Problem Solving and Emotional Regulation Training

The goal of this treatment is to improve executive functioning skills and problem solving by using an integrative problem solving/emotional regulation approach.   This treatment was designed for people who have mild to moderate cognitive deficits related to Stroke, Acquired Brain Injury (ABI), M.S., Parkinson’s Disease.  The program is client centered and wellness focused.  In our experience, the clients we treat with the diagnosis listed above improve in many areas but often get to a level where their executive functioning and problem solving skills seem to get stuck and what they have learned in treatment does not carryover into their daily lives. Often poor emotional regulation sabotages problem solving and executive functioning skills.

This approach is concrete and gives the client a step-by-step concrete approach to regulate their emotions by being more aware of the emotion, triggers that caused the emotion, sensations they feel, behaviors they exhibit and their self talk and then gives them specific strategies to use to regulate these.  They also learn an acronym to use to go through the steps of problem solving where they identify when a problem is occurring, determine/define the problem, brainstorm alternatives, develop a plan and determine how and when to implement the plan and then self-evaluate how effect the plan was and make changes as necessary. In the group setting, the participants not only learn the techniques but they also, help each other brainstorm and work through the techniques while they are all practicing the techniques. Once their emotions are regulated, they are able to problem solve more effectively.

If you would like more information, please feel free to contact us or look up more information about the program on the Mount Sinai Hospital website or the Archives Physical Medicine Rehabilitation. 

Our Physical Therapist has specialized training and experience in assessing and treating individuals with neurological deficits.  Our Physical therapist can help improve or restore the mobility you need to move forward with your life. She will examine you and develop a plan of care using a variety of treatment techniques that help you move better, restore function, and prevent disability associated with a variety of neurological conditions. She also has experience in treating orthopedic deficits and collaborates with many orthopedic physicians in the area for a team approach to your recovery. 

Dementia and Alzheimer's Disease

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life.

Alzheimer's is a disease that attacks the brain. It is the most common form of dementia.

Once the initial assessment is completed, our treatment focuses on helping the individual, family and/or caregiver

• Understand specific information regarding the cognitive deficits
• Learn ways to set up the environment to maximize function
  
• Compensate for the deficits
• Maintain and sometimes improve functioning

Check out this link for Exercises and Games for Memory 

For more information please go to the Alzheimer's and Dementia Website

See 10 Early signs of Alzheimer's Disease  vs. typical age related memory loss (further down the same page).

What is Aphasia?

Aphasia is a disorder that results from damage to the parts of the brain that contain language. Aphasia causes problems with any or all of the following: speaking, listening, reading, and writing.

Damage to the left side of the brain causes aphasia for most right-handers and about half of left-handers. Individuals who experience damage to the right side of the brain may have additional difficulties beyond speech and language.

Individuals with aphasia may also have other problems, such as dysarthria, apraxia, or swallowing problems.

What are some signs or symptoms of aphasia?

Some people with aphasia have trouble using words and sentences (expressive aphasia). Some have problems understanding others (receptive aphasia). Others with aphasia struggle with both using words and understanding (global aphasia).

Aphasia can cause problems with spoken language (talking and understanding) and written language (reading and writing). Typically, reading and writing are more impaired than talking or understanding.

Aphasia may be mild or severe. The severity of communication difficulties depends on the amount and location of the damage to the brain.

What is Apraxia of speech?

Apraxia is a general term. It can cause problems in parts of the body, such as arms and legs. Apraxia of speech is a motor speech disorder. It is caused by damage to the parts of the brain related to speaking. Other terms include apraxia of speech, acquired apraxia of speech, verbal apraxia, and dyspraxia.

People with apraxia of speech have trouble sequencing the sounds in syllables and words. The severity depends on the nature of the brain damage.

What are some signs or symptoms of apraxia of speech?

People with apraxia of speech know what words they want to say, but their brains have difficulty coordinating the muscle movements necessary to say those words. They may say something completely different, even made up words. For example, a person may try to say "kitchen," but it may come out "bipem" or even "chicken." The person may recognize the error and try again, sometimes getting it right, but sometimes saying something else entirely. This can become quite frustrating for the person. It may be hard to understand a person with apraxia of speech.

