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Jack Sisson's TBI Blog
A hug is duct tape for the soul.
Thursday, May 31, 2012
The benefits of early dementia diagnosis
From The Guardian:
It has been described as a ticking time bomb, affecting more people than cancer or heart disease. But for many of the growing number of people in Britain who suffer from Alzheimer's and other forms of dementia, a diagnosis is still out of reach.
The Alzheimer's Society say that the the disease will cost the UK more than £23bn this year and it is one of the main causes of disability in later life, although more than a third of sufferers remain undiagnosed.
Early diagnosis is a key pillar in the Department of Health's national dementia strategy and a new 10-minute memory test, which has just become available for GPs, could help detect if someone is likely to go on to develop Alzheimer's or dementia.
CANTABmobile is an iPad-based test, developed by Cambridge Cognition (CC), which uses voice prompts and touchscreen technology to set a series of visual challenges that test for episodic and short-term memory loss, which can indicate later problems. It also differentiates between memory problems that may be caused by depression.
With a degenerative disease such as dementia, earlier diagnosis could give sufferers more time to prepare for later impairment and makes it less likely that a patient will end up in institutional care; saving more expensive costs in the long term. While it's still early days for research into whether lifestyle factors can alter the disease's path, an earlier diagnosis could give patients a better chance of tackling the disease.
Michael Hurt, dementia care programme manager at NHS Walsall, which is piloting the app, said it takes an average of three years for a diagnosis.
"Diagnosing better will mean higher costs in the short-term as people use more services, but they still use those services now, its just not in the dementia budget. We see people only once they're in a crisis. In the long run it's cheaper to avoid crisis and keep people at home.."
Link to The Guardian here.
Wednesday, May 30, 2012
Four Solutions for Veterans in the Texas Justice System
From the Burnt Orange Report, Texas' largest group political blog:
The Texas Civil Rights Project (TCRP) Justice for Veterans Campaign is a program to help those military veterans who:
-- are struggling with physical and mental health-conditions related to their service
-- all too often find themselves struggling with the criminal justice system as well.
There is a significant correlation between incarceration and the mental health conditions faced by veterans: 40% of veterans with PTSD symptoms commit a crime after discharge from wartime service. As a result, veterans are severely over-represented in the criminal justice system: nationwide, 10% of prison and jail inmates once served in the military, the majority in wartime.
In 2011, the Texas Civil Rights Project (TCRP) received a grant from the Texas Access to Justice Foundation to help address the needs veterans in the criminal justice system. TCRP is working with existing stakeholders and a network of pro bono attorneys to reach out to those veterans before, during, and after their incarceration.
Standing on a Precarious Edge
Transitioning from military life to the civilian world can be a daunting and stressful change under the best of circumstances. And we are not in the best of circumstances. Significant numbers of men and women are leaving military service today carrying burdens that are too great for them to bear.
On October 7, 2001, the United States launched Operating Enduring Freedom in Afghanistan. Less than eighteen months later, on March 20, 2003, the United States launched Operation Iraqi Freedom. A 2008 RAND study estimated 1.64 million troops, up to that point, had been deployed to support operations in Afghanistan and Iraq. Today’s estimate exceeds 2 million.
Estimates vary regarding the number of returning vets who are suffering from Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI), but none of them are good. The same RAND study estimated about 31% of troops returning from Iraq and Afghanistan suffered from either a mental health condition (e.g. PTSD or major depression), TBI, or both.
Post-Traumatic Stress Disorder is an anxiety disorder that can occur after exposure to traumatic events such as combat, natural disasters, assaults or motor vehicle accidents. Symptoms can include nightmares, flashbacks, intrusive memories, feeling numb and detached from people, insomnia, irritability and hypervigilance.
Traumatic Brain Injury is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. Symptoms of mild TBI can include headaches, poor concentration, memory loss, sleep disturbances, and irritability-emotional disturbances.
According to the Department of Veterans Affairs (VA), from 2002 to 2009, 1 million troops left active duty in Iraq or Afghanistan and became eligible for VA care. Of those troops, 46% came in for VA services. Of those Veterans who used VA care, 48% were diagnosed with a mental health problem.
Slipping into a Vicious Circle
Today, one in ten of the people incarcerated in the United States are veterans. The majority of these veterans served in wartime.
There is a relatively high correlation between incarceration and the mental health conditions faced by veterans. For example, people diagnosed with PTSD are 4.5 times more likely to be imprisoned for a violent act, and 40 percent of veterans with symptoms of PTSD have committed a crime after discharge from the service.
Once a person goes to prison, the mental health services available him or her are, as a practical matter, very limited or non-existent.
“The Texas Civil Rights Project receives many letters from obviously mentally ill prisoners. Notable examples include the prisoner who sent copies of ‘peace declarations’ between himself and the United States for the the Civil War, World War II, and Vietnam, [and] the prisoner who threatened to sue the Project through the Intergalactic Space Court . . .These are not prisoners in mental health treatment facilities. These are prisoners in top-security TDCJ units, receiving bare-minimum mental health care that contributes little toward their rehabilitation.”
Even those veterans who do not leave prison with an untreated mental illness will face significant obstacles to reentering society. Having a criminal record can make it very difficult to find either housing or employment, and lacking either makes it difficult to find the other, creating a vicious circle.
“‘A convicted felon is pretty much barred from public housing,’ said [Danny] Sneed, a U.S. Army veteran. ‘Even if you make great money, you can’t live in a lot of apartment complexes because of your felony conviction.’”
Lack of housing and employment for those recently released from incarceration dramatically increases their chances of recidivism and return to incarceration.
Tuesday, May 29, 2012
Songs may hold key for injured brains
From The Age:
MUSIC can help patients with severe traumatic brain injury unlock memories from their past, a new study has shown.
"I played him the No.1 song-of-the-year from when he was 10 to 60, to see if the songs could help bring to mind personal memories associated with the music," Dr Baird said.
