Tag Archives: safety

bike fit

Does Your Bike Fit?

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There is a misconception that only competitive cyclists benefit from bike fittings. The truth is that anyone that rides a bike on a consistent basis should ride a bike that fits them properly. Granted, competitive cyclists are looking for every advantage with respect to power and performance. However, fitness and recreational riders can gain the same benefits while also improving comfort and reducing the risk of on-the-bike injuries. Often, a few basic changes to a bike can make a significant difference with respect to comfort, power, endurance and overall performance. In this blog we briefly examine some of the key areas that must be considered to ensure a proper bike fit.

THINGS TO LOOK FOR

Frame Size
Obviously, not all frames are created equal. Frame geometry can vary dramatically depending on material, the manufacturer and overall design. Head tube angles, seat tube angles, top tube length, wheel base, etc. are all factors which contribute to how a bike handles and rides. This is where test riding a bike will pay dividends. For example, having a steep head angle may sound like a good idea to achieve a responsive ride. However, you may find it a bit unnerving on a steep, fast descent or even when you try to take your hands off the bar to eat or drink. With regard to mountain bikes, different suspension and wheel size options also affect the way a bike handles and rides. All are personal preferences that should match your intended use.

For general fit, most manufacturers will have measurements that you can take on yourself to help you decide which frame size will likely be best for you. However, you may also fall within the acceptable range for two different frame sizes. In that case, there is no substitute for going to a shop that carries the bikes and riding them both. In all likelihood, you will quickly feel the difference and easily decide which will work best for you. If you are leaning toward the larger of the two sizes, make sure to check the stand over height before laying your cash on the counter. Keep in mind that your primary concern with respect to frame size is the fit from the waist down. Reach is obviously important as well. However, most upper body adjustment can be achieved by varying bars or stem length/angle assuming the length of the top tube is appropriate.

Crank Arm Length
This is one area where people seem to be content to accept a length simply because that particular crank arm is what they have been told is standard or best. The truth is that many bikes come equipped with crank arms that are too long for the prospective rider. Even when told they should have a shorter crank arm, some feel that if they can push it, they will be a stronger, more powerful rider. This can be a foolish mindset as this can result in knee and/or back problems. Of course, there are also occasions where the crank arms may not be long enough. In this instance, the rider is likely giving away potential power and performance. When deciding on an appropriate crank arm length, we are usually talking about millimeters of difference. However, there are specifications for crank arm length typically based on inseam length and/or seat height.

Cleat Alignment
Pedal choice as well as cleat adjustment are vital components of bike fit. Proper cleat alignment is the starting point for overall fit and essentially aligns the position of the foot in relation to the spindle of the pedal and the crank arm. It can also be one of the most difficult aspects of fit to get accurately established. This is true primarily because it is hard to align your cleat when it is mounted to your shoe which is on your foot and clipped into the pedal. Furthermore, most modern pedal/cleat combinations allow for considerable adjustment with respect to float, rotation, fore and aft, and side-to-side. Equally important is the shoe. People often buy soft cycling shoes that are comfortable on and off the bike. Although these shoes may be more comfortable for walking, you are giving up considerable force production and performance on the bike. Furthermore, on long bike rides, these softer shoes can result in “hot spots” and foot fatigue. Cycling shoes don’t need to be uncomfortable. However, when you are riding a bike, wear the shoe that is made for the job.

Seat Adjustment
This is another area that results in much debate. Do you go higher for better force generation or lower for better control on descents? Once again, improper seat height can result in pain or injury. It can also significantly limit your performance. For most riders, seat height and saddle setback (fore/aft positioning) is crucial for comfort and performance. This is the area where the biggest abuse of the law of averages has befallen bike fit. Seat adjustment is often based on averages and equations. Unfortunately, this is rarely the correct position. Much better than averages are measured angles with the rider on the bike which results in a more exacting fit.

Stem Length/Bar Height
Fitting stem length and bar height should be based on alignment, posture, comfort and performance. These factors can have a great effect on your back, neck, shoulders and wrists.

You may be saying to yourself, “Then tell me how my bike should be set up.” The fact is that an accurate fit cannot be done without looking at the individual on their bike. Many bike fits are based on measurements such as inseam, reach, trunk length, etc. which are then plugged into a variety of equations. Adjustments to the bike are then made according to the resulting numbers. The problem is that these equations often vary and are based on averages. Most of us aren’t average. We all have differing body composition and physique. Strength, flexibility, experience and orthopedic issues all play into proper bike fit. Proper fit must be done with the rider on the bike looking at specific measures and alignments.

