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Jack Sisson's TBI Blog

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From A Place for Mom:

Anyone who has witnessed a loved one succumb to Alzheimer’s disease knows its cruelty. Although it can strike any of us and cannot be cured,  we do not need to feel powerless against the disease. Years of research has given the medical community a snapshot of factors under our control that are linked to a higher likelihood of developing Alzheimer’s and other types of dementia. By looking at the published body of research, we can adopt healthy lifestyle changes that may decrease our chances of developing dementia while also improving the quality of our lives.
We’re inundated with health advice and a lot of it is contradictory. In the morning we might read a story in the paper saying eggs should be avoided because they cause heart disease. And after work, we may turn on the evening news and hear that eggs are the greatest food since God’s Manna because they contain all 20 protoeogenic amino acids. It can be hard to make sense of it all. But we shouldn’t allow ourselves to tune out entirely.
Here are six easy steps you can take that may reduce your risk of developing Alzheimer’s or at least help you live a healthier life.

1. Live a Heart-Healthy Lifestyle

As the leading cause of death in America, we are waging a formidable battle against heart disease. However, risk factors such as smoking and eating a high-fat diet are under an individual’s control. A heart-healthy lifestyle also lowers your risk of developing memory loss, particularly vascular dementia. Research suggests that vascular dementia can be caused by high blood pressure and heart disease. Here are the core requirements of a lifestyle lived with heart-health in mind:
  • Exercise regularly
  • Eat a healthy diet (low fat, low sugar, lots of vegetables)
  • Don’t smoke
We agree, this is simple advice, but it’s not always easy. It is hard to break longstanding habits, and our demanding, hectic lives often aren’t conducive to healthy eating and exercise. Faced with these challenges, we can try to incorporate increased activity into our daily routine. Take a walk at lunch or trek to a café for lunch if the weather is bad. Take the stairs instead of the elevator whenever possible. Or park further than you need from the entrance to the supermarket.

2. Use Your Brain

Research has shown that higher education levels are linked to decreased risk of cognitive decline. Researchers theorize that well educated people have better connected synapses in their brain. These “cognitive reserves” are thought to help compensate for the havoc wreaked within the brain by Alzheimer’s disease and other dementia  For example, imagine that your brain is a big city and that cars are the messages being sent back and forth within it. In a city with a well-connected transportation grid that has built-in redundancy, a few stalled cars or spinouts won’t keep traffic from reaching its destination and the city will continue to function. But if your city has only a few major roads, and one of them is blocked, your whole city will become congested.

3. Protect Your Head

The Alzheimer’s Association does not beat around the bush: “There appears to be a strong link between future risk of Alzheimer’s and serious head trauma, especially when injury involves loss of consciousness.” While our days of contact sports may be over, that doesn’t mean our heads are in the clear. To minimize your risk of head injury, always wear a seat belt when driving and a helmet when cycling. Falls are also a major cause of head injuries. If you or a loved one have limited mobility or vision problems, be extra careful to make sure that the home is safe and without fall-hazards.

4. Moderate Your Alcohol Use

There are a host of dangers associated with drinking too much, including liver failure and drunk-driving tragedies. But another major risk is dementia. According to a 2008 study, alcohol abuse is the second leading cause of adult dementia in Western countries, accounting for 10% of cases. Men who consume six drinks a day and women who have four drinks per day place themselves at a high risk (more than 10% chance) of developing dementia. If you are having difficulty moderating alcohol use on your own, speak with your doctor, as there are a number of treatment options available. Finally, if you drink red wine for the cardiovascular benefits, you may be surprised to hear that a recent study found nonalcoholic red wine to be more heart-healthy than regular red longevity, happiness,and good health, but it also associated with a lower risk of developing dementia. 

5. Reduce Stress and Spend More Time with Friends

An active social life is linked to longevity, happiness,and good health, but it also associated with a lower risk of developing dementia. The The Alzheimer’s Association says that “experts are not certain about the reason for [the] association of an active social life with decreased dementia risk. It may be due to direct mechanisms through which social and mental stimulation protect the brain.”

6. Get Enough Sleep

Sleep and the dreams that come wit it have fascinated thinkers for ages. While scientists understand a great deal about sleep, many aspects are still a mystery. We still don’t have a concrete answer to what dreams are, exactly, and why we have them. But we do have a pretty good picture of what happens to people who don’t get enough sleep. In the short term, sleep deprivation can change your mood, decrease your reaction time, and make you more prone to simple mistakes. (That’s why airline pilots have strict requirements involving sleep time.) If you go more than around 24 hours without sleeping, which we do not recommend, you may begin to hallucinate and demonstrate other signs of mental breakdown. But even modest disruptions to the sleep cycle could be linked to Alzheimer’s. A September 2012 study found strong evidence indicating that the sleep-wake cycle helps to clear the brain of the amyloid plaques that are thought to cause Alzheimer’s, and another study from October 2012 found that healthy adults who report trouble sleeping have an increased risk of developing Alzheimer’s in the future. Research on sleep and memory that was published only a few days ago in the journal Nature Neuroscience seems to further affirm that when older people sleep poorly it can prevent them from “storing” memories and lead to dementia symptoms.
How do you know what health advice to pay attention to? Do you listen to your doctor, and block everything else out? Or do you try every supplement advertised on TV? Have you decided whether chocolate is good for you, or bad for you? What about coffee? Or is good/bad a false dichotomy in a complex world? 
Link to A Place for Mom:

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From Huffington Post:

I'm a mathematician and am constantly amazed that the world around us can be described mathematically. All it takes is a combination of a handful of simple mathematical concepts. I'm insatiably curious, and I want to understand how things fit together, so, I get involved in many kinds of scientific problems -- everything from the changing statistics of extreme rainfall, to the behavior of life at the scale of molecules, to analyzing voice and speech recordings for forensics. But there's one project, on Parkinson's disease that has occupied me for the last seven years. I fell into it almost by accident.

It is estimated that between 4 and 6 million people worldwide have Parkinson's. Because the disease is more likely to affect older people than younger, and because the population is aging and growing, that figure is expected to rise. Parkinson's primarily affects movement, the 'classic' symptoms are uncontrollable and unwanted motion in the limbs, which looks like shaking or tremors.

I can only imagine what it is like to suffer from a neurological disease. But like so many of us, I have a friend who is affected: Jan Stripling, who used to be a virtuoso ballet dancer. I thought it particularly cruel for him to suffer from Parkinson's, having lived a life dedicated to the performance of the most elegant, controlled movements. But actually, he tells me that it is the little things we all take for granted -- such as buttoning a shirt -- that frustrate him most now.

