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Jack Sisson's TBI Blog

A hug is duct tape for the soul.

From The Stars & Stripes:

The Army on Friday issued a directive clarifying standards for awarding the Purple Heart medal to soldiers with mild traumatic brain injury.

The instruction follows a recent change by the Marine Corps that removed the requirement that Marines be knocked unconscious to qualify for a Purple Heart for TBI, a potentially debilitating condition often caused by blasts.

The Army did not explicitly require loss of consciousness to qualify, but Pentagon officials said there has been uncertainty over the medal standard throughout the services.

To qualify, the announcement said, soldiers must have required treatment from a medical officer – even if one was not available – for concussion, loss of consciousness, memory loss or other symptoms of mild TBI. Types of treatment that would meet the standard for the award include limitation of duty and administration of pain medication.

For soldiers who want to be reconsidered for the medal, instructions for applying retroactively for the Purple Heart medal were issued in Milper Message 11-125 and were expected to be posted soon on the Army Human Resources website at:

Read original article.

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From The Republic:

Growing awareness of the toll that concussions and traumatic brain injuries reap on battlefields and playing fields is drawing new ideas from researchers across many disciplines.

One of the greatest challenges for those treating soldiers, athletes or other trauma victims is simply determining whether a brain injury has taken place.

Most concussion symptoms -- dizziness, nausea, lack of focus -- can also be caused by other medical conditions, making it difficult for athletic trainers or medics to take the next steps toward diagnosis and treatment of an injury that affects more than 1 million Americans each year.

Even brain-imaging tests done after a concussion may not reveal damage from a mild brain injury, particularly if there is no earlier image for comparison.

Now a team of doctors and engineers at the University of Pennsylvania has developed a "blast badge" that changes color in a spectrum that reflects the intensity of an explosion to which a wearer has been exposed.

Made of color-changing crystals designed to break apart when exposed to shockwaves of differing strengths, the badges are lightweight, durable and require no power, yet flexible enough to be attached to uniforms or helmets in thin sheets.

At this point, the scientists have demonstrated that the material will react to explosive shockwaves. Next, they will be working to calibrate color changes to correspond to the potential harm a certain level of blast might cause to the brain, and what kind of medical response might be needed.

The work was published in a recent issue of the journal Neuroimage.

Continue reading for more developments in TBI research.

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From the Huffington Post:
A study from Denmark's Center for Healthy Ageing and the Danish Center for Sleep Medicine, among other places, explains how dreams may hold the clue that people may be on track to develop Parkinson's. Researchers found that one of the earliest symptoms of Parkinson's may be a REM sleep disorder known as REM Sleep Behavior Disorder (RBD). There are a few things that happen with RBD:
  • Usually when we sleep, the body shuts down our muscle movement during REM sleep so that we can't act out our dreams
  • In people with RBD, this shut-down doesn't happen
  • In this case, people have dreams that are very vivid and violent, compelling them to talk, punch, kick, scream, and even jump out of bed.
  • Interestingly, RBD is usually seen in middle-aged to elderly people, and is more likely to happen in men than in women.
This highly active dreaming can appear up to eight years before the onset of other symptoms of Parkinson's, so researchers are eager to see if they can use this to help patients before the disease becomes too severe. The next step is for scientists to see if RBD is always a sign of Parkinson's or if active dreaming could be a benign trait.
Read entire article.

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From MedScape Today:
Despite the fact that depression after traumatic brain injury (TBI) affects up to 30% of patients — or approximately 360,000 individuals annually — an extensive analysis reveals a stunning lack of research into effective treatments.

In the systematic analysis, funded by the Agency for Healthcare Research and Quality (AHRQ), Melissa McPheeters, PhD, and colleagues from the Vanderbilt Evidence-Based Practice, Vanderbilt University Medical Center in Nashville, Tennessee, found that of 112 studies included in the meta-analysis only 2 studies addressed treatment for depression after TBI, and of these, only 1 was a randomized controlled trial.

"Clearly, we don't have nearly enough information about how to identify depression in this specific population of patients, and we certainly don't have enough information about treatment," Dr. McPheeters told Medscape Medical News.

