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Jack Sisson's TBI Blog

A hug is duct tape for the soul.

From the Pittsburgh Tribune-Review:

Allegheny General Hospital plans to enroll up to 15 patients in a study to investigate a promising treatment for traumatic brain injuries like the one Arizona Rep. Gabrielle Giffords suffered.

AGH announced this month that investigators from its Neurosciences Institute joined about 100 medical centers worldwide to test whether the hormone progesterone helps decrease brain swelling in patients.

Progesterone is found naturally in men and women, but women secrete more because it is involved in the menstrual cycle and pregnancy. It could explain why Giffords has shown such remarkable progress in her recovery.

"It's long been known that women who have head injuries have better outcomes than men, and the only real explanation are the hormonal differences," said Dr. Jack Wilberger, chairman of the neurosurgery department at AGH.

The study could result in the first-ever Food and Drug Administration-approved medical treatment for severe traumatic brain injury, Wilberger said. Previous trials were disappointing.

"This is the first study in eight years or so because results were so discouraging," Wilberger said.

Researchers believe they know why progesterone is so critical, Wilberger said.

"When progesterone receptors in the brain are activated, they protect the cell membrane, the covering of the cell that keeps it intact," he said. "The swelling develops when that cover breaks down and allows fluid to leak.

"So the hope is that this will protect the cells by shoring up the covering of the membrane of the cell." The study also will examine whether the hormone is more effective if given within eight hours of injury.

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From University of Miami Health System: W. Dalton Dietrich, Ph.D., scientific director at The Miami Project to Cure Paralysis and professor of neurological surgery, neurology and cell biology and anatomy, and Helen M. Bramlett, Ph.D., associate professor of neurological surgery, will serve as principal investigator and co-investigator, respectively, on a new U.S. Department of Defense grant consortium called “Operation Brain Trauma Therapy.”

Dietrich and Bramlett hope to identify and develop drugs that reduce swelling, improve blood flow, limit neuronal damage and prevent cognitive impairments after mild, moderate or severe traumatic brain injury.

“This new program will allow for a well orchestrated attack on traumatic brain injury and will identify new therapies for these devastating injuries,” said Dietrich.

In light of military efforts in Iraq and Afghanistan, finding new ways to treat blast and penetrating brain injuries is becoming increasingly important to military operations throughout the world.Traumatic brain injury also continues to be a major health problem in the United States with approximately 1.5 million cases each year.

Keep reading.

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From the Los Angeles Times:
In the 1946 issue of the Annals of Surgery, U.S. Army Maj. Ralph A. Munslow chronicled in exquisite detail the emergency care of 140 soldiers and civilians who suffered grievous head wounds — mainly from shell fragments — during the 5th Army's 1944 operation to seize and hold a beachhead in Anzio, Italy.

While liberally sprinkling antibiotic sulfa powder, and later penicillin, directly into his patients' gaping head wounds, Munslow meticulously collected all traces of foreign bodies and skull fragments, he reported. Where it was not possible to coax out debris with a magnet, Munslow would poke his finger into the soft tissue in a thorough effort to clean the patient's brain.

It was an approach that prevailed — with refinements — through the Vietnam War and beyond, yielding only in recent years to new discoveries about the dynamics of the injured brain. Today, neurosurgeons are more likely to remove large chunks of intact skull than to vacuum up tiny shards of debris — to give an injured brain room to expand while also leaving it in peace to recover from a violent insult.

"A lot of what was done in the early treatment of Congresswoman [Gabrielle] Giffords are things that would not have been done 20 years ago — even 15 years ago," says Dr. Jam Ghajar, president of the Brain Trauma Foundation and a neurosurgeon at New York-Presbyterian Hospital/Weill Cornell Medical Center.

Military surgeons such as Munslow have long been the nation's principal repositories of wisdom on the emergency care of those with penetrating brain injuries. But as gun violence accelerated in the United States after the 1970s, civilian physicians like Ghajar developed expertise of their own. And both groups were influenced by what neuroscientists were learning about the brain's response to injury.

The result is the widespread adoption of guidelines drafted by the Brain Trauma Foundation in 1995 for the treatment of severe brain injury. As a result, survival has improved among patients who've suffered a blunt or penetrating brain injury severe enough to have induced coma. In 1980, the overall death rate for such patients was 55%, Ghajar says; by 2010, it was just 20%.
Keep reading.

