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October 31, 2007,
10:08 am
The High Price of a Bump on the Head
In a recent blog, Mike Mason spoke of the problems a woman he knew was experiencing following a "mild brain injury" As his comments illustrate, there is nothing mild about mild brain injury. The effects may take years to be recognized and can include cognitive, psychological and behavioral features which serve to obscure the accurate diagnosis and forestall effective treatment. Many people with Mild Brain Injury end up as psychiatric patients where their psychological issues can be addressed, but the cognitive and related behavioral issues may go undetected and unresolved. There are screening instruments for Mild Brain Injury as well as treatment protocols, but they need to be used to be effective. As Mike Mason points out, the treatment options are sparse, the potential for misdiagnosis high and insurance resources are slim to non-existent. Mild Brain Injury can take its toll on a person's ability to function in relationships, at work and in all aspects of their life. Clinicians need to include screening for Mild Brain Injury and Post Concussion Syndrome in their potential patients.
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8:58 am
Treating Parkinson's at a Price
Recently, Dr. Rolf Gainer forward me a news article by AP writer Lauran Neergaard about brain implants being used for Parkinson's patients–and it brings up interesting implications in brain injury treatment.
The electronic implants are supposed to suppress the Parkinson's palsy in patients, but the procedure comes with a nasty side-effect. Implanted patients are becoming more and more impulsive, and research suggests that the implant interferes with their ability to learn from bad choices. The result is that implant recipients may have reduced tremors, but they could develop gambling habits or other maladaptive behaviors.
The conundrum poses a challenge to neurosurgeons–what is the cost and loss of neurological treatment. Just how dangerous is it to disrupt normal brain activity? I, for one, plan to keep a close eye on the ongoing debate.
Click here to read Neergaard's article.
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8:04 am
Veterans and Suicide
The results of a study involving 800,000 depressed veterans who were in the VA health care system from 1999 to 2004 challenges the assumption that individuals with PTSD or other service disorders are more likely to kill themselves. The study also found that younger men are at a higher risk for suicide than previously thought. It is generally known that suicide rates are higher for veterans than among the general population. With the number of soldiers returning from Iraq and Afghanistan, including many individuals with behavioral health problems, like PTSD as well as individuals with significant disabilities related to war injuries, the need to creating more resources to identify and treat those individuals at risk for suicide becomes very important.
Dr. Kara Zivin, the lead author of the study, contends that the assumption that the risk for suicide is greater for a certain type or group of patients is misleading. Dr. Zivin reported that improving the assessment of suicidal risk in depressed individuals is the more relevant approach. As to the relationship of suicide to PTSD, the study indicates that those with PTSD may be at a lower risk due to contacts they have with mental health resources. The other risk factors of substance abuse and recent psychiatric hospitalizations were considered important indicators for suicide risk.
It is interesting that this study, which was recently published in the American Journal of Public Health, comes at a time when much attention is being focused on the needs of veterans and the state of affairs at military hospitals and in the VA system. This weekend, in Washington, brain injury professionals are meeting to address the needs of the returning veterans and to put forth a blueprint for the needs of these individuals. We cannot be swayed by the recently released study which may minimize suicide risk even though it stresses the need for improved assessment services. We have a group of returning veterans, many of whom, have mental health and rehabilitation needs which are yet to be identified and addressed. The long term needs of these individuals can only be considered if we start by identifying the injuries and conditions which result from their wartime experiences.
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October 25, 2007,
8:11 am
On the Duration of Mild TBI
Just yesterday, I received a call from my sister's friend–a woman who experienced a seemingly benign concussion a year ago while driving her car. At the time of her accident, she was considered a force in her community, as well as a pillar for her husband and kids.
Today, she can barely manage to keep her business afloat, and the daily migraines are about to drive her mad. She has trouble finding the right words, she's a lot more irritable, and she can't remember things like she once could. (If this sounds familiar, take a look at the rather rosy portrait of Bob Woodruff in the recent NY Times posting) .
Recently, a study in the June 2007 issue of Acta Neurologica Scandinavica reported that symptoms of Post-Concussive Syndrome (a common mild TBI diagnosis) can persist even 5-7 years post-injury. While that isn't shocking news for most of us in the brain injury field, it is a sobering truth for thousands of individuals out there who thought their headaches and memory problems might vanish a few weeks after that bump on the head.
Science is supporting the need for intensive, sustained therapies for mild TBI, so why isn't there a single mild TBI clinic in the country? Place a call to your insurance company if you want to find the answer.
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October 19, 2007,
6:57 am
Emergency Summit for Vets with TBI
An emergency summit meeting to address the needs of veterans returning from Iraq and Afghanistan with traumatic brain injury has been convened by the North American Brain Injury Society (NABIS) and the Brain Injury Association of America (BIAA). The meetings will begin on November 2, 2007 in Washington, D.C.and are expected to identify the gaps in services for returning soldiers with TBI as well as to create a standard of care and treatment protocols to support people with traumatic brain injury throughout their lives. This summit is a tremendous step forward and represents the efforts of civilian, military and Veteran's Administration experts in rehabilitation to develop the architecture for a treatment network. The meeting is expected to produce a "white paper" which will be endorsed by brain injury professionals as the blueprint for the needs of TBI survivors. Mike Mason will represent the Neurologic Rehabilitation Institute at Brookhaven Hospital. We look forward to his report and involvement in this important work.
