Finding Your Balance with Dr. Nidhi Shah
Show Notes:
Regaining your balance after sustaining a concussion can be a huge challenge, both in the short and long term. Dr. Nidhi Shah is a New Jersey licensed Physical Therapist with over eleven years of clinical and leadership experience across New Jersey and New York. Today, we speak with her about how physical therapy supports patients in their recovery from PCS. We kick off our episode by learning about Dr. Shah’s background, working with brain injuries, and how this sparked her interest in working with concussions. Next, we dive into the reality of patients often lacking the vocabulary to pinpoint how they are feeling and she introduces us to the five things she addresses post-concussion: physical, neurological, cognitive, emotional, and vestibular factors, with sleep as an additional area of inquiry. Dr. Shah gives us some tips on improving balance from home and urges us to seek professional support in recovery. Finally, we explore the expected recovery period for restoring balance with PCS and Dr. Shah tells us why concussion is oftentimes far worse on teenage girls than boys. Join us for an informative look at the physical aspect of recovering from a concussion today.
Key Points From This Episode:
• An introduction to our guest, Dr. Nidhi Shah.
• How working with individuals with brain injuries sparked Dr. Shah’s interest in concussions.
• The reality of patients being unable to pinpoint how they are feeling.
• Five things to address post-concussion: physical, neurological, cognitive, emotional, and vestibular, with sleep as an additional factor.
• Factors that influence balance: the inner ear, metabolic disturbances, and vision.
• How to diagnose balance issues based on the vocabulary patients use.
• Tips for correcting balance at home: standing and strength-building exercises.
• The importance of seeking professional support.
• Why mental health support and caregiver support are so important.
• The recovery period for regaining balance with PCS.
• Why concussion is worse for teenage girls than boys
Connect with Dr. Nidhi
Website: www.yourmovementspecialist.com
Facebook: www.facebook.com/yourmovementspecialist
Follow Dr. Nidhi on Instagram @yourmovementspecialist
LinkedIn Profile: www.linkedin.com/in/nidhishahpt
Youtube Channel: Your Movement Specialist - YouTube
Webinar about Dizziness after Brain injury: https://youtu.be/QBPetTtnOjM
Transcript - Click to Read
[INTRO]
[00:00:00] BP: Hi. I’m your host, Bella Paige. Welcome to the Post-Concussion Podcast. All about life after experiencing a concussion. Help us make the invisible injury become visible.
[DISCLAIMER]
[00:00:17] BP: The Post-Concussion Podcast is strictly an information podcast about concussions and post-concussion syndrome. It does not provide, nor substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician, or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice, or delay in seeking it because of something you have heard on this podcast. The opinions expressed in this podcast are simply intended to spark discussion about concussions and post-concussion syndrome.
[EPISODE]
[00:01:03] BP: Welcome to today's episode of the Post-Concussion Podcast with myself, Bella Paige, and today's guest, Dr. Nidhi Shah. Dr. Nidhi is in New Jersey licensed Physical Therapist with 11-plus years of clinical and leadership experience across New Jersey and New York. She has received her clinical doctorate in Physical Therapy and a Master's Degree in Neuromuscular Rehabilitation, Cum Laude from Massachusetts General Hospital Institute of Health Professionals.
She has followed her degrees with advanced education in Vestibular Rehabilitation, Parkinson's, as well as concussions from 2012 to 2015. Dr. Nidhi was managing the Joint Commission, certified brain injury rehab program at Encompass Rehabilitation Hospital of Tinton Falls. During this band Dr. Nidhi truly understood the hidden battle that concussion survivors face. She saw the struggles that living with PCS face neurologically, physically, mentally, emotionally, as well as psychologically and dedicated herself to listening too and assisting concussion survivors improve their quality of life through movement.
Dr. Shah’s expertise has helped hundreds of individuals reclaim their lives, through her treatment. Her company specializes in treating individuals with movement disorders, balance deficits, dizziness, visual issues that result from concussions. Over the span of her career, she has been awarded the Marjorie K. Ionta award for Clinical Excellence in recognition of her clinical service at MGH Institute of Health Professions in 2011, a Neuromuscular Specialist in 2014, Operational Excellence Award in 2018, and CEO Award for Patient Satisfaction in 2018, and 2019. Welcome to the show, Dr. Nidhi.
