Category: News

It is estimated that 39 million of people in America suffer from migraine headaches. Symptoms usually vary from person to person and often involve various parts of the body (e.g., pain/pressure around eyes, temples, jaw, neck, sinuses, sensitivity to light, noise, nausea, vomiting, appetite loss, dizziness, blurred vision). A migraine attack can seriously affect person’s day-to-day life. It may lead to changes in mood (e.g., irritability), muscle tension/pain, low energy levels, and trouble concentrating. Not surprisingly, the World Health Organization (WHO) recognizes severe migraine attack as a seriously disabling condition. Fortunately, biofeedback can help a person learn skills to reduce the headache frequency and severity by up to 45-60% (American Migraine Foundation).

Common Migraine Triggers

• Emotional/physical stress
• Poor sleep
• Certain foods (alcohol, especially red wine, dairy products, chocolate), sweeteners and preservatives
• Dehydration
• Hormonal Changes
• Certain Medications
• Barometric pressure changes

Biofeedback

Lifestyle changes can help reduce the above triggers for migraines. Biofeedback can also be beneficial, especially as it can help mange stress that often triggers migraine attacks. Our bodies change when we are in pain or stressed.  The heart rate increases, breathing is faster/more shallow, and muscles get more tense. Biofeedback can provide skills to slow your breathing, reduce heart rate, including physical tension so that you can regain control over your body. Here at NRS, we offer biofeedback which can help you manage your migraine more effectively. If you or someone you know suffers from migraine headaches, please contact our office for a consultation.

Basia Andrejko-Gworek, Ph.D.
Clinical Psychology, Post-Doctoral Fellow
Permit# TP #213-03

Part 1 of a 4-Part Series

For many years it was widely believed that the brain’s immune system was separate from the rest of the body, but extensive research has suggested that the two systems are tightly related. While the immune system plays the beneficial role in the normal development and recovery of the brain, it is also a factor in several neurodegenerative diseases and mental conditions that can cause serious and long-lasting harm.

The central nervous system is protected by an elastic covering called the meninges and the immune cells within this membrane. The specialized blood vessels are sealed off from the rest of the body by the blood-brain barrier. However, in the outermost layer of the meninges, the dura mater, blood vessels are not sealed off. Pathways carry slow moving blood which can create a place where harmful cells can easily accumulate and enter the brain. To account for this vulnerability, the immune cells are highly present in the dura mater.

Recent studies have shown that some of the immune cells in the dura mater are trained to fight these infections by spending time in the gut first. These are called IgA cells and are usually found in other barriers such as the mucous membranes, the lungs, besides the gut. Rather than waiting for infection to occur, IgA cells are constantly pumping out antibodies against microbes that they first encountered in the gut.

Neuroimmunology is a field that is often overlooked when it comes down to the quality of an individual’s thinking. While there are the beneficial elements noted above, unfortunately negative consequences can arise that warrant attention as a result of this connection:

• Autoimmune diseases cause the immune system to attack its own cells. A prominent example of an immune attack on the brain is multiple sclerosis (MS), where the cells that normally protect us mistakenly attack myelin (the protective covering around a brain cell) in the central nervous system and cause neuropsychological problems.
• While MS varies from patient to patient, the attacks to the CNS can cause symptoms such as vision problems, muscle weakness (partial or complete paralysis is not uncommon in later stages), tingling, numbness, balance issues, bladder control problems, fatigue, mood changes, and cognitive changes in memory, processing, and organization.

Here at NRS|LS, our board-certified neuropsychologists are prepared to treat you or your family member that maybe affected by impaired neuro-immunity causing a variety of psychological and neuropsychological changes besides the physical symptoms

Part 2 of the Neuroimmunity Series coming soon.

Please call our office for further information.

