BINA Director's Concussion Article Appears in Health Supplement  

The following article appeared in the August 2013 Health and Living Supplement of The Jewish Press; reprinted with permission.

When a Mild Traumatic Brain Injury Isn't Really So Mild

By Chavie Glustein

Eli, a 19-year-old student, was riding his bicycle home from school when he lost control and rode into a ditch, flying head first into the concrete sidewalk with so much force that he could hear the bang. The next thing he remembered was opening his eyes and seeing a group of worried people surrounding him. Although dazed and lightheaded, he was able to rise unsteadily to his feet. When EMS arrived at the scene in response to a bystander's call, Eli insisted that he was fine and did not need medical attention, but the paramedics recommended that he get checked out at the ER. After a CT showed no unusual findings, Eli was told that he had suffered a minor concussion which would heal on its own. What Eli was not told is that a concussion is often not so minor, and any subsequent symptoms must not be ignored...

A concussion is technically classified as a mild Traumatic Brain Injury (TBI) that is caused by a bump or rapid movement to the head. However, the aftereffects of a concussion are often not mild at all.

The human brain is well protected; it is encased by the bones of the skull and surrounded by fluid. When an individual sustains a sudden strong blow to the head or when the head is jolted hard against an object, the brain shifts inside the skull. This can cause microscopic damage to the brain as well as changes on a cellular level.

The standard diagnostic tools for brain injury are a CT or MRI scan, which will pick up on damage such as bleeding in the brain.  However, in the case of a concussion, the scan will commonly come back "normal." Therefore, a concussion is diagnosed based on the resulting symptoms that develop following the injury. In the mildest cases, the individual will not lose consciousness but will be temporarily confused and dazed, symptoms which clear up within a few minutes. In more severe cases, there will be brief loss of consciousness lasting a few minutes.

...The next morning Eli woke up feeling much better and decided to head out to college. The fluorescent lighting seemed much brighter than usual, and the sound of his classmates' chatter was making him nervous. He couldn't seem to concentrate on the professor's lecture or keep track of what was going on in class. Eli's head started to pound and he felt irritable and restless. He could not figure out what was happening to him and decided to go home, thinking he must be tired from yesterday's incident....

The symptoms and aftereffects of a concussion are:

• Sensitivity to light and noise
• Headaches
• Dizziness
• Difficulty paying attention and concentrating
• Irritability, nervousness and anxiety
• Sleep disturbances, i.e. sleeping more than usual or insomnia
• Feeling tired and fatigued
• Feeling over-emotional or sad

According to the CDC, "Some of these symptoms may appear right away, while others may not be noticed for days or months after the injury, or until the person starts resuming their everyday life and more demands are placed upon them. Sometimes, people do not recognize or admit that they are having problems. Others may not understand why they are having problems and what their problems really are, which can make them nervous and upset."

...As time went on, Eli's symptoms did not improve. He suffered from headaches and dizziness and was extremely sensitive to light and noise, making it difficult to remain in any crowd setting. He couldn't concentrate or focus on his studies and his grades began to suffer...

Although the symptoms of a concussion often disappear immediately, this is not the case for all injuries. It can take days, weeks or even months to fully recover from symptoms, some of which may not appear initially. Young children, teenagers and seniors may need the longest recovery time.

Even though a person with a concussion may look fine, the injury must be taken seriously. The symptoms are real and should not be dismissed. An immediate return to regular activities can slow recovery and should be avoided.

Sports-related concussions have received national attention recently, leading several states to pass legislation mandating that youth athletes who may have suffered a concussion be taken off the playing field immediately. The Zackery Lystedt law was passed in Washington in 2009, named after a gifted 13-year-old football player who suffered a concussion and returned to play too soon. He collapsed after a subsequent injury from "second impact syndrome" due the increased likelihood of serious injury following an initial concussion. After three months in a coma, Zack endured a long and arduous recovery period until regaining his speech and use of his arms and legs, and he remained in rehabilitation for years.