[00:02:58] NS: Thank you so much for having me today, Bella. I appreciate your time.
[00:03:02] BP: To start, do you want to start about, what created your interest in treating individuals with post-concussion syndrome?
[00:03:10] NS: I can't pinpoint one thing, but it was definitely my time working with clients who had brain injury at Encompass. I was managing a program, so I would oversee everybody's outcomes. People with mild TBI, actually ended up facing a lot of long-term issues. Then once you follow up, I used to follow up with them. I got to learn about their struggles and how hard life was and how few – even healthcare professionals really knew everything that they were facing.
Sometimes their problems were actually dismissed, and not taken seriously, by other healthcare professionals. That really caught me and made me realize how much of the need there is, to help these people and make sure they're getting the right treatment and getting the right direction, because it's easy to find a solution, if where the problem is and with post-concussion that's the key. There could be more than one problem we're looking out for, but we need to know where it's stemming from. That's what really made me feel like that would be a great way to help people that are not served by other professionals.
[00:04:26] BP: Yeah, for sure. It's so true, that dismissed feeling, because they can’t see it and trying to explain how you're feeling, sometimes after a brain injury or concussion. It’s really hard to explain it, because you feel so different, like everything is different and trying to pinpoint exactly what's wrong can be really challenging.
[00:04:46] NS: We have this conversation with patients when you're talking about not being able to pinpoint and not being able to express how you're feeling. I have this conversation with most of my concussion patients about vocabulary to use, when you're describing the problem because if you’re not from a medical background, it's hard to have that vocabulary fix. Really describe how you’re feeling. We talk a lot about that too on our evaluation and our treatment.
[00:05:11] BP: That's great. I never had anyone do that for me. That's awesome. It's true, because just saying, “I feel off balance, unstable.” That could mean a million things, “I feel dizzy, that could mean a million things.” Things that, or my problem was, “I had a lot of headaches, so head pain, and I'd be well, the head pain moved all the time.” Trying to explain it was very challenging. Something I read up, when I was looking over, and we talked previously was five things that need to be addressed after a concussion. What are those five things?
[00:05:44] NS: Depends on who is working with the client. If you go to a kidney specialists, they're going to see check the kidneys, obviously. I'm a physical therapist. My job is to make sure I obviously, I look at the physical aspect of the problem. Where the problem is, is it an organic brain issue? Or is it coming from the neck? Or is it coming from somewhere else? I checked, neurological. If it is affecting the brain, exactly how it's affecting the functioning and what's going on that's limited.
The third thing I check is cognitive, if there's any cognitive issue, ongoing, where the patient is feeling they can't remember stuff, or they just feel a brain fog through the day, I try to work through that. We also work emotionally, because actually, that's one of the biggest things with post-concussion that's very misunderstood. That's something that we need to try to ensure we address. The last thing we try to check, well sometimes – I'll tackle, within the neurological, there's a fifth little component, vestibular system.
It's not truly neurological, because it's not the brain. It's right outside the brain. But it's a very important system to check. That's something that is very, very often overlooked. Those are the five components that I will make sure. The last one is sleep too and that I can't do anything about except tell you exercise, and you'll get better sleep. That's another thing to ensure, that is assessed.
[00:07:14] BP: Yeah. Well, that's great. I really liked the emotional component, because that was the last piece of my puzzle to really figure out, was getting through the mental health side of it, because I was doing better physically, but I needed to make that next step, as I've talked about on the podcast before and getting help for my mental health, was that step for sure. Sleep, I find that one's all over the place. I'll sleep great for two weeks, and then I won't, so that one is a whole another issue in itself. Something I really wanted to focus on today, something that I had slight issues with, but it was more if I stood up too quick. I'd almost fall over. It's balance issues in concussion survivors. What causes balance issues?
[00:08:00] NS: To explain what causes balance issues, I'll have to start with explaining where we get our balance from. Balance is basically, like an input-output processing, just like your computer receives inputs and processes the information and sends out the inputs. Similarly, our brain receives the information from our eyes, our inner ears, and the proprioceptive system, or the system of body awareness.