What can I do to help? I'm not a health care professional -- so I can't help directly and I found this very frustrating. I was, however, fortunate enough to have met someone who was involved in a medical research project into Parkinson's, which had recorded the voices of around 50 people weekly. As it happens, although I don't know much about neurological disorders, I do know a lot about the voice and sound. In my PhD at Oxford, I had developed mathematical algorithms for detecting voice disorders, and when we tried these algorithms on Parkinson's voices, we were able to detect those with the disease, with around 86 percent accuracy.

So, for me, it was the chance discovery that voice is affected as much by Parkinson's as limb movements, that set me on the path of trying to detect and monitor Parkinson's using voice recordings. In collaboration with one of my students, I worked for several years and now have algorithms that, in the lab, reach around 99 percent accuracy in detecting the disease. We also know how to predict the severity of symptoms to within a few percentage points of clinical judgment.

Current symptom tests are done in a clinic. They are expensive, time-consuming, and logistically difficult. So mostly, these tests are not done outside clinical trials. Our technology could enable some radical breakthroughs, because voice-based tests can be administered remotely, and patients can do the tests themselves. Also, they are high speed, taking less than 30 seconds, and since they don't involve expert staff time, they are ultra low cost. That makes the technology massively scalable.

There are many areas of medical practice and research where we think this could have an impact -- for example, reducing the need to visit the clinic to find out how the disease is progressing. We could do high-frequency monitoring for individualized treatment decisions. This might allow clinicians to optimize drug timing and dosage. For clinical trials, we could do cost-effective mass recruitment for new treatments. By recruiting very large numbers into trials we could help speed up the search for a cure. And finally, this could enable population-scale screening programs, that might allow us to search for 'biomarkers' that show early signs of the disease before the damage done is irreparable.

Recently, we set up the Parkinson's Voice Initiative with the aim of collecting 10,000 voices from across the world, using the standard telephone network. We wanted to test the technology outside the lab. We had a massive public response, quickly reaching the target in just a few months.

This incredible and unique dataset will tell us whether it is possible to use something as ubiquitous as the telephone to detect and monitor the disease. This now becomes a 'big data' analysis problem, and until the analysis is done, we can't know for sure if it will work. But if it does, we would have the technology to check out some 75 percent of the world's population at a negligible cost.

This analysis problem is already raising many new mathematical challenges that require me to design new algorithms. And as always, I'm finding that these algorithms have uses outside Parkinson's and biomedicine. One particularly fascinating application is the detection of extrasolar planets -- that is, planets circling other stars.

One way to detect these planets is to monitor the brightness of the host star: when the planet passes through the line of sight, it dims slightly, and this dimming is very good evidence for the existence of planet. But the brightness signal is extremely noisy, so, removing the noise requires specialized mathematical algorithms. It turns out that these algorithms have a lot in common with those used to analyze voice signals in Parkinson's!

This is the pattern I find in my mathematical research: a particular problem requires a mathematical solution, and I find that I already have a useful algorithm in my 'algorithm toolbox.' The goal of my research, then, is to discover ways to adapt those mathematical tools to help solve new problems. This process has extraordinary depth and is always fascinating.

Link to Huffington Post.

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From Bloomberg:

President Barack Obama expressed concern about violence and injuries in professional and intercollegiate football, saying he would “think long and hard” if he had a son before allowing him to play.

Obama, an avowed sports fan and the father of two daughters, said in an interview with The New Republic magazine that the National Collegiate Athletic Association in particular should consider rules changes in view of emerging evidence on long-term health consequences of head blows suffered by players.

He said he is “more worried” about amateur college players than professional National Football League players who are “grown men” represented by a union and paid a salary.

“You read some of these stories about college players who undergo some of these same problems with concussions and so forth and then have nothing to fall back on,” Obama said in the interview, to be published in the magazine’s Feb. 11 issue. “That’s something that I’d like to see the NCAA think about.”

Obama predicted that football rules will “probably change gradually to try to reduce some of the violence.”

He said that, while rules changes to tamp down violence, “may make it a little bit less exciting,” the result “will be a whole lot better for the players, and those of us who are fans maybe won’t have to examine our consciences quite as much.”

The family of Junior Seau, the all-pro linebacker who committed suicide in May, sued the NFL on Jan. 23, claiming his death resulted from repeated head injuries he suffered on the field.

Player Lawsuit
More than 3,000 former players have sued the NFL for damages for head injuries. The complaints, which are consolidated in federal court in Philadelphia, accuse the league of negligence and failing to inform players of the link between repeated traumatic head impacts and long-term brain injuries.

Seau, a 12-time Pro Bowl selection who played the last of his 20 NFL seasons in 2009, was 43 when he shot himself in the chest at his home in Oceanside, California. The National Institutes of Health said Jan. 10 that brain-tissue samples showed Seau had chronic traumatic encephalopathy, a progressive brain disease diagnosed after death.

Seau’s suicide followed that of former Chicago Bears player Dave Duerson, an 11-year veteran who shot himself in February 2011 at age 50; and Ray Easterling, an eight-year player with the Atlanta Falcons who killed himself two weeks before Seau at age 62. An autopsy on Duerson found similar traumatic brain injury.

Evidence has been mounting that repeated concussions harm brains.

A study of 34 retired NFL players published Jan. 7 in the journal JAMA Neurology linked mental deficits in former players with changes in brain structure. About 25 percent of the retired players suffered with clinical depression, higher than the 15 percent seen in the general population. The researchers also found physical abnormalities in the brains of some the athletes in medical scans.

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In the United States, each year an estimated 1.7 million individuals experience a traumatic brain injury, or TBI, according to the Centers for Disease Control and Prevention.
A TBI may be a closed head injury — in which the head strikes an object — or a penetrating head injury — in which the object breaks through the skull and can come in contact with the brain tissue.
A TBI can range from mild to severe. The Centers for Disease Control and Prevention noted that 75 percent of annual TBI cases are either concussions or another type of mild TBI.
Concussions are the most common form of TBI and are also the most minor, according to the National Institute of Neurological Disorders and Stroke.
One area of concern with TBI is the risk of developing dementia later in life. Dementia symptoms have been noted in individuals who have careers where they have sustained head injuries.
For example, career boxers may be vulnerable to dementia pugilistica, or chronic traumatic encephalopathy. The National Institute of Neurological Disorders and Stroke said that boxers can begin displaying symptoms of dementia 6 to 40 years after starting their career.
So what does the new research say about the risk of developing dementia in individuals who have had a TBI?
One recent study followed 4,225 individuals ages 65 and older (the average age was 75) who did not have dementia at time of enrollment. Participants were in the study for up 16 years (the mean was 7.4 years) and were seen every two years.
Researchers collected information on participants’ TBI history. About 14 percent of the participants had a history of a TBI with a loss of consciousness when they enrolled in the study.
The researchers found that that having a history of a TBI with a loss of consciousness did not increase the risk of developing Alzheimer’s disease or another type of dementia.
However, they found that if an individual had her first head injury before the age of 25, her risk for having another TBI more than doubled. If her first TBI occurred after the age of 55, her risk of having another one nearly quadrupled,

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From Science Daily:

More than 2,000 former football players are suing the National Football League, saying the league should have taken action earlier to deal with injuries related to concussions more seriously.