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"I played the same songs in a separate session with his wife, they had been married 40 years, so she was a good healthy control.
"Although he's got this brain injury and severe memory problems, there was no difference in the number of songs that brought to mind memories for them."
Dr Baird, of Newcastle's Hunter Brain Injury Service, said the patient's memories were not as vivid of those of his wife, but he could sometimes recall additional details once a song had triggered a particular event.
"When I played him I Want To Hold Your Hand by the Beatles, he said the Beatles were great and he could picture watching Paul McCartney on film," she said.
"His wife said: 'It reminds me of two trips with my husband in the 1970s, we listened to music on the beach, lit a fire and talked with friends'."
Another song that triggered a memory was for the 1981 No.1 Bette Davis Eyes, with the patient recalling: "I bought this song from a record shop for my wife and we would turn it up if it was on the radio."
Dr Baird — who is now conducting the same study with a larger group of brain-injured patients — said her research had shown the potential for music to help restore personal memories in that group.
"It's something that we know very well in everyday life — we all put on songs that bring back memories from the past — but it's something that hasn't been researched that well to date," she said.
"There have been a couple of studies in healthy people but mine is the first study in a person with a brain injury."
In addition to her work with brain-injured patients, Dr Baird has also received funding from Alzheimer's Australia to see if music can improve the memories of dementia patients.
"We're putting information into a song, and seeing if people can remember it better as a lyric than if it's said to them," she said.
"Things like 'at 9 o'clock in the morning, take your aspirin', to the tune of Waltzing Matilda. We're just starting that, and we'll be comparing musicians and non-musicians to see if a musical background helps."
Sunday, May 27, 2012
Veterans' Courts: What are they and will they help?
From The Huffington Post:
When Larry, my uncle through marriage, came back to New York City from Vietnam, everyone knew he wasn't quite right but was unprepared to help him.
His life post war took a downward turn that he never recovered from. Loitering, bouncing between relatives' houses and church shelter programs, he would often get arrested for public drunkenness. He would ride the subways. And that's where he killed himself.
Across the country this story has been repeated over and over again. It was a time where in pop culture people were a lot less aware of PTSD (post-traumatic stress disorder) and TBI (traumatic brain injury).
Today the issue is even more urgent.
"Studies have shown that about 35 percent of homeless vets are suffering from alcohol or drug addiction and about one-quarter had these issues before they committed crimes," says Peter Gravett, Secretary of the California Department of Veterans Affairs (CalVet).
"California being the most populous state has over two million veterans -- the vast majority located in L.A. and San Diego -- L.A. because it's our most populous city and San Diego because of its great weather," Gravett explains.
For these reasons, a new judicial processing system, veterans' courts, has been set up across the nation to help wayward soldiers find a path they can take to get their lives back on track.
"I was in the military, and I was in law enforcement several years ago. We had veterans returning from Vietnam and we didn't recognize [their symptoms] -- they did not get the help and assistance needed," Gravett said.
Veterans' courts, according to Gravett, are a hybrid of government and mental health drug court models that address the unique issues presented by those who served in the military and may be suffering from serious mental health problems or other recurring illnesses.
Started in Buffalo, NY, in 2008, veterans' courts have been established in several states around the country, including California, which has nine such courts statewide, most located in Southern California.
There are approximately 23.4 million veterans, 1.7 million of whom served in Iraq or Afghanistan. As much as one-third of the nation's homeless population has served in the armed forces, according to estimates from the U.S. Department of Veterans Affairs. Nearly half of all homeless vets suffer from some sort of mental illness, and 75 percent struggle with substance abuse.
Unable to cope with life after the military, Gravett explains veterans often wind up homeless or on the street, or pulled over by police for committing misdemeanors like jaywalking. These courts are there for those offenses.
Saturday, May 26, 2012
Diagnosis of Alzheimer's isn't always accurate
From the Newsleader.com:
Martin Rosenfeld's loved ones dreaded what might be next: a diagnosis of Alzheimer's.
He had called too many times — confused and frustrated — from a parking lot outside his synagogue, after driving there in the middle of the night for services that wouldn't begin for hours.
Once a meticulous pattern-maker in the clothing industry, he now nodded off mid-conversation. Spilled things. Mumbled.
"We'd be getting calls all night long. He'd say, 'What time is it? Can I get up now?' " said his daughter, Shelley Rosenberg, whose husband, Don Rosenberg, chairs the Alzheimer's Association — Greater Michigan Chapter.
Rosenfeld's confusion, which turned out to be caused partly by sleep apnea, reflects what the head of Wayne State University's Institute of Gerontology worries is a growing trend in the number of Americans being wrongfully assumed — even medically misdiagnosed — with Alzheimer's, the most common form of dementia and perhaps the most feared disease of old age.
"It's a real problem. If you're older and you get a label of Alzheimer's — even a hint that you have Alzheimer's — there's no more critical thinking about it. You're written off by a lot of people," said Peter Lichtenberg, head of the institute and a clinical psychologist who has testified in several probate cases in which a person's mental capacity was at issue.
Lichtenberg, in a December paper for the journal Clinical Gerontology, highlighted two case studies: in one, a man's bouts of confusion and agitation in his late 70s were caused by illness and painful cellulitis, not Alzheimer's; in the other, an 87-year-old woman, who seemed suddenly confused, was suffering from depression.
Lichtenberg's paper builds on research elsewhere that suggests that the difficulty in pinning down Alzheimer's makes misdiagnosis too easy. The research is based mostly on small studies but also on an ongoing, long-term study supported by the National Institute on Aging, which is part of the National Institutes of Health. In cases reviewed so far, about one-third of Alzheimer's diagnoses were incorrect, according to the lead researcher, Lon White.
"The diagnosis was dead wrong one-third of the time, and it was partially wrong a third of the time, and it was right one-third of the time," White said.
The project, called the Honolulu-Asia Aging Study, has been under way since 1991 and focused on the precise brain changes linked to Alzheimer's disease and other types of dementia. Pathologists examined the brains of 852 men born between 1900 and 1919, about 20 percent of whom were diagnosed with Alzheimer's.