Ultimately, a good bike fit is well worth the money and can go a long way toward improving comfort on the bike, improving your performance, and reducing the risk of injury. There are obviously many approaches and “schools of thought” when it comes to bike fit. The point here is that the most accurate fits are accomplished by evaluating you on your bike. Remember, depending on your effort and ability, cycling can be a very intense form of exercise. However, that doesn’t mean you have to hurt. If you have pain on the bike, something is typically wrong. More often than not, the problem can be addressed by improving fit. The bottom line is that you want to be sure the bike you ride is fit specifically to you. You should never be forced to fit yourself to the bike.

Written by Michael Choate, MSPT, USA Cycling Certified Coach at North Lake Physical Therapy & Rehabilitation in Portland, Oregon.

North Lake Physical Therapy & Rehabilitation clinics use progressive techniques and technologies to stay on the forefront in their field. OTheir staff is committed to providing patients with advanced healing techniques. To learn more about them click here.

lower limb amputation

Lower Limb Amputations

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The goal for every patient with a lower limb amputation is to walk normally again.
A patient with a lower limb amputation faces many challenges when it comes to walking safely in a variety of walking surfaces and without exerting excessive energy. Generally, the higher the amputation level, the more we can expect to see gait deviations or difficulty walking. This is because with each segment of the anatomy is lost to amputation, more muscle, sensory receptors and leverage are also lost. A Physical Therapy treatment program can be designed to assist a patient return to a “normal” walking pattern in terms of posture, step length, stability, balance, rate of speed, and limb positioning.

GAIT TRAINING
Almost all patients with a lower limb amputation will benefit from physical therapy and gait training at some point in their recovery to help them return to a more normal walking pattern. Pre-amputation exercises will assist the patient in arm and leg strengthening to help them prepare for using a walker during gait training with their prosthesis. After amputation surgery a prosthetist will work with the patient to fabricate and align a prosthesis to assure that it will optimize the patients walking pattern.

WHAT TO EXPECT DURING PHYSICAL THERAPY

  • The physical therapist will typically work with the patient 3 days per week

  • The physical therapist and prosthetest will remain in close communication with gait training is occurring since any changes in the prosthesis will affect the gait pattern

  • Initially physical therapy is focused on standing and walking with enough stability to ensure safety (this initial gait training is performed in parallel bars with the assistance of the physical therapist holding the patient with a gait belt for additional safety)

  • Initial gait training is supplemented with strength and flexibility exercises for the legs and trunk muscles since strong trunk and leg muscles make it easier to progress the patient’s gait training

  • The physical therapist will also work with the patient to improve balance and coordination to help the patient develop a more normal step length and walking speed

Physical therapists use many different techniques during gait training sessions

leg amputee

LEARNING HOW TO WALK AGAIN
Specialized Treatment Techniques

  • SPLINTER SKILLS: Technique where the walking pattern is broken down into a sequence of events that are practiced individually before putting them all together to build the walking pattern
  • WHOLE WALKING: Technique in which the entire gait pattern is performed all at one time without thinking about the individual components of walking therefore relying on the body’s natural tendency to find the most stable and energy efficient way to walk

BUILDING CONFIDENCE
Once the patient feels confident and the physical therapist believes that it is safe, a walker can be used instead of the parallel bars. When using a walker, the focus will change to helping the patient walk on uneven surfaces such as outdoors and walking around obstacles or stepping up and down stairs.

Even patients who have walked with a prosthesis for years can benefit from gait training for a “tune up” of their walking skills or to learn a new skill such as side stepping, tandem walking or even running.

FCE

Functional Capacity / Work Capacity Evaluation

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What is FCE / WCE Testing?
A Functional Capacity / Work Capacity Evaluation evaluates an individual’s ability to perform work activities post injury or illness. It documents the patient’s current ability from physical, medical, behavioral and ergonomic perspectives. It is within the scope of practice for occupational and physical therapists to provide such testing.