But if a lack of speed in tackling concussions warrants criticism, the NFL isn't the only player deserving a penalty, according to a study co-authored by health care and law expert David Orentlicher, who teaches at Indiana University Robert H. McKinney School of Law in Indianapolis.

Neurologists were also slow in sounding the alarm, and for decades, concussions were viewed as a "benign phenomenon," according to Orentlicher.

Orentlicher's study "Concussion and Football: Failures to Respond by the NFL and the Medical Profession," co-authored by William S. David of Harvard Medical School, traces the evolution of the medical understanding of concussion over the past several decades.

"In reviewing the response of the National Football League to concussion, one can easily think that the league was too slow to worry about the medical consequences of head trauma," according to the study published in this month's Social Science Research Network. "But the extent to which its response was unreasonable is unclear. If many medical experts did not worry about concussions, it is difficult to fault the NFL for not worrying either."

"Still one can question the NFL's failure to adopt concussion guidelines in the late 1990s when medical experts did issue guidelines," Orentlicher said.

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From Science Daily:

Sports-related concussions and mild traumatic brain injuries have grabbed headlines in recent months, as the long-term damage they can cause becomes increasingly evident among both current and former athletes. The Centers for Disease Control and Prevention estimates that millions of these injuries occur each year.

Despite the devastating consequences of traumatic brain injury and the large number of athletes playing contact sports who are at risk, no method has been developed for early detection or tracking of the brain pathology associated with these injuries.

Now, for the first time, UCLA researchers have used a brain-imaging tool to identify the abnormal tau proteins associated with this type of repetitive injury in five retired National Football League players who are still living. Previously, confirmation of the presence of this protein, which is also associated with Alzheimer's disease, could only be established by an autopsy.

The preliminary findings of the small study are reported Jan. 22 in the online issue of the American Journal of Geriatric Psychiatry, the official journal of the American Association for Geriatric Psychiatry.

Previous reports and studies have shown that professional athletes in contact sports who are exposed to repetitive mild traumatic brain injuries may develop ongoing impairment such as chronic traumatic encephalopathy (CTE), a degenerative condition caused by a build up of tau protein. CTE has been associated with memory loss, confusion, progressive dementia, depression, suicidal behavior, personality changes, abnormal gait and tremors.

"Early detection of tau proteins may help us to understand what is happening sooner in the brains of these injured athletes," said lead study author Dr. Gary Small, UCLA's Parlow-Solomon Professor on Aging and a professor of psychiatry and biobehavioral sciences at the Semel Institute for Neuroscience and Human Behavior at UCLA. "Our findings may also guide us in developing strategies and interventions to protect those with early symptoms, rather than try to repair damage once it becomes extensive."

Small notes that larger follow-up studies are needed to determine the impact and usefulness of detecting these tau proteins early, but given the large number of people at risk for mild traumatic brain injury -- not only athletes but military personnel, auto accident victims and others -- a means of testing what is happening in the brain during the early stages could potentially have a considerable impact on public health.

For the study, the researchers recruited five retired NFL players who were 45 years of age or older. Each had a history of one or more concussions and some were experiencing cognitive or mood symptoms. The players represented a range of positions, including linebacker, quarterback, guard, center and defensive lineman.

"I hope that my participation in these kinds of studies will lead to a better understanding of the consequences of repeated head injury and new standards to protect players from sports concussions," said Wayne Clark, a player in the study who had normal cognitive function.

For the study, the UCLA scientists used a brain-imaging tool they had developed previously for assessing neurological changes associated with Alzheimer's disease. They employed a chemical marker they created called FDDNP, which binds to deposits of amyloid beta "plaques" and neurofibrillary tau "tangles" -- the hallmarks of Alzheimer's -- which they then viewed using a positron emission tomography (PET) scan, providing a "window into the brain." With this method, researchers are able to pinpoint where in the brain these abnormal proteins accumulate.

After the players received intravenous injections of FDDNP, researchers performed PET brain scans on them and compared the scans to those of healthy men of comparable age, education, body mass index and family history of dementia.

The scientists found that compared to the healthy men, the NFL players had elevated levels of FDDNP in the amygdala and sub-cortical regions of the brain. These regions control learning, memory, behavior, emotions, and other mental and physical functions. Those players who had experienced a greater number of concussions were found to have higher FDDNP levels.

The study was funded by the Brain Injury Research Institute; the Fran and Ray Stark Foundation Fund for Alzheimer's Disease Research; the Ahmanson Foundation and the Parlow-Solomon Professorship.

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From The Globe and Mail:

Many forms of dementia are untreatable, but Tiffany Chow believes that patients do not need perfect cognitive function to feel safe, productive and loved. 

In her new book, The Memory Clinic: Stories of Hope and Healing for Alzheimer’s Patients and Their Families, she offers advice for patients and caregivers on how to cope, from delaying the onset of cognitive decline to managing expectations.

Chow shares some of her advice with The Globe and Mail:

In the book, you discuss various defences against dementia, from mental stimulation and maintaining social networks to diet and exercise. But how much can you really do to prevent it?

That’s an important point that has some subtlety to it. In this day and age, we have some ability to detect the abnormal proteins that are markers for dementia. But there are quite a few people among us with these abnormal proteins, yet who are still doing everything the way they used to without extra help and who don’t look to the casual observer as if they have dementia. I think the goal for more people should be to be like them. So you might have some of the abnormal proteins of dementia, but the idea is to not have symptoms of dementia.

How can someone tell if they have dementia or just absent-mindedness?