...When Eli's symptoms persisted, he consulted with a physician with expertise in concussion who gave him accurate information and guidelines about the condition. He also told him that had he been supplied with this information immediately after the injury, his symptoms probably would have eased sooner...

The key to recovery after a concussion is to allow the brain to rest. Pushing too hard and going back to school or work and resuming one's regular routine can slow recovery. Symptoms will often worsen when the brain is overexerted both physically and cognitively. Increased headaches and fatigue over the course of the day is the brain's way of telling you that it's time to stop and take a break. When symptoms increase, increased breaks, naps, and hours of sleep are needed.

Parents must inform the school that a child has had a concussion, and a shorter day and decreased academic load may be necessary. Adults returning to work may need to cut back on their hours and workload in order to facilitate recovery. A physician will determine whether a driver can get back behind the wheel and may recommend an evaluation by a Driving Rehab Specialist, especially if the concussion has slowed reaction time and affected concentration.

Eli questions where he should have turned for guidance after his accident...

A consult with a healthcare professional with experience and expertise in mild TBI is often warranted. Concussion centers have been set up at leading medical centers staffed by physiatrists (rehab specialists) and neurologists, as well as neuropsychologists with training in mild TBI who evaluate and manage the effects of brain injury including concussion on one's thinking abilities.

Additional information can be found at:

CDC: www.cdc.gov/concussion

Brain Injury Association of America: http://biausa.fyrian.com/about-brain-injury.htm#concussion

Brainline: www.brainline.org/landing_pages/categories/concussion.html

LEARNet (For students returning to school): www.projectlearnet.org 

BINA welcomes Elchanan Schwarz as Director of Crisis Intervention and Caregiver Support Services.  

How did you become interested in brain injury?

I've always been fascinated by the field of neuropsychology and wanted to work with individuals whose needs intersected both the emotional and neurological. In fact, my favorite professor in college - despite the fact that he was an incredibly tough marker - was a neuropsychologist whose classes had a strong biological basis that I really enjoyed. I was actually very surprised and gratified to find this opportunity at BINA that fit so well with my interests - my "dream job" to use a clich�.

A lot! Most important is how misunderstood brain injury is on so many levels. Anyone living in the aftermath of a brain injury, whether the survivor or a family member, is dealing with a challenge that the average person cannot fully or properly comprehend. Most people, assuming that they even recognize the illness or injury as a brain injury, view it as similar to any other medical condition. What they don't realize is how different it is in the sense that brain injury, from one minute to the next, can change the person who existed before - personality, emotions, behavior, cognitive abilities - which in turns affects every member of the family.

My role is to work with both survivor and family. Immediately following the injury, I'm usually dealing directly with the family rather than the patient. The first job is to orient them to the unfamiliar world of brain injury and help them process what's happening and understand all the new terms and procedures. In essence, I'm working with them to adjust to their new reality, to what may eventually become the "new normal." There are so many phases as the family moves through the rehabilitation process, from the initial shock of the injury, transfer from hospital to rehabilitation facility, homecoming, and the adjustment when the brain injury survivor hopefully returns to school or work. It's very important that the support originate from people who understand the unique challenges they're facing and guide them appropriately every step of the way.

We're very excited about a networking event being planned for caregivers which will feature speakers familiar with brain injury. The event will be educational and also allow families going through the unique challenge of brain injury to network with each other. Although no two stories are exactly alike, the families do share the common theme of brain injury that only they truly understand. I have found that our families are very resilient and can offer a very special level of support and understanding to each other which we hope they will benefit from through these networking events.

Another project is the expansion of our crisis intervention services to ensure that we're reaching families as soon as possible post injury, during the initial stages when every member of the family - parents, spouse, children, and siblings - desperately needs support and education about the unknown and difficult world of brain injury.