In the cases carrying an Alzheimer's diagnosis, two-thirds of the brains exhibited the types of lesions closely linked to Alzheimer's. Half of those featured other problems, as well, such as scarring on the hippocampus, the part of the brain responsible for memory, White said.
That didn't mean that those without the Alzheimer's lesions were otherwise healthy, "but what we're calling Alzheimer's is very often a mixture of different disease processes," White said.
Lichtenberg said his concerns about misdiagnosis in no way lessen the enormity of Alzheimer's impact.
"I don't know how vast a problem it is, but I see it too often," Lichtenberg said.
The Alzheimer's Association estimates that 5.4 million Americans are living with Alzheimer's. Lichtenberg's grandmother had the disease. A picture of her, dancing, sits in his office at Wayne State.
But understanding how often Alzheimer's and other dementia are misdiagnosed is hard to quantify. Sometimes, that's because loved ones have not yet noticed a decline; sometimes, they don't want to face the possibility, Lichtenberg said.
Rosenfeld's most pressing problem was severe sleep apnea that had aggravated the more manageable symptoms of undiagnosed Lewy-body dementia. Lewy-body dementia causes a visual processing disorder, disrupts the ability to organize, plan and focus and can causes sleep problems and hallucinations.
A breathing machine at night made a dramatic difference, said Shelley Rosenberg: "I'm thrilled. He is what he used to be. I have my father back."
Some quick to judge
It's a difficult balance for the Alzheimer's Association: trying to raise awareness and boost early intervention efforts for Alzheimer's and other dementias, while also cautioning families and clinicians not to jump to conclusions.
Diagnosing Alzheimer's is tricky and is done, in part, by ruling out other health problems, such as an undetected stroke or brain tumor.
Even well-meaning doctors can be too quick to judge, especially when confronted by worried loved ones listing Mom's memory lapses, said Jennifer Howard, executive director of the Alzheimer's Association — Michigan Great Lakes Chapter.
An expert evaluation by an interdisciplinary team that includes a geriatrician and neurologist is crucial, she said.
"The brain is not just a physical structure. It's this incredible computer. It's constantly computing where resources are needed and redirecting, depending on energy is coming from and what task you need to do," said Rhonna Shatz, director of Behavioral Neurology at Henry Ford Hospital in Detroit.
For that reason, a common urinary tract infection, a sudden change in blood pressure or depression are all stresses on an older brain that, combined with other problems, can quickly short-circuit it, Shatz said.
The result is acute confusion or delirium that, to an untrained eye, may look like Alzheimer's disease.
"Pulling these things apart and the need for a real diagnosis — that's important so people can live the best quality of life as possible for as long as possible," said Howard at the Alzheimer's Association.
Other factors missed
In the case of Al Edelson, a former Wayne State professor and cancer survivor, the confusion was really the result of a regular cocktail of 18 medications prescribed for a variety of health issues.
In his mid-70s, the once sharp-witted, effervescent professor of instructional technology began to withdraw, family members said. Eventually, a doctor gave the diagnosis of Alzheimer's.
"The problem is that when you're older and you have a lot of medical conditions, no doctor speaks to the other doctor, and that's basically what happened," said his wife, Joanna Edelson, a retired teacher.
After consulting with other doctors, family members scaled back Al Edelson's drugs. They were amazed.
"It was like he came out of a coma," his wife said.
Link to the Newsleader here.
Thursday, May 24, 2012
Most GPs can't recognise signs of Alzheimer's
Wonder if the problem is as bad on this side of the Atlantic?
From The Independent:
Dementia will kill one in three people over 65, but a survey of GPs reveals that almost two-thirds admit they are not properly taught to recognise the signs of it.
Only 37 per cent of GPs say they have adequate basic training on dementia, according to research by the Alzheimer's Society. As a result, just 43 per cent of people with the condition are diagnosed, leaving hundreds of thousands of patients untreated, the charity claims.
Around 800,000 people in the UK have a form of dementia, costing the economy more than £23bn every year. In less than 10 years, it is estimated that a million people will be living with the condition, rising to 1.7 million by 2051. If dementia is discovered and treated early, the onset of the worst symptoms can be delayed, giving people a better quality of life.
The Alzheimer's Society also found that 75 per cent of GPs wanted to know more about the management of behavioural symptoms of the disease. The survey of 382 GPs was commissioned ahead of Dementia Awareness Week which begins tomorrow.
Diane Abbott, Labour spokesperson on public health, said: "This is alarming, because we've got an ageing population with a higher incidence of Alzheimer's than ever. If dementia is caught early people can still have a high quality of life. But, if most GPs don't feel trained to deal with it, that's very worrying news for Britain's elderly and their families."
Poor diagnosis rates can also be attributed to the embarrassment and fear that prevents some patients from coming forward. When asked what the barriers to identifying the disease were, 65 per cent of GPs said "many people with dementia do not present to general practice" and 66 per cent also cited the stigma attached to the disease as putting patients off visiting their doctor.
Allan Grogan, 70, from the Wirral, took his wife, Mavis, 67, to the doctor in 2006 when she first showed symptoms, but the GP dismissed her unusual behaviour as "no cause for concern". A year later she was diagnosed with Alzheimer's and now she is in full-time care in a nursing home.
"She was telling the same stories, and doing little things such as wearing her coat inside the house ,or putting the dishes and cutlery in funny places," said Mr Grogan.
"We were worried about it and took her to the GP and he said there was no cause for concern. It was only when we went back a second time that it was taken seriously."
Dr Alex Turnbull, a GP from Wigan, said: "Having a diagnosis of dementia as early as possible is really important, allowing people to plan for the future as well as to access support and potential treatments. But it is also vital that, as GPs, we get the support and information we need to help people to the best of our ability."
An online learning tool to help GPs tackle the problem is being launched this week by the Alzheimer's Society and the British Medical Association.