There are times in our life when we have some transient lapses in our memory because we’re distracted or we’re sleep deprived or we’re ill. But when it’s happening more consistently and you’re forgetting the kinds of things that you think are really important, that can be one of the major symptoms of the illness. For healthy individuals, whatever intelligence or talents you had before, you should be able to keep those up until the end of your life.

Can you explain why education is a strong defence against dementia?

There is a correlation between having a high level of formal education and being able to have abnormal proteins in your brain without showing symptoms. But, in fact, building your cognitive reserves has to do more with constantly expanding your repertoire as you age.

It turns out reading can be helpful in sustaining your cognitive function and it’s not clear yet whether that’s reading non-fiction or fiction. The idea is you want to introduce your brain to new stories and episodes and have new things to discuss with people.

How does does calorie reduction – reducing one’s energy intake by 33 per cent – benefit the brain?

There are cellular organisms, the mitochondria, which help scan protein products as they’re made, like a quality-assurance team. As we get older, that machinery slows down, so a few more rejects get through. And with time, we get the deposition of abnormal proteins. With calorie reduction, there’s a message sent to the quality-control team that says, “We’re in a little bit of a crisis here. It’s not huge, but would you please get back on the job and do some overtime.” So in that way, you might be able to key up the vigilance for abnormal proteins.

Your late grandmother had Alzheimer’s disease. How has your family history affected your perspective on the illness?

First, I have to take my own advice. The other part of it has to do with pursuing more of a meditative life and focusing more on equanimity, which I think will play into how I am going to react if I feel like I’m losing it later in life. We’re all open to pleasant surprises, but it’s so important to remain open to something that is not going to go the way you want it to.

Yet being diagnosed with dementia can be devastating.

Yes. However, by the time patients come see me, it’s not a surprise. They’ve been worried for a long time. When I do give the diagnosis, more times than not, as opposed to shock, there is a certain sense of relief. They feel, “Now it’s settled. We have a name for this and we have a direction we can go in.”

You emphasize the importance of compassion when caring for patients. But what are some of the biggest mistakes caregivers make?

The No. 1 one mistake is thinking, “I can do this all by myself.” That’s a guaranteed recipe for burnout. Caregiving has to be done with some allies, whether it’s your personal friends, neighbours, other family members or professional care providers. There are couples who have been together forever and the wife or husband has gotten used to the idea that they’re a unit: They can handle everything on their own. But they forget that the other half of the unit now can’t contribute as much. It’s hard to compensate for the other person for the 15 to 20 years for the dementia to run its course.

What is the best way for caregivers to deal with patients who are aggressive or agitated?

This is one of the most stressful things for a caregiver. In order for us to figure out how to address aggression or agitation, we have to take a fearless and honest appraisal of what the patient is doing, and what may be triggering that behaviour.

There are some behaviours that are caused by the dementia itself. But sometimes it’s the only way the patient has of stating that an important need is not being met, such as boredom. They may be craving stimulation or interaction. If you can create some kind of activity – it may be very simple but meaningful – it may give that person a feeling of having accomplished something that day. Then, everybody wins.

This interview has been edited and condensed.  

Link to The Globe and Mail.

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From The Boston Globe:

Alarmed by concussions on the athletic fields, ex-Harvard quarterback aims for a game-changing high-tech helmet

Vin Ferrara’s first brush with concussions was in the seventh grade, when a head injury ended his season in youth football. He endured lesser hits to the head as he ascended football’s ranks, his career culminating as star quarterback for ­Harvard University in the 1990s.

But it was not until years later, as he was finishing medical school, that Ferrara saw sports concussions in a new light. He was watching an old clip of a notorious hit on hockey star Eric Lindros, whose stellar NHL career was undermined by a series of concussions.

“I literally stood up and said, ‘This is ridiculous! They need to do something about this,’ ” Ferrara recalled on seeing the Lindros hit. “Then I started to think that maybe I should do something about it.”

The result is Xenith LLC, a company Ferrara started to make high-tech helmets to minimize the possibility of concussions in football players. Conventional helmets rely on foam padding, but Ferrara came up with the idea of packing the inside of the helmet with air-filled disc-shaped pads that act as shock absorbers. When the helmet is struck, the shock absorbers compress and release air, and then quickly reinflate. This has the effect of deflecting energy away from a player’s skull.

“It’s basically similar to the way pneumatic shock absorbers work on a car,” Ferrara said.

Each Xenith helmet has 12 to 18 shock absorbers installed at precise locations that the company determined by conducting thousands of lab tests that simulated hits from ­virtually every possible direction.

“In this helmet, I haven’t even had a headache or anything from a couple of big hits that I had during the season,” said New England Patriots cornerback Devin McCourty, one of some two dozen NFL players who wear the Xeniths.

Xenith’s target markets are high school and college programs — players from Notre Dame, Ohio State University, and several dozen other colleges use its helmets, as do athletes in thousands of US high schools.

“We’ve really cut down on concussions since we started using Xenith helmets. It’s the best move I’ve made in 36 years as a coach,” said John Papas, football coach at Buckingham, Browne & Nichols, a private school in Cambridge.

Debilitating concussions have become a dominant topic in sports — both professional and amateur — as more evidence emerges of the long-term damage athletes suffer from vicious or repeated hits to the head. This month, the autopsy results of former NFL All-Pro Junior Seau, who committed suicide in 2012, revealed he had chronic traumatic encephalopathy, a brain disease linked to head trauma.

The National Football League, meanwhile, is being sued by several thousand former players who charge that the organization suppressed information about the long-term effects of concussions and related injuries.

Among student athletes, the Centers for Disease Control and Prevention estimates, 173,300 youths a year seek emergency-room treatment for concussions or similar injuries from sports or recreational activities.

Ferrara suffered his own knocks as a student athlete but nonetheless was the starting quarterback for Harvard in 1994 and 1995. He then went to medical school at Columbia University, only to realize he was less interested in practicing medicine and more drawn to the business of health care. That idea further took shape after he watched the Lindros hit, when Ferrara decided to start a company to manufacture a safer sports helmet.

“It was really upsetting to watch an elite athlete get knocked out of his profession by something that seemed like it shouldn’t be happening,” Ferrara recalled. “From that moment on, I was hooked on the idea of making a better helmet.”

He moved back to Boston and set about starting Xenith, now located in Lowell.

The idea for the shock absorbers came from an ordinary enough moment: One day, he came across a plastic bottle of nasal rinse in his medicine cabinet and studied its simple mechanics. The bottle had bellows that compressed easily when Ferrara squeezed lightly, but became increasingly rigid the harder he pushed. The more squeezes, the more that building air pressure boosted the plastic’s resistance to outside force.