What to Expect
• FCE / WCE s can be used by physicians to complete work status reports. The FCE / WCE identifies the ability of an individual to safely return to work at full, modified or transitional duty
• The patient’s strength for material handling activities are identified via Department of Labor Standards: ex.) sedentary, light, medium or heavy
• An individual’s tolerance to non material activities such as sitting, walking, bending, etc. are quantified as never, occasional, frequent or constant as per Department of Labor standards
• A FCE / WCE will identify discrepancies between symptoms and objective findings
• FCE / WCEs can identify whether further medical evaluation or intervention is appropriate
• It can determine if there is a need for therapy or change in current therapy or direction
• If the individual is not ready for return to their previous job, it can establish a baseline for a work hardening program

Shoulder Stretch

This information provided by Rebound Physical Therapy, an outpatient physical therapy group located throughout Bend, OR. Rebound’s Bend North location specializes in industrial rehabilitation and More information about their industrial rehab center can be found here.

PT News

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This Month in PT News. Featuring articles from PTandMe partnering clinics!

2. Early Intervention is the Key to Success
Written by Ben Eggleston, PTA at the Center for Physical Rehabilitation – Grand Rapids, MI

The relationship between longevity of symptoms and healing time is of reciprocal proportion? Read more

3. Overtraining Doesn’t Help, It Hurts 
Written by the Therapy Team at Momentum Physical Therapy – San Antonio, TX

Working to achieve a sports or fitness goal can drive many people to overtrain in an effort to get stronger, better, faster. Read more

reduce back pain

No Turning Back: Reduce Back Pain with These Spine-Stabilizing Exercises

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We take so many things about our bodies for granted. They feel good, we go about our daily activities and we never think about the complex mechanisms at place. That is until something goes wrong. Take your back: it serves as stabilizer, flexor, movement and relaxor too. But unfortunately, back pain troubles many of us — about 8 in 10 people in their lifetime will experience back pain. But you don’t have to rely on pills to relieve symptoms or even countless trips to a doctor. Exercises offer a proactive approach to reduce back pain, and this graphic can help with ideas.

reduce-back-pain-with-these-spine-stabilizing-exercises-web-1

Increased Risk Zones

Work Related Stress & Increased Risk Zones: Part 1 of 2

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INCREASED RISK ZONES
All Risks Increase with Duration, Frequency and Magnitude.

• Excessive Force

• Repetition of Activity (Can irritate tendons and increase pressure on nerves)

• Awkward Posture (Can compress nerves and irritate tendons)

• Sustained Static Posture (Can restrict blood flow and damage muscles)

• Unsupported Positions

• Motion (Increased speed or acceleration when bending / twisting, can increase the amount of force exerted on the body)

• Compression (Grasping sharp edges like tool handles, can concentrate force on small areas of the body, reducing blood flow and nerve transmission, and damaging tendons and tendon sheaths)

• Inadequate Recovery Time (Overtime, lack of breaks, & failure to vary tasks)

• Vibration of Tools (From vibrating tools, can decrease blood flow, damage nerves, and contribute to muscle fatigue)

• Whole Body Vibration (From driving trucks or operating subways, can affect skeletal muscles and cause low-back pain)

• Effects of Temperature (Cold temperatures can adversely affect a worker’s coordination and manual dexterity while Heat stroke can be very serious as when the body becomes unable to control its temperature, it rises rapidly, the sweating mechanism fails, and the body is unable to cool down.)

• Environment (Slip/Fall hazard-Uneven Floor Surfaces)

• Material Handling Guidelines:
Weight Loading over 50lbs
Lift Speed greater than 5/minute
Vertical Lift Exceeds 3ft
Carry over 1 minute
Sustained Push/Pull over 30 seconds
Static reach holding tasks over 1 minute

Part two of our Work Related Stress & Increased Risk Zones can be found here

work related stress

Sources:
1) Ergonomics: The Study of Work, U.S. Department of Labor, Occupational Safety and Health Administration, OSHA 3125, 2000 (Revised)
2) T. R. Waters, “Manual Materials Handling”, in: Physical and Biological Hazards of the Workplace 2nd. Edited by P. Wald and G. Stave. New York: John Wiley and Sons, 2002.
3) Ergonomics and Musculoskeletal Disorders, Centers for Disease Control and Prevention/ National Institute for Occupational Safety and Health (NIOSH) © Fit2WRK 2015 R.Gagne

winter safety tips

Winter Safety Tips for Children

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winter safety tips for Children PTandMe
When the temperature drops and snow is on the ground, your children can still benefit from some outdoor physical activity. All it takes is a little extra planning to stay safe.

