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Jack Sisson's TBI Blog

A hug is duct tape for the soul.

From Science News:
Newborn nerve cells may help heal the brain after a traumatic injury.

In a study in mice, blocking the birth of new neurons hindered the mice’s ability to learn and remember a water maze after a brain injury, researchers from the University of Texas Southwestern Medical Center at Dallas report in the March 30 Journal of Neuroscience. The finding could help settle a debate about what new nerve cells do for the brain and may eventually change the way brain-injured patients are treated.

Although scientists have known for a decade that adult brains can make new neurons in two parts of the brain, the role of the newborn cells has not been clear. Some scientists thought that, in adults, neurogenesis, as researchers call the process of generating new nerve cells, may be a leftover from building a new brain during development and has no affect on the adult brain at all. Others have evidence that the new wiring that hooks up new brain cells sometimes gets tangled and may lead to seizures after a brain injury or in epilepsy. Many researchers have suspected that making new cells is good for the brain, but data to definitely settle the claim has been lacking.

The new study suggests that newborn neurons made in the hippocampus — an important learning and memory center in the brain — are beneficial, at least in aiding recovery after traumatic brain injuries. “It’s clear they are doing something, and that that something aids recovery,” says Jack Parent, a neurologist and neuroscientist at the University of Michigan Medical Center.
Keep reading.

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From WABC TV, New York, NY:
More than 1.5 million people live with Parkinson's disease in the United States. While the disorder tends to be more common in older people, it isn't always the case.

Driving, pouring coffee, and flipping through a book are simple things people take for granted, but for people living with Parkinson's disease they become a big challenge.

Parkinson's disease drastically changed Resa King's life just before her fortieth birthday.

"For me, it was really intolerable. I couldn't really walk because people thought I was drunk," said King. At just 39 years old, King got the news. Her constant shaking and inability to control her own movements was an early onset of Parkinson's disease. Medicine initially offered relief, but the side effects became just as debilitating.

"You take the medication four times a day, so you go through this valley, rising four times a day," said King.

Desperate for relief, King tried deep brain stimulation (DBS).

"The advantage of deep brain stimulation is that you don't take anything by mouth, so it's 'on' all the time. So, the patients don't go into 'on' periods and 'off' periods," said Dr. Helen Bronte-Stewart.

Stanford doctors implanted a pacemaker-like device into King's chest. Wires from there went into King's brain, sending out pulses of electricity that help ease the uncontrolled movements.

Like any brain surgery, there's a risk of infection and hemorrhaging. But after DBS, patients often experience less stiffness and tremors, and most are able to cut the medications in half.
Keep reading.

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During a large-scale study of the socioeconomic costs of this neurodegenerative disease, Danish researchers, some from the University of Copenhagen, discovered that very early symptoms of Parkinson's disease may be revealed in dream or REM sleep.

Parkinson's disease is a best known for the trembling it causes. It is an incurable, chronic disease and gradually affects the muscles and mental capacity, seriously afflicting the lives if the patient and his or her immediate relatives.

"In the study we saw that eight years before diagnosis, Parkinson's sufferers exhibited work and health indications that something was wrong," says Poul Jennum, professor of clinical neurophysiology at the Center for Healthy Ageing, University of Copenhagen, and the Sleep Centre at Glostrup Hospital.

Among the very early symptoms is the sleep disorder RBD, or behaviour disorder. REM is a particular stage of sleep in which we dream, and our eyes flicker rapidly behind our eyelids, hence the term REM, or . To prevent us from actually acting out our dreams the body usually shuts down our muscle movement during REM sleep, but in RBD it is still active, and REM sleepers with RBD display a range of behaviours from simple arm and leg spasms to kicking, shouting, seizing or jumping out of bed.

"In some cases their behaviour may be violent and result in injuries to the patients or their partners," Professor Jennum explains.

"Our is that the very earliest stages of Parkinson's disease show up as various other diseases such as RBD," Jennum says.

Keep reading.

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Here's an excellent article from the San Francisco Chronicle:

Every year, 1.7 million Americans seek medical care for a traumatic brain injury, and countless more never do. Unfortunately, for decades traumatic brain injury has been a silent epidemic, exacting a confusing and heavy burden on patients, their caregivers, employers, families and friends.

That changed when U.S. Rep. Gabrielle Giffords, D-Ariz., survived a gunshot wound to the head and NFL star Dave Duerson committed suicide so his brain could be donated to researchers to assess the consequences of traumatic brain injuries incurred on the gridiron.

The silent epidemic suddenly roared.