It gets the information and there are centers in the brain that process this information, just like the processing unit on a computer. Then it relays information to your muscles and how we're moving and things like that, just like we see on the monitor the information that we just typed and what we got back. It's like that, how our balance system works. A problem with any of these systems will cause issues with balance, specific to individuals who have survived a concussion, it's very, very common that the metabolic disturbances in the brain that occur due to the injury that messes with the processing of the information, and that causes imbalance or people to feel off balance.
The other one is very often, the trauma of the concussion itself will cause a disturbance within the inner ear. People have concussions not only in the brain, but also in the inner ear, that will cause them to feel dizzy and that's actually one of the indicators that a concussion will take a long time to heal. If you're dizzy at the site of the event, or rather you get injured, if you get dizzy right away, that is one of the strong indicators that say, that you might take a little bit longer to recover.
Then the third thing would be your vision, because if something's off with the vestibular system and the brain, your vision is off and that's definitely going to throw off your balance. The last thing is if you ended up injuring any of your muscles, or if the neurological output towards your muscles is messed up, you're not going to be able to control your balance. It's a combination of factors. Could be any of these, or many of these, too.
[00:10:09] BP: Yeah, I could see that, because so many, I find that's also one of the issues with treating concussions is there's so many factors you're not treating – it's like, I broke my foot twice in one year, and all you had to treat was my foot. Then I had to relearn how to balance after, because I spent so much time on crutches, but like that was – it was just one area, there was no – your balance, and then your eyes and then there's just so many different factors that can affect you and how your health was, before your concussion.
How was your balance before? And then that could affect you too. There's just so many different aspects to it, which I find really fascinating, but definitely explains why concussions, their treatment options are getting better, but they're still definitely need improvement with research. Is there a specific way to diagnose balance issues other than just, I feel like I'm going to fall over?
[00:11:03] NS: How we talk a little bit about the vocabulary. When patients come to me with concussion, I'm just going to give you an example. I have this lady who was in a ski accident. She found me and she told me she was feeling off-balance. Then when we dug in deeper, not only was she feeling off balance, she was also feeling lightheaded, which means when she got up too quickly, her heart rate was going up and her blood pressure was going down, causing her to feel that she was going to pass out, which is different from feeling off balance.
Again, that's the way you use the word, it's hard for a person who's experiencing it. Who has no medical background, or no training whatsoever to explain this, but they're always going to say dizzy or off-balance. She came to me saying she was having difficulty standing up, because she got lightheaded right after. She said that whenever she looked down or climbed up the stairs, she was getting spinning sensations or vertical to be specific. She couldn't walk in a dark room or to the bathroom at night.
Then we basically to test every system, we checked her cardiac system first, to make sure how her body was reacting, because that's another thing with concussions that it messes with how your heart is reacting. Again, anything with the brain, the brain controls everything. If there's something going on with the pituitary, your heart rate’s going to go up and down, you're not going to know why you're feeling that. We checked your cardiac system. Then I checked her vision, she had a deficit with convergence, her eyes aren't converging, so she couldn't see things that were close up, so everything would look double. That made her feel off. She had something called BPPV. I'm sure you've heard of it before. If you haven't, it's basically tiny little crystals in the inner ear that move from their normal location and cause a disturbance in the input that goes into the brain, because of that causes a spinning sensation. She was experiencing that as well. She was a classic example of where all the problems should come from. This is all we test. We test your neck, we test your vision, we test your cardiac system, we test your brain, the cerebellum, all of it. There are tests for each of these. The best way to test it, physical therapist who works with people who have concussions.
[00:13:23] BP: Yeah. I definitely push that to find someone who works with concussions, find someone who's interested in it, because when you're going to someone who is not interested in the field or specializes in the field, you're expecting a lot from someone who doesn't look into it, right. I find that can be really hard and disappointing, because you go there – I've read this online, which is great. If they've never researched into anything related to concussions, it's going to be a big learning step for both of you, instead of just wanting you. I get the lightheadedness. I call lightheadedness. I always feel like – I call it a head rush. It's this, where you stand up and everything goes whoa.