Apraxia of speech can be mild or severe. People with apraxia may have difficulty

• imitating speech sounds
• difficulty imitating non-speech movements (oral apraxia), such as sticking out their tongue
• groping when trying to produce sounds
• in severe cases, an inability to produce sound at all
• inconsistent errors
• slow rate of speech
• somewhat preserved ability to produce "automatic speech" (rote speech), such as greetings like "How are you?"

Apraxia can occur in conjunction with dysarthria (muscle weakness affecting speech production) or aphasia (language difficulties related to neurological damage).

What is Cognition?

Cognition refers to thinking skills. Cognitive difficulties are common in people who have had a stroke on the right side of the brain, brain injuries in general as well as other neurological deficits. They vary in seriousness depending on the location and severity of the damage.

The following problems may occur:

• Poor attention to tasks
• Trouble concentrating when there are internal and external distractions (e.g., carrying on a conversation in a noisy restaurant, dividing attention among multiple tasks/demands)
• Slower processing of new information
• Memory difficulties
• Recent memory is affected in some people, making new learning difficult. For example, some people may have trouble learning the new things they are being taught, such as how to get in and out of their wheelchair safely
• Poor reasoning skills
• Poor problem solving skills
• Poor executive functioning (e.g., goal setting, planning, initiating, self-awareness, self-inhibiting, self-monitoring and evaluation, flexibility of thinking)

What is Dysarthria?

Dysarthria is a motor speech disorder. The muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all after a stroke or other brain injury. The type and severity of dysarthria depend on which area of the nervous system is affected.

Some causes of dysarthria include stroke, head injury, cerebral palsy, and muscular dystrophy. Both children and adults can have dysarthria.

What are some signs or symptoms of dysarthria?

A person with dysarthria may experience any of the following symptoms, depending on the extent and location of damage to the nervous system:

• "Slurred" speech
• Speaking softly or barely able to whisper
• Slow rate of speech
• Rapid rate of speech with a "mumbling" quality
• Limited tongue, lip, and jaw movement
• Abnormal intonation (rhythm) when speaking
• Changes in vocal quality ("nasal" speech or sounding "stuffy")
• Hoarseness
• Breathiness
• Drooling or poor control of saliva
• Chewing and swallowing difficulty

LSVT Big

Ann Juntunen, Physical Therapist, is a certified Parkinson’s Disease LSVT (Lee Silverman Voice Treatment) Big Physical Therapist. This treatment is primarily for individuals with Parkinson’s Disease, although it has been shown to be beneficial for other neurological disorders as well. LSVT Big is a research-based exercise approach inspired by the Speech LSVT Loud treatments. LSVT Big is a standardized treatment protocol that has been shown to improve balance, trunk rotation, and walking in individuals with Parkinson’s Disease. Exercise is medicine and neurologically protective. LSVT Big trains individuals with Parkinson’s Disease and other neurological conditions to avoid inactivity and participate fully in everyday activities, thereby improving overall quality of life.

For more information please go to the LSVT Global website.  

 LSVT Voice Treatment for Parkinson's Disease

Cathy Fisher, Speech-Language Pathologist, uses the LSVT (Lee Silverman Voice Treatment) to treat the voice of people with Parkinson Disease as well as people with other neurological voice disorders. Purpose

Most patients with Parkinson's Disease experience a decreased voice volume and decreased intelligibility of their speech as their disease progresses. The purpose of LSVT is to reverse that decline by focusing the patient's attention on increasing voice volume through an intensive set of exercises.

For more information please go to the LSVT Global website.

Interactive Metronome

The IM program provides a structured, goal-oriented process that challenges the patient to synchronize a range of hand and foot exercises to a precise computer-generated reference tone heard through headphones. The patient attempts to match the rhythmic beat with repetitive motor actions. 

A patented audio or audio and visual guidance system provides immediate feedback measured in milliseconds, and a score is provided.

Today, Occupational Therapists, Speech Language Pathologists, Physical Therapists, Educators, Athletic Trainers, Licensed Rehabilitation Medical and Mental Health Professionals Neurologists, Psychiatrists, Psychologists and Chiropractic Care Professionals are enhancing traditional therapy approaches with IM and achieving measurably improved outcomes. IM has been shown to improve:

• Attention & Concentration
• Motor Planning & Sequencing
• Language Processing
• Behavior (Aggression & Impulsivity)
• Balance and Gait 
• Endurance Strength
• Motor Skills

 For more information, please visit the Interactive Metronome Web page.