The tremendous burden of this disease was revealed, not only for severely injured patients like Giffords and Duerson, but also for athletes, victims of car accidents and children on the playground. Yet traumatic brain injury remains one of the greatest unmet needs in medicine and public health. Why?

Funding for traumatic brain injury by the National Institutes of Health this year is an estimated $85 million out of its $32 billion budget, or less than 0.3 percent -- compared to the $60 billion combined costs of traumatic brain injury in the year 2000 (the last figures to date) for acute care and indirect expenses for lost productivity. Put in context, the amount of dollars-per-patient

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From MedPage Today:

WASHINGTON -- Two members of Congress have introduced legislation that would give companies that make helmets for young athletes nine months to improve safety standards.

If the companies failed to improve their standards, the Consumer Product Safety Commission (CPSC) would be required to set standards aimed at reducing the number of brain injuries sustained by athletes under the age of 18.

The bill was introduced last week in the House by Rep. Bill Pascrell (D-N.J.). who is the co-founder and co-chairman of the Congressional Brain Injury Task Force, and in the Senate by Sen. Tom Udall (D-N.M.). In September, the House passed Pascrell's Concussion Treatment and Care Tools Act, which would establish national protocols to manage sports-related concussions.

"We want our children to be active and athletic, but in the safest possible circumstances right down to the helmets they put on their heads," Pascrell said in a press release from the Kessler Foundation, a charity for people with physical and cognitive disability caused by injuries to the brain and spinal cord. "This bill is the logical next step in Congress' effort to protect our young athletes from brain injuries."

The bill would direct the CPSC to determine within nine months whether the voluntary safety standards for helmet-makers are adequate to result in reduction of the risk of injury. If the voluntary standards are found to be not good enough, the CPSC would have 30 days to set new standards for all football helmets that manufacturers would be required to follow. The bill also would require manufacturers to post warning labels on helmets noting their limited protection capabilities, a date of manufacture, and the date the helmet was last reconditioned.

The bill also would increase potential penalties for using false injury prevention claims to sell helmets and other sports equipment.

A football helmet's ability to protect athletes from injury declines over time as the helmet receives hits. Many football helmets are more than a decade old, the bill said.

Keep reading.

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Vitamin D has gotten a lot of press in the last year or so, ever since researchers decided that Vitamin D deficiency is widespread and seems to be related to many health concerns, including osteoporosis, depression, heart disease and stroke, cancer, diabetes, and more. Now, a new study has linked Vitamin D to Parkinson's Disease.
People with a recent onset of Parkinson’s disease have a higher than average likelihood of having a vitamin D insufficiency, according to researchers from the Emory University School of Medicine.

"Many people don’t consistently differentiate (between vitamin insufficiency and deficiency)," says Marian L Evatt, co-author of the study. "However, most vitamin D researchers would say that that deficiency is a vitamin D level below 20ng/ml and insufficiency is a vitamin D level below 30 ng/ml." These are the figures the researchers used for the study.

As the disease progressed, vitamin D levels appeared to stabilise; whereas 70 per cent of the study participants had vitamin D insufficiency when first affected by the disease, that figure fell to 51% when it had progressed. Similarly, vitamin D deficiency was seen in 26% of patients at onset, and only 7% later on. This, say the researchers, indicates that it might be involved in the manifestation of Parkinson’s disease.
Keep reading.

From Women to Women:

The growing awareness of how much our bodies rely on vitamin D has raised concern that the dietary recommended daily intake values (DRI’s) are woefully obsolete — 200 IU (International Units) a day for adults 19–50 years old, 400 IU for those 51–70, and 600 IU for those over 70. Experts now agree that the DRI’s for vitamin D are way too low, particularly for people who don’t get sufficient sun exposure.

Some studies have shown that adults need 3000–5000 IU per day, and others indicate healthy adults can readily metabolize up to 10,000 IU vitamin D per day without harmful side effects. The European Union’s Scientific Committee on Food lists 2000 IU per day as the safety cut-off, as does the US Food and Nutrition Board. But the latest science strongly suggests most adults should be taking more. What gives? We agree that unless you have testing and monitoring, there is wisdom in keeping the safe upper intake at 2000 IU per day. On balance, the point here is that vitamin D at doses far higher than today’s daily intake values (DRI’s) appears to be safe, to promote optimal health, to reduce the risk of many serious diseases, and even to speed healing for serious health concerns.