Layer Up!
Infants and children lose heat more quickly due to their size. As a result, they are more likely to suffer from low body temperature, also known as hypothermia. Dressing in layers is a good way to provide your child with added warmth during the winter months. Your child should wear 1 more layer than an adult would wear. Choose fabrics that wick moisture to help pull sweat away from your child’s skin and keep them warm.

Here are some other winter stafety tips to help keep your child safe in the cold:
• Mittens are warmer, but gloves allow your child to use their fingers more. Consider having your child wear mittens over a pair of light gloves.
• Keep your child’s feet warm and dry with 2 pairs of socks.
• Avoid long scarves and drawstrings or ties, which could become a choking hazard. Consider neck warmers or turtleneck garments.
• Choose hats and hoods that do not obstruct your child’s vision.
• Keep a dry set of clothing at school in the event your child’s clothes become wet.

Winter Sport Safety
Winter safety tips for sports such as skiing, skating, snowboarding, and sledding require adult supervision and added safety measures. To help keep your child safe:
• Make sure your child wears a helmet and other protective gear such as wrist guards for snowboarding and a mouth guard for ice hockey.
• Teach your child to be aware of and avoid hazards when sledding such as cars, trees, and ponds.
• Do not allow your child to skate on surfaces until you are sure the water is frozen solid.
• Do not allow your child to wear headphones while playing. Headphones will block traffic or grooming machine sounds.
• Encourage your child to keep moving when outdoors to help generate body heat.

Bring your child inside at the first sign of frostnip—skin that is red, numb, and tingly. Soak your child’s skin in warm water until the symptoms go away. Do not rub the skin. If symptoms do not improve, call your child’s doctor. If your child’s skin becomes white, hard, and swollen, your child may have frostbite. The skin may also burn, tingle, or become numb. If you think your child has frostbite, bring your child inside and put your child in dry clothes. Do not rub the skin, rubbing can cause more damage. Call for medical help right away.

hockey_player

Don’t Skip the Sunscreen
It is possible for your child to get a sunburn in the winter since sunlight reflects off of the snow and ice. Your child should use a sunscreen with an SPF of at least 30. Apply it to your child 20 minutes before going outside and reapply it every 2 hours.

Fuel Up for Fun
Dehydration can contribute to hypothermia. Encourage your child to drink plenty of fluids, especially during vigorous physical activities. Your child will also need to fuel up to generate body heat needed for outdoor play. Provide your child with plenty of healthy snacks such as trail mix, fruit and bread.

When to Play
Freezing temperatures and wind are risk factors for hypothermia and frostbite. Avoid severe cold. Keep an eye on weather forecasts and plan outdoor activities for warmer days without snow or rain.

Following these winter safety tips will allow you and your child to safely enjoy the beauty of winter.

by Cynthia M. Johnson, MA

RESOURCES:
Family Doctor—American Academy of Family Physicians
http://familydoctor.org

Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org

CANADIAN RESOURCES:
Canadian Paediatric Society
http://www.cps.ca

Health Canada
http://www.hc-sc.gc.ca

REFERENCES:

Chillin’ with winter safety. Healthy Children—American Academy of Pediatrics website. Available at: http://www.healthychildren.org/English/safety-prevention/at-play/Pages/Chillin-With-Winter-Safety.aspx. Updated January 19, 2016. Accessed February 11, 2016.

Frostbite in children. Lucile Packard Children’s Hospital Stanford website. Available at: http://www.stanfordchildrens.org/en/topic/default?id=frostbite-in-children-90-P02820. Accessed February 11, 2016.

Keeping kids safe in the cold. American Academy of Pediatrics website. Available at: http://www2.aap.org/sections/schoolhealth/ECarchivenovember11.html. Accessed February 11, 2016.

Sunscreen FAQs. American Academy of Dermatology website. Available at: https://www.aad.org/media-resources/stats-and-facts/prevention-and-care/sunscreens. Accessed February 11, 2016.

Last reviewed February 2016 by Michael Woods, MD Last Updated:10/20/2014

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

For more winter safety tips to keep you out of harm’s way this season check the articles below!

Staying Warm in Winter PTandMe  snow shoveling safety PTandMe  

December 2016 Events

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Check out our Physical Therapy Monthly Events Calendar! Focusing on events from PTandMe.com participating physical and occupational therapy clinics. Read more to find out what’s happening in your community in December 2016!

