Category Archives: Memory

Right Hemisphere Brain Damage


Illustration showing the position of the parie...

Illustration showing the position of the parietal lobe of the brain, the site of damage related to visual extinction. (Photo credit: Wikipedia)

Right Hemisphere Brain Damage

  • What is right hemisphere brain damage?
  • What are some signs or symptoms of right hemisphere brain damage?
  • What treatment is available for individuals with right hemisphere brain damage?
  • How can I communicate more effectively with a person with right hemisphere brain damage?

What is right hemisphere brain damage?

Right hemisphere brain damage is damage to the right side of the brain. The brain is made up of two sides, or hemispheres. Each hemisphere is responsible for different body functions and skills. In most people, the left side of the brain contains the persons language centers. The right side controls cognitive functioning thinking skills.

Damage to the right hemisphere of the brain leads to cognitive-communication problems, such as impaired memory, attention problems and poor reasoning. In many cases, the person with right brain damage is not aware of the problems that he os she is experiencing anosognosia.

What are some signs or symptoms of right hemisphere brain damage? 

Cognitive-communication problems that can occur from right hemisphere damage include difficulty with the following:

  • attention
  • left-side neglect
  • memory
  • organization
  • orientation
  • problem solving
  • reasoning
  • social communication pragmatics

Attention: difficulty concentrating on a task and paying attention for more than a few minutes at a time. Doing more than one thing at a time may be difficult or impossible.

Left-side neglect: a form of attention deficit. Essentially, the individual no longer acknowledges the left side of his/her body or space. These individuals will not brush the left side of their hair, for example, or eat food on the left side of their plate, as they do not see them or look for them. Reading is also affected as the individual does not read the words on the left side of the page, starting only from the middle.

Memory: problems remembering information, such as street names or important dates, and learning new information easily.

Orientation: difficulty recalling the date, time, or place. The individual may also be disoriented to self, meaning that he/she cannot correctly recall personal information, such as birth date, age, or family names.

Organization: trouble telling a story in order,giving directions, or maintaining a topic during conversations.

Problem solving: difficulty responding appropriately to common events, such as a car breakdown or overflowing sink. Leaving the individual unsupervised may be dangerous in such cases, as he or she could cause injury to himself or herself, or others.

Reasoning: difficulty interpreting abstract language, such as metaphors, or responding to humor appropriately.

Social communication pragmatics: problems understanding nonverbal cues and following the rules of communication e.g., saying inappropriate things, not using facial expressions, talking at the wrong time.

Source — read more:  Right Hemisphere Brain Damage.

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“Brain injury survivors …”


“Brain injury survivors need to laugh at the things that happen. Even some of the most difficult times can be funny…at least when you reflect on what happened. Communication difficulty of various degrees occur with brain injury. This situation is an unfortunate communication barrier. I give details surrounding the situation so others can better understand what happens in the lives of brain injured survivors.” Edie, author, Brain Injury Self Rehabilitation

Brain Injury Self Rehabilitation

One of the resources that I have recently discovered is the “Brain Injury Self Rehabilitation” blog on WordPress! The blog is owned by Edie, a  Registered Nurse and member of Sigma Theta Tau International Honor Society of Nurses from Ohio, who is now a Traumatic Brain Injury (TBI) survivor.

Edie’s Story

Edie is a Rehabilitation Nurse that was assaulted at work. She eventually got treatment after nearly 20 years following her injury. She documented her journey through the American health care, legal, insurance, and Workers’ Compensation System showing what an ordinary American mother, spouse, nurse, and family had to go through before she had proper treatment.

She discusses how she restored her life through her determination and self rehabilitation. She indicates that she lives just 20 miles from world renowned healthcare facilities. After many twists and turns in her cold and complex case, and an ordeal that lasted for nearly 20 years, she finally got proper treatment 200 miles away from home!

Edie now shares her experience and educates survivors of Chronic Traumatic Encephalopathy (CTE), “Mild Traumatic Brain Injury” (mTBI) and Traumatic Brain Injury (TBI) about “Brain Injury Self Rehabilitation“. She speaks out to protect other nurses and healthcare workers, and advocates for patients through education.

Humor is Sometimes the Best Medicine!

Edie uses humor to maintain a level head even in dire circumstances. In a recent blog post titled, “Laughter as brain injury medicine – Permanent Hairdo? A Day in My Life. Keep Smiling!” she states:

“Brain injury survivors need to laugh at the things that happen. Even some of the most difficult times can be funny…at least when you reflect on what happened. Communication difficulty of various degrees occur with brain injury. This situation is an unfortunate communication barrier. I give details surrounding the situation so others can better understand what happens in the lives of brain injured survivors.”