Also in development is a program to work with mental health professionals who may be treating brain injury survivors or their family members, to ensure that they recognize and understand brain injury, and if necessary, will recommend specialized brain injury services. We're also expanding our own network of mental health therapists who are experienced in brain injury and to whom we can refer our clients.

BINA Evening Inspires and Enlightens: Hoping and Coping With Brain Injuries 

Reprinted with permission of Hamodia.

By: C. Baumwolspiner

When I informed a friend that I was going to the BINA evening in Lakewood she was rather surprised, since I do not write for Binah Magazine. After I told he r it was BINA, not Binah, she was more puzzled. What is BINA?

Ten years after its founding, the Stroke and Brain Injury Assistance (BINA) organization is still known mainly to those who have had to use its services and their families and friends. The inspiring BINA dinner reception held at the Oros Chaim Hall last Sunday night finally got the word out that BINA is changing the challenge of brain injury for the Jewish community, and that it belongs up there with other prominent medical assistance organizations that work on behalf of cholei Yisrael.

Let's see why.

Defining Brain Injury

Brain injury ... the very words send chills down the spine. Perhaps because it sounds so frightening, so severe and potentially life-threatening, the chapter on brain injury is rarely thumbed through in most household medical books, with the result that few people know much about it - unless it happens.

Mrs. Chavie Glustein, the founder and director of BINA, explains that brain injury falls into two categories. A traumatic brain injury (TBI) is caused by an external force and is commonly the result of occurrences such as car accidents, falls, assaults and sports injuries. A non-traumatic brain injury is caused by such events as a stroke, loss of oxygen to the brain, a brain tumor, an aneurysm, encephalitis or meningitis.

While every brain injury is different, Mrs. Glustein explains that there is one common denominator. A brain injury can occur to any person at any time. In a matter of moments, the head of a household may be rendered helpless; a child on his way home from school may fail to arrive; a mother may become powerless to care for her children. Victims may suffer paralysis, memory loss, or the inability to speak, eat or swallow, chas v'shalom. These are only a few of the possible effects of brain injury, which can also be fatal.

Many people do survive brain injury - but damage to the brain, whether mild or severe, will inevitably impair physical and/or cognitive functioning, and possibly affect behavior, emotions, and personality as well. Rehabilitation, frequently more than one type, is therefore a crucial part of the recovery process, because it helps patients overcome or cope with these impairments. Most people are bewildered and overwhelmed when faced with this type of injury. Suddenly they have to quickly make decisions involving complex issues.

They face a frightening, unknown world.

Where to go? What to choose?

And who will guide them through the maze of insurance questions?

Enter BINA.

BINA's Mission

When Rabbi Ahron Glustein, a kollel yungerman, suffered a stroke following a virus a decade ago, his young wife had no one with any real knowledge to consult about his treatment and rehabilitation options. Since her husband's miraculous recovery, she has devoted herself with great mesirus nefesh to providing others with the guidance and support she didn't have.

Today BINA assists brain injury survivors and their families through every stage of the recovery process, providing well researched referrals to the rehabilitation facilities and practitioners that best suit their needs. After patients return home, BINA helps with the special accommodations they may need to deal with their impairments.

Among its services BINA offers home management, longterm home care, insurance options, crisis intervention for family members forced to face a new reality, educational and vocational options for the injured, support groups for wives of brain-injured spouses, classes and informational material.

Lakewood Mashgiach Harav Matisyahu Salomon, shlita, said of BINA, "It is hatzalas nefashos... It's giving people back their lives."

A Well-Kept Secret

In spite of these extensive efforts and services to 1,500 families, BINA is still not a familiar name in the community. In contrast, almost everyone has heard of the tireless work of Chai Lifeline for cancer patients, and about ECHO, the medical referral service agency. These organizations and others receive the respect and support that is their due. BINA provides comparable services for those with stroke and brain injuries, but it has remained out of the limelight. Is there a reason?