According to the study, TBI is responsible for more than 1.2 million emergency department visits a year — a statistic that does not include TBI incurred during military service. In addition, this is likely an underestimation because many individuals with mild TBI do not present to the emergency department. The Centers for Disease Control and Prevention estimates that up to 75% of TBI is "mild."
Keep reading.

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From U.S. News and World Report: Nearly one-third of people who suffer a traumatic brain injury (TBI) will experience depression after the injury, a new study finds.

A team at Vanderbilt University Medical Center analyzed existing research on blunt force trauma head injuries suffered by civilians in traffic accidents, falls, sports and assaults.
Click here to find out more!

"Any patient who has a traumatic brain injury is at a real risk for developing depression, short and long term," study co-author Dr. Oscar Guillamondegui, an assistant professor in the trauma and surgical critical care division, said in a medical center news release.

"It doesn't matter where on the timeline that you check the patient population -- six months, 12 months, two years, five years -- the prevalence is always around 30 percent across the board."

The rate of depression in the general population is about 9 to 10 percent, Guillamondegui said.

Each year, U.S. hospital emergency departments treat 1.2 million cases of traumatic brain injury. These findings suggest that about 360,000 of those patients will suffer depression after their head injury.

The study authors said their findings about the high rate of post-injury depression are especially important considering the lack of research on whether antidepressants are a safe and effective treatment for brain-injured people.

Keep reading.

The U.S. National Institute of Neurological Disorders and Stroke has more about traumatic brain injury.

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Have you ever heard of NPH, or normal pressure hydrocephalus? I hadn't, so I found this report from ABC 30 in Fresno, CA, very informative:
This year, tens of thousands of Americans will face a devastating diagnosis, Parkinson's disease, Alzheimer's, or dementia.

But doctors now say sometimes when people think they have one of these debilitating diseases; their brains are really saying they have something else -- a neurological disease that affects one in every 200 adults over age 65.

"I couldn't walk properly, I couldn't keep my balance." Ramona Luckman, who was diagnosed with Parkinson's, told Ivanhoe. "You start to feel like your feet are attached to the floor, and you can't pick your feet up. I couldn't get my words out."

In 2007, a doctor told 69-year-old Ramona Luckman her symptoms added up to one thing -- Parkinson's.

"That just threw me for a loop, and I started to cry," Ramona said.

But two agonizing years later, CT scans confirmed Ramona didn't have Parkinson's at all. It was NPH -- normal pressure hydrocephalus. NPH is a buildup of cerebral spinal fluid that enlarges the ventricles -- those black spaces you see in the brain.

"They believe that the symptoms are a result of the expansion of these fluid-filled spaces," Joseph Zabramski, M.D., neurological surgeon at Barrow Neurological Institute explained.

Although symptoms of NPH can mimic Parkinson's, dementia or even Alzheimer's, treatment for this neurological disorder is very different. A programmable shunt was placed in Ramona's brain. It drains about a cup of fluid a day through a long tube into her abdomen.

"What happens is when you start to drain the fluid, the patient'ssymptoms dramatically resolve," Dr. Zabramski said.

It worked," Ramona said. "I feel that I've got about 85 to 90 percent of my abilities back."

Now, with a steady hand and an eye for every detail, Ramona is healthy, happy and back in control.

More than 750 thousand Americans may be living with NPH with many of those unaware they are affected. Studies have shown about five percent of dementia is actually caused by NPH -- not Alzheimer's. Although NPH can occur at any age, it's most commonly seen in adults over age 60.

If you would like more information, please contact:
Carmelle Malkovich, Public Relations
Barrow Neurological Institute
(602) 406-3319
Link to original article here.

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From MedScape Today:
Results of a randomized trial suggest low-intensity treadmill walking for a longer duration is most effective in improving gait and mobility among patients with Parkinson's disease (PD).

However, stretching and resistance training were more effective than anticipated and exceeded results seen with high-intensity gait training on the 6-minute walk. It was also the only intervention that affected motor scores on the United Parkinson's Disease Rating Scale (UPDRS).

Patients often ask their physicians what exercise they should consider to improve their PD symptoms, lead study author Lisa M. Shulman, MD, principal investigator of the trial and professor of neurology at the University of Maryland School of Medicine, Baltimore, told a press conference here.