I am already learning a lot from Edie’s posts on her “Brain Injury Self Rehabilitation” blog. I highly recommend that CTE, mTBI, and TBI survivors visit her blog to learn more. I will be reading her blog judiciously!

Read more: 

http://braininjuryselfrehabilitation.com/

There is Help for Battered Athletes and TBI patients!


A CT of the head years after a traumatic brain...

A CT of the head years after a traumatic brain injury

One of the doctors that has been at the forefront of the battle against traumatic brain injury (TBI) and chronic traumatic encephalopathy (CTE) is Dr. Daniel Amen. He has been working with athletes, military servicemen, and other brain trauma patients to provide a treatment regimen to help them to better cope with living with the effects of CTE and TBI — memory loss, dementia and depression. As Dr. Amen said recently, “My hope is that through increased awareness and education we can help these athletes before it’s too late.”

Since people with the CTE and TBI condition often do not have visible scars, it is hard for most people, including some physicians and other medical providers, to understand the extent to which short-term memory loss affects one’s ability to cope with daily living. Things that other people take for granted just takes much longer to do. Unless one is very organized, one can spend an inordinate amount of time looking for things that one needs on a daily basis. Just getting ready to leave the house for work or an appointment becomes a stressful  ordeal unless one has a routine that is not disturbed in any fashion.

Realization of the Consequences of Brain Trauma

It takes a while — maybe years for person with a CTE or TBI condition to fully understand that their brain no longer functions properly. Those that are lucky enough to have proper treatment may come to the realization sooner that those who do not receive treatment or worse still have to contend with skeptical or uncaring physicians and medical providers.

For instance, I have never had any neurological treatment or rehabilitation for the brain trauma that I sustained while working at Ameriprise Financial in July 2004. It took a number of years for me to realize that I had to take care of my own health rather than succumb to despair. I used my skills as a research analyst to search for articles on traumatic brain injuries so I could better understand what had happened to my brain and why I was experiencing short-term memory problems while my long-term memory was so crystal clear. In fact, I believe my creativity even increased as a result of the brain trauma resulting in a deluge of new and often very brilliant ideas. The only problem is that if I don’t write them down immediately,I would not be able to recall the  ideas after a short time. As I now sometimes joke that — my long-term memory is probably near genius level while my short term memory is significantly impaired. For someone that is particularly cerebral, with a background as a money market portfolio manager and an investment research analyst, one can only imagine my frustration with the situation. What I have essentially had to do is my own “self rehabilitation” using nutrition, naturopathic solutions, and coping mechanisms and systems that I have developed by myself which may not be the most efficient methods but nevertheless do work for me. Now I have the daunting task of going through an administrative hearing regarding the State of Washington‘s Department of Labor & Industries (L&I)‘s  premature termination of my medical benefits and I have to do it by myself, if I don’t get any legal help! A tall order for me but I am determined to go the distance to ensure that the State of Washington‘s Department of Labor & Industries (L&I) ensures compliance with workplace safety standards and more importantly, that L&I changes the way it treats workplace traumatic brain injury cases. A traumatic brain injury is not tantamount to a broken limb and should not be treated as such!

Coping with the Effects of Brain Trauma

Ultimately, one has to come to terms with the fact that the brain trauma has caused a fundamental change in one’s brain function. The best way to deal with the effects of the trauma is to accept it, the same way that one would accept the loss of a limb, and then find the best way to cope and live with it. It is not an easy journey coming to terms with the loss of brain function. High performance super athletes,  military servicemen, and intellectuals always like to perform at or above  a certain level of excellence.  It is very difficult and frightening for super-achievers that suffer a brain trauma to come to terms with the loss of a part or most of their  brain function. It is even more frustrating when one has to contend with all the pseudo-brain specialists that have never read a single pamphlet or sheet on brain science nor have any clue about the effects of CTE or TBI but think they know more than the brain specialists. Anabel Maya, a psychologist who is an expert on memory wrote an article titled “A Closer Look Into Memory” and she admits that she is fascinated by memory because of the amount of information that the human brain is able to store; however, she states that she does not completely understand memory — she is still learning about it!

Support of Family and Friends!

It is really important that people that have sustained brain trauma have support from their families and friends. Support also means understanding how the trauma affects the brain and how to help the person cope with the effects of the brain trauma. I am lucky to have the support of my family and close  friends and I will forever  be grateful to them. I would not have survived without their love and support! I have information on this blog that can help families to understand TBI and CTE and what role they can play to help their loved ones to cope and live with the condition.

