September 29, 2005, 9:42 am

Southwest Conference on Disability

Both Dr. Gainer and I are attending the Southwest Conference on Disability this week in Albuquerque, NM, where Dr. Gainer will be presenting a talk entitled “What Happens When Rehab Ends.”

So far, the conference has provided a wealth of information and resources for people with disabilities. Each session regarding brain injury has been “standing room only,” as brain injury issues are moving to the forefront of concern for many practitioners, advocates, and survivors. So far, this seminar has tackled tough issues ranging from sexual health to substance abuse and neurobehavioral treatment options.

The conference continues until Friday afternoon. Our booth is located right next to the Christopher Reeve Foundation, so if you’re attending the conference or live in the area, please stop by the Albuquerque Convention Center downtown and say hello.

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September 26, 2005, 2:26 pm

When Lightning Strikes

Among the more bizarre and complicated forms of brain injury is electrocution, and among the most severe forms of electrocution is the lightning strike. While over a hundred people a year survive lightning strikes, very few of them emerge without some degree of impairment–not a surprise, I know, given that a lightning bolt runs about 50,000 degrees on average.
Because of the global injuries sustained by lightning strike survivors, it’s a good idea to run a comprehensive batter of neurological testing. This article excerpt from Medpage Today offers an excellent introduction to the world of TBIs due to lightning strike:

“Extensive neurocognitive or neuropsychological testing measuring memory, IQ, and organizational skills are more useful, because they may reveal specific deficit patterns common among lightning-strike survivors, according to Dr. Cooper.”

For those of us who don’t need any other misfortunes than we already have, take note of the 30-30 rule: If the interval between lightning and thunder is less than 30 seconds, seek shelter right away. And make sure to stay indoors for 30 minutes after the last lightning strike.

Click here to read “An Electrifying Tale of Lightning Strikes”

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September 21, 2005, 11:24 am

Another Post-Concussive Victim

Just thought I would point you to this recent news: professional boxer Leavander Johnson was hospitalized following a fight at the MGM Grand in Vegas this past weekend. According to reports:

“Johnson, who took at least a dozen unanswered punches before Weeks stopped the fight, left the ring under his own power but began to drag a leg on the way to the dressing room. He was rushed to the hospital.”

Click here to read “Boxer Leavander Johnson...“

Check out the two posts below for more info on post-concussive syndrome.

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September 19, 2005, 1:34 pm

Post Concussive Syndrome and Mild to Moderate Brain Injury

There is nothing mild about mild brain injury. Each year approximately 500,000 individuals make emergency room visits and 200,000 hospitalizations occur from Mild Brain Injury, according to a 2003 report by the Centers for Disease Control. The effects of a Mild Brain Injury may not be seen at the time of the original emergency room visit and the subtle cognitive and psychological changes may take days, weeks or even months to be recognized.

According to the ICD-10, Post Concussive Syndrome (PCS) consisting of three of eight symptoms and functional changes consisting of:

headache; dizziness; fatigue; irritability; insomnia; concentration difficulty; memory difficulties and intolerance of stress, emotion and/or alcohol.

The DSM-IV identifies Post Concussive Syndrome as: a history of TBI causing significant cerebral concussion; cognitive deficits in memory and/or attention; and presence of at least three of eight symptoms consisting of:

fatigue; sleep disturbance; headache; dizziness; irritability; affective disturbance; personality change and apathy.

Similar, but different in establishing the criteria for Post Concussive Disorder.

In an article by Corwin Boake, Ph.D. and Harvey S. Levin, Ph.D. et al, Diagnostic Criteria for Post Concussional Syndrome After Mild to Moderate Brain Injury, in The Journal of Neuropsychiatry and Clinical Neurosciences, V.17, N.3, Summer 2005 the authors note the discrepancy in the diagnosis of Post Concussive Syndrome (PCS)using the ICD-10 vs the DSM-IV. The authors found that the prevalance of PCS was substantially higher using the ICD-10 criteria. The article confirms the findings of WHO Task Force which suggested further diagnostic refinement of the DSM-IV and ICD-10.