"These results suggest that a combination of low-intensity treadmill training plus stretching and resistance training is likely to provide the greatest range of improvements for gait, mobility, and cardiovascular fitness in Parkinson's disease," she concluded.
Keep reading.

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From NewsWise:
While there has been increased media coverage in the last year related to head injuries incurred in the NFL as well as in collegiate and high school football, there are many sports and recreational activities that cause serious head injury. “There is a huge need to build awareness, because far too many people, including children, are suffering serious and life-altering head injuries and the incidence is increasing,” said American Association of Neurological Surgeons President James T. Rutka, MD, PhD, FRCS. Further, there is a growing body of scientific evidence that indicates that repeated blows to the head incurred in some sports cause grave consequences, including chronic traumatic encephalopathy. There were an estimated 446,788 sports-related head injuries treated at U.S. hospital emergency rooms in 2009. This number represents an increase of nearly 95,000 sports-related injuries from the prior year.
The Position Statement on Traumatic Brain Injury in Sports is posted here.

The AANS has in-depth information on sports-related head injury here.

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From the Huffington Post: Most traumatic brain injuries result in damage to the brain because the brain ricochets inside the skull during the impact of an accident. Mild traumatic brain injury (MTBI), also called "closed head injury" or "post-concussion syndrome," is a condition where an individual suffers a mild concussion, whiplash or blow to the head, and subsequently develops symptoms such as recurring head pain, cognitive difficulties, emotional and personality changes, hypersensitivity to light or sound, nerve damage, memory difficulties, etc.

Every couple has their "how'd you meet?" story. Ours is particularly useful because it offers both the story and a casual reminder that I actually did get a film made at one point in my illustrious career...This film, from a screenplay I co-wrote (with Patricia Royce) called "To Cross the Rubicon," was being produced in Seattle, and at some point early in the process I went to the company office and met the company attorney, Pete Wilke, Esq. Not long after, Mr. Wilke, Esq. negotiated my contract for the film, we fell in love, and on Oct. 1, 1990 we drove to the courthouse in Mount Vernon, Washington, where Judge Gerald Mullen postponed his lunch to solemnly don a long black robe, and in the company of our two witnesses, court secretary Pam Green and jovial bailiff Harold Johnson, we took our vows. I remember wondering if the whole courthouse/elopement scenario would feel generic and unemotional, but when Judge Mullen said, "The union into which you two are now about to enter is the closest and tenderest into which a human being can come," I was a goner.

We moved from Seattle into my L.A. apartment. I got pregnant. We moved into a bigger house. He passed the California Bar. We had our son. We shared time with his daughter. We struggled with our careers, wrestled with money, had good times and bad. Work. Marriage. Schools. Careers. Playgrounds. Families. College. Parenthood. Life.

Three years ago Pete was in his car, stopped at a crosswalk waiting for a couple of pedestrians to make their way across the street, when a distracted driver smashed into him from behind at about 25 miles an hour with no attempt to brake. Pete's head had been turned slightly to the right; the impact was stunning, and amongst other injuries, his right frontal lobe sustained damage. "MTBI," they called it -- mild traumatic brain injury. Mild because he can still walk and talk. The impact on his life, however, was anything but. In fact, nothing has been the same since.

This is a man who rarely took an aspirin. A man who hiked down the Grand Canyon almost every year and trekked through the Montana wilderness pheasant hunting every fall. A man for whom music, theater, singing and the whole gamut of sensual, creative and aural pleasures was deeply appreciated. A man who longboarded down the Strand with his teenage son and played softball with his band of buddies. Who, even after being hit by a car as a pedestrian and breaking all sorts of bones and body parts years before, had healed quickly enough that a walking trip through Spain was doable only a year later. That kind of man. The man before MTBI.