From that, Ferrara extrapolated that a similar system inside a football helmet would give the player a graduated level of protection from hits large and small. He actually used his squirt bottle for demonstrations, which were convincing enough that Ferrara swayed Cleveland Cavaliers NBA owner Dan Gilbert, NFL legend Nick Buoniconti, and others to invest $10 million in Xenith.

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This is SCIENCE FRIDAY. I am Flora Lichtman filling in for Ira today. Imagine this. You're a brilliant scientist, a biophysicist studying the causes of dementia. And one day, mid-Power Point, you can't recall what you're supposed to say when the next slide comes up. Eventually you learn that the disease you're studying is now the disease you have.
That's the plot of the Broadway play called "The Other Place." It stars Laurie Metcalf as the scientist - and you may remember her as Jackie on the TV show "Roseanne." And joining me now is the man who wrote the play, Sharr White. Thanks for coming into our studio today.
SHARR WHITE: Thanks for having me, Flora.
LICHTMAN: This is an intense play.
WHITE: Yes. Absolutely.
LICHTMAN: Would you agree? Tell us a little bit more about it.
WHITE: Well, I mean, it's really - I do always say that it's a play about the smartest woman on Earth who discovers that actually nothing she knows is true. And it's told really, really, especially from the beginning, really from the first person. She is really the ultimate narrator - sorry, the ultimate unreliable narrator. So as things start to go wrong with her, because it's told so - it's told so closely from her perspective, as she starts to break down, we sort of really experience it along with her.
LICHTMAN: Right. And she is very credible. And I wondered if part of that is because she's a scientist.
WHITE: Well, absolutely. And there is a bit of trickery in there. I mean, the real key in making the play work is establishing that she is indeed the smartest person on Earth. So it opens with - it essentially opens with her giving this - yeah, this medical lecture to other doctors. And you establish really - I think it does establish really quickly that no one can really top her in terms of her intelligence.
LICHTMAN: Right. I mean, you write, actually - I came across an article you wrote, and you say a particular feature of the very smart people in my life is that they think their sheer intelligence can protect them from all manner of harm. And it seems like this is echoed in this play.
WHITE: Yeah. Absolutely. I mean I think in a lot of ways there's something very Greek about the play. I think it definitely has undertones of Oedipus. You know, here is this reigning king whose life is really taken quite suddenly.
LICHTMAN: By the dementia.
WHITE: Yeah. Yeah, that's right. Yeah.
LICHTMAN: How did the research go for this play?
WHITE: The research was really intense for me. I mean, I really - I do a lot of research for plays. I love the research. And because - because - I mean, the research around dementia is very fascinating and especially around protein (unintelligible) disorders such as Alzheimer's and early onset Alzheimer's.
My father is a scientist. He actually works with protein structures. So it was a really great thing for me to be able to delve more into the processes that he works with. So you know, so I really just - I think you can go as deeply as you want to into any research but especially with scientific - researching any sort of scientific issue, you can delve very deeply into it.
LICHTMAN: How did you decide when enough was enough? I mean, it seems like you could've made this - you could have even added more had you wanted to.
WHITE: Well, yeah. And there was a tremendous amount when we first began the process. And really a lot of the rehearsal process and putting the script together was about peeling the non-necessary science out. There was a night when I was at home on the couch and I was doing all this research - and I said, you know, and part of the storyline is that she has developed a very plausible drug that can interrupt, you know, the processes of Alzheimer's.
And I was sitting there on my couching - and I had to say to myself, you know what? Actually, you don't have to figure out how to cure Alzheimer's. You just have to figure out...

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From ABC News:

Dick Wagner had enjoyed a successful life on stage, playing lead guitar for bands like Alice Cooper, Aerosmith and Kiss, when he had a stroke and a heart attack in 2007.

"I woke up from a coma after two weeks with a paralyzed left arm," said Wagner, now 70 and living in Arizona. "My profession as a guitarist, I thought was over."

He and Cooper co-wrote the majority of the band's top-selling songs, including the 1975 hit, "Welcome to My Nightmare."

But Wagner's own personal horror show had just begun. He worked hard at rehabilitation, but new symptoms began to appear: mental fuzziness and an odd gait.

"I couldn't turn to the left as I walked, only to the right, and I would do a spiral and fall," he said. "I fell completely flat on my face in the driveway on the concrete. I didn't know what had happened to me."

Another fall by his swimming pool precipitated a blood clot and surgery. Wagner was convinced his career was over.

But in 2011, Wagner was diagnosed with NPH, or normal pressure hydrocephalus, a condition caused by a build-up of spinal fluid in the ventricles of the brain, which puts pressure on nerves that control the legs, bladder and cognitive function.

Doctors at Barrow Neurological Institute in Phoenix surgically placed a shunt in his head to redirect the fluid through a tube under the skin to his abdominal cavity. A small amount is drained every day for the rest of his life.

Now, Wagner is back on tour with a band in Denmark.

"I am like a new man almost overnight," he said. "For five years, I couldn't even pick up a guitar -- I didn't have the strength or the coordination."

NPH is a condition that typically strikes after the age of 55 and often mimics the dementia of Alzheimer's and the impaired motor skills of Parkinson's disease.

An estimated 5 percent of all dementia patients actually have NPH, which is correctable, according to Dr. Joseph M. Zabramski, the neurosurgeon who placed Wagner's shunt at Barrow.

In Wagner's case, it wasn't the initial stroke that deprived him of his musical ability, but NPH, which took away his coordination and timing.

"The stroke he suffered usually produces relatively mild deficits, and over time patients are able to resume most normal activities," Zabramski said. "Dick cannot raise his left arm as well as he used to, but his fine motor function in his left hand is excellent.

"Music is Dick's life and so he tried to resume playing but couldn't," Zabramski said. "Once we had the shunt in place I saw the improvements. ... Gradually, much to my pleasure, the old Dick Wagner returned."

An estimated 200,000 to 400,000 Americans suffer from NPH, a number that is on the rise because of an aging population, according to Zabramski, who is chief of cerebrovascular surgery at Barrow.

NPH is diagnosed with a CT scan or MRI, followed by a spinal tap to drain fluid from the brain. If the patient's condition improves, NPH is the likely cause.

The reason NPH is easy to miss is that the "triad of symptoms" are so insidious: difficulty walking, failing memory and urinary urgency, all of which go hand in hand with old age.

"None of us wants to admit there is anything wrong when we have a little trouble walking and balancing," Zabramski said. "We just think we are getting older. It's not until it progresses and threatens our independence that we seek evaluation."