You are not alone — there is lots of help!

Some people with a CTE or TBI condition receive treatment; however, there are a significant number of people like me that  receive little or no treatment and have to find ways to cope and live with the condition. The result of no treatment is despair and depression that eventually leads some to suicide! Some insurers like Zurich advise their clients to take precautionary steps to minimize workplace injuries, report injuries in a timely manner in order to start treatment soon after the injury occurs so that to that the employee recovers and returns to work resulting in lower worker compensation costs to the employer. Some employers don’t even bother to follow state mandated safety guidelines, do not report injury claims and time to ensure proper and timely treatment of their employees, and do not care what happens to the employee that has been injured due to their own negligence.  The only thing that matters to such employers is return to shareholders and management bonuses. The injured employee and their family be damned!They are much more interested in covering their tracks and paying the lowest premiums they can muster than doing the right thing!

However, there is help available.  Dave Duerson, Junior Seau and Ray Easterling did not need to take their own lives out of frustration, fear and despair! Most likely they could have been saved, if they had been under the care of physicians and other providers that specialize in the treatment of patients with CTE and TBI conditions.

Resources Available for Brain Injury Treatment

Amen Clinic: Dr. Daniel Amen of the Amen Clinic has a practice that focuses on helping former athletes,  servicemen and others that have sustained brain trauma. He has posted the article below on his blog to let people know that they need not commit suicide when there is lot of help available for them. You can visit his website to learn more and also for the contact information.

Brain Injury Research Institute (BIRI): Dr. Bennett I. Omalu, the forensic pathologist that discovered the presence of “Tau Proteins” in the brains of Mike Webster and other dead athletes and who coined the term “chronic traumatic encephalopathy” (CTE), and his partner Dr. Julian E. Bailes established the Brain Injury Research Institute (BIRI)  to continue their research on CTE and also to treat people that have sustained brain trauma and brain injury from multiple concussions.You can contact them by visiting their website.

Federal Agencies: The Federal Government has established  a dedicated section on its HRSA website to provide information and guidance to doctors, patients, and schools on dealing with Traumatic Brain Injury . The Center for Diseases Control (CDC) also has a section on its website that is dedicated to traumatic brain injury.

Military servicemen and veterans are returning from war with high incident rates of brain trauma which used to be generally diagnosed as post-traumatic stress syndrome. Now the Federal Government is on top of it game and military servicemen and veterans are receiving state of the art diagnosis and treatment for traumatic brain injuries. The Defense Departments’ Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (CDoE) was established in November 2007 to integrate knowledge and identify, evaluate and disseminate evidence based practices and standards for the treatment of psychological health and TBI within the Defense Department. The Defense and Veterans Brain Injury Center (DVBIC) serves active duty military, their beneficiaries, and veterans with traumatic brain injuries (TBIs) through state-of-the-art clinical care, innovative clinical research initiatives and educational programs.

State Agencies: Your best bet is to start with your State’s Brain Injury Association  of  America(BIAA). You can contact your State BIA‘s office by visiting the Brain Injury Association  of  America(BIAA)‘s website and then click on the map to select your own State.

Web: The internet abounds with information on brain injuries. You can do your own research using Google to type in keywords. Please see the tags on this page for examples of keywords that you can use for your search..

Brain Health Resources Blog: This blog has lots of information and links to help you to quickly find the resources that are available. If you have a question for me, kindly leave a comment and I will revert to you to guide you to find the information that you need.

Disclaimer: Please consult your own doctor first for guidance on your brain injury condition and treatment options.

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There is Help for These Battered Athletes

Shock, dismay and grief descended upon family, friends, and fans when news broke that former 12-time pro bowl NFL linebacker, Junior Seau had taken his own life.  The news came as shock to all, even those that were close to him, but this tragic story is becoming far too common.

Just two weeks ago, former Atlanta Falcons safety Ray Easterling, 62, shot himself in Richmond, Va.  His wife, Mary Ann Easterling, told news reporters that her husband suffered from depression, insomnia and dementia after his football career.  Another ex-NFL player Dave Duerson, a former Chicago Bears Pro Bowl safety, committed suicide nearly 15 months ago by shooting himself in the chest.  Duerson, 50, thought he suffered from dementia that fueled his depression. His suicide note included the request: “Please, see that my brain is given to the NFL’s brain bank.”

Post-death exams of Duerson’s brain showed he suffered moderately advanced evidence of chronic traumatic encephalopathy — a progressive degenerative disease related to repeated concussive blows. The disease has been linked to at least 18 deceased NFL players.