Jeremy Hughes, chief executive of the Alzheimer's Society, said: "Currently, only 43 per cent of people with dementia get a formal diagnosis. This could be for several reasons, including stigma and lack of awareness in the general public, as well as people not visiting their doctor.
"We need to support GPs as much as possible as they have a vital role to play in diagnosing and supporting people with the condition."
Case study: 'It was frustrating: it was such a hard fight just to be diagnosed'
Heather Roberts, 57, from Derby, a former lecturer
"I was 50 when I was diagnosed with Alzheimer's, a good three years after I first told a GP my symptoms. My grandmother had dementia and I started recognising the same signs in myself. My brain was very, very sluggish. I was a college lecturer and have a degree in computing, but I suddenly found myself struggling to add two numbers together.
Everyone said I was too young. My first memory test showed I was functioning slightly above average, which they said was fine. A year later, I'd dropped to below average and it was dismissed as a bad day. On the third test, there was a huge drop and finally I was told, 'Yes, you probably do have Alzheimer's'. I was given treatment and my memory is significantly better now. It was frustrating that it was such a hard fight to be diagnosed. GPs aren't trained enough in this and I don't see it improving. My new GP is sceptical even though I have a written diagnosis."
Link to The Independent here.
Tuesday, May 22, 2012
From donkey rides to maypoles: Archive films help to revive memories in dementia patients
This sounds like a promising project recently developed in the United Kingdom. Perhaps it will make its way to the U.S. sometime soon.
From The Mail Online:
Footage housed at the Yorkshire Film Archive (YFA) have been carefully selected for the "Memory Bank" initiative in collaboration with experts from Age UK, the Alzheimer's Society and Methodist Homes for the Aged.
It is mainly from home movie collections held by the YFA and features familiar subjects such as holidays, sports, school days and working life. It follows an 18-month research project.
Organisers of the study said the films promoted conversations with the participants on everything from knitted bathing costumes, free school milk and 1960s fashion mistakes through to favourite fireworks and clocking on at work.
YFA director Sue Howard said one Memory Bank user in the study said: 'It's like the years peeling back - the memories are all still there, it just needs a trigger.'
Social gerontologist Professor Dianne Willcocks said: 'Memory Bank offers older people a compelling and fun tool to reclaim their lived past - and to share it with family, friends and carers alike. It works both for those living with dementia and for those simply living with rich memories.'
Memory Bank packs have been developed with a user guide, film notes, discussion ideas, suggestions for activities, guidance on starting a memory box and a "Life and Times" section spanning the changes over the decades from the 1920s to the 1970s.
The project has been supported by the Screen Heritage UK Programme.
Link to The Mail Online here.
Sunday, May 20, 2012
What you need to know about traumatic brain injuries
From Fox News:
Traumatic brain injury (TBI) occurs when an external force, such as a violent blow, damages the brain. Depending on the severity of the injury, this could end in serious long-term damage or even death. Centers for Disease Control and Prevention report that about 1.7 million people will experience a TBI each year.
The Individuals with Disabilities Education Act (IDEA) is the special education law in the United States. It defines TBI as "an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment."
Ricardo Jorge Komotar, neurological surgeon at the University of Miami School of Medicine, said that people should know about the chronic nature of the condition. "Most of the focus is on concussions but people need to understand that there are repercussions 10 to 15 years down the road, not just right now."
Frank Toral, senior partner at Toral Garcia Battista (a brain and spinal cord injury law firm), explained that TBI the leading cause of death and disability for children 14 and under.
There are two basic forms of TBI: Closed head injuries (blows to the head) and penetrating injuries (penetration of brain by foreign object). One can receive TBI from acts of violence, sports injuries, blasts during combat or falls, reports the Mayo Clinic.
An external physical blow can damage brain cells, cause the brain to push harshly against the skull, tearing internal structures or causing internal bleeding.
The American Speech-Language-Hearing Association reports that primary brain damage (which is complete at time of impact) can include skull fractures, contusions, blood clots, tearing of the lobes or blood vessels and nerve damage. Secondary damage (which evolves over time after impact) can include brain swelling, epilepsy, fever, infection, extreme blood pressure, anemia and more.
Owing to the brain's intricacy, the complications are predicated upon the particular section harmed. Scientists separate the brain into various lobes: frontal lobe, temporal lobe, parietal lobe, occipital lobe, the cerebellum and the brain stem--each responsible for particular functions.
The Brain Injury Association of America explains, for instance, that the occipital lobe controls vision, whereas the cerebellum controls balance, motor activity and coordination. However, these sections are not mutually exclusive and responsibilities may overlap, as visual perception is partially controlled by the cerebellum.
To assess the severity of the injury, doctors gauge the patient's capabilities to follow directions on the 15-point Glasgow Coma Scale. If medical personnel are responding in the immediate aftermath of the blow, they will interview witnesses to uncover specifics, such as how long the person has been unconscious, where the head was struck and how the injury occurred, among other details.
Imaging tests (MRIs, CT scans) are vital to properly understanding the kind and scope of injury sustained.
Since tissue swelling may transpire (increasing the internal pressure, which leads to further damage), doctors might use a probe to monitor the intracranial pressure.
No two brain injuries are identical, so treatment varies considerably. Komotar emphasized that the key is giving the brain enough time to recover.
In the immediate aftermath of the traumatic injury, treatment focuses on ensuring that the brain receives sufficient oxygen and blood. Particular care is given to the neck and head to prevent further injury.
To prevent secondary damage, multiple drugs may be provided: temporary coma-inducing drugs (a person in a coma needs less oxygen in his/her brain), anti-seizure drugs and diuretics (relieves some pressure on brain).
Surgery and rehabilitation depends greatly on a specific patient's particular trauma.
Saturday, May 19, 2012
Caring for Loved Ones with Dementia
From Daily Rx:
It is not a situation hoped for, but one many people will have to tackle. As loved ones age and mental capacities fade, how do you handle proper care and ensure a high quality of life?
