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Jack Sisson's TBI Blog

A hug is duct tape for the soul.

 
From PsychCentral:
Nerve cell production in the human brain is directly related to learning and memory, according to a new study from the University of Florida. The findings, published online and in an upcoming print issue of the journal Brain, are the first to show such a link in humans.

Scientists have long observed that new nerve cells generate in the hippocampus, a memory-related area of the brain. Animal studies have shown that an increase in nerve cell production in this area improves memory, while a disruption of new nerve cell generation results in memory loss.

To investigate if these findings applied to humans, UF researchers, in association with colleagues in Germany, studied 23 epileptic patients with differing degrees of associated memory loss. They recorded and evaluated the patients’ memory functions and also studied their hippocampus stem cells removed during epilepsy surgery. Researchers were able to observe if and how these stem cells multiplied and changed into other types of nerve cells.

In patients with normal memory scores, stem cells were able to proliferate in laboratory cultures. However, the stem cells of patients with low memory scores could not generate new cells. These findings demonstrate a strong correlation between the patient’s memory and the ability to generate new cells.

“The study gives us insights on how to approach the problem of cognitive aging and age-related memory loss, with the hope of developing therapies that can improve cognitive health in the aging,” said Dr. J. Lee Dockery, a trustee of the McKnight Brain Research Foundation.

Read the entire article.

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From The Chicago Tribune:
We’ve written a lot about high school athletes and concussions recently, but what about your 8-year-old football player?

He or she could end up in the emergency department because of a concussion, also known as a “mild traumatic brain injury,” according to a new study in the journal Pediatrics.

While the number of sport-related concussions is highest in high-school aged athletes, head injuries among younger athletes are significant and on the rise, said Dr. Lisa Bakhos, the study’s lead author and a pediatric emergency attending at Jersey Shore University Medical Center.

“I think some used to feel concussions (in younger kids) didn’t happen,” said Bakhos. “But with the increasing competitiveness of sport and as our children generally are bigger throughout the country, the numbers are rising.”

The study, one of just a few to look at pre-high schoolers, found that the rate of concussion-related visits to the emergency department was highest in football, hockey and soccer for children between the ages of 8 and 13. It was released on the same day that the American Academy of Pediatrics issued updated guidelines on sports-related concussions.

What surprised researchers was that, overall, the rate of emergency room visits went up between 2001 and 2005, even though participation in the top five organized team sports (football, basketball, soccer, baseball, hockey) went down. This could be due to the increased awareness and reporting, the study noted.

Read the entire article.

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From Mercury News.com:

The first apparent concussion happened sometime during a football game early last season, and Joey De Stefano did his best to ignore it. He kept trying to tough it out, even after another jarring hit in practice the following week left him nauseated and dizzy.

But the effects became so noticeable to his Leigh High coaches in a game 10 days later that they took De Stefano's helmet away so he couldn't leave the sideline. After the game, he couldn't recall where he had parked his car. He didn't even remember who had won the game, and his worried mom took him to the hospital.

As a new high school season kicks off, it does so without De Stefano, a senior who still suffers from headaches and neck pain. He hopes to be a cautionary tale for other teenagers about the dangers of football-related concussions.

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High school football conjures up all-American images of Friday night lights and homecoming games. Nationally, 1.2 million teens strap on helmets each fall.

Another tradition: boys pleading with moms to sign the permission slip to let them play. Football always has been a risky game. But the stakes have risen dramatically with the growing research into head trauma's long-term effects.

"If you had to, you could replace a knee or an elbow or a shoulder," said Dr. Robert Cantu, a leading authority on sports head trauma. "But you can't replace the brain. If you have a permanent impairment to the brain, that's life-altering."

Once downplayed as "having your bell rung," concussions are brain injuries that in some cases, if not treated properly, can lead to dementias and other problems such as depression.

Kids also are more susceptible to concussions than adults, and they take longer to recover. Yet Comstock, principal investigator at the Center for Injury Research and Policy, is alarmed by one study that found 40 percent of high school athletes return to their sport before they have recovered.

Part of that is the nature of the injury -- it is unseen. Then there's the ethos of football. Players are taught, from the earliest age, the importance of adopting a warrior mentality, overcoming adversity and pain, and refusing to let down the team.

Read the entire article.

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On July 26, we posted about The Caregiver's Path To Compassionate Decision Making: Making Choices For Those Who Can't, a new book by Viki Kind, 216 pages, Greenleaf Book Group (July 1, 2010).

Viki Kind is a clinical bioethicist, medical educator and hospice volunteer. Her book, The Caregiver’s Path to Compassionate Decision Making: Making Choices for Those Who Can't, guides families and healthcare professionals through the difficult process of making decisions for those who are losing or have lost the ability to think. She has also been a caregiver for many years for four members of her family.