I just wrote about how serious a problem CTE is for athletes in contact sports and returning soldiers in last week’s newsletter and here we are again dealing with another heartbreaking story.  Junior Seau was a legend, but even legends cannot escape the ravages of chronic brain damage.  There is help for these athletes and anyone suffering from chronic traumatic brain injuries, depression, and irritability and memory problems.

I began studying the effects of football on brain health in 1999 when Brent Boyd, a former NFL player, came to the Amen Clinics.  After Anthony Davis came to the clinic in 2007 our work with active and former NFL players really took off when we partnered with the Los Angeles Chapter of the Retired NFL Players Association to perform the world’s largest brain imaging/brain rehabilitation study.

As part of the rehabilitation study we scanned the brains of 116 NFL players and found that 113 suffered brain damage and the level of brain damage was just awful.  People who have chronic, traumatic brain injuries, which almost all football players have because they get hit in the head thousands of times in their careers; have a much higher incident of depression and suicidal ideas and suicidal behavior.  Thirty percent of the players we studied had issues with severe depression.  That is four times the rate of depression among the general population!  Even worse, linebackers, like Junior Seau, who lead with their heads on the field, suffer the most significant damage.  The study showed patterns in damage to the front part of the brain and temporal lobes, under the temples and behind the eyes, which manage memory, mood stability and impulse and temper control.

The good news is the brains of contact-sport players and soldiers can be rehabilitated.  We have conducted three clinical studies with 116 active and former players from the National Football League here at the Amen Clinics and each study shows that it’s not only possible, it’s likely, that with a brain-directed health protocol, significant improvement can be experienced in decision-making, reasoning, depression, mood and memory.

Our studies found significant evidence that, fortunately, there are treatment protocols that can often reverse many of the symptoms caused by brain damage and improve brain function.

The studies include:

  1. Effects of Elevated Body Mass in Professional American Football Players on rCBF and Cognitive Function, Transl Psychiatry (2012) 2, eK, doi:10.1038/tp.2011.67.
  2. Impact of Playing Professional American Football on Long Term Brain Function. Journal of Neuropsychiatry and Clinical Neurosciences, J Neuropsychiatry Clin Neurosci 23:1, Winter 2011, 98-106.
  3. Reversing Brain Damage in Former NFL Players: Implications for TBI and Substance Abuse Rehabilitation. Journal of Psychoactive Drugs, 43 (1), 2011 Online publication date: 08 April 2011.

Junior may have damaged his pre-frontal cortex, which is responsible for decision-making.  Brain trauma symptoms can appear decades after the playing days and can include dementia, memory loss, violent behavior, obesity, mental illness and depression. And unfortunately, suicide is more common in people who have experienced brain trauma.

Playing football is a brain damaging sport and for those that are going to play it, my message would be to get your brain examined before you play and after you stop as well as any time you get a concussion.  The best way to prevent tragedies like these from happening aside from avoiding the things that are harmful to the brain, are early detection and treatment.  My hope is that through increased awareness and education we can help these athletes before it’s too late.

Source: http://70.32.73.82/blog/5758/there-is-help-for-these-battered-athletes/

AP ENTERPRISE: Hall of Famer Tony Dorsett, other ex-players suing NFL, describe negligence


By Associated Press, Published: February 2

The helmet-to-helmet shot knocked Tony Dorsett out cold in the second quarter of a 1984 Cowboys-Eagles game, the hardest hit he ever took during his Hall of Fame NFL career.“It was like a freight train hitting a Volkswagen,” Dorsett says now.

( Martha Irvine / Associated Press ) – In this image take from video shot on Wednesday, Jan. 25, 2012, Tony Dorsett, a retired Hall of Fame running back for the Dallas Cowboys, listens to a reporters question in his home in suburban Dallas. Dorsett, 57, is one of at least 300 former players suing the National Football League, claiming the NFL pressured them to play with concussions and other injuries and then failed to help them pay for health care in retirement to deal with those injuries.