Luckily, as numbers grow and research proliferates, our knowledge and understanding of dementia increases as well. Information about how to provide a happy, rewarding and loving life for these patients is now widely available.
A Condition on the Rise
In a report titled “Dementia: a public health priority” released by Alzheimer’s Disease International (ADI) and the World Health Organization (WHO) in April 2012, it estimated that 35.6 million people have dementia worldwide, a number expected to double by 2030 and triple by 2050.
This growth represents a huge potential burden on both medical systems and the families of patients, because patients often live for many years after onset begins. In the report, ADI and WHO urge the participation of these key publics in the development of laws, policies and services that will surely grow relating to dementia.
The report encourages active participation and self-education, saying “With appropriate support, many can and should be enabled to continue to engage and contribute within society and have a good quality of life.” By building a base of respect and love, these patients are able to thrive and enjoy their remaining years.
Emotional Health: Creating an Environment of Respect
According to the Alzheimer’s Society, one of the first and most important steps in caring for a loved one with dementia is understanding their world and ensuring an environment of respect. This time of mental decline can leave a patient feeling vulnerable and lost, but proper support can help maintain their individuality, happiness and self-esteem.
Steps to go about this include:
Thursday, May 17, 2012
Awakened: Immune cells revive woman in coma
Researchers from the University of Munich recently reported that they were able to awaken an 82-year-old woman who’d been in a persistent vegetative state by using injections of her own immune cells.
The woman, who had suffered a stroke, had been cared for at home by her family and a home health nurse -- for nine long years.
Then her doctors proposed an experimental new treatment, offering to give the octogenarian intramuscular injections of her own immune cells, specially activated in the laboratory to produce substances thought to modulate brain activity.
Remarkably, after starting the weekly injections, the patient began to respond to commands and even regain some movement in previously weakened limbs. She opened her eyes and turned toward people entering the room, grabbed the hands of her grandchildren (with both hands) and looked at them, and would voluntarily move her tongue when her teeth were brushed.
Although she’d been on a feeding tube for years, her swallowing reflex even began to return.
The implications of her awakening are truly astounding.
As a neurosurgeon who treats patients with traumatic brain injuries and serious strokes on a daily basis, I'm too often presented with a patient, who despite our team's best efforts, fails to awaken from a coma.
Sometimes the combination of time, patience and a tireless family results in a patient who wakes up six months after their injury. Other times, though, they don't -- primarily because no treatments are available to change the outcome for patients in persistent coma. But perhaps this new research will change that.
According to the article, published in a recent issue of the Journal of Medical Case Reports, the doctors manipulated the patient’s own cells to somehow restore some brain function nine years after a devastating stroke, a claim few physicians can make.
Their results also suggest that injections of these sorts of cells might even be effective in patients who have recently suffered brain injury.
This news is especially significant since, despite decades of research in neuroscience and behavioral medicine, no therapies have emerged in the last 50 years that systematically reverse coma in patients that have suffered significant strokes or traumatic brain injuries. However, the last decade of neuroscientific research has produced a wealth of data regarding neural responses to injury and potential routes to neuronal rehabilitation and even restoration.
Modern medicine is quite good at rehabilitating patients who are awake but disabled from their brain injury. Specifically, physicians and physiatrists in the field of rehabilitation medicine do a superb job at retraining the mind to rewire around injury and compensate for functions that have been lost. However, modern medicine still has yet to come up with a solution for patients who do not wake up. That’s why this research is so intriguing.
Wednesday, May 16, 2012
Those who put concussion onus on the players aren’t thinking clearly
Tuesday, May 15, 2012
Woodruff's struggle 6 years on
From the Omaha World-Herald:
It's been six years, and sometimes Bob Woodruff's brain still doesn't allow him to find the words.
The famed ABC broadcaster — the one-time anchor who was nearly killed by a roadside bomb in Iraq in 2006 — recently broadcast live from the John Edwards trial.
Appearing on “Good Morning America,” he stood outside the courthouse, looked into the camera and tried to say that one of the trial's witnesses “went in and testified.”
Instead he said this: “He went in and terrified.”
Such are the dangers of going on live TV while still recovering from a severe brain injury that affects memory and word recognition.
Such are the stories that Woodruff himself wants to tell on behalf of thousands and thousands of American service members who have suffered traumatic brain injuries, now known as the signature wound of the Iraq and Afghanistan Wars.
“I didn't even know what a TBI was before this happened to me,” Woodruff said last week, as he took a break from the Edwards trial to talk about brain injuries and an appearance that he and wife Lee Woodruff will make in Omaha.
“There's much more attention paid now, more funding and financing, more studies,” he said. “People know a lot more about this ... but it's really in some ways still an overwhelming problem.”
The Woodruffs are the keynote speakers at the 2012 D.J.'s Hero Awards Luncheon, a Salvation Army fundraiser scheduled for Monday at the CenturyLink Center Omaha.
They will speak about Woodruff's stunning recovery from a head injury in 2006 that left him in a medically induced coma for more than a month and had doctors theorizing he would never walk or talk normally again.
Today, he reports regularly for ABC. He and Lee co-wrote a best-selling book, “In an Instant” about Woodruff's injury and recovery.
The Woodruffs will also talk about the unvarnished reality of a serious brain injury.
They will talk about how Bob Woodruff's recovery has proceeded in fits and starts, with four fantastic days followed by a tough one where he is fatigued and gets frustrated trying to remember words that used to come effortlessly.
Lee Woodruff, an on-air contributor to the CBS morning show and the author of three books, will talk about her experience as her husband's primary caregiver.
She'll talk about the days just after the injury, when she was successfully juggling hospitals and doctors and the couple's four children. She'll talk about when her husband started to recover, and she took a deep breath and plunged into depression.
“By all accounts, people would say, ‘Wow, but you are doing so well now,'” Lee Woodruff said. “But it's not easy, and it's not logical. It's not a straight line, recovering from trauma.”
