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Jack Sisson's TBI Blog

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USA TODAY, Gregg Zoroya, November 22, 2007 --Marine Lance Cpl. Gene Landrus was hurt in a roadside bomb attack outside Abu Ghraib, Iraq, on May 15, 2006, and faces medical separation from the Corps. He's also up for a Purple Heart.

Along with 20,000 other veterans, he's not included in the Pentagon's official count of U.S. troops wounded in Iraq and Afghanistan.

That's because Landrus' wound was to his brain and hidden from view. Landrus, 24, of Clarkston, Wash., says he did not realize the nausea, dizziness, memory loss and headaches he suffered after the blast were signs of a lasting brain injury.

Army medics who examined him in the field didn't find the wound either. "They wanted to know if we had any holes in us, or if we were bleeding. We were in and out of there (the aid station) in 10 to 15 minutes," Landrus remembers.

For the balance of his combat tour, he tried to shake off the blast's effects and keep going. Now, "my goal is to get back to a normal life," he says.

A USA TODAY survey of four military installations and the Department of Veterans Affairs, where combat veterans are routinely screened for brain injury, has found that about 20,000 people show signs of damage. They are not counted in the Pentagon's official tally of 30,000 war wounded.

The military lacks "a standardized definition of traumatic injury or a uniform process to report all TBI (traumatic brain injury) cases," Assistant Secretary of Defense Ellen Embrey wrote in a memo last month. As a result, it is hard to determine the scope of the problem, she wrote.

Continue reading article.

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ATLANTA, Nov. 20 /PRNewswire/ -- Georgia is not the place to get long-term help for a traumatic brain injury. Just ask Ben Fuller, the young father in North Georgia who, after being injured in a car accident, impeachforpeace.orghas spent more than two years shuttled between hospitals, unable to return to home. During his odyssey, more than 117 Georgia nursing homes have denied him admission because staff wasn't trained to handle his behavioral issues. More than anything Ben wants to be with his family, yet there are insufficient community services to support him there. He is not alone. Up to 18,000 people are suffering similar fates, according to a new report that evaluates the costs and gaps in care for Georgians with neurobehavioral issues.

The study, "Georgia's Neurobehavioral Crisis: Lack of Coordinated Care, Inappropriate Institutionalizations," reveals the alarming extent to which Georgians with traumatic brain injuries fail to receive appropriate care. The report was conducted by the Brain and Spinal Injury Trust Fund Commission, the state's only funding source dedicated to meeting the needs of people with traumatic brain injury (TBI).

At the heart of the problem is Georgia's lack of a coordinated system of care for people suffering from neurobehavioral issues stemming from TBIs. Too often, people with TBI are not identified and diagnosed properly, do not receive basic rehabilitation and end up in nursing homes, out-of-state programs, state hospitals, prison or become homeless-at tremendous cost to individuals, families and the state. For example, when a person with a severe TBI is sent to a state mental hospital -- at a cost of $178,000 a year - both the person and the facility suffer. The facility is not equipped to provide the type of medical care needed for neurobehavioral rehabilitation.

Continue reading article.

Or read the full story in the Atlanta Journal-Constitution.

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The Atlanta Journal-Constitution, By ANDY MILLER, 11/20/07 --

Room 491, where Ben Fuller lives, has filled with family.

Fuller's parents and older brother are there. His son, Logan, romps about the Floyd Medical Center room, crawling under furniture and playing with an inflated medical glove.

Fuller is slow to react to the action. Sitting in a wheelchair, he stares out into space for long periods of time. His mother asks him occasional questions, and each answer seems a struggle.

The Fullers have spent three frustrating years searching for needed services for Ben, who suffered a traumatic brain injury at 24 that left him prone to profane and violent outbursts. At each turn, they seem to run into roadblocks. It's estimated that thousands of other Georgia families have encountered similar problems.

A new report says Georgia lacks services for patients like Fuller, whose behavioral problems are linked to jarring blows to the head.

An estimated 187,000 Georgians have a disability related to a traumatic brain injury (TBI), and up to 10 percent of those may need ongoing care for TBI-related behavioral problems, according to the report from the Brain and Spinal Injury Trust Fund Commission. Those problems can include physical aggression and an inability to communicate and control emotions.

Because of that, many of those TBI victims end up institutionalized: in jails, prisons, even the state's mental hospitals. Some become homeless.

The absence of a coordinated system of rehabilitative care for these brain injury victims is largely due to a lack of public and private funding, according to the report, which calls the situation "a crisis."

Money is scarce because of a lack of understanding by lawmakers and insurers, experts say. Private insurers, as well as Medicare and Medicaid, "don't see these services as medically necessary," says Susan Johnson, director of brain injury services at Shepherd Center in Atlanta and a commission member.

The report calls for more training and support for caregivers, better screening of TBI-related behavioral problems and more funding for rehabilitation. Often, residential and community services for TBI patients are either too expensive or don't exist. The report also calls for the Georgia General Assembly to look into the state's deficiencies in dealing with traumatic brain injury.

Continue reading the article.

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The New York Times
Published: November 8, 2007

FEELING a little less mentally quick than you did a few years ago? Maybe you are among the many people who do “brain exercises” like sudoku to slow the cognitive decline associated with aging. We’ve got a better suggestion.