While the research needs to move forward to establish the criteria for the diagnosis of PCS, the problems of brain injury are very real and immediate. Individuals who present with potentially mild brain injury in emergency departments need to be educated better about the effects of the injury. Many of these individuals are at risk for multiple concussive injuries through sport and recreational activities. Preventing an another injury for the individual may be the key function performed through education. Brain injury professionals continue to work with high school, college and professional sports coaches to establish strategies to protect injuried players from subsequent injuries.

With the recent death of Terry Long, a professional football player, on our minds and the countless daily practice sessions undertaken by both professional and amateur athletes during which an injury to brain can occur, the focus on prevention cannot be discounted. Athletes at any level and, of any age, cannot be sent back into the fray following a bump to the head. Coaches, parents, physicians and fellow players must take heed: “Prevention is protection.”

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September 14, 2005, 1:01 pm

Pro-Footballer Dies from Repeated Head Injuries

From the Phildelphia Post:

“Former Steelers lineman Terry Long died from swelling of the brain caused in part by repeated and chronic head injuries received while playing football, according to the findings of Allegheny County Coroner Dr. Cyril Wecht.

The injuries are similar to those seen in boxers who have been repeatedly hit in the head, a condition commonly referred to as being punch drunk, Wecht said yesterday after his office released its report.”

Terry Long is just one in a long line of athletes who die as a result of repeated trauma to the head. We don’t see the press releases on the numerous head injuries that occur on non-professional football fields, baseball diamonds, basketball courts, or other sporting arenas, but as a brain injury case manager, I’m the one who shows up and conducts the evaluation.

In the last two months, I’ve met four people who are permanently disabled as a result of post-concussive syndrome occuring during amateur athletics. Two of them knew that they weren’t supposed to return to the game following a concussion, and they did not pay attention to the advice from their doctors. The other two had never heard of post-concussive syndrome and had no idea about the risks they were taking.

If you’re a coach or a parent, please do all you can to learn about brain injury prevention. Contact the Brain Injury Association of America and ask for help today.

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September 9, 2005, 7:19 am

Some Recent Findings on TBI

Since the Center for Disease Control and Prevention (CDC) has a booth here at the NASHIA conference, I availed myself of a few materials and found the following information:

Of the 1.4 million brain injuries that happen every year, children under 14 make up a third of those reported.

Many people believe motor vehicle accidents are the largest cause of TBIs, but more TBIs occur as a result of falls. The fall rate is highest for ages 0-4 and 75 and up.

Each year, an estimate 80,000 to 90,000 people are permanently disabled by a TBI. That means that every decade, these individuals could populate a city the size of Detroit.

Once you start to get your mind around these numbers, it is distressing to find out how difficult it is for a TBI survivor to access the services they need.

Click here to read an online version of the CDC’s “Traumatic Brain Injury in the United States“

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September 8, 2005, 12:18 pm

Aging with a Brain Injury

As more people survive severe brain injuries and research becomes available regarding individuals at the 10 to 20-year interval following injury, we are seeing information about “the graying of brain injury”. For those of us who live and work with TBI survivors, our experiences are a practical and evolving research project.

Many of these people live on their own, with family members or in congregate living situations. For those individuals who were injured between ages 20 and 35 and who returned to living with their parents, we are now seeing those parents enter into retirement age and address their own health issues and mortality.

In a recent discussion with the 81 year-old father of a person with a brain injury, the father spoke to me of his growing concerns with the problem of who would make decisions about his now 51 year-old son in the future. His son,who is 18 years post-injury, had experienced a medical decline about two years ago and now has stabilized and returned to his long term care program. I remember the father’s issues distinctly from that period and the degree to which he participated daily in care decisions and visits to his son while he was in acute medical care. I admired his devotion to his son and to his needs and I remember telling staff that a child couldn’t ask for a more loving and concerned parent.