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From NPR:
The head of a congressional subcommittee announced today that she is looking into why the Pentagon's health plan won't pay for veterans with traumatic brain injuries to receive an intensive form of rehabilitation.

Sen. Claire McCaskill (D-MO), chairman of the subcommittee on contracting oversight, said she's starting the inquiry because of troubling questions raised by NPR and ProPublica in a December report about a contract study funded by Tricare, the Pentagon's health plan.

The study found limited evidence of the benefits of cognitive rehabilitation programs. The rehabilitation, which has been used by major medical centers for at least 30 years, is designed to retrain patients' brains to perform basic life functions.

But in a letter to Defense Secretary Robert Gates, McCaskill cited the NPR/ProPublica investigation, which found that scientific experts had questioned the Tricare-funded study in confidential reviews, calling it "deeply flawed" and "unacceptable."

Read the full story about McCaskill's letter at ProPublica's Web site.

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From NPR:
A 2000 study that surveyed 1,090 former NFL players found that more than 60 percent had suffered at least one concussion during their career.

Concussions, a type of traumatic brain injury, generally occur when the head either spins rapidly or accelerates quickly and then stops — like when a player tackles another player on the field. The National Football League and Congress have both held hearings on the head injuries, which can cause memory loss, confusion, nausea, blurred vision and long-term neurological effects, including symptoms of dementia, headaches and concentration problems.

A study commissioned by the NFL in 2009 reported that former NFL players have been diagnosed with Alzheimer's disease or other memory problems 19 times more than the normal rate for men between 30 and 49. And pathologists who have examined the brains of ex-athletes have found signs of chronic traumatic encephalopathy (CTE), a progressive neurological disease that patients get after sustaining repeated head injuries.

Chris Nowinski, who runs a nonprofit organization that raises awareness about concussions, explains how the head injuries continue to damage players years after they've left the field.

Nowinski knows this first-hand. After playing football at Harvard, he became a professional wrestler with World Wrestling Entertainment. His over-the-top personality and penchant for referencing his Ivy pedigree made him a superstar in the ring. In 2002, he was named the "Newcomer of the Year" by RAW Magazine and became the youngest male Hardcore Champion in WWE history.

But Nowicki's wrestling career was cut short in 2003, after he suffered at least six concussions.

Nowinski started reading everything he could about head injuries. He soon realized concussions were a far bigger crisis than anyone realized. In 2006, his book Head Games: Football's Concussion Crisis, helped put the concussion issue on the NFL's radar, after he profiled several players who exhibited symptoms of neurological damage after their playing careers ended.
Continue reading.

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From the Medical College of Georgia:
An old Indian spice and a dye whose cousin makes sports drinks blue are pointing scientists toward better treatment of traumatic brain injuries.

TBIs, the signature wound of the Iraq and Afghanistan wars, occur on football fields and roadways as well when an injured brain swells inside the closed confines of the skull, causing cell damage and symptoms ranging from headaches and confusion to seizures, slurred speech and death.

Medical College of Georgia researchers suspect that one day curcumin – the biologically active ingredient that makes the spice turmeric yellow – and the dye brilliant blue G – or their analogues – may be what doctors order to block the dangerous swelling.

“Today we don’t have good therapies for TBIs, which can mean many good and often young minds are damaged or even lost,” said Dr. Cargill H. Alleyne Jr., Chairman of the MCG Department of Neurosurgery. “We believe these attempts to characterize how edema and secondary injury develop after head trauma will enhance our efforts at prevention as well as identify novel therapies. This may eventually make a big difference for those injured on battlefields, football fields and highways.”

Read the entire article.

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From Minnesota's ABC 6 News at
Congresswoman Gabrielle Giffords continues to improve after being shot in the head.

"This is her... so typical of her. She's in the ICU. You know, gone through this traumatic injury and she spent ten minutes giving me a neck massage. I'm pretty sure she wouldn't do that for somebody else... and she's looking me in the eye," said Mark Kelly.

This is the the first time we've heard from the husband of Congresswoman Gabrielle Giffords since the shooting in Tucson, Arizona ten days ago. Mark Kelly says he's also convinced his wife recognizes him despite the fact she was shot in the head.

