June 29, 2006, 2:36 pm

Alaska: TBIs on the Last Frontier

This week I’ve had the pleasure of travelling throughout Alaska, conducting assessments of brain injury survivors. On Monday, I found myself near the scenic salmon runs of Seward–a popular cruise ship stop. Tuesday’s travels took me to Fairbanks Memorial Hospital (no time for the geothermal springs, unfortunately).

On Wednesday, I was back in Anchorage and had the opportunity to chat with the state’s TBI coordinator, Jan Eidlebach with the Alaska Department of Behavioral Health Services. Although she had only been at the job for about a week, she was already aware of the gross lack of services Alaskans with TBIs face. Alaskans are accustomed to making due without luxuries, for certain, but TBI care isn’t a luxury. It’s a necessity. She asked me for advice on how to go about promulgating change in the Alaska healthcare system, and I encouraged her to start collecting data.

It’s my hope that by showing legislators the individuals suffering under our own noses, we can create better and more efficient caretaking strategies. If you’re from a state that doesn’t offer much to TBI survivors, consider starting a survey of those in need. Information drives policy, and policy drives change.

To help you state head injury administrator, visit nashia.org

Link to this post

, 10:01 am

Coping with Compassion Fatigue

In an insightful interview with WebMD.com’s Medscape, Dr. Charles Figley discusses compassion fatigue, a state experienced by those helping people in distress and a phenomena that affects health care workers and the general public alike.

Dr. Figley began his study of psychologically traumatized people in the 1970’s which led him to notice in the 1980’s that many of his colleagues no longer worked in the field. When he studied deeper he found that these professionals were reacting to the “toxicity of the work”. Further study revealed that those health care professionals who could remain in the field had certain methods of self care that he came to identify as ways of preventing and mitigating compassion fatigue.

Click here to read the full interview, courtesy of WebMD.com’s Medscape (may require free registration)

Link to this post

June 28, 2006, 10:29 am

In Case You Were Wondering: Cell Phones & The Brain

If you’re one of those people who suspect that holding up an electronic device to your brain for hours a day may have an effect, here’s a tidbit from Reuter’s:

“It should be argued that long-lasting and repeated exposure to EMFs (electromagnetic frequencies) linked with intense use of cellular phones in daily life might be harmful or beneficial in brain-diseased subjects.”

Click here to read “Cell phone signals excite brain, study finds.“

Link to this post

June 22, 2006, 8:01 pm

Ariel Sharon Update: Possible PVS for Prime Minister

Despite the odd silence that surrounds so many stroke victims, I’ve learned through various online resources that Ariel Sharon was transferred to a long-term care facility in Tel Hashomer, and that this transfer suggests that Sharon is not expected to emerge from his coma in the foreseeable future.

Here’s an interesting blurb from the Guardian:

“At best, his outlook is bleak,” says Dr Pankaj Sharma, a stroke expert at Hammersmith Hospitals NHS Trust. “At worst, it’s hopeless.” While young trauma victims can sometimes lie in a vegetative state for years, elderly stroke sufferers normally succumb relatively quickly to an infection, a blood clot or a heart attack, he explains. “We’d all be extremely surprised if he survived. If he’d been any other person, he would probably have died by now.”

Sharon’s condition could have sparked an international discussion on the care and treatment of individuals in a persistent vegetative state, but instead, the taboo and political implications surrounding the diagnosis has caused the press to run as far away as possible.

This is just one case in which we can challenge our newsmakers to break open stories that lead to true social reform.

Link to this post

June 21, 2006, 10:26 am

Ambien for PVS? Surprising Findings for Coma Patients

In what seems to be a serendipitous stroke of luck, researchers may have stumbled upon a medical breakthrough in coma stimulation:

Before treatment with the drug, Patient L did not respond to any commands and showed no signs of language comprehension. According to Clauss, after taking his first, 10 milligram dose of zolpidem the patient could meaningfully interact with family, friends and strangers. He could name his favourite rugby player and make simple calculations.

While the initial reports sound promising, it’s important to remember that no hard research validates the findings. But it is a hope, and sometimes that’s enough to drive good science.

Click here to read “Sleeping pill may rouse coma patients.”

Link to this post

, 10:19 am

The Beauty of the Brain

Thanks to the guys at Mindhacks, I found a beautiful slide show on Flickr that offers some spectacular images of the brain up close. Neurons, synapses, and dendrites, oh my:

Click here to see the brain images

Link to this post

June 19, 2006, 11:41 am

Traversing the States

This past week took me to the Department of Health in Des Moines, a jail in Iowa City, the VA in Minneapolis, and a high-rise in Milwaukee–all brain injury-related visits. Today, I’m stopping by a rehab in Carbondale, IL for a facility tour.

One of the issues that repeatedly surface in my travels is the matter of available services for people with brain injuries. What awaits the Iraq veteran once he returns to his small town? Where can someone get stroke rehabilitation home health care? Is there a neuropsychologist within a hundred miles that can evaluate my son?

Time and time again, brain injury survivors are forced to find treatment many miles away from home–a simply reality forged by our current healthcare system. If you’re a caretaker, it’s important to keep in mind that even though something may not be available near you, it doesn’t eliminate your loved one from the opportunity to benefit from specialized treatment. A few TBI facilities will actually work with your state to arrange care–and sometimes transportation–so that a survivor can get on with their life.