Julianna R. Greco
Academy of Allied Health and Science

Robert B. Sica, Ph.D.
Board-Certified in Neuropsychology
Founder/Owner, Neuropsychological Rehabilitation Services|LifeSpan

Research indicates the ability to complete everyday tasks declines in people with dementia, causing increased stress in their home environment. Home is the place where people with dementia spend most of their time. Modifying their home environment can help support their sense of independence and reduce anxiety and depression. Below are examples of the changes you can make to your home if you have a family member with dementia:

• People with dementia reportedly do better in rooms with clear functions (e.g., kitchen, dining room). The rooms using open-concept floor plans produce confusion.
• Label drawers, simplify the room, and remove clutter to make it easier for them to find things.
• Automated lighting increases safety.
• Play preferred music during mealtimes to increase food intake in people who have low appetite and forget to eat.
• Make “help yourself” meals instead of giving a person a pre-prepared plate to increase the use of utensils and social interaction.
• Display pictures showing how to brush teeth and use magnifying mirrors in the bathroom to help improve oral hygiene.
• Choose clothing items considering their individual style and cultural preferences and arrange them in order to make dressing easier.
• Place photos and objects bringing happy memories around their room to create a pleasant environment.
• Add easy-to-read digital clocks and keep window curtains open during the day to help them stay oriented to time.

If you have any questions about neuropsychological testing that will define the needs and treatment options for dementia patients, please call our office.

__________________________________
Eleonora Gallagher, Psy.D.
Neuropsychology Post-Doctoral Fellow
NJ Permit: TP# 213-079

“Music can lift us out of depression or move us to tears- it’s a remedy, a tonic, orange juice for the ear. But for many of my neurological patients, music is even more–it can provide access, even when no medication can, to movement, to speech, to life. For them, music is not a luxury, but a necessity.” -Oliver Sacks, neurology professor, best-selling author, and physician

Music is shown to help with mood, cognition, and motor function. In fact, multiple areas of the brain are engaged when we listen to and/or create music, including auditory cortex, prefrontal cortex, motor cortex, amygdala, and hippocampus.

Specifically, for individuals with Alzheimer’s disease or other forms of dementia, familiar tunes can help them recall past experiences as well as enhance cognitive function. According to research, this is due to the connection between music and the hippocampus. Neuroscience News reports, “Music has a unique link to our memories. An old song can transport us back to a specific place and time, evoking vivid emotions.”

Music is often used as a therapeutic tool as it releases dopamine, a neurotransmitter associated with pleasure and reward. To put it simply, it makes us feel good. Research has revealed music therapy has shown promise in treating a variety of conditions, including Parkinson’s disease, depression, stroke, and brain injuries.

In addition, the relaxing properties also help individuals with chronic pain, insomnia, stress, and anxiety. In fact, some music is designed for deep relaxation using specific frequencies and binaural beats.

Lastly, does musical genre matter? Below is a list of different types of music and their benefits:

• Classical: can enhance dopamine secretion and synaptic function, learning, and memory
• Rap: can stimulate emotion, language, motivation, motor function, and processing
• Jazz: can soothe the body
• Heavy Metal: can elicit a sense of identity and a knack for community development
• Pop/Rock: can improve endurance and enhances physical performance

It is a fact: Music shows promise for helping to heal the brain.

Michelle Blose, PsyD
Neuropsychology, Post-Doctoral Fellow
NJ Permit: TP# 203-032

Myth #1: “Stress is all bad and it’s ruining my life.”

From an evolutionary perspective, stress is one of the primary reasons we survived to 2023 as a species. “Stress” is like an elaborate internal alarm system to help us detect potential threats and challenges so that we can problem-solve if necessary. The hormones associated with stress, such as cortisol, are also not inherently harmful and biologically equip us to be productive and goal-oriented. Stress, when managed correctly, can help us rise to life’s challenges and reap the rewards associated with feeling alive and successful.

Myth #2: “All forms of stress are bad for you and I’m probably going to have a heart attack because of it.”

There is no doubt about it – stress CAN be bad for our health, physical and emotional. However, not all “stress” is created equally. Depending on the type of stress you experience, the biological effects can range from benign (barely detectable) to severe (shortening life expectancy). For instance, there is a meaningful physiological difference when the stress that is being experienced is perceived as “in my control” versus “out of my control”. Also, chronic stress (in comparison to acute stress) is significantly more damaging to one’s health, independent of age.

Myth #3: “So the goal is to reduce stress…I have to get rid of stress.”