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October 16, 2007,
5:52 am
Brain Fitness Gaining Popularity
Recently, the LA Times did a big story on brain fitness, and at the center of it was Sharp Brains, a blog and website devoted to providing research-based cognitive exercises. It wouldn't surprise me if brain fitness programs start making their way into schools and hospitals, and perhaps with a little encouragement, nursing homes:
Americans already understand the value of physical fitness as a means of preserving the body's proper function and preventing age-related diseases, says Fernandez. He predicts that cognitive fitness will become a goal to which Americans equally aspire as we learn more about aging and the brain.
Click here to read a good follow up post on the trend towards better brain health.
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October 8, 2007,
7:32 am
Brain Injury Conferences: Season Wrap-Up
It's been one of the most interesting months in brain injury that I can recall. At this year's various conferences–NASHIA, BIAs, NABIS–there was a strong sense of urgency regarding the treatment of brain injured veterans. Brain injury professionals know more than anyone that (as Mentor's Dr. Debra McMorrow puts it) "As it goes for the soldier, so it goes for the civilian." If American can adequately address the issue of Iraq War brain injuries, then all brain injury survivors may one day benefit.
Already a tremendous amount of action has taken place. A townhall meeting was called to order in DC to promulgate the vets issue. A bill was introduced that would require both the DoD and the VA to make plans (this is a read-only bill, so action may not follow plan-making). And most exciting, an urgent Call to Action Consensus Conference on Brain Injuries Caused by Blast organized by NABIS has been set for early November. The expectation is that a new proposal for the treatment of brain injured troops will be formed by the nation's foremost experts on brain injury.
It's never been a more important time to get involved with your state's Brain Injury Association. By advocating at the grass roots level, you're sending a clear message to local legislators that now is the time for brain injury reform in America.
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October 1, 2007,
3:12 pm
Girls & TBI: The Underreported Truth
When's the last time you read a story about sports concussions? If you're like me, within the last week–it's been all over the news lately. Now ask yourself this: when is the last time you read about a female getting a sports-related concussion? In some sports, girls actually sustain more brain injuries than boys, but you wouldn't know that from watching recent reports.
The Times has a great article about the tendency to ignore concussions that happen to female athletes. Here's an excerpt:
According to a study to be published in the Journal of Athletic Training, in high school soccer, girls sustained concussions 68 percent more often than boys did. Female concussion rates in high school basketball were almost three times higher than among boys.
Girls also consistently took longer for their symptoms to resolve and to return to play. The study, conducted by researchers at Ohio State University and Nationwide Children’s Hospital, examined data submitted by 425 certified athletic trainers across the United States during the 2005-06 academic year. According to the National Federation of High School Sports Associations, 1 million youngsters play high school basketball and 700,000 play high school soccer each year; male participation is only slightly higher than among girls.
Click here to read more.
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10:20 am
A Forty Year Quest Leads to An Answer for Brain Injury Outcomes
Donald Stein, PhD. has worked for over forty years to identify a treatment for traumatic brain injury which could improve survivability and lead to improved clinical outcomes. Starting in animal research in the 1960's Dr. Stein has toiled for years to identify an agent which could help heal an injured brain. Dr. Stein's research has gone unnoticed for most of the past forty years as his interest in the hormone progesterone, a female hormone, did not attract the attention of the research monies coming from the big pharmaceutical companies. Finally, in 1999, while working as an administrator at Emory University, Dr. Stein working with emergency medicine physicians, Arthur Kellerman, MD and David Wright, MD, received a $2.2 million NIH grant to study the effect of progesterone on people who had received traumatic brain injuries. The study focused on 100 individuals with traumatic brain injury who were treated at Grady Memorial Hospital in Atlanta.Some patients received the standards brain injury protocol while others received intravenous progesterone at triple the highest levels found at the end of pregnancy. The 2005 study yielded positive results, the death rate was 13% vs 30% for the standard protocol.Progesterone also showed no negative effects.Dr. Stein published the results in the Annals of Emergency Medicine reporting that "Moderate traumatic brain injury survivors who received progesterone were more likely to have a moderate to good outcome than those randomized to placebo." Dr. Stein's research with animals had led to this small study involving humans which has been replicated in dozens of other studies at numerous research institutions. Dr. Stein has applied for NIH funds for a 1000 patient study and has received $229,000 in grant planning funds.Emory University hasn't applied for the research grant yet, however the technology transfer office at the university is "optimistic" about developing and marketing progesterone for the treatment of brain injury.
Studies of this type are very important to improving survivability and outcome for individuals with traumatic brain injury. Dr. Stein's dedication to research in this area in spite of funding and support difficulties may finally pay off for the 1 million people who experience a TBI each year.
A discussion with researchers at Emory University about progesterone treatment for traumatic brain injury can be found at WSJ.com/video.
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