Viki was kind enough to provide the following post for our blog:

The other day, I helped a woman who was struggling to make the right medical decisions for her husband who had suffered a traumatic brain injury. As a bioethicist, one of the first things I teach caregivers is to use Substituted Judgment. This ethical standard tells us that as the caregiver, you are supposed to consider all that you know about the person, what he or she has told you in the past, and what would be important to the person. Using this information, do your best to make the decision you think the person would make.

If you know the person's preferences or if there are written instructions, then you should follow what was stated. If you aren't exactly sure what he or she would want, ask yourself the following questions:

• What would the patient say if he or she could talk right now?
• Did the patient say anything to you or others in the past that indicates what he or she might want?
• What would the patient say is important to consider when making this decision?
• What personal, religious or cultural beliefs would be important to the patient in this situation?
• If the patient would say, “I want my family involved in making these decisions,” or “I would want to do what my family wants me to do,” then you can add the family’s opinions to the decision making process. If not, you should focus on what the patient would tell you.
• If I don’t know what the patient would say, whom should I ask? Did the person talk to his or her best friend about these issues?
• What do I not want to admit to myself or to the doctors about what the patient would say about this situation?
• What am I afraid to say aloud?
• What would I want, and how is that different from what the patient would want?

Not only will you need to ask yourself what the patient would want, you also need to ask the doctor lots of questions until you have enough information to make an “informed” decision. For a complete set of questions you can use when making medical decisions, go to my resource page on TheCaregiversPath.com.

For now, just remember that it is your responsibility to be fully informed before you make any decisions. After the treatment begins, check in to see how the patient is reacting to the treatment. Is the person doing better? Did the treatment help? Is it making your loved one worse? If the patient is not receiving the proposed treatment, how is she doing without it? If the treatment is not going as it should, you can change your mind and create a new treatment plan.

This is an ongoing process. You will need to continually reevaluate and adjust the plan as the patient’s condition changes. Your job won’t be done with one good decision. Your job as the decision maker is an active one, and you will need to continue to stay in communication with the healthcare team. And be careful. Too often, doctors, patients or caregivers get going in one direction and forget to change course when the plan stops working. Be willing to say, “We need to stop and make a new plan.”

It is a truly heroic act to be the decision maker. I honor and respect the courage it takes to make these difficult decisions.

Have a kind and respectful day.

Look for future posts by Viki in the near future.

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From 24/7 Press Release:
There is rarely such a thing as a non-serious motorcycle accident. When a motorcycle is hit by a passenger vehicle or the motorcyclist loses control because of a weather or road condition, serious injury or even death often result.

If motorcyclists are lucky, they may walk away from an accident with a couple of broken bones and road rash. Many riders, however, suffer a much more catastrophic injury, including a traumatic brain injury (TBI), spinal cord injury, amputation or multiple fractures. These injuries can result in tens of thousands of dollars in medical expenses, multiple surgeries and extended hospital stays. The injured motorcyclist also may require extensive help caring for him or herself, either at a live-in residential facility or at home from a family member or visiting nurse.

Many people do not realize that when a loved one suffers a serious injury, their lives also are going to change. This is particularly true in cases of TBIs and other catastrophic injuries where the person is going to require round-the-clock care. Oftentimes, families cannot afford a nurse to provide this care and must provide it themselves. In order to provide sufficient care, a family member may have to quit his or her job, or switch to a job with less of a time commitment, usually for less pay.

Caring for a loved one with a catastrophic injury can be emotionally difficult as well. In the case of TBIs, the person may undergo severe personality changes and never be the same again. TBI victims can suffer from depression, anxiety and aggression. They also can have trouble concentrating and may lose some of their short-term memory. This can be just as frustrating for the TBI sufferer as it is for the loved ones trying to help him or her deal with the condition.
Read the entire article.

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Jack has Parkinson's Disease. I'm not sure if we've discussed this on the blog before, but in typical Jack fashion, he set out to learn everything he could about the disease, and especially the latest research and treatment options. He says, "I will get a case manager to make sure I get the best consideration to use all that neuroscience offers, and offer myself to PD researchers so as to use what offers promise while I can still function. My talents have given me great satisfaction in many fields, so that I will feel impotent when I cannot function."

One interesting fact that might apply to Jack's case, considering that he suffered a TBI:
Recent research points to a link between damage to the head, neck, or upper cervical spine and Parkinson's. A 2007 study of 60 patients showed that all of them showed evidence of trauma induced upper cervical damage. Some patients remembered a specific incident, others did not. In some cases Parkinson's symptoms took decades to appear.
Thanks to Parkinsons Disease Information at Parkinsons.org for the following information:
Parkinson's disease is one of a larger group of neurological conditions called motor system disorders. Historians have found evidence of the disease as far back as 5000 B.C. It was first described as "the shaking palsy" in 1817 by British doctor James Parkinson. Because of Parkinson's early work in identifying symptoms, the disease came to bear his name.