Many of us are amazed at Giffords' recovery so far, but it's safe to say she has a very long road ahead of her. But it's a road that others have traveled... including two local residents who continue to fight back from their own traumatic brain injuries.

When Kurt Joblinske was 12-years-old, he was hit in the head with a metal bar.

"I passed out and went into a coma. Well the coma lasted a whole year," said Joblinske

And 46 years later he's still trying to overcome the affects of his brain injury.

Continue reading.

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Patrick Monahan has come home to his mother, Laura Acosta, after five years at a residential facility for brain-injury victims in Carbondale, IL, because his 22nd birthday disqualified him from further state aid. This leaves Acosta with the nearly impossible choice of paying hundreds of dollars a day out of pocket or turning her household inside-out in an attempt to give him constant care.

From the Chicago Tribune:
Eleven years ago, an aneurysm left Acosta's son, Patrick Monahan, with a wounded brain and a dangerous lack of impulse control. He's friendly, funny, a devoted Bears fan, but his behavior is wildly unpredictable. He has heightened sexual urges, the result of a rare syndrome that developed after the brain injury, and cannot be left unattended.

After more than five years at a residential facility for brain-injury victims in Carbondale, Monahan returned to his mother's Chicago Ridge home last week, facing an uncertain future. Though he has the intellectual capacity of a 13-year-old, the state does not classify him as either developmentally disabled or mentally ill, so he has dropped through a crack in Illinois' social services network, losing all the state aid that covered his care for the past decade.

"I'm at my wits' end," said his mother, who along with his stepfather works full time. "I've done everything I can, but the state of Illinois will not help us, and I don't know what we're going to do."

Monahan was seated next to Acosta as she spoke, shaking his head in frustration. He looked up at his mother through wire-rimmed glasses and said, "It's my fault."

Once a jovial kid with aspirations to become a dentist, Monahan was robbed of his future by the aneurysm and several strokes that followed. He is now a grown man, often confused and guilt-ridden by his own actions, most of which he is unable to control.

His mother said her son has never been charged with a crime, though she described several minor acts of vandalism he has committed over the years.

More troubling, Monahan's brain injury led him to develop Kluver-Bucy Syndrome, which causes hypersexuality. Acosta said he has made impulsive attempts to act on his sexual desires, all of which have been stopped before harm could come to anyone. He also receives a monthly shot to help control sexual behavior.

"He can't be left alone," Acosta said. "He's my son, and I want him safe, but I also worry about other people. If he hurt someone I could never live with myself. But I don't know how we're supposed to take care of him."

John Schornagel, executive director of the Community and Residential Services Authority, which helps advise the state on the residential needs of children with severe emotional and behavioral disorders, said that, unlike many other states, Illinois has no lead agency to deal with people who have suffered brain injuries.

And, he said, once people with brain injuries reach age 22 — making them adults in the eyes of the state and not qualified for special education or other youth-focused funding — they are essentially out of luck.

"Some states have shoehorned (patients with traumatic and acquired brain injuries) into their mental health systems," he said. "Other states have shoehorned them in with people with developmental disabilities. What's at the heart of the problem here is that Illinois simply hasn't made a decision about adults with brain injuries that have residential needs. Which agency should have lead responsibility for this? Which agency should fund this?"

Read the entire article.

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From AOL Health:
So you already know that the spare tire around your middle probably isn't good for your health, but it turns out, it isn't good for your mind either.

According to a new study published in Brain Research, having a bigger belly may not only put you at higher risk for chronic conditions like heart disease, it could also be reducing the size of your brain, particularly the areas that control your eating behavior.

A team of researchers at the New York University School of Medicine set out to uncover the impact of obesity on the physical structure of the brain. They used magnetic resonance imaging (MRI) to compare the brains of 44 obese individuals against 19 lean people of similar age and background.

"The study found that obese individuals have more inflammation and smaller brain volume in areas that affect appetite and reward; whereas, lean individuals did not," Dr. Lisa Davis, corporate medical officer for Maryland-based weight loss company Medifast, told AOL Health.

Findings show that obese people had more water in the amygdala, a part of the brain that helps regulate eating behavior. The study also revealed that obese individuals had smaller orbitofrontal cortices, which are important for impulse control and also play a part in feeding behavior.