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From USA Today: Cutting-edge gene therapy on Parkinson's disease patients significantly improved the tremors, rigidity and other motor skill problems that are hallmarks of the illness, a small new study reports

The phase 2 study enrolled 45 patients with moderate to advanced Parkinson's disease, with half randomly assigned to receive the gene therapy and half assigned to undergo a "sham" surgery, a mock procedure glutamic acid decarboxylase (GAD) gene — which prompts the production of a chemical known as GABA that improves motor control — half experienced "clinically meaningful improvements" of their symptoms within six months of surgery, the study authors said.

Although several open-label trials on gene therapy have shown promise in treating neurologic disease, the researchers noted that this is the first of its type to be confirmed in a follow-up randomized double-blind trial, a study in which neither the investigators nor the patients knew which patients were receiving the real or sham treatment.

"It's a completely novel therapy — unlike anything that's currently offered," said co-investigator Dr. Andrew Feigin, an associate investigator at the Center for Neurosciences at Feinstein Institute for Medical Research in Manhasset, N.Y.

"I think we expected to see this effect, but you never know," Feigin added. "I was gratified."

The study is published online March 17 in The Lancet Neurology.

Continue reading.

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From the Marine Corps Times:

More U.S. troops who sustain combat-related brain injuries could soon be eligible for the Purple Heart.

Senior military leaders at the Pentagon are considering individual service proposals to change the guidelines for awarding the medal to troops who sustain mild traumatic brain injuries or concussions, Military Times has learned. The Purple Heart recognizes U.S. military personnel wounded or killed by enemy action.

It’s not immediately clear whether any new guidelines would allow for Purple Hearts to be awarded retroactively.

Officials from all four services are scheduled to meet this week with Dr. Clifford Stanley, undersecretary of defense for personnel and readiness, to discuss the recommended changes, said Army Lt. Col. Steve Warren, a spokesman for Vice Chief of Staff Gen. Peter Chiarelli, who is leading the Army’s initiative.

“Up to now, he thinks soldiers have received concussions and not received Purple Hearts as they should,” Warren said.

Marine Commandant Gen. Jim Amos ordered the Marine Corps’ review to account for new research indicating the severity of a head wound is not necessarily linked to being knocked unconscious on the battlefield, as current Purple Heart criteria dictate, Marine officials said, noting that in some cases, the long-term effects can be far worse.

The issue, Warren said, is “what is a concussion?” The regulation, he said, awards Purple Hearts for concussions, but “do you have to be knocked out? Does your head have to bleed?”

Marine officials would not discuss details of their proposal.

Read more.

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From The Parkinson's Action Network:
The National Neurological Diseases Surveillance System Act (S. 425) was introduced in the U.S. Senate on March 1, 2011 by U.S. Senator Mark Udall (D-CO), Senate Co-Chair of the Congressional Caucus on Parkinson’s Disease. Sen. Udall was joined as original co-sponsor of the bill by Sen. Bob Casey (D-PA), Sen. Johnny Isakson (R-GA), Sen. Mike Johanns (R-NE), and Sen. Debbie Stabenow (D-MI). The bill will create, for the first time, separate, permanent, and coordinated Multiple Sclerosis (MS) and Parkinson's Disease national registries at the Centers for Disease Control and Prevention (CDC). The registries will rely upon existing databases including Medicare, Veterans Affairs, state registries, and other databases to determine the incidence and prevalence of MS and Parkinson's disease across America. You can help the Parkinson’s community gain support for this important piece of legislation by contacting your Members of Congress.

Why is this Important to the Parkinson’s Community?
We estimate that more than one million Americans are living with Parkinson’s disease, but that figure is just a rough estimate. This lack of core knowledge inhibits Parkinson’s research, treatments, programs, and services. A national neurological surveillance system at the CDC will provide data on the epidemiology, incidence, and prevalence of this progressive, neurodegenerative disease. Better data will fuel scientific inquiry, and will advance our understanding of how to treat and support the Parkinson’s community.

It is our hope that the National Neurological Diseases Surveillance System will facilitate research that may lead to discovery of breakthrough treatments, and one day, cures for Parkinson’s, MS, and many other neurological diseases.

Bill Summary
The legislation will establish a national data surveillance system that will track and collect data on the epidemiology, incidence, prevalence, and other factors of neurological diseases, including Parkinson’s and MS. More.
Keep reading.

"A concussion is a brain injury. Get the facts." That's the message of the Brain Injury Association of America's (BIAA) nationwide education and advocacy campaign. March is Brain Injury Awareness Month, and the BIAA is ramping up its efforts to educate the public about this "misdiagnosed, misunderstood, under-funded neurological disease."
This year’s campaign launches in March with radio and print public service announcements, awareness proclamations and special events. A state advocacy effort to introduce legislation to train coaches and protect youth athletes will continue throughout the year along with ongoing nationwide education.