Symptoms usually show up in one or more of four ways:

* tremor, or trembling in hands, arms, legs, jaw, and face
* rigidity, or stiffness of limbs and trunk
* bradykinesia, or slowness of movement
* postural instability or impaired balance and coordination.

Though full-blown Parkinson's can be crippling or disabling, experts say early symptoms of the disease may be so subtle and gradual that patients sometimes ignore them or attribute them to the effects of aging.

Most people manage Parkinson's with medication, but there are surgical options available (each with its own inherent risks):
* Pallidotomy
* Deep Brain Stimulation (DBS) –
* Thalamic stimulation
* Pallidal stimulation
* Subthalamic DBS
Visit Parkinsons.org for more information.

Jack believes that "this disease will have more progress than any condition because of Michael J Fox, and Sergey Brin, the co-founder of Google who has already shown the value of DNA testing thru 23andme.com."

From Wired magazine's July issue:
Buried deep within each cell in Brin’s body—in a gene called LRRK2, which sits on the 12th chromosome—is a genetic mutation that has been associated with higher rates of Parkinson’s.

Not everyone with Parkinson’s has an LRRK2 mutation; nor will everyone with the mutation get the disease. But it does increase the chance that Parkinson’s will emerge sometime in the carrier’s life to between 30 and 75 percent. (By comparison, the risk for an average American is about 1 percent.) Brin himself splits the difference and figures his DNA gives him about 50-50 odds.
Sergey Brin has so far donated about $50 million to Parkinsons research. But being who he is, he's not after the usual route:
Brin is after a different kind of science altogether. Most Parkinson’s research, like much of medical research, relies on the classic scientific method: hypothesis, analysis, peer review, publication. Brin proposes a different approach, one driven by computational muscle and staggeringly large data sets. It’s a method that draws on his algorithmic sensibility—and Google’s storied faith in computing power—with the aim of accelerating the pace and increasing the potential of scientific research. “Generally the pace of medical research is glacial compared to what I’m used to in the Internet,” Brin says. “We could be looking lots of places and collecting lots of information. And if we see a pattern, that could lead somewhere.”

In other words, Brin is proposing to bypass centuries of scientific epistemology in favor of a more Googley kind of science. He wants to collect data first, then hypothesize, and then find the patterns that lead to answers. And he has the money and the algorithms to do it.

Read the entire in-depth article at Wired.com

You might also visit the Michael J. Fox Foundation for Parkinson's Research for more helpful information abo
ut living with Parkinson's and current research into the disease.

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From The Associated Press:

WASHINGTON — At the height of the Iraq war, the Army routinely fired hundreds of soldiers for having a personality disorder when they were more likely suffering from the traumatic stresses of war, discharge data suggests.

Under pressure from Congress and the public, the Army later acknowledged the problem and drastically cut the number of soldiers given the designation. But advocates for veterans say an unknown number of troops still unfairly bear the stigma of a personality disorder, making them ineligible for military health care and other benefits.

"We really have an obligation to go back and make sure troops weren't misdiagnosed," said Dr. Barbara Van Dahlen, a clinical psychologist whose nonprofit "Give an Hour" connects troops with volunteer mental health professionals.

The Army denies that any soldier was misdiagnosed before 2008, when it drastically cut the number of discharges due to personality disorders and diagnoses of post-traumatic stress disorders skyrocketed.

Unlike PTSD, which the Army regards as a treatable mental disability caused by the acute stresses of war, the military designation of a personality disorder can have devastating consequences for soldiers.

Defined as a "deeply ingrained maladaptive pattern of behavior," a personality disorder is considered a "pre-existing condition" that relieves the military of its duty to pay for the person's health care or combat-related disability pay.

According to figures provided by the Army, the service discharged about a 1,000 soldiers a year between 2005 and 2007 for having a personality disorder.

But after an article in The Nation magazine exposed the practice, the Defense Department changed its policy and began requiring a top-level review of each case to ensure post-traumatic stress or a brain injury wasn't the underlying cause.

After that, the annual number of personality disorder cases dropped by 75 percent. Only 260 soldiers were discharged on those grounds in 2009.

At the same time, the number of post-traumatic stress disorder cases has soared. By 2008, more than 14,000 soldiers had been diagnosed with PTSD — twice as many as two years before.

The Army attributes the sudden and sharp reduction in personality disorders to its policy change. Yet Army officials deny that soldiers were discharged unfairly, saying they reviewed the paperwork of all deployed soldiers dismissed with a personality disorder between 2001 and 2006.

