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Jack Sisson's TBI Blog

A hug is duct tape for the soul.


I don't know what's happened. Maybe it's all the attention generated by the number of brain injuries in the Iraq War. Maybe it took a celebrity speaking out (and writing a book), like Bob Woodruff, to finally focus widespread attention on this pervasive condition. But whatever the reason, I can only say it's about time.

If you've been reading this blog for any length of time, you probably know that Jack wants Harvard to do a study of brain injury in the homeless population. He believes, as do I, that TBI is more widespread among the homeless than most people think. He also believes that such a study, coupled with appropriate medical and rehabilitative intervention, could reduce homelessness. And it could serve as a pilot project for other areas across the country to follow.

Another of Jack's concerns is TBI in our prisons. There have been many discussions about the number of brain-injured people on Death Row -- some believe all are brain injured while others acknowledge that most probably are.

In Jonathan Pincus's excellent book Base Instincts, he advances the theory that ethics and morals originate in the brain. Pincus re-tells the story of Phineas Gage, a 19th century railroad worker who sustained significant frontal lobe damage when a tamping iron shot through his head. Gage survived the injury without losing consciousness. Although Gage’s cognitive ability was unaffected – he could still read, write, and do arithmetic -- his behavior, by some accounts, changed dramatically, in ways characteristic of a loss of ethics and/or morals. Phineas Gage, computer generated imageGage began drinking, fighting and carousing, ending his life as a vagrant. The medical museum at Harvard obtained his skull because the idea that a lesion to the brain could affect ethics and morality, especially when cognitive functions were left intact, was quite shocking at the time.

Pincus further theorizes that 3 distinct elements combine to cause violence. The first of these is brain damage. The second is mental illness. And the third is child abuse. Abuse here is defined as treatment that leads to a legitimate and daily fear of injury or loss of life.

Pincus notes than none of these three components by themselves leads to violence; 80-90% of abused children do not commit abuse in adulthood. And we certainly know that only a small minority of mentally ill persons or those with one or more TBIs commit violent crimes. But if some of the violent crimes being committed are caused by a medical condition, does it make sense to put that person in prison? To punish him for having a brain injury or some form of mental illness?

There have been various studies done over the years, but they've been infrequent and, to my knowledge, not much ever came from them. Now, however, the Department of Justice and the Centers for Disease Control are jointly and publicly discussing TBI in prisons, more so than they've done in the past. For example:Of the more than 2 million people in America's prisons and jails, 25% - 87% report having had a head injury or TBI compared to 8.5% of the general population.

As anyone familiar with TBIs know, many of its symptoms can lead to additional problems for sufferers in a correctional facility. Memory deficits, irritability , anger, slowed verbal and physical responses, uninhibited behavior -- if misinterpreted, these can lead to disciplinary action by guards and/or altercations with other inmates. In 2006, the Commission on Safety and Abuse in America's Prisons issued a report recommending increased health screenings, evaluations and treatment for inmates. However, TBI experts and even some prison officials want more, like routine screenings for history of TBI.

We'll be posting more about this major step forward in the coming week, and we'll look at the Justice Department's TBI guide for criminal justice professionals.

If you'd like to read more about Phineas Gage, the Wikipedia site has a long list of additional references.

Someday soon, we're hoping to unveil here at an online forum for discussions of Jack's two major interests -- TBI and the beginning of human life. Until then, if you're interested in reading about or discussing TBI issues within "a secure, reliable support community for people with neurological disorders and diseases," check out NeuroTalk's Traumatic Brain Injury and Post Concussion Syndrome forum.

A sampling of recent discussion topics, copied-and-pasted from the "thread list" (table of contents):
  • TBi Resources-Reports
  • TBi Survival Guide
  • Common Problems following Brain Injury
  • about Post Concussive Syndrome, Mild Traumatic Brain Injury & other Brain Injury
  • Life after TBi ??
  • Can concussions really do this much damage?
  • Videos~ on brain, injury, effects, symptoms, diagnosis & more
  • Brain Injury Symptoms
"Stickies" -- posts and discussions more or less permanently in place -- exist for "Post Concussion Syndrome Useful Links" and "TBI articles, research, & more useful links."

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The number of TBI's caused by injuries in the Iraq War continues to stretch the government's ability to treat them. As the following excellent article points out, no one was prepared for the high number of wounded, kept alive by improved body armor. And no one really knows exactly how many of those wounded are TBI survivors:
Only an estimated 2,000 cases of brain injury have been treated, but doctors think many less obvious cases have gone undetected. One small study found that more than half of one group of wounded troops arriving at Walter Reed Army Medical Center had brain injuries. Around the nation, a new effort is under way to check every returning man and woman for this possibility.
Even with the continuing media coverage of the war's injured, and the recent flurry of interest by Congress, I still don't think the average American's knowledge (or even awareness) of TBI has increased by much. I hope I'm wrong. I know that Bob Woodruff got a lot of press, and that he made the rounds of television talk shows. I suppose we just need to be patient. Change takes time, and it will be a while before people's understanding of TBI increases appreciably. Here's an excerpt from the article:
Orangeburg Times Democrat, June 23,2007 -- These are America's war wounded, a toll that has received less attention than the 3,500 troops killed in Iraq. Depending on how you count them, they number between 35,000 and 53,000.

More of them are coming home, with injuries of a scope and magnitude the government did not predict and is now struggling to treat.

"If we left Iraq tomorrow, we would have the legacy of all these people for many years to come," said Dr. Jeffrey Drazen, editor-in-chief of the New England Journal of Medicine and an adviser to the U.S. Department of Veterans Affairs. "The military simply wasn't prepared for its own success" at keeping severely wounded soldiers alive, he said.
Continue here to read the entire article.

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These are some TBI clinical trials now recruiting:

*Enhancing Performance of Persons With TBI

*Efficacy of Pharmacological Treatment of Working Memory Impairment

*Pharmacological Intervention in Depression After TBI

*Antidepressant Maintenance in Traumatic Brain Injury

Here's a link to the complete list.

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N.Y. Times, June 10, 2007 --
For several years, many medical experts have maintained that high school football players who sustain concussions should not return to the games in which they are injured. So when doctors commissioned by the National Football League published a study two years ago concluding “it might be safe” for such players to do so, the assertion sparked widespread criticism. Now the criticism is coming from authors of the paper itself.

Two of the five authors of the paper published in the journal Neurosurgery, Dr. Henry Feuer of the Indiana University Medical Center and Dr. Cynthia Arfken of Wayne State University, said in telephone interviews last week that the paper’s conclusion was inappropriate, and that the research should not be applied to high school and college players.

Arfken also said the passage had been added without her knowledge.

The two principal authors, Dr. David Viano of Wayne State and Dr. Ira Casson of Long Island Jewish Medical Center, acknowledged that they had altered the conclusion but said that all authors had received proof copies before publication. They said the section in question was added to appease peer reviewers who asked for a discussion of high school and college players, and they continued to stand by what was written.

Arfken and Feuer disavowed the paper’s recommendation that high school and college medical personnel “keep an open mind” about the paper’s analysis of concussions, which deemed safe the league’s record of allowing half of the players with concussions to return to the same game. Arfken and Feuer thereby joined critics who had long claimed that such a suggestion was dangerous for younger players. Their less-developed brain tissue is believed to be more susceptible to short- and long-term damage than adults’. They also receive considerably less medical attention than players in the N.F.L.

Feuer said that he “would change that sentence; I’d eliminate it.” Regarding high school players, he added: “It’s been shown that they don’t seem to recover as fast. Period.”
Continuing reading the article.

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