If you’re in a quandery about what direction to take for brain injury treatment, feel free to contact me at 888-298-4673, and I’ll be happy to provide you with information and direction.

Link to this post

June 7, 2006, 8:39 am

Blast Injuries Among Returning Veterans

The Defense and Veterans Brain Injury Center report that 59% of an “at risk” group of injured soldiers returning from Iraq and Afghanistan for treatment at Walter Reed Hospital in 2003-2004 suffered at least “a mild brain injury”. Of another group of 433 returning injured soldiers, at least half were identified as having moderate to severe brain injuries. In another group of 1303 soldiers with injury to the lower extremities, 51% had neurologic symptoms. This group included 36% with EEG abnormalities. As the group of 1303 injured individuals has been followed by VA physicians and neuropsychologists, 30% are demonstrating both neurological and EEG abnormalities into the “chronic stage”.

Blast injuries have been studied since World War I. The survival rates of the battlefield injured Iraq and Afghanistan soldiers are significantly higher than any of the past wars and are producing more individuals who will live with lifelong effects of brain injuries. We also are becoming aware of a group of soldiers who are having multiple concussive injuries from IED’s and are returning to the battlefield with little to no treatment.

Research into the area of blast injuries is growing as evidenced in an article: Blast-Related Traumatic Brain Injury: What is Known? (Taber, Warden and Hurley, J. of Neuropsychiatry 18:2, Spring 2006) in which the authors address the specific aspects of the brain trauma from these injuries and the implications for functional impairment.

Earlier this week, a CNN broadcast, identified that there is a growing number of soldiers returning to the battlefield with concussive injuries suffered via exposure to IED explosions. They reported individuals with multiple concussions returning to battle with little to no medical care or identification of their concussive injuries.

Unfortunately, this is group of individuals for whom the identification of their neurologic injury and resulting problems may be delayed. They may leave the armed forces and experience personality, behavior and cognitive problems years later. Who will know that the problems they are having relate to the multiple mild brain injuries which occurred while in the military? And, who will offer and support the needed treatment and rehabilitative services?

The toll for the injured soldiers surviving horrific injuries and living with life long disabilities is significant and incalculable. The toll for those with unidentified brain injuries is yet to be determined.

Link to this post

June 6, 2006, 9:57 am

An Effective Response to Behavior Change Following Brain Injury in Children

Children who develop behavioral problems and personality changes following brain injury can have great difficulty in their return to school, peers and family. Parents report that behavior management problems are more difficult for them to cope with than the physical and cognitive changes related to their child’s brain injury. Similarly, teachers report that the problem behaviors demonstrated by a student with a brain injury exceed their resources and even the expertise available within the school’s special education program. While many children with brain injury will make great strides in their recovery, behavior problems can inhibit social role return in the classroom and within family life.

Catherine Dodds and Rebecca Swift-Weir are two educators who have devoted their careers to working with children with brain injuries. Recently they wrote an excellent workbook for educators, “Unlocking the Myths: Keys to Success, Effective Behavioral Strategies for Children With Acquired Brain Injury.”

Dodds and Swift-Weir take the approach that most behavioral problems are caused by cognitive impairments, such as: attention, language problems, memory deficits and the child’s lack of understanding of their injury and related problems. Strategies which rely on contingency management often fail with children due to their cognitive problems. As Dodds and Swift-Weir point out, children with brain injury can fail to remember simple rules from minute-to-minute, yet are often expected to understand and anticipate the consequence of their behavior. Drawing on the research and applied strategies pioneered by Mark Yvilsacker and Ron Savage, Dodds and Swift-Weir offer practical solutions for the classroom teacher, parents and other professionals. Ms. Dodds is the School Re-Entry Coordinator with NRIO in Toronto and Ms. Swift-Weir is an Educational Specialist withBrain Injury Services of Simcoe County in Barrie, Ontario.

Their workbook is available for purchase through Brain Injury Services of Simcoe County. It is a tremendous tool for the education and rehabilitation professionals and the parents of a child who has developed severely disruptive behavior following a brain injury. In addition to the workbook they are presenting workshops in the greater Toronto area which offer practical and innovative solutions to treating children with behavioral problems.

Click on this link, then navigate to the bottom of the page for the order form.

Link to this post

June 2, 2006, 2:03 pm

Smoking & Drinking Causes Brain Injury?

Add brain injury to all the other health-related woes that smokers and drinkers face over the long haul. Recent collaborations between researchers at the University of California and the Department of Veteran’s Affairs have uncovered a host of brain problems that result from alcohol and tobacco use:

“Recent neuroimaging studies of chronic smokers have shown brain structural and blood-flow abnormalities,” said Dieter J. Meyerhoff, professor of radiology at the University of California… “Specific cognitive dysfunction among active chronic smokers has been reported for auditory-verbal learning and memory, prospective memory, working memory, executive functions, visual search speeds, psychomotor speed and cognitive flexibility, general intellectual abilities, and balance.”

The overall effect of smoking and drinking is a net loss of cortical gray matter, which makes the brain vulnerable to other long-term problems. Brain injury should be a serious motivation for those interested in kicking their bad habits.

Click here to read more about Smoking, Alcohol and Brain Injury

Link to this post