In the three years since, Pete's world has been about ERs, hospital visits, neurology treatments, pain management, ear/hearing care, and pharmaceutical assistance for a myriad of injuries and symptoms including painful ear nerve damage, considerable hearing loss, 24/7 tinnitus, excruciating head pain, cognitive challenges, persistent startle reflex, loss of certain emotional components, etc. Though the cognitive struggles have improved significantly, allowing him to continue and rebuild his law practice (which suffered in the first year after the injury), and though the extreme nature of the head pain has subsided enough on a day-to-day basis that he's once again able to enjoy many aspects of his life, the landscape of his existence -- and ours as a couple, a family -- has changed significantly.

He has to wear hearing aids now and cannot hear well enough inside his head to sing or play guitar, yet he can no longer go to clubs to listen to music because the volume is intolerable; the same with movies and sporting events. Softball is out, hunting is a thing of the past, and travel became challenging. Activities with our son in the two years before college were mostly nonexistent. Sometimes Pete could barely tolerate talking, and silence became a big part of our lives. Laughter? Not so much.

Keep reading. I highly recommend it.

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From NW Missourian:
Genia Brin, mother of Google co-founder Sergey Brin, assisted Stanford University scientists in late March in breakthrough discoveries about Parkinson's disease. The scientists excised a dime-sized patch of skin from her upper arm, chemically matured the cells and watched them die. By replicating the process that naturally occurs in Parkinson's victims, they are one step closer to finding how the disease affects our brain cells.

Until recently, Parkinson's was a tricky disease to observe because only humans are afflicted with it, ruling out animal testing, and deep brain cell extraction in a live patient would be fatal. The embryonic stem cell debate revolved around degenerative disorders like Parkinson's because it appears to victimize people sporadically. Harvesting embryonic stem cells for research, a practice abhorred by pro-life activists, was supposed to help scientists replicate the process in which Parkinson's hijacks brain cells.

The process used in Brin, who carried a rare genetic form of the disease, employed adult stem cells. After extraction, her skin cells were genetically manipulated to take the form of neurons involved in Parkinson's disease.

This is at least the second major breakthrough in adult stem cell research for Parkinson's disease, following the University of California, Los Angeles case in early 2009. In that instance, adult stem cells were removed from the afflicted patient, genetically modified into mature neurons and reintroduced to the brain for an 80 percent improvement in motor skills.

If such a process has proven its worth and does not lie in a moral gray area like embryonic stem cells, it ought to spearhead stem cell research. Unfettered by debate or strong opposition, it is more likely to attract grant monies or even public funding. Finally, we have disease-fighting research that most Americans would not mind being taxed for.

Read original source.

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With all the strangeness and partisan battles going on in the Florida Legislature this session, there are still some worthy bills under consideration. One such bill is HB 301/SB 730. Definitely worth our support!

From St.

A significant student athlete bill is moving closer to approval by the Legislature this session. We believe it's about time.

Our energetic future leaders deserve all the protections they can get in competitive school sports where they may misstep for the sake of winning and could suffer a life-long injury.

State Rep. Ron Renuart, R-Ponte Vedra Beach, is the sponsor of House Bill 301 which would require an independent sanctioning authority for youth athletic teams and the Florida High School Activities Association to adopt guidelines, bylaws and policies relating to risk of concussion and head injury in youth athletes. It also requires written clearance from a medical doctor to play after injury.

Renuart is an osteopathic physician and recently served as the chief medical officer for the Florida National Guard. He also has been involved in youth sports programs. His bill has cleared the K-20 innovation subcommittee and has two more stops; the health and human services access subcommittee and the full education committee before final House action.

A companion bill, SB 730, is in the Senate. It has made it through the Health Regulation Committee and moves on to the Rules Committee before heading to the Senate floor. The bill's sponsor is Sen. Anitere Flores, R-Miami.

Keep reading.

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From The Los Angeles Times:

Just in time for Parkinson's Awareness Month (April), the Michael J. Fox Foundation for Parkinson’s Research has partnered with Polo Ralph Lauren to create a limited-edition dog tag necklace to raise funds for the fight against the debilitating disease.

The nickel-plated brass tags, which are priced at $95 each at Polo Ralph Lauren in Beverly Hills and online, are engraved with quickie motivational quotes including “Be Inspired,” “Be Involved” and “Be Bold,” as well as the logo for the Michael J. Fox Foundation.

Ralph Lauren is donating 100% of the net proceeds for the dog tags to the foundation.