Bob Woodruff thinks speaking about his recovery is important because he can speak with serious experience about what life is like for the staggering number of wounded American troops.
Some 320,000 Americans have suffered a traumatic brain injury in Iraq or Afghanistan, according to a RAND study. Most are minor, similar to a slight concussion, with no lingering effects. Others are major and can cause severe headaches, memory loss and personality changes.
At least 20 percent of returning troops come home with post-traumatic stress disorder or some form of depression, that study says.
Often, Woodruff says, a veteran returns home from Iraq or Afghanistan with both a brain injury and post-traumatic stress.
These veterans may not get the care they need quickly: A recent report by the VA inspector general found that a majority of American veterans who sought mental health care waited about 50 days before the VA evaluated them fully.
“These invisible injuries are going to keep going up” as more service members return home, Woodruff says. The VA “just hasn't caught up fast enough. That's not an excuse, by the way. But it is happening.”
Lee Woodruff thinks talking about recovering from trauma is important because nearly everyone, whether they are a soldier or not, will eventually experience it.
She cites recent research that says as many as 90 percent of us will experience a traumatic event in our lives, like a car crash, a natural disaster or the sudden death of a loved one.
Too often, Lee Woodruff thinks, the advice we get from celebrities “makes it appear that if you work hard and put your head down, it all gets better.”
“I think you start to work on acceptance, and that's a squiggly line,” Lee Woodruff says. “There are a bunch of great days and then a big payback day where you think, ‘Why did this happen to our family?'”
“I didn't see any point is us telling our story publicly, talking about our journey, if we weren't going to be absolutely honest.”
Sunday, May 13, 2012
A Father's Battle To Change The Future Of Brain Research
At a recent lunch organized by Jeffrey Lieberman, Columbia University’s chairman of psychiatry, New York’s top neurological researchers gathered to meet the nonprofit team they had been told would transform the very nature of their jobs.
Patrick Kennedy (Ted’s son and a former Congressman from Rhode Island), the cochairman and public face of the charity One Mind for Research, kicked off the meeting by deeming the assembled luminaries “today’s astronauts.” General Pete Chiarelli, One Mind’s new CEO—recruited from his just-completed stint as the U.S. Army’s vice chief of staff—discussed the astonishing increase in post-traumatic stress disorder and traumatic brain injury seen in soldiers returning from Afghanistan and Iraq.
The key figure at the gathering, though, was Garen Staglin, the quiet force behind One Mind and two other mental health charities, all of which have helped promote psychiatric-drug research even as big pharmaceutical firms have scaled back their efforts. Despite pressure on the National Institutes ofHealth’s budget, Staglin averred, it was still possible to get the government to open its coffers—if politicians could only be made to recognize the toll taken by mental illness, from the Alzheimer’s striking aging baby boomers to the autism afflicting their grandchildren.
“The time is now. We can move from treatments to preventions to early diagnosis and develop cures,” Staglin told the group.
His talk unleashed the floodgates: Scientists doing research on nerve signaling in worms were now trading ideas with those who study how concussions can lead to Alzheimer’s-like brain tangles. Drug-company researchers conferred with academics trying to treat mental illness with electromagnetic fields. The room came alive with ideas.
Such connections in the service of a larger good are something of a Staglin hallmark. One Mind for Research was in part Kennedy’s brainchild, but Staglin has actually made it work, enlisting big partners, including Johnson & Johnson, General Electric, IBM, and Eli Lilly, and recruiting Chiarelli, who spurned more lucrative opportunities to become the group’s chief executive. Stag-lin has long been an “integrator” in the fight against mental illness: someone who gets people who otherwise might never speak to work together. (At times, he has forced competitive academics to collaborate, warning them they won’t get grants from his charities otherwise.)
“With brain research, we’re where cancer was 20 years ago,” Staglin says. “There’s no American Brain Society. The American Cancer Society has unified the public behind the idea that we can cure the disease, not just from government but also private sources. We need to do the same.”
Continue reading to find out Staglin's personal motivation for supporting brain research.
Saturday, May 12, 2012
What the brain tells us
From Yahoo News:
In the past 20 years, neuroscience, buoyed by advances in imaging technology—namely, functional magnetic resonance imaging or fMRI—has been giving us a cranial roadmap into our behavior, extreme and otherwise. As the technology keeps improving at a dramatic pace, so can the development of treatments for diseases, some of which couldn't even be diagnosed until after death.
Last week yielded some amazing reports on brain research, from diagnosing injury before the symptoms manifest to tracking emotional behavior to specific little gray cells. Here are just a few:
The serious consequences of a blow to the head, and a possible test. Most people know the insidious consequences of a knockout or a concussion, the worst case scenario being a blood clot that leads to a stroke. Less understood are consequences of blows to the head—direct or percussive, like from being too near an explosive device—that leave you reeling, but conscious. If you're not out cold, the layman reasoning goes, you're OK.
But as NFL helmet lawsuits, post-traumatic stress disorders (PTSD) in veterans, and the living example of Muhammed Ali show, there are long-term consequences to repeated knocks. The Center for the Study of Traumatic Encephalopathy, which focuses on progressive degenerative brain disease, points out that this has been recognized in boxers since the 1920s. Unfortunately, diagnoses don't happen until literally long after damage has been done.
However, a project launched last year in Nevada—the Professional Fighters Brain Clinical Research Study—has looked into the gray matter of more than 100 mixed martial artists and boxers with compelling results already: MRI scans might reveal injuries beforesymptoms show.
The physical changes, detected by MRI scans, are a reduction in size in the hippocampus and thalamus of the brains of fighters with more than six years in the ring. These parts of the brain deal with such functions as memory and alertness. While those who had fought for more than six years did not exhibit any declines in cognitive function, fighters with more than 12 years in the ring did. Thus, Dr. Bernick's group concluded, the lag between detectability and physical symptoms probably occurs sometime during those six years. (April 24, The New York Times)
This could have far-reaching repercussions for disorders like Alzheimer's or PSTD, especially given our burgeoning veteran population, 30% of which have been diagnosed with PSTD, brain injuries, or depression. Connecting such problems with physical injury might also help alleviate the stigma surrounding them.