GEORGIA PHYSICAL THERAPY EVENTS

ROME, GA
DATE: November 23rd – December 16th 2016
Advance Rehabilitation Canned Food Drive
CLINIC: Advance Rehabilitation – Rome
Help Feed the Hungry This Holiday Season.
Advance Rehabilitation is accepting food donations at all locations through December 16th
Pantry Program Needed Items are:
• Canned Vegetables (low sodium or no added salt)
• Canned Fruit (in its own juice or 100% juice)
• Canned Tomato Products (low sodium or no added salt)
• Canned Tuna/Chicken (low sodium)
• Boxed Potatoes
• Boxed/Bagged Stuffing
• Whole Grains
• Brown Rice

All South Georgia locations are accepting donations along with Columbus, GA.
For more information about Advance Rehabilitation, visit them online at http://www.advancerehab.com.

MICHIGAN PHYSICAL THERAPY EVENTS

GRAND RAPIDS, MI
DATE: December 6th 2016, 5:30PM – 6:30PM
CPR Downtown Yoga Classes Begin!
CLINIC: The Center for Physical Rehabilitation – Downtown Grand Rapids
Join the Academy at CPR’s Downtown location for an “All Levels Yoga Class”. Whether you are new to the mat, or an experienced student, this class is designed for everyone to work at their own ability and comfort level. New students will be exposed to basic poses and body positioning, while more experienced student will be challenging their body through variations in poses they have mastered.
For more information about The Center for Physical Rehabilitation, visit them online at http://www.pt-cpr.com.

SALINE, MI
DATE: December 10th 2016, 10:00AM – 1:30PM
Saline Area Chamber of Commerce Treasure Trail to Santa
CLINIC: Physical Therapy In Motion – Saline
The event is the Saline Area Chamber of Commerce Treasure Trail to Santa at the Saline Shopping Center. Children will go on a treasure trail starting at Physical Therapy in Motion, stopping at all of the businesses for a treat, and end at Busch’s to see Santa. Carriage rides, photo booth, and a petting farm will be available. For more information about Physical Therapy In Motion, visit them online at http://www.physicaltherapyinmotion.com/.

NEW JERSEY PHYSICAL THERAPY EVENTS

NEW MILFORD, NJ
DATE: November 23rd – December 23rd 2016
Spread the Warmth Blanket & Jacket Drive
CLINIC: Madison Spine & Physical Therapy – New Milford
Please support the Madison Spine & Physical Therapy charity campaign by donating today! On December 23rd They will drive into NYC with the Donations & Hand Them Out to Those Who Could Use a Little Warmth!
Items needed are:
• JACKETS
• BLANKETS
• BOOTS
• GLOVES
• HATS
• SCARVES
YOU DONATE, MADISON SPINE DELIVERS! Let’s all come together and make a difference! All locations are accepting donations now. For more information about Madison Spine & Physical Therapy, visit them online at http://madisonspinept.com/physicaltherapy.

TENNESSEE PHYSICAL THERAPY EVENTS

PULASKI, TN
DATE: December 8th 2016, 11:30AM – 1:00PM
Sudden Violence: Surviving an Active Shooter
CLINIC: STAR Physical Therapy, LP – Pulaski
Giles County Workforce Employer Outreach Committee invites you to join us for an informative lunch and learn. Lunch Provided by STAR Physical Therapy.
Speaker: Barry Crotzer, Agent – TN Homeland Security
Located at: First National Bank Building, 206 South 1st Street, Pulaski, TN
Please RSVP by Tuesday, December 6th online: https://goo.gl/forms/0ckSzRdplrMv89m13
We look forward to seeing you there!
For more information about STAR Physical Therapy, LP, visit them online at http://www.starpt.com.

MURFREESBORO, TN
DATE: December 14th 2016, 12:00PM – 1:30PM
Sudden Violence: Surviving an Active Shooter
CLINIC: STAR Physical Therapy, LP – Murfreesboro
The WEOC is an ongoing effort by the TN Department of Labor & Workforce Development to reach out to Tennessee employers and provide valuable information to foster economic development and to promote our services. Lunch Sponsored by STAR Physical Therapy.
Speaker: Barry Crotzer, Agent – TN Homeland Security
Located at: Rutherford County Chamber of Commerce, 3050 Medical Center Parkway, Murfreesboro, Tennessee 37129.
Please RSVP by Tuesday, December 12th online: https://goo.gl/forms/qWqCr8LJoPdSk6Ex1
We look forward to seeing you there!
For more information about STAR Physical Therapy, LP, visit them online at http://www.starpt.com.