 “Did they know it was a concussion?” he asks rhetorically during an interview with The Associated Press. “They thought I was half-dead.”
And yet, he says, after being examined in the locker room — a light shined in his eyes; queries such as who sat next to him on the Cowboys’ bus ride to the stadium — Dorsett returned to the field and gained 99 yards in the second half. Mainly, he says, by running plays the wrong way, because he couldn’t remember what he was supposed to do.“That ain’t the first time I was knocked out or been dazed over the course of my career, and now I’m suffering for it,” the 57-year-old former tailback says. “And the NFL is trying to deny it.”Dorsett traces several health problems to concussions during a career that lasted from 1977-88, and he has joined more than 300 former players — including three other members of the Pro Football Hall of Fame, and at least 32 first- or second-team All-Pro selections — in suing the NFL, its teams and, in some cases, helmet maker Riddell. More should have been done in the past to warn about the dangers of concussions, their lawyers argue, and more can be done now and in the future to help retired players deal with mental and physical problems they attribute to their days in the NFL.In interviews conducted by the AP over the past two months with a dozen plaintiffs, what emerged was, at best, a depiction of a culture of indifference on the part of the league and its teams toward concussions and other injuries. At worst, there was a strong sense of a willful disregard for players’ well-being.“It’s not about whether players understood you could get a concussion playing football. It’s about the negligence of care, post-concussion, that occurred,” says Kyle Turley, an offensive lineman for the Saints, Rams and Chiefs who was the No. 7 overall pick in the 1998 draft and an All-Pro in 2000.

Players complain that they carried owners to their profits, in an industry that now has more than $9 billion in annual revenues, without the safety nets of guaranteed contracts or lifetime medical insurance.

“Yeah, I understand you paid me to do this, but still yet, I put my life on the line for you, I put my health on the line,” Dorsett says. “And yet when the time comes, you turn your back on me? That’s not right. That’s not the American way.”

Head injuries are a major topic of conversation every day of the NFL season. With the Super Bowl as a global stage, the NFL will air a one-minute TV commercial during Sunday’s game highlighting rules changes through the years that have made the sport safer.

The owners of the teams playing for the Lombardi Trophy in Indianapolis — Bob Kraft of the New England Patriots and John Mara of the New York Giants — acknowledge the issue’s significance.

Brain Tour


The Alzheimer’s Association takes us on a “Tour Inside the Human Brain“!

1. Three pounds, three parts PREVIOUSNEXT
Illustration of Human Brain and Head Your brain is your most powerful organ, yet weighs only about three pounds. It has a texture similar to firm jelly.It has three main parts:

  1. The cerebrum fills up most of your skull. It is involved in remembering, problem solving, thinking, and feeling. It also controls movement.
  2. The cerebellum sits at the back of your head, under the cerebrum. It controls coordination and balance.
  3. The brain stem sits beneath your cerebrum in front of your cerebellum. It connects the brain to the spinal cord and controls automatic functions such as breathing, digestion, heart rate and blood pressure.
NEXT

Read more:

Source: http://www.alz.org/braintour/3_main_parts.asp

Brain Injury – Memory


Brain Injury (journal)

Brain Injury (journal) (Photo credit: Wikipedia)

By Dr. Glen JohnsonClinical Neuropsychologist

MEMORY

Impaired memory is one of the universal problems of people with head injury. All of my patients have complained about memory problems following their injury. Most people think of memory as being “good or bad.” As we get older, we recognize that our memory isn’t as good as it used to be. It’s more complicated than that. There are several different types of memory . Let’s take a look at them.

TYPES OF MEMORY

First, we’ll look at the different types of memory. For example, we all have memory for music. We can be listening to a song on the radio and have a very distinct feeling associated with that music. The brain processes music and puts that information in one part of the brain. We also have memories for taste and smell. We know the taste of chocolate. We know the smell of burning rubber. We have memories for the things we feel (physical). We can remember the difference between the feel of silk and the feel of sand paper. Each type of memory has a different site in the brain. Two of the more important types of memory are vision and hearing (in this case, words). Visual things are the things we see, such as a familiar place or where we’ve left our car. We also have memory for language, including things that we’ve heard or read (things we’ve read we translate into language). Verbal information is stored in the left hemisphere with visual information stored in the right hemisphere of the brain.

IMMEDIATE MEMORY

Information going into the brain is processed at several stages. I’m going to simplify at this point and discuss what I call immediate memory. Immediate memory really doesn’t last very long–perhaps minutes. When do you use immediate memory? When you call information for a phone number, the operator will tell you a seven digit number. If you’re pretty good, you can remember those seven digits long enough to dial the phone. That’s immediate memory–information that is briefly saved. With people who have a head injury, immediate memory can be “good” or it can be “bad.” The problem for most head-injured people, however, is with short-term memory.