But it's amazing like you said, different terms, same thing. It can definitely affect your ability to get treated and we've talked about it on this podcast before, how one word you have to find other words to describe those simple words, because off-balance –
[00:14:20] NS: If you keep saying, yeah.
[00:14:22] BP: Yeah, it's not enough. It's not enough to get healthy but know that in general, that's how you're feeling. With that, you can find out more about Dr. Shah on your movementspecialist.com which like always will be found in our show notes and description. But we're going to take a break. Be sure to stay tuned for our continued talk on balance.
[MESSAGE]
[00:14:48] BP: I just wanted to say thank you. The podcast is just over six-months-old and I couldn't be happier with the response. If you truly love the podcast. Please consider leaving a tip and our Support the Podcast tip jar, found at the bottom of our episode description. All tips are greatly appreciated, and help cover costs of the show.
[00:15:14] BP: Welcome back to the Post-Concussion Podcast with myself, Bella Paige and today's guest, Dr. Nidhi Shah. So far, we've been talking about balance issues, which can be a really big problem for concussion survivors. I wanted to ask, what can our listeners do at home to help their balance? Anything that specific that they can look into?
[00:15:36] NS: As I told you earlier, it's always good to evaluate where the problem is coming from, because if you don't know where the problem is coming from, you're just going to be throwing shooting darts in the dark. You want to make sure where the problem is coming from. You want to make sure you have the right vocabulary to describe it. Seek professional help first, because sometimes when you try to do things on your own, you're putting yourself a little bit at a risk of falling.
The simplest things that I tell people to do is just work on basic strengthening and basic links of the legs, that's never going to hurt you. Do some standing exercises, and start off with just holding on with one hand and slowly progress yourself to doing it without holding on, and then slowly progress yourself to doing it with your feet close together, slowly progress yourself with eyes closed.
There's ways to progress balance exercises but if you are feeling not so great, you're really fresh out of the concussion, or you've been facing a lot of other issues like if you what you describe a head rush, some people right after concussion actually experienced such a bad head rush, that every time they stand up, they collapse. You don't want to do that, because you don't want more injuries. You have to be a little bit cautious in implementing these things on your own. I'd rather get professional help first, and get their opinion on exactly what you should be doing by yourself, get their opinion on your homework.
[00:17:06] BP: For sure and it's true. I got really bad head rushes to the point where I would, well my vision would blackout, which was a whole different underlying issues. It would not be worth it, I had to get that problem solved first like sometimes there steps before. I had to do that. There's things that people will do at home like when you leave therapy. What about – is it different when you go to therapy? Like is there more advanced training or therapy that you do when you're there? I never really had to do a lot of balance but I've seen people do things with weights. Is there anything that people partake in to help improve their balance? When they come to say, see you?
[00:17:42] NS: Yes, absolutely. A lot of what I do is working with people in balance. Again we find out where the problem is coming from. If it's a similar issue, we address it in that way but most often, it's progressively challenging what you can do and doing more of it. We have equipment, and we make use of techniques that are challenging you to pushing your reserves a little bit more, which if you are by yourself, that would be very, very difficult to do.
Having the supervision, the guarding, and having that mental peace that if God forbid you were to lose your balance someone is there, which makes a huge difference, gives you a lot more confidence. It's always good to seek help from a trained physical therapist, you know Concussion Certified Physical Therapist.
[00:18:31] BP: That's some great advice and the confidence party like, because sometimes your confidence dwindles, when your life changes and all of a sudden. It's really loud to go outside or you go and take a natural normal day, you spend a normal day doing something, and then you pay for it the next day, which is really common.
It's important to create confidence as you start to do things, because if your confidence gets crushed, it can be really hard to overcome it. It happens to a lot of survivors, where so many things have gone wrong in a row. It just seems everything's going wrong, that your confidence is shot to go anywhere. You don't want to leave the house. You don't want to do anything. It's important to do it right first, so that we don't lose that confidence that we are almost losing anyways.
[00:19:19] NS: It's a really challenging time. Again, mental health is so important. Obviously, seeking mental health help early on is always a good way to go about it. Going to healthcare professionals, the doctors and if you're younger, then pediatricians and physical therapists, who know the language and who know how you're feeling, even if it's not specific. They’re more gentler, much calmer and they have a very good way of making you feel comfortable.