According to the CDC, an estimated 3.8 million sports- and recreation-related concussions occur in the United States each year. Of that number, U.S. emergency departments treat approximately 135,000 sports- and recreation-related traumatic brain injuries (TBIs), including concussions, among children ages 5 to 18.

To learn more about these initiatives or to learn more about awareness and advocacy events taking place in your state during the month of March and throughout the year and how you can get involved, contact your chartered state affiliate today. For more information on media materials contact the Director of Affiliate Services by e-mail or phone at 703-761-0750, ext. 622.
Find more information on Brain Injury Awareness Month here.

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Artist credit: Sven Geier
If you've been reading this blog, you might already know that Jack is a big fan of 23 and Me, Google co-founder Sergey Brin's firm (co-founded with his wife) which lets people analyze and compare their own genetic makeup. Jack believes that the type of research being done by firms like 23 and Me is going to revolutionize medicine. We will definitely be following this one closely.

From Bloomberg Business Week:

Genetic test makers are defending their fledgling industry and arguing the benefits of marketing their disease-predicting kits directly to consumers before regulators from the Food and Drug Administration.

The two-day meeting will shape the regulation of technology that has attracted millions of dollars in venture capital investments, as well as skepticism from doctors and scientists.

Companies like 23andMe Inc., deCODE Genetics and Illumina Inc. sell saliva-based test kits that attempt to predict the likelihood of developing heritable diseases like breast cancer and Alzheimer's Disease.

The companies have marketed their services to consumers online for years, but in the last year the FDA has begun scrutinizing the technology for the first time.

Keep reading.

Go here to see more of Sven Grier's fractal art.

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Interested in chatting with other TBI survivors?

The Broken Brain - Brilliant Mind blog, operational since 2007, lists five missions on its "About" page. These include numerous objectives familiar to many bloggers on the topic, but my favorite is the last, mission #5:
To celebrate my successful long-term survival from a TBI and show others how I did it... and how I continue to do it, so they can have hope and, in the words of Winston Churchill, "Never, ever, ever give up!"
That really is the key, isn't it?

But it's hard to remember. The biggest hurdle you have to get over when you decide to "never give up": the fear that you're on your own -- that every barrier you encounter, every hoop you must jump through, every trick your mind plays on you, is uniquely yours. You think you must be brave, and you think you must go it alone. Your family and friends, well, you're already putting them through so much, right? Your doctors, physical therapists, and other specialists, true -- you pay them to help you. But realistically, you can't expect them to be on call 24x7, 365 days a year... let alone forever. (And you couldn't afford it, even if they offered.)

So what do you do with the frustration and the fear? Bottle it up?

The best thing to do with it: share it with others who've been there or are on the way. No matter what your problem, TBI or anything else, you are not -- in having that problem -- 100% unique. Someone else has encountered it. Someone else has learned to live with it. Someone has researched it. And even if you're housebound, physically or psychologically, there's always a way to hook up with those people.

BB, of Broken Brain - Brilliant Mind, has an idea whose time is now: an online chat.
The Give Back Traumatic Brain Injury community has a chat feature. Would anyone out there be interested in setting up a time to chat live about TBI recovery?

Sunday mornings (say 9-10 a.m. Eastern Time – GMT-5) are generally good for me. Anybody else interested in chatting at that time next week, Sunday the 13th of March?
You may already know that March is National Brain Injury Awareness Month here in the US. Why not drop BB a line and sign up? Because the first step in truly never, ever giving up is... the first step you take with someone else.

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Popular quote of the day:
Insanity is doing the same thing over and over, in the same way, and expecting different results.
No one seems to know with 100% certainty who said this first. Some say Benjamin Franklin; some -- the largest contingent -- say no, it was Einstein; some ascribe it to Alcoholics Anonymous; and some say no, it was author Rita Mae Brown. No one can point to the author.

I don't know what the answer is. I do know it's a brilliant observation on human nature. And wherever else it applies, it applies regarding brain injury in athletes.

From a recent feature in the Abbotsford (BC) News, about hockey player Michael Funk:
After suffering four concussions in 14 months, the former Buffalo Sabres and Vancouver Canucks prospect has been advised by neurosurgeons and hockey managers that continuing his pro career could be detrimental to his long-term health...

"I don't want to risk the chance of being out of it, of being in that state anymore," he says. "I've been in that state for long segments of my life, and I would never want to be like that for years, or longer."
But: "I've still got my head wrapped around hockey."