Mrs. Glustein finds that people with brain injuries often do not like to talk about their experiences publicly - a fact borne out by the decision to "import" a young Brooklyn teen to describe his remarkable road to recovery at the BINA Lakewood event.

In addition, people may feel that although they hear all too often about Jews who have had cancer, a heart attack, or other sicknesses, they know of few people who have survived a stroke and may never have met anyone who has suffered a brain injury...Just because we may not know about them doesn't mean they aren't there.

As much as other organizations fill a very crucial place in our communities, there is a gaping need for organizations to help brain-injury survivors. BINA is currently the only Jewish organization filling this role. If it is to continue to do so effectively as the numbers grow, the interest and support of Klal Yisrael are vital.

Why Lakewood?

Although BINA maintains a small office in Brooklyn, in many ways it is an organization without walls. Much of its work is done on the phone, although it does have a social worker and a caseworker who drive to locations in the tri- state area without delay whenever there's a need.

BINA also provides help for people who call from Europe and Eretz Yisrael, sharing experience and expertise across geographical boundaries. A caller from England recently received advice from Mrs. Glustein that saved her husband's life.

Why has BINA come to Lakewood?

Actually, it's been here a long time. Most of the evening's hosts were BINA families who have used its services extensively at some point - and some still do.

Harav Elya Brudny, the guest speaker and a close friend of BINA, pointed out that Lakewood is the number-one address for many mosdos and tzedakos today. To the surprise of the audience, he remarked that this was also the case in Rav Schneur's time, over three decades ago.

Isn't it ironic that Lakewood is considered the premier city of chessed in the U.S.? After all, Lakewood is largely a kollel community, hardly the wealthiest town around. The answer, explained Rav Brudny, is precisely that. Because it is a town comprised mainly of bnei Torah, including those who are not learning full time, Lakewood is the place where the concept of nosei b'ol im chaveiro is most keenly felt. Organizations establish their bases in Lakewood because they know that Lakewood residents will not only feel their pain but act upon it.

More on the Lakewood Families

I was told that BINA's Lakewood families would be in attendance and expected to be able to spot them at once. After all, brain injury is not something that simply goes away.

But all the women in the room looked healthy and happy. Did this mean that all the stroke and brain-injury victims were men?

As I chatted with some of the women in the crowd, I soon found out that they were not.

The lovely young woman sitting near me had had a stroke following the birth of her fifth child. After two years of intensive therapy, she has recovered completely.

A smiling woman whom I've seen around for years has a son who was injured in a serious road crash several years ago. Baruch Hashem, he has also recovered completely.

Another pleasant-looking young woman seemed outwardly hardly likely to have suffered pain. It turned out that her second child nearly drowned, suffering a lack of oxygen and subsequent brain damage, and is now wheelchair-bound; however, the child has made great progress, and no one can predict the lifetime prognosis.

Mrs. Glustein had told me in a phone call earlier in the day that brain injury can happen to anyone, and I had heard it again, more than once, from the speakers that evening. But only now, after meeting some of those who have suffered its consequences, did the full reality sink in.

It happens right here in Lakewood, among people you meet in town, at the co-op, the gym and the playground. Sometimes there's recovery, sometimes there's partial recovery, and sometimes, R"l, the unspeakable occurs.

What all the people I spoke to have in common, however, is their effusive praise for BINA. BINA has been there for them every step of the way and continues to help them with whatever they need. The mother of a brain injured daughter told me that BINA informed her of an advanced therapy program to which she would have had no access because of its astronomical cost; no insurance policy covers this treatment. But the girl had received an accident settlement, so they could pay for the therapy that saved her life and her future.

When the time for shidduchim arrived, the first person this mother called was Mrs. Glustein, who diligently and patiently walked her through any issues, however slight, that resulted from the lingering effects of her accident. Fortunately, with Hashem's help, the path was a short one. This girl, along with many other young brain-injury survivors whose rehabilitation was facilitated by BINA, is now happily married, and the horrendous traumas of her youth are a thing of the past.