The emerging science on stress suggests that “stress management” needs some rebranding. Stress management was long equated with messages that people need to eliminate source of stress in their life in order to improve health outcomes and feel happier. But too many people feel stuck when they can’t necessary control what sources of stress exist (for instance, having to be a caregiver for your spouse who just got diagnosed with dementia). Instead, the goal of “stress management” is actually “stress resilience”, which is similar to the idea of equipping yourself with psychological armor to combat stress and bounce back faster physically and emotionally from the effects of stress.

Myth #4: “Just think positively and try to relax…”

Changing one’s attitude about life circumstances is a popular choice for coping and, truthfully, many mental health professionals have supported versions of “positive thinking” for decades. The “fake it until you make it” mentality sounds good in theory but neuroscience studies show that positive thinking and forced relaxation can actually do more harm than good in truly stressful circumstances. Trying to repetitively manufacture a positive outlook when you don’t authentically feel that way drains cognitive resources, which worsens attention, short-term memory, and fatigue. Alternatively, mindfulness-based counseling techniques have promising cognitive and emotional results.

The information above is just a small sampling of the research about modern-day stress and how it affects our psychological and physical health. If interested in learning more about building stress resilience or to get treatment for stress-related issues, contact our office at 732-988-3441 for a consultation with our clinical health psychologist, Dr. Lauren Gashlin.

Those who are educated and trained in forensic (e.g., legal), neuropsychology are often called upon to provide expert neuropsychological testimony.  This frequently occurs in cases of personal injury (e.g., traumatic brain injury) and medical malpractice, and less frequently in cases involving criminal behavior (e.g., attempted murder).  Following a comprehensive, forensic-quality neuropsychological evaluation, the neuropsychologist may be requested by either the plaintiff or defense attorney to provide expert testimony either through a formal deposition or live testimony at trial.

Following the swearing-in process, the neuropsychologist will be asked questions regarding their credentials including their formal education, training, research, areas of specialization, and other aspects of professional development.  The neuropsychologist’s qualifications may be scrutinized by opposing counsel during cross examination.  In any event, this is an important initial part of formal testimony whereby the neuropsychologist has the opportunity to set the stage for being considered an expert and able to render a neuropsychological opinion with a reasonable degree of neuropsychological certainty.

As noted above, formal testimony will begin with direct questioning and examination with regard to the neuropsychological test results, consequences of the case at hand, formulation of clinical opinions, and possible recommendations.  It is imperative that one’s testimony makes sense to the jury and thus, formal discussion should be completed, as much as possible, in layman’s terms and refraining from complex and esoteric terminology.  Undoubtedly, cross examination will be an attempt to refute one’s opinions, often times asking redundant questions in an attempt to derail the neuropsychologists clinical focus and previously addressed conclusions and opinions.  While formal testimony can be an anxiety provoking and daunting task, these concerns can be tempered with excellent preparation including ongoing research and consultation with colleagues.  Below are a number of simple strategies that can be utilized during complex neuropsychological testimony:

• Dress appropriately and professionally; appearance is imperative!
• Remain consistent and persistent with your testimony; don’t allow opposing counsel to change your testimony.
• Remain as calm and cool as possible; never appear angry or hostile during even the most upsetting questioning.
• Prior to questioning, spend as much time as needed with the attorney who issued the subpoena to avoid any misinterpretation regarding your clinical understanding of the case, data interpretation, conclusions, and diagnostic opinions.
• Make sure you have obtained, reviewed, and analyzed ALL records pertinent to the case.
• NEVER testify on an issue or render an opinion without having full knowledge of that information and defense against the potential for hostile questioning during cross examination.
• During your testimony, make sure you make eye contact and address the jury, as opposed to the attorney when answering questions.
• Questions should always be answered in a complete, accurate, and truthful manner and without elaboration.
• Be aware and knowledgeable during the differences between legal and neuropsychological concepts.
• During the preparation phase, it is important that you understand the statistical aspects of the tests administered and data obtained including validity, reliability, and standard error of measurement.  Your knowledge and understanding will in all likelihood combat any potential embarrassing circumstances.
• Choose your words carefully during testimony and avoid irrelevant or prolonged explanations; an over explanation or elaboration of information often leads to unwarranted questioning by opposing counsel.
• Finally, and most importantly, NEVER deviate from the facts of the case or information that had been previously provided in a formal report.