The unisex tags are a smart and stylish way to support a great cause.

-- Emili Vesilind

Photo: Dog tags created by Polo Ralph Lauren for the Michael J. Fox Foundation. Credit: Polo Ralph Lauren

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Here's another item from New Scientist (Health Section). It's interesting, but a little disturbing.

Psychopaths are typically considered untreatable, but brain scans could change that

DANGEROUS, manipulative and, above all, untreatable. The traditional picture of the psychopath is one that everyone, from psychiatrists to members of a jury, seems to share.

But although this picture encourages a "lock them up and throw away the key" mentality, surprisingly little is really known about how, or if, rehabilitation is possible for psychopaths. Now, brain scans of children with psychopathy-like conditions suggests objective ways to diagnose psychopathy, new targets for therapy - and techniques for settling the question of whether or not psychopaths can be successfully treated and released.

For 15 years, psychiatrists have relied on the Hare psychopathy checklist to diagnose the condition. The revised version - the PCL-R - consists of a formal interview and an analysis of an individual's past behaviour, which is scored for indicators including superficial charm, pathological lying, a grandiose sense of self-worth, and a lack of guilt or empathy. The PCL-R is generally accepted as the best available way to diagnose psychopathy, but such interview-based methods are vulnerable to subjective scoring, and clever individuals can learn how to pass them.

"Psychopaths by their nature are deceitful and cunning, so they can pick up on what authorities want to hear," says Michael Koenigs, a neuroscientist at the University of Wisconsin, Madison.

Looking for the signs of psychopathy in brain scans could sidestep such problems, but with every new glimpse into the psychopathic brain, the picture seems to become more confused.

For instance, initial studies of brain activity as psychopaths were presented with photographs of negative emotional scenes showed abnormally high activity in the cerebellum, fusiform gyrus and postcentral gyrus, suggesting these brain regions are involved in the condition. But a repeat run of the experiment in different psychopaths revealed different foci of abnormal activity: the medial temporal lobe, and occipital and parietal cortices (Molecular Psychiatry, DOI: 10.1038/mp.2010.124).

Such results suggest that identifying psychopaths through brain scans is no easy task, says Marcus Raichle at Washington University in St Louis, Missouri. He thinks the task is made more difficult because "their brains are likely to show signs of drug or alcohol abuse and violence-related head injuries".

The study of children with psychopathic traits could help. So-called callous unemotional traits are considered symptoms of psychopathy in children, and some, though not all, go on to be diagnosed with psychopathy as adults. The condition is thought to be genetic in around half of them. These youngsters may already have embarked on a similar lifestyle to adult psychopaths, but their brains have had less time to pick up the signatures associated with this damage, so pinpointing the brain behaviour relating directly to the condition may be easier.

Keep reading. You might have to register at the site to read this article. Registration is free.

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From New Scientist:

TOO much of a good thing can be bad for you. The synchronous firing of neurons is crucial for many ordinary brain functions, but excessive, uncontrolled synchronisation might be behind the symptoms of Parkinson's disease. Now a computer model has backed up the idea.

Parkinson's disease has been linked to a lack of dopamine, a chemical that, among other things, dampens the transmission of signals across nerve junctions called synapses. Measuring this effect in humans is not currently possible, so Leonid Rubchinsky and colleagues at Indiana University-Purdue University Indianapolis turned instead to a computer model of neural networks.

As they boosted signal strength, the network became more prone to switching from non-synchronised to synchronised firing. By comparing the pattern of neural signals recorded from people with Parkinson's against those predicted by the model, the team found that in Parkinson's, the brain readily switches between synchronised and non-synchronised behaviour even when it is relaxed. This might explain the disease's motor symptoms.

A healthy brain fires synchronously in a brief and controlled way to coordinate motor behaviour and perform tasks. The stronger connections in the brains of people with Parkinson's mean that attempts to coordinate behaviour trigger sustained synchrony, which may make it difficult to end a task or begin a new one (Physical Review E, in press).

"This is a simple and elegant study," says Peter Brown of the University of Oxford. "The model beautifully captures the dynamic behaviour of the system."

Visit New Scientist Health section.

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