Computer programs to improve brain performance are a booming business. In the United States, consumers are expected to spend $80 million this year on brain exercise products, up from $2 million in 2005. Advertising for these products often emphasizes the claim that they are designed by scientists or based on scientific research. To be charitable, we might call them inspired by science — not to be confused with actually proven by science...

...One form of training, however, has been shown to maintain and improve brain health — physical exercise. In humans, exercise improves what scientists call “executive function,” the set of abilities that allows you to select behavior that’s appropriate to the situation, inhibit inappropriate behavior and focus on the job at hand in spite of distractions. Executive function includes basic functions like processing speed, response speed and working memory, the type used to remember a house number while walking from the car to a party...

...Exercise is also strongly associated with a reduced risk of dementia late in life. People who exercise regularly in middle age are one-third as likely to get Alzheimer’s disease in their 70s as those who did not exercise. Even people who begin exercising in their 60s have their risk reduced by half.

Read the entire article.

NOTE: If you're a regular reader of this blog, you know that we've long promoted physical exercise as one of the best things you can do for your brain. Jack himself (81 years old) is proof-positive. He showed tremendous improvement in memory and impulse control after getting back into tennis and playing regularly several times a week. Within a year's time, Jack's friends began to notice the difference. Nothing short of amazing. Please, please get up and move. Walk, ride a stationary bike, play tennis, swim, dance, whatever. Just get that body moving. Brain improvement will follow.

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NASHIA logoThere's almost too much to blog about here -- and there's certainly too much to blog about in detail -- at the page on NASHIA's recent 2007 State-of-the-States conference.

What is NASHIA? It's the National Association of State Head Injury Administrators (and I bet you didn't know there was even one state head injury administrator, let alone a whole national association):
TBI is a complex disability that challenges States’ ability to respond to the needs of persons with TBI and their families. These individuals need services that cross multiple programs including Medicaid, vocational rehabilitation, employment, education, home health care, mental health, substance abuse, and long-term care programs. Without coordinated systems of care, individuals are often placed inappropriately into nursing homes or left to the families to care for without much support or assistance. When families are no longer able to care for these individuals, the families turn to the State, which is generally the only resource for these crisis situations.

In 1990 NASHIA became the first and remains the only forum addressing State government’s significant role in brain injury. NASHIA is the premier source of information and education for State Agency employees who are responsible for public brain injury policies, programs, and services. NASHIA is also the voice of State government in Federal TBI policy issues.

NASHIA reaches out to all State Agency employees who interact with individuals with brain injury and welcomes membership by advocates, professionals, and organizations with an interest in State and local policy and service delivery.
(From the About NASHIA page)

The theme of the September conference this year was "Gateway to Solutions: Doing What Works." Many presentations from the conference are available as (often large) MS Powerpoint files and/or Adobe Acrobat (.pdf) documents.

The first day's presentations focused largely on TBI and the military (a subject which we've covered here regularly). Topics:
  • Veterans and TBI
  • Department of Veterans Affairs
  • The True Welcome Home (Missouri's State Veterans Ombudsman and "Operation Outreach" program)
  • Heart of a Hero
  • States Panel ("how four States have encountered challenges and opportunities in bridging the gap between current systems for veterans with TBI")
Day 2 moved on to some other topics:
  • CDC Update: TBI Resources from the CDC and How You Can Use Them
  • TBI in Jails and Prisons: Ethics and Implications of Screening
  • TBI and Aging
  • Behavioral Issues after Brain Injury: Where To From Here?
  • TBI and the Substance Abuse System
  • Domestic Violence and the Link to the World of TBI
  • Assistive Technology and Employment
  • Having Our Say: Consumer-Directed Services and People with Brain Injury
  • Mining the Online TBI Collaboration Space (TBICS) to Find Publication Gems
  • Homelessness and Acquired Brain Injury: Identification, Needs Assessment, and Case Management
  • TBI is a Community Health Issue
  • Protection and Advocacy Work with Veterans
  • Shaken Baby Prevention Initiatives
...and there were still Friday and Saturday to come!

Visit the NASHIA conference page for links to the presentations themselves. And while you're there, also see their page of information on yet more conferences which they sponsor. Excellent resource.

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The U.S. has some catching up to do. In England, "the Children's Trust wants to raise awareness of acquired brain injury (ABI) among parents and teachers because the effects can be misdiagnosed or just seen as bad behaviour." In launching their campaign, they stated that "some bad behaviour may be a result of an undiagnosed brain injury...the effects can be more noticeable at times of stress, like the move from primary to secondary school. It can affect a child's memory, alter their personality, affect physical skills and reduce their ability to concentrate in class or to develop relationships with peers and teachers."

I'm not aware of any program in the U.S. that seeks to identify ABI or TBI in schoolchildren, although, according to a 2006 CDC study, "The two age groups at highest risk for TBI are 0 to 4 year olds and 15 to 19 year olds." Surely someone has thought of this and there's a program out there that I just haven't heard about. But maybe not. We're only now getting serious about studying TBI in our military (due, of course, to the large number of TBI victims returning from the Iraq War) and in our prisons, two populations obviously at risk.

Where TBI is concerned, seems like we've been content with merely reacting, rather than taking a proactive approach.

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