SHORT-TERM MEMORY

There’s some variation in how people define short-term memory. I define it as the ability to remember something after 30 minutes. In a head injury, someone’s immediate memory may be good, yet they may still have problems with short-term memory. For example, a nurse in the hospital asked a head-injured patient to get up and take a shower and get breakfast. The patient said that he would, but the nurse came back 30 minutes later and the patient was still sitting in bed. When the nurse asked him why he didn’t get up and take a shower, he said that the nurse never told him. So immediate memory is something you quickly “spit back”, but the problem rests more with short-term memory. For example, someone may tell you to go to the store and get some milk, some eggs, a newspaper, and some dish soap. By the time you get to the store, all that you remember is the milk. In head injury, impaired short-term memory is a very significant problem.

LONG-TERM MEMORY

Long-term memory is information that we recall after a day, two weeks, or ten years. For most head-injured people, their long-term memory tends to be good. One patient told me “I can tell you what happened 10 years ago with great detail; I just can’t tell you what happened 10 minutes ago.” After you get a head injury, short-term memory isn’t working, so information has a hard time getting to long-term memory. For example, head-injured people may double or triple their usual study time in preparing for a test the next day. By the time they get to the exam, they are completely blank on the material. People with head injuries have also told me “you know, time just seems to fly by.” The little events of the day are sometimes forgotten, making life “fly by” when you look back at events that have happened since the injury.

Read more: http://www.tbiguide.com/memory.html

Source: TRAUMATIC BRAIN INJURY SURVIVAL GUIDE

By Dr. Glen Johnson, Clinical Neuropsychologist
Website http://www.tbiguide.com/

Copyright ©2010 Dr. Glen Johnson. All Rights Reserved.

Mild Brain Injury and Concussion


Definition
What happens in a mild brain injury
Diagnosis of Mild Brain Injury
What can I do if I have a mild brain injury
Mild Brain Injury Issues
Mild Brain Injury and Concussion
Additional Resources

Definition

The term “mild brain injury” can be misleading. The term “mild” is used in reference to the severity of the initial physical trauma that caused the injury. It does not indicate the severity of the consequences of the injury.

Read Anne’s story about a person who sustained a mild brain injury and the challenges she faced in understanding this injury.

The Centers for Disease Control as part of its Report to Congress on Mild Traumatic Brain Injury in the United States developed the following definition of mild brain injury:

A case of mild traumatic brain injury is an occurrence of injury to the head resulting from blunt trauma or acceleration or deceleration forces with one or more of the following conditions attributable to the head injury during the surveillance period:

  • Any period of observed or self-reported transient confusion, disorientation, or impaired consciousness;
  • Any period of observed or self-reported dysfunction of memory (amnesia) around the time of injury;
  • Observed signs of other neurological or neuropsychological dysfunction, such as—
    • Seizures acutely following head injury;
    • Among infants and very young children: irritability, lethargy, or vomiting following head injury;
    • Symptoms among older children and adults such as headache, dizziness, irritability, fatigue, or poor concentration, when identified soon after injury, can be used to support the diagnosis of mild TBI, but cannot be used to make the diagnosis in the absence of loss of consciousness or altered consciousness. Further research may provide additional guidance in this area.
  • Any period of observed or self-reported loss of consciousness lasting 30 minutes or less.

The definition focuses on the actual injury or symptoms, not the possible consequences. For many people, there are challenges in getting an accurate diagnosis and treatment, especially when there is no documented or observed loss of consciousness. There does not need to be a loss of consciousness for a brain injury to occur.

What happens in a mild brain injury?

The brain is not a hard, fixed substance. It is soft and jello-like in consistency, composed of millions of fine nerve fibers, and “floats” in cerebral-spinal fluid within the hard, bony skull. When the head is struck suddenly, strikes a stationary object, or is shaken violently, the mechanical force of this motion is transmitted to the brain.

When the head has a rotational movement during trauma, the brain moves, twists, and experiences forces that cause differential movement of brain matter. This sudden movement or direct force applied to the head can set the brain tissue in motion even though the brain is well protected in the skull and very resilient. This motion squeezes, stretches and sometimes tears the neural cells.  Neural cells require a precise balance and distance between cells to efficiently process and transmit messages between cells.  The stretching and squeezing of brain cells from these forces can change the precise balance, which can result in problems in how the brain processes information.
Closed Head Injury
Any time the brain suffers a violent force or movement, the soft, floating brain is slammed against the skull’s uneven and rough interior. The internal lower surface of the skull, pictured to the left, is a rough, bony structure that often damBase of Skullages the fragile tissues within the brain as it moves across the bone surface. The brain may even rotate during this process. This friction can also stretch and strain the brain’s threadlike nerve cells called axons.