The implementation of a few of these simple strategies during potentially complex neuropsychological testimony might prove beneficial in alleviating some pre-testimony anxiety, nervousness, or other concerns.  While there is no guarantee that the successful implementation of some of these strategies will prevent instances of frustration, they might prove beneficial; time will tell.  The more one testifies the more one feels comfortable; however, even the most experienced and seasoned neuropsychologist will and should experience pre-testimony “jitters.”

For additional information or to schedule a consultation, please contact our office at 732-988-3441.

Michael J. Raymond, Ph.D., ABN, FACPN
Board Certified Neuropsychologist #232
Licensed Psychologist #35S100252900

Tossing and turning in bed at 2 a.m. trying to fall asleep might seem like an impossible dream, but you have more control over a good night’s sleep than you might think.

Researchers have concluded that “healthy sleep” practices and habits – defined as “sleep hygiene” – can help maximize the hours you spend sleeping, despite disrupted sleep due to insomnia, sleep apnea, jet lag, shift work, or any other sleep disorders.

Sleep hygiene is defined as the recommended behavioral and environmental practices that are intended to promote better quality of sleep. They are habits that are essential for both physical and mental health necessary to promote overall quality of life and full daytime alertness.

Following are some simple guidelines for making the sleep of your dreams a persistent reality:

• Avoid stimulants – alcohol, nicotine, caffeine, and other chemicals that interfere with sleep
  • Avoid for 4-6 hours before bedtime
  • Although alcohol may aid with sleep onset, within a few hours it acts as a stimulant causing increased awakening and a general decrease in the quality of sleep
• Turn your bedroom into a sleep-inducing environment
  • A quiet, dark, and cool environment can promote good sleep
  • Your mattress and pillows should be comfortable
  • The room temperature should be between 60 and 70 degrees
  • Keep the lights off!
• Bright light from the television and phone can make it difficult to fall asleep, resulting in a dysregulated sleep cycle
  • Consider using black out curtains, eyeshades, earplugs, or “white noise” machines to promote serenity
  • Keep computers, TVs, and other work materials out of the room to strengthen the mental association between your room and sleep
• Establish a Relaxing Pre-Sleep Routine
  • A smooth transition from wake time to sleep time with a period of soothing activities an hour or so before bed should be considered
  • Take a bath, read a book, or practice relaxation exercises.
  • Avoid stressful, stimulating activities – work, engaging in emotional discussions, and exercising.
• If you cannot fall asleep within 20 minutes, get up from your bed.
• Maintain a regular sleep routine
  • Go to bed at the same time
  • Wake up at the same time
  • Ideally, your schedule should remain the same (+/- 20 minutes) every night of the week including weekends
  • Regular sleep routine sets the body’s “internal clock” to expect sleep at a certain time at night consistently.
• Nap Early – or Not at All
  • Naps decrease the “sleep debt” that is so important for easy sleep onset
  • People, who nap, as a part of their day, find falling asleep or staying asleep though the night problematic
  • If you must nap, it’s best to keep it short and before 4 p.m.
• Exercise Early and Regularly
  • Exercise can assist you falling asleep and sleeping more soundly – if it’s done at the right time and on a consistent basis
  • Exercise before 2 p.m. can help initiate and maintain restful sleep.

Incorporating the tips above in your daily routine can majorly improve your ability to achieve optimal restful sleep. However, not all sleep problems are easily treated and may signify the presence of a sleep disorder.

If your sleep problems do not improve or you find it difficult to accommodate healthy sleep habits, you may want to consult our team at NRS|LS for a consultation and treatment plan.

Mihir J. Shah, Psy.D.
Clinical Neuropsychologist

A person suffering from different forms of dementia places significant pressure upon the spouse, children, and extended family members. Additionally, it becomes confusing when your loved one with dementia is better one day versus another in how they think and behave. What do you do when you are unsure of someone’s capabilities? How can you plan a schedule? How comfortable are you if your loved one with dementia is driving, cooking, handling money, credit cards, and obvious problems are noted?

The NPE is the “blueprint” explaining the patient’s ability to function with regard to activities of daily living, independent living skills, cognition, emotion, and behavior.