Individualized therapy to develop and implement practical solutions to the challenges of everyday living with MS.

The goal of the program is to help people with MS stay active in daily life by facilitating participation in the activities that are valuable and meaningful to them. This includes productive, self-care, and leisure activities.

Comprehensive focus includes but is not limited to:

• Fatigue management
• Activity Modifications
• Adaptive equipment use
• Memory compensation techniques
• Visual changes
• Fine motor coordination
• Upper extremity strength and range of motion
• Home modifications.

Multiple Sclerosis program at Neuro Rehab and Fatigue Management

For more information on Multiple Sclerosis please visit the National MS Society web page.

 Stroke Rehabilitation

The effects of a stroke on communication (speaking, understanding, reading, writing), memory, upper extremity function, self care management, and independent living skills can vary greatly from one patient to another and the pace and progress of rehabilitation can vary, too. It is important to find a care provider that specializes in stroke rehabilitation as we do at Neuro Rehab Associates. We can help people to achieve the best outcomes possible through evidence based treatment.

For more information please visit the National Stroke Website or this fact sheet on Post Stroke Rehabilitation or the American Speech and Hearing Association website.  

 The Listening Program

When auditory perception is distorted—whether through illness, injury, developmental or other challenges—auditory processing problems can lead to academic, emotional, cognitive and social challenges, including problems with the following:

• Attention and concentration
• Listening
• Speech and language
• Memory
• Communication
• Reading
• Physical balance and coordination
• Vocal performance and musical ability

Whether you are interested in improving brain health for longevity, expanding your own abilities or helping someone you care about, TLP can make a significant difference.

With the guidance of a TLP Provider, like Cathy Fisher, The Listening Program is an easy-to-use, cost effective, portable method that can bring about lasting change.

Find out more about The Listening Program

Mild Brain Program/Post Concussion

The goals of the program include:

Helping clients develop a better understanding of the effects of their brain injury, their strengths and weaknesses, and the benefits of compensatory strategies as a tool for life-long success.

Teaching compensatory strategies and cognitive skills that will facilitate and sustain their ability to function independently, return to work, and /or participate in academic coursework.

Facilitating improvement in neurocognitive function through evidence based graded activities in targeted areas of deficit.
The program is a multi-phase approach to retrain:

• Attention
• Memory
• Information processing
• Auditory Processing
• Executive function
• Time management
• Reasoning
• Problem solving
• Higher level language skill

What you should know about Mild TBI

Symptoms Checklist

Many people don’t realize there is more to vision than how clearly you see. In addition to acuities, the vision system includes gross ocular skills (how the eyes move and work together) and visual perceptual skills. These components of vision are often impacted by an acquired brain injury and other neurological deficits.

Symptoms can include, but are not limited to:

• Headaches
• Light Sensitivity
• Dizziness
• Seeing Double
• Blurred Vision
• Eye strain or aching eyes
• Difficulty reading (fatigue, poor comprehension, difficulty keeping place)
• Feeling overwhelmed visually or difficulty scanning
• Poor tolerance or attention for visual tasks

Similar to other systems in your body, the visual system can be trained and rehabilitated. Our Occupational Therapists have special training and over 10 years of experience in vision therapy and they address visual skills as part of their Occupational Therapy program in collaboration with local optometrists who are knowledgeable in vision rehabilitation

Print out our hand out on Rehabilitation of Visual Skills

What is NDT?

Michelle Rosen, OTR at Neuro Rehab Associates is NDT certified. The NDT (Neuro Dynamic Treatment) Approach is used for management and treatment of individuals with central nervous system (CNS) pathophysiology and used with adults who have suffered a stroke or other neurological deficits.  The individual's strengths and impairments are identified and addressed in relation to functional abilities and limitations. The NDT Approach continues to evolve with the emergence of new theories, models, research, and information in the movement sciences. NDT is a hands-on, problem solving approach. Intervention involves direct handling and guidance to optimize function. The approach is guided by the client's reactions throughout every treatment session. An NDT Trained or NDT Certified™ therapist's education in neurology, physiology, and current research is translated into daily practice. They work collaboratively with patients, families, caregivers, and other healthcare professionals to develop individualized comprehensive treatment programs based on NDT theory and philosophy.

 For more information, please visit the NDTA website. 