That that really helps boost your confidence and that really helps make you feel like, I'm going to get through this. I have help. I have support. Would I do a lot is take the caregiver on the side and explain a lot of times what's going on, because for a parent or a spouse or a loved one to truly understand how you're feeling is impossible next to impossible. Just saying, I just make sure I tell them to ignore, or support and emotional outbreaks or any difficult moments or we tried to provide a lot of caregiver support and that aspect too.
[00:20:27] BP: It's really important, the family aspect is huge to me, because I have a really crazy supportive family like really close siblings, my parents are really close to me. I still had severe depression and things like that. People, sometimes are shocked, they like don't expect it, because they're like, “Oh, well, you have this great family and all the support system.” But sometimes you still need the mental health help, even though it seems you have all this support around you.
It was really hard to explain to them what was going on. It was really hard on them emotionally as well, because I was in pain. Something I posted about before we recorded this was, I didn't like feeling like a burden and telling someone that you're in pain every single day. It was like, you see their face shift, and they try to hold it to prevent it, but you see it anyways. Then you don't want to tell them that you feel bad. There's just so many factors like that. It's really nice that you try your best to help them understand even more, because they do need that to really do.
[00:21:29] NS: Thank you.
[00:21:30] BP: So, when recovering from balance, is it like a slow process? Is it something that usually takes a few months? Like I know, everybody's concussion is totally different. They're all snowflakes, but what can survivors expect when they start?
[00:21:46] NS: Again, it is different and depends on how many concussions you've had. How severe your PCS, if you have PCS, how severe it is? How you react to the training? Some people take it really well. They have symptom provocation for 30 minutes, and then they're off, on the way they take nap and they're good. However, there are some people that have therapy for a day they need to rest the entire day the next day.
Again, it depends on the tolerance, the intensity and severity of the concussion itself. It also depends on gender sometimes, because women end up having worse symptoms than men do, or girls, high schoolers, girls have a harder time, because of estrogen and because of the hormones. Concussion is actually much severe for them than it is for boys. Not to say that the boys will have a hard time, but it lasts longer and takes longer for them.
Even though balance can be improved in five to six sessions, especially if you're doing homework. It depends on how intense, how severe the problem is? Where it's coming from? If it's just a simple neck issue, we can solve it in three sessions. If it is inner ear issue of a similar nerve issue or concussion in the sewer system, it can take anywhere between 12 to 15 sessions. If it's just BPPV, your balance can improve in two sessions. It truly depends on how you are and where the problem comes from.
[00:23:11] BP: I really like that you mentioned that. It's not something we've talked a lot about on the podcast is the gender differences between concussion recovery. It's true, I have a lot more female listeners who reach out to me about having issues than I do male and I understand the estrogen hormone imbalances, because it took me – I spent six, over a year trying to figure out what was the right, what would work for me, because I'd have that one record below, and everything would go wrong, and then I'd be good.
It does take time to figure all that out as well. It's something you don't really think about, because people think men for some reason, because concussions and athletes and people think men instantly, because they think football and hockey. They instantly think of men but they forget that you can get a concussion anywhere to start. It's not just sports. The other thing is, a female athletes struggle more than they definitely do. I agree. So is there anything else you would to add before we end today's episode?
[00:24:15] NS: Nothing Bella, I think you're doing a wonderful job. Thank you for being such a good resource for the people that follow you. I think that this kind of someone out there to support other survivors. Someone who's been through it is so important. Instagram is such a powerful tool, and you're utilizing it in the best possible way. Thank you for all your work.
[00:24:38] BP: Yeah. Well, thank you so much for coming on the podcast and sharing your work with concussion survivors.
[00:24:44] NS: You're welcome.
[END OF INTERVIEW]
[00:24:48] BP: Has your life been affected by concussions? Join our podcast by getting in touch. Thank you so much for listening to the Post-Concussion Podcast and be sure to help us educate the world about the reality of concussion by giving us a share. To learn more, don’t forget to subscribe.
[END]
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