Below are some example areas that the NPE can answer:

•  Driving ability.
• Independent activities of daily living.
• Taking care of finances.
• Level of independence.
• Adjusting to unexpected changes.
• Taking care of personal hygiene.
• Remembering locations and work-like procedures.
• Detailed instructions.
• Maintaining a schedule and self-reliance.
• Interacting appropriately with general public.
• Overall summary of level of functioning.

Needless to say, there are many other areas of appraisal that maybe unique to your loved one.  We can answers those for you.

If we can be of help in answering any of your questions and plan a course of treatment for you, please give us a call and schedule a consultation.

Sincerely,

Robert B. Sica, Ph.D., ABN, FACPN
Board-Certified in Neuropsychology # 84, #255
Director, Principal, Neuropsychological Rehabilitation Services|LifeSpan
Fellowship/Residency Supervisor
Jersey Shore University Medical Center, Neuroscience Division
Clinical Assistant Professor, Rutgers-Robert Wood Johnson Medical School
Clinical Assistant Professor, Seton Hall – Hackensack Meridian School of Medicine

Mild Cognitive Impairment (MCI) occurs with a decline in memory and other thinking abilities that are more serious than in healthy aging, but not as severe as in dementia. Although people diagnosed with MCI can take care of their daily chores independently, they still see a decline in their quality of life. Quality of life has to do with physical and mental well-being, mood, and the ability to complete activities of daily living such a taking care of finances and have positive relationships.

MCI can also negatively affect the quality of life of family members, typically spouses and/or adult children who are involved in the care of their loved one with MCI. The most significant challenges for families include uncertainty about whether their loved one’s cognitive abilities (i.e. MCI) will progress to dementia and the potential for a long-term disease, causing anxiety and depression.

According to research, the quality of life in patients and their family members can improve. For instance, multiple patients with MCI and their family members reported that their quality of life improved after receiving counseling focused on adjustment strategies for memory, participating in support groups, receiving cognitive training and wellness education, and participating in yoga.

Here at NRS|LS, we offer an opportunity to get tested for MCI and receive Medical Adjustment Counseling ® and Cognitive Rehabilitation Therapy. If you have any questions, call our office for more information.

_______________________
Eleonora Gallagher, Psy.D.
NJ Permit: TP# 213-079
Neuropsychology Post-Doctoral Fellow

Annually, children age 16 years and younger account for half a million emergency department visits for traumatic brain injuries (TBIs). Several factors such as the patient’s age at the time of the occurrence, severity, comorbidities, and timely access to quality care can drastically affect the short-term and long-term effects of pediatric TBIs and mild concussions. While prognoses can be highly variable, research published in the Journal of Head Trauma Rehabilitation shows that these key factors have been shown to help kids recover both medically and socially:

• Educating healthcare providers, parents, and teachers about the importance of prompt TBI care at the time of the injury.
• Parents should be encouraged to establish a positive family dynamic, attend all medical follow up, and communicate with schools.
• Medical professionals should provide parents with clear documentation of their child’s diagnosis that informs them of any recommendations as well as possible complications their child may experience. They should be instructed to report these documents to their child’s school.  Neuropsychologists are uniquely equipped to spearhead the child’s recovery.
• All children with mild to moderate TBI should receive an evaluation to determine if they would benefit from rehabilitation services, and if so, to what extent.
• Neuropsychological testing is encouraged to characterize the changes that may have occurred and describe how they will affect real world functioning. From here, more recommendations for treatment planning will be established with the child, family, and school.
• Bridging the gap between healthcare and educational care is often overlooked, but the transition back to school can be a very difficult experience for TBI patients. If needed, students should take advantage of specialized support services such as speech therapy, occupational therapy, vestibular therapy, cognitive rehabilitation, and medical adjustment counseling(MAC).
• Students should be gradually reintroduced into their school work and routine. 504 plan most likely will be needed.
• The utilization of child-validated symptom rating scales to target concerns and improve patient care.

Dr. Greco has been serving children in Monmouth and Ocean counties for nearly twenty years.  If your child incurred a concussion and assistance is needed, please call our office as soon as possible.  Timing is key after a concussion.

Sincerely,

Steven P. Greco, PhD, ABN
Board Certified Neuropsychology
Clinical Assistant Professor
Department of Neurology/Psychiatry
Rutgers Robert Wood Johnson Medical School
Seton Hall-Hackensack Medical School