Although the stretching and swelling of the axons may seem relatively minor or microscopic, the impact on the brain’s neurological circuits can be significant.  Even a “mild” injury can result in significant physiological damage and cognitive deficits.

A Single Neuron
Another mechanism of injury involves changes that occur in the neuron’s ability to produce energy for the cell’s vital functions in structures called mitochondria. An initial increase in energy production occurs followed by a dramatic decrease that affects the ability of the cell to produce structural proteins to preserve the diameter of the axon. This change occurs gradually after the time of impact and may be responsible for the delay in symptoms sometimes observed.

As a person recovers, the cells re-establish the precise balance needed to ensure effective information processing, but this may mean some compensation or adjustments to the neural cell’s original alignments. The more often neural cells must compensate or adjust to injury, the more likely the task takes longer and may not be as complete. For example, when a person sprains or fractures an ankle, professionals recommend cold/heat treatments, rest and supports (i.e., cast, brace) and specific exercises to help the ankle adjust to the injury and recover maximal function. Depending on the severity of the ankle injury (i.e., sprain, fracture) and what is required after recovery (i.e., long distance running, ballet), the injury to the ankle can disrupt a person’s life.

Obviously, a human brain is much more complicated than an ankle. Yet, similarly, rest, supports (i.e., compensations, modifications) and “exercises” (i.e., therapies, education) for the brain may be recommended to rehabilitate and restore useful function. Depending on the severity of the injury and what the person needs to do (i.e., care for a family, return to work or school, manage a large company), a mild brain injury can disrupt a person’s life for a short period of time or even longer.

Read more: http://www.biausa.org/mild-brain-injury.htm

HRSA Federal Traumatic Brain Injury (TBI) Program


Traumatic Brain Injury Program
Do you know someone who’s had a Traumatic Brain Injury? Chances are you do…

It may have been called by a different name: a concussion, Shaken Baby Syndrome, head injury, or anoxia due to trauma. These are just a few of the other names for Traumatic Brain Injury (TBI), but all of them have the potential to kill or leave an individual with a need for life-long assistance.

  • A bus sideswiped Melissa as she was driving her car to work. She moved in and out of consciousness during the ambulance ride, but was coherent when she arrived at the hospital. She was treated for cracked ribs and a ruptured spleen and was given an MRI which showed no apparent brain injury. Several months later she began having memory problems and serious depression. She began drinking heavily to deal with the depression and lost her job as a legal secretary. She is attempting to live off of unemployment insurance.
  • A babysitter shook Alfred when he was 6 months old. He was in a coma for 2 days and diagnosed with Shaken Baby Syndrome. Alfred walked and talked much later than other children his age. He was evaluated for developmental disability services and enrolled in special education when he started school.
  • Ricardo was blindsided by a check in a high school hockey game. He was diagnosed with a concussion resulting in his missing two games. He began having problems concentrating in class and his grades dropped. As a result his parents are concerned about his being admitted to college.

Despite their outward differences, all of these people have experienced a Traumatic Brain Injury (TBI). These examples provide a glimpse into the complex and unique nature of TBI and its effects.
Program Vision

The goals of the Federal Traumatic Brain Injury Program focus on helping State and local agencies develop resources so that all individuals with TBI and their families will have accessible, available, acceptable, and appropriate services and supports.
Goals

Assist States in expanding and improving State and local capability which, in turn, will enhance access to comprehensive and coordinated services for individuals with TBI and their families;

Use existing research-based knowledge, state-of-the-art systems development approaches and the experience and products of previous TBI grantees in meeting program goals; and

Generate support from local and private sources for sustainability of funded projects after Federal support terminates, through State legislative, regulatory, or policy changes which promote the incorporation of services for individuals with TBI and their families into the State service delivery systems.

Background

Current estimates state that at least 3.2 million Americans have a long-term or lifelong need for help to perform activities of daily living as a result of a TBI1. These individuals and their families are often faced with challenges, such as improper diagnosis, inability to access support or rehabilitation services, institutional segregation, unemployment, and being forced to navigate complicated and cumbersome service and support systems.

Recognizing the large number of individuals and families struggling to access appropriate and community-based services, Congress authorized the Federal TBI Program in the TBI Act of 1996 (PL 104-166). The TBI Act of 1996 launched an effort to conduct expanded studies and to establish innovative programs for TBI. The Act gave the Health Resources and Services Administration (HRSA) authority to establish a grant program for States to assist it in addressing the needs of individuals with TBI and their families. The TBI Act also delegated responsibilities in research to the National Institutes of Health, and prevention and surveillance to the Centers for Disease Control and Prevention.

