’s my hero I’m gonna do whatever he tells me so I tazed him and he goes goes to sleep I’m like wow a true champion who wound up homeless depressed the story of Webster’s decline was revealed on ESPN and then the local newspapers he was arrested for forging 19 prescriptions for Ritalin which he used to combat the erratic behavior caused by his damaged brain I think he was embarrassed he was a leader on the team he was Mike Webster and then to be down to a place of poverty a place where you know your brain can’t function to finish a sentence without some help from Ritalin or or whatever you need to to function for a short period of time for Iron Mike TV interviews became impossible no I’m talking about no I’m just trying to find yeah we’ll everybody went through trauma as a kid I’m not saying I was different than that I’m just saying the things we do to one another ok hell I don’t know what I’m saying I’m just tired and confused right now that’s why I say I can’t really I can’t say it the way I want to say it I could I could answer this real easy at other times but right now I’m just tired maybe the saddest I ever heard him say was when someone saw my dad and aren’t you Mike Webster and he said I used to be I think that was really how he felt because he really was he wasn’t the same person ah it was it was like you know a picture of him that was just shattered into a million pieces and just to wrap up I want to thank of all of my students and colleagues who continue to enhance our knowledge more and more I find students and faculty talking to me about concussion the more we talk about it acknowledge it we can advise better so thank you very much and thank you Christine for such a great presentation very informative let’s give her a hand

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