Traumatic Brain Injury (TBI)

Traumatic brain injury (TBI) is caused by an impact to the head from direct blows or sudden movements such as whiplash. TBI can result in physical, cognitive, behavioral, or emotional difficulties. Injuries can range from minor to extremely severe and call for various levels of intervention and treatment.

People with TBI may experience short-term memory loss, have difficulty concentrating or paying attention, become easily disoriented, have impaired judgment, experience headaches or migraines, have slurred speech, experience seizures, become fatigued, depressed, or easily agitated, or experience increased anxiety and impulsive behaviors.

Our team of Brain Injury Specialists at Neuro Rehab Associates can help people who have sustained a TBI. The type and duration of intervention depend on how severe the injury.

What can our team of therapist do?

• Evaluate the skills necessary for the client to engage in daily activities at home; at work; at school and during leisure activities, and facilitate the resumption of those activities.
• Educate the client so they understand their specific deficits and how to work around them and improve them
• Restore cognition, language, movement, coordination, balance, endurance and strength so that a person with TBI can be more independent.
• Help the client perform simple tasks that are meaningful to the person's life.
• Recommend equipment that can aid a person in performing daily life activities with greater independence, such as a tub or shower seat to allow bathing without standing when the client has poor balance and grab bars for greater safety when getting in or out of a tub or shower.
• Teach a person with TBI to compensate for problems with thinking, such as memory impairments, use of weekly checklists of household chores, minimizing overstimulation and confusion in their environment.

 Vestibular Deficits

Ann Jutunen, DPT, Physical Therapist, has worked for nearly 5 years with individuals with various vestibular deficits including: BPPV (Benign Proximal Positional Vertigo), Unilateral Vestibular Lesions, Bilateral Vestibular Lesions, and Central or Neurological Vertigo caused from Strokes, MS, brain tumors or cysts, and deformities of the upper spine.
If you experience the following symptoms, you may be a candidate for vestibular rehabilitation:

• Overall feeling of imbalance
• Decreased vision during head movements or head movement sensitivity
• Visual motion sensitivity
• Disequilibrium in the dark
• Disequilibrium on uneven surfaces such as when walking on the grass or carpet
• Overall feeling of imbalance while walking
• Dizziness or vertigo when changing positions such as when turning over in bed or going from a lying down to a sitting position

Our Occupational Therapists provide excellent occupational therapy services to individuals experiencing neurological conditions, including cerebral vascular accidents (stroke), brain injury, Parkinson’s Disease, Multiple Sclerosis, and many other diagnoses. The therapy services provided are individualized to each patient’s needs and may include: self-care management training (training for self-bathing, grooming, dressing, toileting), strengthening, flexibility training, cognitive training and instrumental activities of daily living training (cooking, cleaning, finance management).

 Accent Modification

 For more information, please visit the American Speech and Hearing Association Website.

 What are Communication Deficits? 

Communication Deficits involve difficulty relaying your ideas whether it be verbally or in other ways. Deficits include aphasia, apraxia, dysarthria, voice and fluency disorders.  Speech-Language Pathologiest assess and treat these disorders.  At Neuro Rehab Associates, our Speech-Language Pathologists have many years of experience in treating individuals with communication deficits related to acquired neurological disorders, such as stroke, brain injury, Parkinson's Disease, Multiple Sclerosis, and dementia to name a few. 

Mild Cognitive Impairment

Mild cognitive impairment (MCI) is a diagnostic category used to describe gradual cognitive decline associated with aging, but distinct from dementia. It can affect memory specifically or other areas of cognition, such as attention, executive function, language, and visuospatial skills.

In cases of MCI, it is often difficult to identify the specific starting point, or the transition from asymptomatic phase to symptomatic phase. Estimates of occurrence in the general population range from 3-17%. There is still a great deal of uncertainty regarding the likelihood of progression to dementia or Alzheimer’s Disease(AD), but it is generally thought to be around 10%. Many cases of MCI are stable over time.

The main clinical criteria for MCI diagnosis includes a concern about a change in cognition (memory or non-memory), impairment in one or more cognitive domains that is corroborated by family, generally preserved independence in functional abilities and no significant impairment in social or occupational functioning.

Speech therapy can be beneficial for those diagnosed with MCI. The primary focus would be on education regarding diagnosis and residual strengths, teaching of compensatory strategies, training family members in use of supportive strategies for home carryover, and strengthening the existing “strengths”.