Such was the case with Alicia Harper of Orlando, Fla., an active 74-year-old who played piano and organized programs at her church.

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From ABC News:

It's a condition once known as being "punch drunk" because it affected boxers who suffered multiple blows to the head, but it is a growing occupational hazard for the hard hitting sport of football because players are bigger, faster and more powerful than ever.

Chronic traumatic encephalopathy (CTE), a degenerative brain disease, has been linked to repeated head trauma and to former pro football player Junior Seau, the 20-season veteran NFL linebacker who committed suicide last year.

Seau is the latest football player to commit suicide and later be diagnosed with CTE. Former NFL veterans Dave Duerson, Terry Long and Andre Waters all shot themselves to death and were later found to have the disease.

Earlier this year Kansas City Chiefs linebacker Jovan Belcher killed his girlfriend and then himself. It's not known whether his brain is being studied for CTE.

Two recent studies – one released by the National Institutes of Health Thursday -- have discovered abnormalities associated with the condition in the brains of former pro football players like Seau.

Of the 34 former NFL players who have died and donated their brains to research, the percentage of them who have pathologically confirmed CTE is staggering – over 90 percent, a 2009 University of Michigan report found.

"Despite improvements in technology and equipment and modifications to rules in the game on both the pro and amateur level, there's just a rougher style of play now than in the past," said Dr. Jaime Levine, the medical director of brain injury rehabilitation with the Rusk Institute in New York.

Levine noted that pro football players are a lot bigger than they used to be. According to ESPN statistics, from 1979 to 2011, the typical top-five offensive tackle enlarged from an average of 6-foot-4, 264 pounds to 6-foot-6, 314 pounds. From 1979 to 2011, NFL-bound centers grew from an average 6-foot-3, 242 pounds to 6-foot-4, 304 pounds. In the same period, guards enlarged from an average 6-foot-3, 250 pounds to 6-4, 317 pounds.

"Size and physical conditioning techniques in sports at all levels have evolved to create an intense athlete," she said. "They're able to create more force, power and speed than ever before and that leads to harder hits and a greater number of hits."

Harvard neurologist, Dr. Marie Pasinski, said part of the problem is that brain trauma almost certainly begins years before an athlete enters the professional arena. According to the American Association of Neurological Surgeons, between 4 percent and 20 percent of college and high school football players sustain at least one brain injury during the course of a single season.

Pasinski said she views CTE as a kind of overuse syndrome, the result of repeated injury rather than one catastrophic event.

"Sports have become more competitive over time and kids now seem to practice a lot more than in previous generations. Think of the player who works out with the team 12 months of the year," Pasinski said.

Damage from this sort of mild, "subclinical" head traumas add up over time. Shots to the head that don't necessarily cause obvious symptoms lead coaches and trainers to assume -- mistakenly – that a player is fine to get back in the game. And sometimes athletes keep quiet about this type of injury because they want to keep playing.

"There is still a pervasive belief that only a concussion serious enough to knock the athlete out will do damage, but that's not the case," Pasinski said. "Any blow to the head that leaves a person slightly dazed or not quite right may cause harm to the brain."

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Getting mugged may have been the best thing that ever happened to Jacob VanLandingham.

It changed his life, that much is certain. The head injury he sustained also inspired him to develop a drug to treat concussions, an invention that has the Florida State University professor and researcher knocking on the door of what could end up being the next big thing.

VanLandingham has created what he hopes will be the first Food and Drug Administration-approved medicine for treating mild traumatic brain injuries such as concussions.

“It’s an unmet need,” the Gadsden County native said.”We’re trying to take people out of the dark.”

But first there’s the back story, how VanLandingham evolved from a career as a physical therapist into a neuroscientist fascinated with brain injuries.

It starts in Gainesville in the summer of 1995, when VanLandingham was helping his older brother move into an apartment so he could begin medical school. VanLandingham was blind-sided by a vagrant, knocked to the ground and struck the back of his head on the curb.

His head hurt — a lot. But he didn’t think anything was too wrong until the next day when he realized he was woozy.

An emergency room doctor discovered VanLandingham’s brain was bleeding. He had suffered a concussion, and for the next 19 months he coped with short-term amnesia. Eighteen years later, he is still aware that his sense of smell has been dulled.

VanLandingham believes that if there had been a nasal spray available similar to what he has developed, a product to quickly reduce swelling in the brain, his recovery time could have been shortened immeasurably.

His drug, Prevasol, contains the female hormone progesterone. It is almost two years in the making at this point, still 90 days from earning a patent, VanLandingham said.

While it will be at least three years, and more likely five, before VanLandingham’s product will be readily available — and that’s assuming all goes well along the way during clinical trials and investors continue to step up — a lot has happened already.


VanLandingham, eager for clinical patient trials to get under way, sees unlimited markets for his drug, from youth sports programs to the military to aging Americans who are more prone to falls that can cause concussions. It could even be used as a preventative treatment, prior to participating in contact sports, he said. Traumatic brain injuries are a big business in the United States. The Centers for Disease Control and Prevention reports that 1.7 million Americans sustain a TBI every year, and 75 percent of all TBIs are concussions or other mild brain injuries. Treating them is a multi-billion dollar industry.

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From Huff Post Post 50:

Researchers at Utah State University have discovered that the progression of decline in brain functioning among Alzheimer's patients may be dramatically slowed if caregivers simply change the patient's environment.

More specifically, caregivers who utilize higher levels of "positive" coping strategies -- problem-focused coping, seeking greater social support, counting blessings -- were able to slow down dementia's progress as measured by a variety of global standards. Historically, patients whose caregivers rely more on "negative" coping strategies -- avoidance, blaming themselves or others, wishful thinking -- resulted in a faster decline on cognitive and functional measures, researchers said.

Problem-focused coping targets the cause of a problem in a practical way, such as by gathering information and taking control of a situation, they said. For example, one might evaluate the pros and cons of various options for dealing with a stressful issue.

"This study is a groundbreaking event in the fight against dementia, including Alzheimer's, which has been so pervasively devastating for individuals and families, especially given the limited treatment options for patients and their families," said Dr.JoAnn Tschanz, professor at USU and the study's lead author. "Except for psychiatric symptoms, few studies have examined how caregiver characteristics affect the rate of dementia progression, and our findings indicate significant associations between caregiver coping strategies and the rate of cognitive and functional decline in dementia."