[T]he increased military and media attention given to post-traumatic stress disorder and traumatic brain injury has had the effect of stigmatizing veterans, advocates say. Some employers fear that soldiers diagnosed with these conditions are prone to violence or instability. (April 25, The Los Angeles Times)
Finding how to stop extreme behavior. Thanks to crime literature and serial killer movies, Americans are aware of many different "-paths": sociopath, psychopath, and antisocial personality disorder. What has been a raging debate is if one is doomed to that diagnosis and basically lifetime incarceration, or if there's a window of intervention. One researcher went on a roadtrip into the heart of darkness: Using a mobile MRI unit, a University of New Mexico associate professor of psychology took a snapshot of 2,000 inmate volunteers.
He found that compared to the average offender, 60 percent of psychopaths re-offend within the next 200 days. Maximum-security juveniles showed a similar pattern: 68 percent of individuals who were at high risk for psychopathy re-offended.
Using images of the brain, [Kent] Kiehl said he could predict psychopathy as well as one can with clinical error. (April 23, Duke (University) Research Blog)Among preliminary findings, Kiehl zeroed in on the interaction with a gene (MAOA) and a "stressful" upbringing and that treatment like group therapy actually ends in "violent failure" among adults. For juveniles, intervention's a different story and can show a 50% reduction in violent recidivism.
"We have a problem in the United States: We incarcerate a lot of people," he said. "We incarcerate more per capita than any other country. It's expensive—it costs $2.34 trillion per year, which is about the same as the annual estimate for all health care [in the country]." (April 23, Duke (University) Research Blog)Continue reading.
Thursday, May 10, 2012
Clinic in Afghanistan is first stop for U.S. troops recovering from brain trauma
From the Statesman:
The first room they go to is small and dark, with a single bed in the corner and a blanket hung over the window. The building is covered in a hardened foam that muffles the constant drone of the Apache helicopters, Warthog attack jets and massive cargo planes coming and going from the airfield at this base just north of Kabul.
One of the major lessons of the Iraq and Afghanistan wars is that quick treatment and rest after a blast can reduce such long-term symptoms as depression, mood swings and thinking difficulties. For service members who have suffered a traumatic brain injury, this clinic can dramatically improve quality of life in the years to come.
Thousands of troops who suffered a brain injury earlier in the wars went right back into the fight without missing a beat. All too often, commanders and soldiers themselves, unable to see the brain injury, did not give the wound the attention it needed. More than 200,000 American service members, about 10 percent of the troops who served in Iraq and Afghanistan, have been diagnosed with TBI, and many more have probably gone undiagnosed, according to veteran advocates. Some will suffer psychological and physical problems such as personality shifts, increased impulsivity and epilepsy in the years to come because they received additional brain trauma before their initial injury was given a chance to heal.
But as the war ended in Iraq and begins to wind down in Afghanistan, military officials have begun paying better attention to TBI, especially the more prevalent mild brain injuries, which include concussions. In 2010, the Department of Defense ordered mandatory TBI screening for soldiers who have suffered a blow to the head, were in a vehicle accident or were near a blast. Troops who show signs of brain injury after a screening that tests memory and concentration are taken to one of seven brain injury clinics in Afghanistan, where they receive forced rest and cognitive therapy.
In eastern Afghanistan, troops are airlifted to Craig Joint Theater Hospital at Bagram Air Base, where they spend from three to seven days at the nine-bed brain injury clinic. Nearly all return to duty after going through the program. "If they get to us early enough, we send 100 percent back to their units," said Air Force Maj. Katherine Brown, an occupational therapist and the officer in charge of the clinic.
Brown said that when service members arrive, they are often disoriented and confused and have problems with their balance. They are encouraged not to do anything but sleep for that first day.
"Usually, if they take advantage of the rest period, they feel much better the next day," she said.
Rest is perhaps the most important aspect of the recovery process, but in combat areas, where soldiers and Marines share tents and live on bare-bones bases, quiet areas are hard to find.
After their initial rest at Bagram, patients go to a day room, where they can watch TV, but not traditional soldier fare. "The brain is not ready for a lot of stimulation," Brown said. "They don't watch war movies, action movies. We start them out on 30-minute comedies." On a recent afternoon, a recovering soldier relaxed in front of an Ashton Kutcher romantic comedy.
At this point, some soldiers ask to return to their units. "We tell them it's not safe for them or their teammates if they go back before they're ready," Brown said. "If they are not ready to deal with something coming at them, they can't be in a war situation."
In a third building, improving patients perform cognitive reasoning exercises such as Sudoku, Foosball and Origami (at this point, soldiers are also allowed to watch war movies again). Patients also begin doing exercises in which they have to move their eyes up and down, such as passing drills with volleyballs. Quick eye movement can be affected by brain injuries but is key to surviving in a war zone.
Brown said that she is working with the Department of Defense on developing TBI rehabilitation protocols, which she said have not been well-researched.
After completing the course, patients might be referred to counselors in the hospital's combat stress department. Others might need more physical rehabilitation. But most return to their units on the battlefield.
"Everybody who comes through these doors are miracles," Brown said. "Six inches the other way and they wouldn't be with us."
Tuesday, May 08, 2012
We owe it to our troops to rehabilitate brain injuries
From The Orlando Sentinel:
It is now believed that Sgt. Robert Bales, the U.S. soldier who is accused of killing 16 Afghanistan civilians in cold blood, had a previous history of traumatic brain injury.
This confluence of circumstances — a war-torn soldier likely with post-traumatic stress disorder gone unexpectedly violent — could easily boil down to the neuroanatomy of Bales' brain. Not unlike when theNFL had to ultimately recognize that violent, repeat head trauma to players can irrevocably change a player's mental state, the military may now be forced to recognize that war trauma can cause complex impacts on the brain, which can contribute to making soldiers social risks.