Davis describes this problem as "fatty brain syndrome."
Continue reading the article.

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From MedGadget: The National Football League (NFL) has announced that they will be launching a pilot program next season in which accelerometers will be placed in players' mouthpieces, earpieces, and helmets to analyze how blows to the head relate to the effects and severity of concussions and other traumatic brain injuries. The data could potentially help team doctors diagnose the severity of a concussion within a few minutes. Collected long-term from groups of players, the impact data could help coaches and doctors determine how players get injured and the possible effects of such injuries. Such data could also help engineers design a better football helmet.

Visit Wired to read more.

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From ABC News:
It is hard to remember how I felt at that very moment when my life changed in an instant. Although I had covered wars for years as a journalist I never really thought about death, let alone traumatic brain injuries.

I didn't know Congresswoman Gabrielle Giffords but my assumption is she never imagined that a gunshot would put her where she is either.

But there is hope.

Like the doctors who saved me almost five years ago, her surgeons knew exactly what to do. Her brain was swelling just like mine. They removed part of her skull on the left side of her head almost exactly like mine, and she is now in a drug-induced coma so that her brain can recover. For me it was 36 days before I woke up.

But in one way her case is more hopeful. She responded to verbal commands by the doctors and reacted by squeezing their finger, indicating she understood, although she could not speak. I never heard the words and never squeezed my doctors' fingers when they tried to get me to respond.

So now Ms. Giffords' family and friends are on the long or short road. When she awakes, which I believe will happen, we will know about her future. No one really knows right now how long that road will be.

Keep reading the article.

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Pima County Sheriff Clarence Dupnik said Arizona U.S. Rep. Gabrielle Giffords was the intended target in the shooting and he described suspect Jared Loughner as one with a criminal record and one with mental issues. Dupnik also said he was "not convinced" that the suspect acted alone, but he declined to elaborate.

Giffords, 40, a third-term Democrat, was shot through the head at shortly after 10 a.m. Saturday morning at a Safeway at Ina and Oracle roads in northwest Tucson. Loughner, 22, is currently in custody. (Initial news accounts and reports from authorities misidentified the name as Laughner.)

Giffords has undergone brain surgery after being shot by a man who opened fire with a handgun when the Congresswoman was holding a public appearance in Tucson.

One of the surgeons who operated on Giffords said afterwards, "I'm very optimistic about her recovery."

We send our prayers and best wishes to Rep. Giffords as she begins her long road to recovery. And we extend our deepest sympathy to those who lost loved ones in this tragedy. God bless you all.

Read more

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Jack believes The Mayo Clinic offers the best opportunity for help with his Parkinson's Disease. With that in mind, I thought we might look at the Mayo Parkinson's site, which is extensive.

It covers Symptoms, Causes, Risk Factors and Complications. Some complications might include depressions, sleep problems, difficulty chewing and swallowing, urinary problems, constipation, and sexual dysfunction.

If you visit the Mayo Parkinson's site, you will find sections on Tests and Diagnoses as well as Treatments and Drugs.

I found Lifestyle and Home Remedies quite interesting. There is also an Alternative Medicine section that discusses topics like Massage, Yoga and Tai Chi.

If, like Jack, you're considering becoming a patient at Mayo, you might want to explore this section of their site. It contains more specific information for potential patients on topics like treatment, appointments, clinical trials, research and patient stories.

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From (Houston Chronicle):
A drug already used in some leukemia patients prevented brain cells linked to Parkinson's disease from being destroyed in mice, a finding that could point to a way to slow progression of the disease, San Antonio researchers are reporting.

The research is early, and the drug used in the experiment doesn't work well in the human brain. But similar drugs are in development that might better penetrate the brain as well as target the specific enzyme at fault more precisely, scientists said.

The results were being published Wednesday in the Journal of Neuroscience.

About a half-million people suffer from the tell-tale tremors and stiffness of Parkinson's, which is caused by damage to the dopamine-producing cells in the brain.

"In Parkinson's disease, we know the number of patients is increasing," said Syed Imam, the lead author of the paper and an adjunct assistant professor of medicine at the University of Texas Health Science Center. "The (current) treatments are mostly to improve symptoms. They do not address how to slow down the disease. Our studies were targeted at whether we could actually slow the progression."

Continue reading.

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