She said the Cache County Dementia Progression Study is the first published academic research to show evidence that environmental factors could slow the progression of Alzheimer's disease, offering hope for those trying to mitigate the effects of the disease

Alzheimer's is the most common form of dementia, affecting one in eight older Americans. A degenerative disorder of the brain, Alzheimer's is the only disease among the top 10 causes of death nationally that, to date, cannot be prevented, cured or even slowed.

Tschanz told Huff/Post50 that caregivers should employ a problem-solving approach to caregiving. "Examples of this may include finding a stimulating activity to engage the care recipient, or ensuring appropriate medical follow-up for changes in symptoms," she said. "Future studies can build on our findings to develop new treatment options focusing on caregiver and other environmental factors."

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From Mother Nature Network:

The Department of Veterans Affairs will pay for service dogs assigned to veterans with impaired vision, hearing or mobility, but it will not cover the cost of dogs assigned for mental disabilities like post-traumatic stress disorder, according to new federal regulations.

Army veteran Brad Schwarz with his service dog, Panzer. Schwarz has suffered
from PTSD since returning from a 2008 tour in Iraq. (Photo: Scott Olson/Getty Images)
Many dogs provide support to veterans suffering from PTSD, but although more veterans are being diagnosed with the anxiety disorder, the VA says there's not enough evidence that these dogs help with the symptoms of combat-related disabilities. A new Army policy has already made it more difficult for soldiers to obtain service dogs and keep them on Army bases.

There’s plenty of anecdotal evidence that service dogs help veterans cope with PTSD, but research lags and the VA is skeptical.

"VA has not yet been able to determine that these dogs provide a medical benefit to veterans with mental illness. Until such a determination can be made, VA cannot justify providing benefits for mental health service dogs," the department said.

There have been no double-blind, randomized controlled trials on the benefits of service dog and PTSD patients, and there are no widely accepted standards for training dogs to alleviate PTSD symptoms.

Researchers at the James A. Haley Veterans Hospital in Tampa, Fla., are conducting the first study to look at benefits of pairing veterans with PTSD with specially trained dogs. Congress recommended the three-year study, permitting the Department of Veterans Affairs to match as many as 200 veterans with dogs, but only 17 participants are currently enrolled.

Three service dog organizations partnered with the hospital to conduct the study, but Guardian Angels Medical Service Dogs (GAMSD) is the only association still involved in the research. The organization trains PTSD service dogs to perform such tasks as awakening clients from nightmares and reminding them to take medication.

Carol Borden, GAMSD’s executive director, says she’s seen dramatic improvements in veterans’ lives after they’ve been matched with dogs.

"The results are very immediate. They’re very quick. It’s not a cure, but they are able to manage their challenges much better than they have in years,” Borden told NBC News.

Demand for PTSD service dogs is high, according to Borden, who says that most recipients spend four years on her organization’s waiting list.

Determining the need for service dogs
It’s estimated that 13 to 20 percent of the more than 2.6 million Americans who served in Iraq or Afghanistan since 2001 have or could develop PTSD.

But unlike service dogs for people with more obvious physical disabilities, there can sometimes be confusion over who can have a dog accompany them into certain places. The American Disabilities Act requires businesses to allow people with disabilities to enter with service animals, but dogs whose sole function is to provide comfort or emotional support do not qualify as service animals under the ADA. However, according to the ADA, dogs that calm a person with PTSD during an anxiety attack are considered a reasonable modification to ADA policies.

Service dogs assist disabled people with specific tasks like opening doors and pulling wheelchairs. Therapy dogs, on the other hand, provide comfort, motivation and emotional support. With proper documentation they can often be taken onto planes and other spaces where animals aren’t usually allowed.

Although PTSD service dogs are trained to respond to certain cues, such as nudging an owner into a petting session if he exhibits panic attack symptoms, and to perform tasks like reminding him to take medications, some people are skeptical of the idea that a dog can assist with a so-called "invisible" disability.

However, there’s evidence that interacting with animals produces biochemical changes in some people’s brains.

Research shows that when people focus on petting a dog, it can increase oxytocin, a chemical that quiets the brain’s fear response. Caring for a pet also helps people become more secure and self-sufficient, according to Hal Herzog, a psychology professor at Western Carolina University.

Training service dogs can also be a form of therapy, according to Rick Yount, founder of Warrior Canine Connection, an organization that has PTSD patients train service dogs. After completing a 2008 training program at a veteran’s hospital, many participants reported lower stress levels, decreased depression, better impulse control and improved sleep.

Yount says that it might be most effective for veterans with PTSD to train a service dog before receiving one themselves.

"They have to convince the dog the world is a safe place, rather than letting the dog prove to them that the world is a safe place,” he told MSNBC.

For more information on service dogs, visit the International Assistance Dog Week website.

Link to Mother Nature Network.

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All of these books are in hardcover and softcover. 

Tiffany Field

2001 The MIT Press

The first sensory input in life comes from the sense of touch while a baby is still in the womb, and touch continues to be the primary means of learning about the world throughout infancy and well into childhood. Touch is critical for children's growth, development and health, as well as for adults' physical and mental well-being. Yet, the American society is dangerously touch-deprived.

  • Touch Hunger 
  • Touch as Communication
  • Touch in Development
  • Touch Deprivation
  • Touch Messages to the Brain
  • Touch Therapies 
  • Infant Massage
  • Massage Therapy for Children, Adolescents and Adults 

Touch and Massage in Early Child Development

Tiffany Field

2004 Johnson & Johnson Pediatric Institute, L.L.C

This book is a groundbreaking compilation of studies on the power of touch in growth and development. Today, a growing body of research around the world shows that human touch is a powerful contributor to infants’ ability to thrive and grow. The studies in this book establish a powerful case for touch, and they remind us that in this high technology world, there is still room for low technology therapies that can increase health and happiness of infants and families around the world.