“Who will be there for my son when he can no longer do that job?” the father asked me. I offered to talk with his other adult daughter about her brother’s needs, but he was concerned that she wasn’t prepared or experienced enough to make major decisions for him. He expressed to me his fear–not of her competency or love of her brother–but of the overwhelming level of committment required. We agreed that I would talk to his daughter when he was ready, but so far six months have passed since we last spoke.

In Brain Injury Professional, Volume 2, Issue 2, of the North American Brain Injury Society, the articles address with the long term issues of aging with a brain injury. The authors are well known rehabilitationists who have focused on the important issues of maintaining health, family issues, independence and long term healthcare implications. They advise us that the research into aging with a brain injury is sparse, but slowly evolving. Unfortunately, research is this area will occur after most problems are confronted and resolved by the individuals living with a brain injury and their family members. Eventually, pragmatic solutions will be developed in response to problems, and over the course of time will be implemented.

Today, the issue of aging remains a largely unattended issue for TBI survivors, so I encourage researchers and advocates alike to begin contributing to the discourse.

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, 8:50 am

Indispensible Resource for Mild/Moderate TBI Survivors

Everytime I attend a brain injury-related conference, I get inspired by the fascinating individuals I meet and the programs they’re involved with. This morning, at the National Association of Head Injury Administrator’s Conference (NASHIA), I had the honor of meeting Lisa Keller, a TBI survivor who turned her recovery into a remarkable tool for individuals and family members that struggle with a mild or moderate brain injury.

Lisa’s “brain child” is called the Brain Injury Recovery Kit, presented by Daytimer. The kit contains a 5-step program that provides essential information, tips, and strategies to begin moving into and through recovery. The kit also contains DVDs and organizational tools that many survivors will find extremely useful. Lisa herself continues to use many of the components offered in the kit.

The Brain Injury Recovery Kit isn’t meant to replace rehab or medical care, but it should be a fantastic supplement to recovery. I think it would be especially critical to individuals living in rural areas with limited access to resources.

Click here to find out more about the Brain Injury Recovery Kit from Daytimer.

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September 7, 2005, 7:19 am

Nebraska and Rattlesnakes

Yesterday, I conducted an evaluation just a short drive from Denver, in Western Nebraska. The terrain was yellow and desolate and the sky absolutely enormous–all in all a lovely time to roll down the windows and turn on the radio. Here’s a snapshot I grabbed at a rest area:

Out in remote areas, I’m lucky to pick up any radio signals, so more often than not, I’m resigned to the AM dial, and take what I can get. And yesterday, it was all news.

Most of what I heard on the radio involved the evacuation in New Orleans, and the ensuing migration to other cities, but I couldn’t help thinking how this is going to affect the healthcare system, and particularly TBI survivors. Obviously, we’re going to see many new TBIs as a result of injuries sustained during and after the hurricane, but my fear is that TBI survivors were among the most disadvantaged during the evacuation, and that many of their numbers perished in the aftermath. In our attempts to implement tighter emergency plans, it is imperative we consider the unique challenges different disabilities pose, and that in the event of emergencies, people with TBIs can continue receiving a similar level of care or better.

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September 1, 2005, 7:26 am

NASHIA's State of the States Conference

Next week, I’ll be attending the National Association of State Head Injury Administrator’s (NASHIA) State of the States Conference in Denver, Colorado. In case you ‘re unfamiliar with NASHIA, it’s goal is “to assist state government in promoting partnerships and building systems to meet the needs of individuals with brain injury and their families.” So what does that mean to survivors?

Well, for one thing, it’s a great resource for finding an advocate in your state. The individuals who attend this conference are state or federal employees who can really make a difference–and they come to NASHIA’s conference to learn about effective ways to advocate for TBI survivors. If you’re a survivor or a family member, and you’re having big funding problems, one of the best ways you can support your state’s “head injury administrator” is to get involved with your local Brain Injury Association (BIA). And if your local BIA isn’t active, then it’s up to you to turn things around. Time and time again, the BIA relies on individuals like you to make the difference.

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