And: "As of right now, I'm not done."
It's hard to know where to begin with that sort of thinking.

Surely, as human beings, we have to sympathize with anyone else's frustration about career disappointments, injuries (of any sort) severe enough to jeopardize one's life's work...

But my gosh. Contemplating  a return to the rink after four (haha) "concussions" in a little over a year -- that's not exactly like a professional typist who keeps banging away at the keyboard despite his or her carpal-tunnel injuries, is it?

How many brain injuries is one too many? I always thought the answer was one.

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From ABC News:
Nearly three months after she was shot in the head, Arizona Rep. Gabrielle Giffords is progressing well in her rehabilitation at TIRR Memorial Hermann in Houston, where, according to her doctors, she is receiving a combination of physical, cognitive and speech rehabilitation. They say she is vocalizing more and is able to mouth the words to songs.

While Giffords is getting top-flight care at a facility that specializes in rehabilitation after major brain injuries, many patients get nothing close to it. The fine print in many health plans -- including Medicare and Tricare, which serves U.S. military members -- excludes coverage of certain types or even complete rehabilitation for thousands of patients with traumatic brain injuries, or TBIs.

"Cognitive rehabilitation services designed to improve cognitive functioning after a brain injury are not supported by reliable scientific evidence of efficacy," according to a 2008 Tricare coverage manual.

However, the manual stated that cognitive rehabilitation is subject to coverage if cognitive rehabilitation is combined with other forms of rehabilitation and "not billed as a separate service."

But the Brain Injury Association of America, a non-profit group that advocates on behalf of people with brain injuries, says studies have shown that cognitive rehab is very effective.

Experts say that despite the promising research, insurance companies provide little coverage for long-term rehabilitation, leaving many TBI patients with almost nowhere to turn to get the services they need for recovery.

"Increasingly, insurance companies are saying to health care providers, 'Don't talk to the patient about where he or she should be discharged until you talk to us first. Don't recommend a comprehensive rehab center if we don't cover it,'" said Susan Connors, president and chief executive officer of the Brain Injury Association.

Keep reading.

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From The New York Times: Efforts to outlaw fighting in hockey go back decades. But though the number of fights in the N.H.L. has dropped significantly in recent years, fighting persists, preserved by the idea that it is a deterrent against cheap shots, a safety valve against more serious mayhem and something that fans like to watch.

This core belief in the value of fighting may prevent the league’s general managers, when they meet this month in Florida, from reacting decisively to the latest research findings, including the determination announced Wednesday that the longtime enforcer Bob Probert had chronic traumatic encephalopathy, a degenerative disease of brain tissue associated with repeated concussions.

Probert, who retired in 2002 after a 16-year career with the Detroit Red Wings and the Chicago Blackhawks, died last year at 45.

At least three N.H.L. players have sustained concussions this season as a result of fighting, and Commissioner Gary Bettman has acknowledged that concussions from fighting are one reason for a slight uptick in reported brain injuries this year over years past.


Dr. Michael Stuart of the Mayo Clinic, the chief medical officer for USA Hockey and an expert on head trauma, said he was not surprised that fighting carries an increased risk of concussion.

“You’re punching each other in the face,” Stuart said. “The objective of boxing is to cause traumatic brain injury — to knock your opponent out. So when big, powerful people fight on skates, it’s not unexpected that somebody may sustain a concussion.”

Keep reading.

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Photo credit: All Diet Reviews
People who follow a Mediterranean diet have lost weight and experienced a drop in blood pressure, blood fats, blood sugar and insulin levels, and these health benefits offer a longer life expectancy compared to people who are on a typical Western diet. Recent research showed that people who choose to follow a traditional Mediterranean diet are less likely to develop depression.

From the Press Citizen: Picture a meal of tomatoes with garlic and basil sautéed in olive oil served over pasta, vibrant salad greens drizzled with olive oil vinaigrette, crusty bread and a glass of red wine. The flavors and aromas of the Mediterranean -- as well as the colors -- engage our senses.

Much evidence points to the benefits of eating a wide array of plant foods in a spectrum of colors. For more than 50 years, scientists studying the Mediterranean eating pattern have supported it for its healthy outcomes. One recent review published in the American Journal of Clinical Nutrition found a Mediterranean eating pattern has a protective effect against chronic diseases such as cardiovascular disease, stroke, cancer, Parkinson's disease and Alzheimer's disease. Another review published in Diabetes Research and Clinical Practice found a Mediterranean eating style to be associated with reduced risk of type 2 diabetes.

Keep reading to find out what makes up a Mediterranean diet.

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