Read the entire article.

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From PR Newswire:

WHITE PLAINS, N.Y., Aug. 11 /PRNewswire/ -- While it has long been known that whiplash can cause injuries to the cervical spine, a new study published in the July issue of the journal Brain Injury, ("Chiari and Whiplash Injury," co-authored by Ezriel E. Kornel, M.D. F.A.C.S., Michael D. Freeman, Ph.D., and others) shows that whiplash may also cause anatomical changes that can result in brain injury.

The study, one of the few to look at the connection between whiplash and brain injury, examined the MRI scans of 1200 neck pain patients and found that those patients suffering from whiplash were more likely to have anatomical changes to the brain resulting in brain injury, specifically, a herniation of the brain called Chiari malformation, in which the bottom part of the brain (the cerebellum) dips through an opening in the base of the skull after a whiplash injury. Preliminary findings showed that brain injury occurred in 23% of the whiplash cases studied.

Read the entire article.

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From the Pittsburgh Tribune-Review:
Veterans Affairs Secretary Eric Shinseki has provided a brief explanation of how $6.3 million targeted for traumatic brain injuries suffered by service members in Iraq and Afghanistan has been utilized.

The explanation, which was immediately labeled as insufficient, was sent to Sen. Richard Burr, R-N.C., ranking member of the Senate Veterans Affairs Committee, and Rep. Brad Miller, D-N.C., chairman of the Investigations Subcommittee of the House Science and Technology Committee.

The money was supposed to go to a now-closed Texas research facility whose director, Robert Van Boven, was fired after charging that $2 million of the $6.3 million had been improperly diverted.

"We're reviewing the VA's response but remain concerned that VA hasn't explained why or how, after seven years, the $6 million Congress appropriated for traumatic brain injury research hasn't been used to conduct that critical research," said David Ward, a spokesman for the senator.

Read the entire article.

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UCLA research has implications for recovery from brain injuries

Many neuroscientists believe the loss of the brain region known as the amygdala would result in the brain's inability to form new memories with emotional content. New UCLA research indicates this is not so and suggests that when one brain region is damaged, other regions can compensate.

The research appears this week in the early online edition of the journal Proceedings of the National Academy of Sciences (PNAS).

"Our findings show that when the amygdala is not available, another brain region called the bed nuclei can compensate for the loss of the amygdala," said the study's senior author, Michael Fanselow, a UCLA professor of psychology and a member of the UCLA Brain Research Institute.

"The bed nuclei are much slower at learning, and form memories only when the amygdala is not learning," he said. "However, when you do not have an amygdala, if you have an emotional experience, it is like neural plasticity (the memory-forming ability of brain cells) and the bed nuclei spring into action. Normally, it is as if the amygdala says, 'I'm doing my job, so you shouldn't learn.' With the amygdala gone, the bed nuclei do not receive that signal and are freed to learn."

The amygdala is believed to be critical for learning about and storing the emotional aspects of experience, Fanselow said, and it also serves as an alarm to activate a cascade of biological systems to protect the body in times of danger. The bed nuclei are a set of forebrain gray matter surrounding the stria terminalis; neurons here receive information from the prefrontal cortex and hippocampus and communicate with several lower brain regions that control stress responses and defensive behaviors.

"Our results suggest some optimism that when a particular brain region that is thought to be essential for a function is lost, other brain regions suddenly are freed to take on the task," Fanselow said. "If we can find ways of promoting this compensation, then we may be in a better position to help patients who have lost memory function due to brain damage, such as those who have had a stroke or have Alzheimer's disease.

"Perhaps this research can eventually lead to new drugs and teaching regimens that facilitate plasticity in the regions that have the potential to compensate for the damaged areas," he said.

While the current study shows this relationship for emotional learning, additional research in Fanselow's laboratory is beginning to suggest this is a general property of memory.

###

Fanselow's PNAS study was federally funded by the National Institute of Mental Health.

Co-authors include lead author Andrew Poulos, a research scientist in Fanselow's laboratory; Ravikumar Ponnusamy, also a research scientist in Fanselow's laboratory; and Hong-Wei Dong, UCLA assistant adjunct professor of neurology and a member of UCLA's Laboratory of Neuro Imaging.

For more information about Fanselow's research, please visit http://fanselowlab.psych.ucla.edu/Main/Home.html.

Press release found at EurekAlert.

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From Live Science:
  • The brain is big.
  • Brains are getting smaller.
  • Brains burn through energy.
  • Wrinkles make us smart.
These are just four of the fascinating facts explained in this article. And if they're not enough to get you interested, how about
  • Women are not from Venus?
Definitely interesting reading.

Read the entire article.

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