Physical Therapy Day

World Physical Therapy Day

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World Physical Therapy Day is on September 8th. The day is an opportunity for physical therapists from all over the world to raise awareness about the crucial contribution the profession makes to keeping people well, mobile and independent. This year the focus is on adding years to your life by being physically active! See how a little bit of movement can go a long way!

WPTD2016_infographic_A4_FINAL

To  learn more about World Physical Therapy Day click here.

concussion

True or False: A Person With a Serious Head Injury or Concussion Should Be Kept Awake

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All head injuries should be treated seriously. While most won’t cause lasting effects, if improperly treated, they can lead to long-term disabilities or even death.

The most common type of head injury is a concussion. It is a jarring trauma to the brain that can cause a person to lose consciousness or have amnesia.

What do you do if you are around someone who experiences a serious head injury or concussion? You may have heard that you should not let the person go to sleep, but is this true? Most health professionals don’t think so. It is generally considered safe for people with head injuries or concussions to go to sleep. In some cases, a doctor may recommend waking the person regularly to make sure his or her condition has not worsened.

Evidence for the Health Claim
Many people will go to great lengths to keep a person who has had a head injury from falling asleep. They argue that keeping the person awake will decrease the risk that he or she slips into a coma.

This misunderstanding probably stems from hearing about a rare occurrence known as a lucid interval that has been associated with certain types of severe head injuries. A lucid interval occurs when the initial bleeding in the brain does not cause loss of consciousness. The bleeding eventually worsens and brain structures become compressed. The person’s condition can rapidly deteriorate, requiring emergency brain surgery.

Evidence Against the Health Claim

Most medical professionals say it is fine—sometimes even advised—to let people sleep after incurring a head injury.

The American Academy of Family Physicians states it is not necessary to keep a person awake after a head injury. If a person needs to be watched that closely, a doctor will most likely admit him or her to the hospital. The Dartmouth College of Sports Medicine advises that it is fine to go to sleep after a concussion so long as someone wakes you up every two hours. They are to check to make sure you can be easily awakened and aren’t displaying symptoms of a worsening condition.

In a study in the September-October 2005 issue of the Journal of Head Trauma Rehabilitation, researchers reported greater levels of fatigue in people who have had head injuries, compared with those who have not. The researchers concluded that regular rest breaks and increasing intervals of restful sleep should be a part of the rehabilitation from head injury.

neon concussion

Conclusion
If you are around someone who has a head injury or possible concussion, monitor the symptoms closely. It is important to call a doctor or go to a hospital immediately if the person has worrisome symptoms such as:
• Open wound in the scalp or misshapen deformity of the skull
• Severe or progressive worsening headache
• Changes in behavior (eg, confusion, restlessness, irritability, lethargy)
• Dilated pupils or pupils of different sizes
• Convulsions or seizures
• Difficulty waking from sleep
• Trouble walking or speaking
• Bleeding or drainage of fluids from nose or ears
• Unusual sleepiness or decreasing alertness
• Severe or persistent nausea, or vomiting more than twice
• Weakness or numbness in the arms or legs

When a head injury is serious enough to require medical care, a doctor will give you instructions on how to monitor and treat the injury once the person is released from the hospital or clinic. These instructions will generally not include keeping the person awake and alert.

by Krisha McCoy, MS

More PTandMe articles about concussions can be found here:

concussion physical therapy   concussion treatment

   

REFERENCES:
Head injuries. KidsHealth.org website. Available at: http://www.kidshealth.org/parent/firstaid_safe/emergencies/head_injury.html. Accessed November 5, 2008.

Head injuries: what to watch for afterward. Familydoctor.org website. Available at: http://familydoctor.org/084.xml. November 5, 2008.

Head injury: concussion. Dartmouth College of Sports Medicine website. Available at: http://www.dartmouth.edu/~sportmed/concussion.html. November 5, 2008.

Radiology for traumatic brain injury. Trauma.org website. Available at:http://www.trauma.org/neuro/neuroradiology.html. Accessed July 23, 2006.

Subjective reports of fatigue during early recovery from traumatic brain injury. Journal of Head Trauma Rehabilitation. 2005;20:416-425.

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.