If Bales had suffered a previous brain injury, we know the likely effects include what is known as "disinhibition," due to frontal-lobe injury. Brain injury could have damaged the area of the brain that controls his emotional reactions and speech, making him unable or less able to control his anger and suffer from explosive outbursts.
This condition often makes victims maladapted to the exquisite complexities of social interactions and can often lead them to be socially isolated, suffering depression and anxiety.
To compound this history of a brain injury with the extraordinary level of stress involved in serving in war on numerous deployments makes the emergence of PTSD far more likely. Recent research has shown that exposure to life-threatening situations, such as criminal victimization, natural disasters and war, can change both the wiring and neurochemical make-up of our brains.
The region of the brain that controls "fight or flight" fear is known as the amygdala. When this area becomes over-stimulated by life-threatening circumstances, it triggers past memories and fears, which repeat in a pathological cycle. This condition is not caused by character flaws. It is caused by biological processes in the brain.
The pioneering neuroanatomy work of Dr. Joseph LaDoux has shown us that in dangerous environments, the brain reacts to sudden stimuli, not with our rational frontal-lobe, but with our amygdala. The instantaneous reaction to danger actually bypasses our higher brain and its rational judgments.
Thus, the area of the brain affected by PTSD is the same area of the brain that reacts to danger. Placing a soldier in a hostile environment with a brain injury and PTSD greatly increases the likelihood of a violent reaction to perceived danger.
Soldiers who have suffered a brain injury and are suffering from severe PTSD should not be on the front lines of any war zone. When I lecture around the world on frontal-lobe damage, I explain that such an injury inevitably makes the victim "less human and more animal." His judgments, as well as his emotions, are impaired, and he is certainly ill-equipped to deal with the extraordinary stressors and rapid-fire, life-or-death decisions experienced in a battle zone.
This is not to make excuses for the actions of Bales, but to put his actions in proper context.
Perhaps Bales' case will open up the long-overdue discussion about the complex impacts of brain injury, for our soldiers and others in society who need an honest evaluation of their circumstances. Many of our violent prisoners, and particularly our death-row prisoners, have a history of brain injury. Their relative inability to resist the lures of drugs, alcohol or violence can, in part, be explained by the faulty wiring in their brains.
With an untold number of soldiers returning from the battlefield with brain injury and/or PTSD, the U.S. must embark upon proper rehabilitation and acknowledgment of this problem. We need to allocate the resources to rehabilitate our soldiers as fully as possible, to make them as human as possible upon their return.
Sunday, May 06, 2012
Junior Seau's Brain To Be Donated For Research Into Head Injuries, Concussions
From The Huffington Post:
Saturday, May 05, 2012
Junior Seau's Death After NFL: Is There a Brain Injury Link?
From ABC News:
The circumstances coming to light about the death of former NFL linebacker Junior Seau may highlight what some doctors see as a growing link between head trauma, mental illness and suicide, a connection that has come to the forefront of sports safety research in the last decade.
Seau was found dead from a gunshot wound to the chest at his home in Oceanside, Calif. Wednesday morning.
If Seau did indeed commit suicide, his death would bear a resemblance to that of other athletes in hard-hitting sports, including Chicago Bears football player Dave Duerson. Duerson shot himself in the chest in February of last year.
Seau played in the NFL for 20 years for the San Diego Chargers, Miami Dolphins and New England Patriots. On Wednesday, Chargers Chaplain Shawn Mitchell told ABCNews.com that Seau died of a "self-inflicted gunshot wound to the chest this morning." Seau was 43 and leaves behind three children and an ex-wife, Gina Deboer.
The Chargers released a statement to ABC News' San Diego affiliate: "Everyone at the Chargers is in complete shock and disbelief right now. We ask everyone to stop what they're doing and send their prayers to Junior and his family."
The case may be similar to that of Duerson, who left a note requesting his brain be sent to the "NFL brain bank" for study.
Several former NFL players have committed suicide in recent years, and many experts believe the deaths could be related to repeated blows to the head. In addition toDuerson, ex-Pittsburgh Steelers offensive lineman Terry Long and Philadelphia Eagles defensive back Andre Waters took their own lives. Chronic traumatic encephalopathy, or CTE, a degenerative and progressive disease found in people who have experienced repeated hits to the head, has shown up in the brains of several former athletes who committed suicide, including Duerson.
CTE has similar brain features to that of Alzheimer's, Parkinson's and Lou Gehrig's disease.
Last May, Dr. Ann McKee, co-director of Boston University's Center for the Study of Traumatic Encephalopathy, a research center that studied Deurson's brain after his death, told reporters that Duerson "had classic pathology of CTE and no evidence of any other disease," ESPN reported at the time.
"Exactly how the brain damage causes mood disturbance is not clear," said Dr. John Whyte, director of the Moss Rehabilitation Research Institute in Philadelphia, who does not know Seau's medical history. "There could be biological changes going on, or changes in the neurotransmitters that affect mood, or it could be a psychological factor that this brain injury has disrupted work and family life so much that it has really changed your life."
Until more research has been done, Whyte said the public should not jump to conclude a definitive link between concussions that Seau may have experienced in his career and death. But repeated blows to the head may also damage parts of the brain that have to do with impulse control and the ability to weigh the long-term consequences of decisions.
"Some people may feel really bad one day, but they can say, 'OK, this thought is out of proportion with reality,'" said Whyte, "whereas, if you're acting on impulse to certain emotions, you may feel bad one day and that can lead you to take action."
A concussion is caused when the brain is shaken so hard that it hits the inside of the skull, resulting in brain trauma. Studies have contributed to the growing concern over head injuries, particularly concussions, in football and other contact sports.
Thursday, May 03, 2012
Computer use and moderate exercise reduce odds of memory loss
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