  • Maternal Touch and Touch Perception
  • Fetal Responses to Foot and Hand Massage of Pregnant Women
  • Touch Perception in Neonates
  • Maternal Touch Effects on Infant Behavior
  • Touching During Mother-Infant Interactions
  • Differences Across Cultural Groups in Mothers’ Nonverbal Teaching Methods
  • Therapeutic Applications of Touch in Pregnancy, Labor and Postbirth
  • Pregnancy, Labor and Infant Massage
  • Skin-to-Skin Care for Breastfeeding Difficulties Postbirth
  • Touch In Premature Infants
  • Tactile Stimulation of Neonatal Intensive Care Unit Preterm Infants
  • Preterm and Full-term Infant Massage in China
  • Optimizing Growth and Bone Mass in Premature Infants: Are Diet and Physical Movement the Answers?
  • Effects of Massage on Sleep, Relaxation and Well-Being
  • Massage Therapy and Sleep-Wake Rhythms in the Neonate
  • Massage, Relaxation and Well-being: A Possible Role for Oxytocin as an Integrative Principle?
  • Massage Therapy for Orphans and Pediatric Problems
  • Massage Therapy With Preterm Infants and Children With Chronic Illnesses
  • Massage Therapy Effects on Illness Symptoms in Infants Living in Ecuadorian Orphanages
  • Massage Therapy for Pediatric Problems

Touch Therapy

Tiffany Field

Churchill Livingstone · Harcourt Brace-2000

This book focuses on recent research on touch therapy in promoting wellness and healing. Research is reviewed on the effects of massage therapy on growth and development, stress reduction, pain relief, immune function and auto-immune disorders.


  • Introduction 
  • Enhancing growth 
  • Pain reduction during painful procedures and chronic pain syndromes 
  • Enhancing attentiveness 
  • Alleviating depression and anxiety 
  • Auto-immune disorders 
  • Immune disorders 


Massage Therapy Research

Tiffany Field
2006 Elsevier Health Sciences

This book examines the practical applications of important massage therapy research findings. Each chapter of this comprehensive resource provides a clear and authoritative review of what is reliably known about the effects of touch for a variety of clinical conditions such as depression, pain management, movement problems and functioning of the immune system. Coverage also includes the benefits of massage to specific populations such as pregnant women, neonates, infants, and adolescents. This book is suitable for massage therapists aromatherapists, chiropractors, osteopaths, physical therapists, and nurses, etc.

  • Massage Therapy Research Methods 
  • Reducing Prematurity 
  • Enhancing Growth and Development 
  • Increasing Attentiveness 
  • Decreasing Depression and Aggression 
  • Improving Neuromuscular Function 
  • Movement Studies 
  • Pain Reduction 
  • Enhancing Immune Function 

Complementary and Alternative Therapies Research

Tiffany Field

2009 American Psychological Association (APA)
This book describes the most common complementary and alternative therapies that have empirical support from peer-reviewed journals and provides guidance on which therapies have been most useful for which psychological and medical issues. In addition, Tiffany Field documents the positive emotional, behavioral, physiological, and biochemical effects of these therapies as well as proposed mechanisms of change. Information is provided on how complementary and alternative therapies can be used in conjunction with traditional therapies. Although focused primarily on adults the book offers data and guidance on pediatric populations as well. Information on the training and credentials of complementary and alternative therapy practitioners is provided as well as contact information for professional associations so psychotherapists can have confidence in making referrals. The information is easily accessible to graduate students and medical students as well as novice and seasoned clinicians and researchers.

  • Combining Complementary Therapies with Psychotherapy
  • Origins of Complementary and Alternative Therapies
  •  Massage Therapy, Acupressure, and Reflexology
  • Acupuncture
  • Tai Chi and Chi Gong
  • Yoga and Pilates
  • Exercise
  • Music Therapy
  • Aromatherapy
  • Progressive Muscle Relaxation
  • Imagery
  • Hypnosis
  • Biofeedback
  • Meditation
  • Complementary and Alternative Therapies in Pediatric Populations


Tiffany Field

1990 Harvard University Press

In this book Tiffany Field provides a readable account of our current knowledge about infant development. She looks at the emergence of sensorimotor and cognitive skills which plays an important role in social and emotional development in the months following birth as the infant experiences the world. She also reviews the literature on infants in nursery and daycare programs, countering negative assessments with studies that show an enhancement of infants’ social interaction in good care settings. In the concluding chapter she pays particular attention to infants at risk because of disease, maternal drug use, prematurity and maternal depression and describes possible intervention strategies.

  • Studying Infants
  • Before and After Birth
  • Motor Development and Learning
  • Emotions, Interactions and Attachments
  • Peer Interactions and Daycare
  • Infants at Risk

The Amazing Infant

Tiffany Field
2006 Blackwell Publishers

Tiffany Field, world renowned infant development scholar, writes an engaging and comprehensive book that collects and reviews the latest findings in the field, exploring cutting edge research and contemporary theories about infant development. This is an engaging and accessible book that integrates research, theory and real life experiences and practices to provide a closer look at how infancy research is conducted. It features illustrative photos and data graphs covering research from recent years. It also draws on recent advances in neuroscience to examine the progress made in the areas of prenatal and cognitive development.

  • How we conduct infancy research
  • Being a fetus (Prenatal Growth and Development 
  • Coming into the world (The Perinatal Period)
  • Being in tune with the world (The Early Senses)
  • Body-Talk with Parents and Others (Social Development)
  • Being Emotional and Temperamental (Emotional and Personality Development)
  • Moving Around in the World and Making Objects Do Things and Things Happen (Motor and Cognitive Development)
  • Finally Using Words (Language Development)
  • Taking Turns with Peers (More Social Development) 

Children A to Z

Tiffany Field
2009 Xlibris

Parents often feel the need to consult a reference book regarding problems their children are experiencing. In the book Children A to Z Tiffany Field has reviewed recent research on childhood issues from A to Z. This book is an encyclopedia-like book that reviews recent research on children’s medical and behavioral problems. The volume Children A to Z is organized alphabetically for the reader’s easy access and its entries are based on current research data.


  • Accidents
  • Aggression
  • AIDS (Acquired Immune Deficiency Syndrome)
  • Allergies
  • Anger
  • Anxiety
  • Apnea
  • Asthma
  • Attachment
  • Attention-Deficit Hyperactivity Disorder
  • And many more


Tiffany Field

2009 Xlibris

In this book Tiffany Field reviews studies on the heartbreak phenomenon as well as various therapies for heartbreak in addition to chapters on recovery, forgiveness and finding love again. Also included are several writing exercises for recovering and quotes from recommended books.

  • Introduction
  • Heartbreak Pain Scenarios-Our Stories
  • The Heartbreak Phenomenon
  • Rejection, Betrayal and Loss
  • Social Emotional Pain
  • Intrusive Thoughts
  • Dreams and Insomnia
  • Crying
  • Loneliness, Depression, Anxiety and Anger
  • Complicated Grief
  • Psychological Therapies for Heartbreak
  • Alternative Therapies for Heartbreak
  • Chemical Therapies for Heartbreak
  • Recovering
  • Finding Love Again

Books are now available in bookstores and online at: (type in "Tiffany Field" in search box)

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