The Traumatic Brain Injury Act of 2008 (P.L. 110-206) reauthorized the programs of the TBI Act of 1996. The 2000 Amendments (PL 106-310 – Title XIII of the Children’s Health Act) recognized the importance of protection and advocacy (P&A) services for individuals with TBI and their families by authorizing HRSA to make grants to Federally mandated State P&A Systems.

The HRSA Maternal and Child Health Bureau administers the Federal TBI Program. The Fiscal Year 2010 appropriation was $9.939M, a slight increase of $.062M from Fiscal Year 2009.

1 Current Centers for Disease Control and Prevention estimates (Selassie et al., 2009) include only TBI emergency department visits, hospitalizations and deaths in the United States (2002-2006). In the Children’s Health Act of 2000, Congress recognized that the estimated figure of Americans living with TBI-related disability is an under-count. Estimates fail to capture individuals who have visited physician’s offices, individuals who have not sought treatment for a head injury, State-level TBI data, or TBIs counted from Federal, military or Veterans Affairs hospitals.

Source: http://www.hrsa.gov/gethealthcare/conditions/traumaticbraininjury/

Dementia of football the next major public health issue.


June 14th, 2007

On September 24, 2002, Pro Football Hall of Fame center Michael Lewis Webster died in Allegheny General Hospital’s coronary care unit at age 50. Known as “Iron Mike” during his playing years, Webster’s discipline and overachieving nature helped propel the Pittsburgh Steelers to four Super Bowl championships. But soon after retiring in 1990, Webster’s life became plagued by debt, depression, family turmoil, and eventually homelessness.

Through an entirely serendipitous set of circumstances, forensic pathologist and neuropathologist Dr. Bennet Omalu had an opportunity to conduct an extensive examination of Mike Webster’s brain shortly after his death. What Dr. Omalu found was astonishing. While Mike Webster’s brain did not show any outward physical signs of dementia, at a cellular level his brain resembled that of an 80-year-old advanced dementia patient.

Over the next 5 years, Dr. Omalu conducted post-mortem tests on additional former pro football players, and he began to notice an emerging pattern which seemed to indicate an entirely different form of progressive chronic traumatic encephalopathy. Termed “Dementia of Football,” this syndrome was very different from dementia pugilistica, or the boxers’ “punch-drunk syndrome.” In contrast, “Dementia of Football” tended to occur without the presence of any motor symptoms – which would explain why it would often be misdiagnosed or completely overlooked.

Join us in this fascinating conversation with Dr. Omalu where we discuss this newly emerging syndrome in detail and ponder what could very well be one of the next major public health issues to affect athletes – both amateur and professional – worldwide.

Click to listen to the Podcast.

Source: http://intrepidinsights.com/2007/06/14/dementia-of-football-the-next-major-public-health-issue/

Game Brain


Game Brain
Let’s say you run a multibillion-dollar football league. And let’s say the scientific community—starting with one young pathologist in Pittsburgh and growing into a chorus of neuroscientists across the country—comes to you and says concussions are making your players crazy, crazy enough to kill themselves, and here, in these slices of brain tissue, is the proof. Do you join these scientists and try to solve the problem, or do you use your power to discredit them?

By Jeanne Marie Laskas
GQ Magazine
X-ray image by Nick Veasay
October 2009

On a foggy, steel gray Saturday in September 2002, Bennet Omalu arrived at the Allegheny County coroner’s office and got his assignment for the day: Perform an autopsy on the body of Mike Webster, a professional football player. Omalu did not, unlike most 34-year-old men living in a place like Pittsburgh, have an appreciation for American football. He was born in the jungles of Biafra during a Nigerian air raid, and certain aspects of American life puzzled him. From what he could tell, football was rather a pointless game, a lot of big fat guys bashing into each other. In fact, had he not been watching the news that morning, he may not have suspected anything unusual at all about the body on the slab.

The coverage that week had been bracing and disturbing and exciting. Dead at 50. Mike Webster! Nine-time Pro Bowler. Hall of Famer. “Iron Mike,” legendary Steelers center for fifteen seasons. His life after football had been mysterious and tragic, and on the news they were going on and on about it. What had happened to him? How does a guy go from four Super Bowl rings to…pissing in his own oven and squirting Super Glue on his rotting teeth? Mike Webster bought himself a Taser gun, used that on himself to treat his back pain, would zap himself into unconsciousness just to get some sleep. Mike Webster lost all his money, or maybe gave it away. He forgot. A lot of lawsuits. Mike Webster forgot how to eat, too. Soon Mike Webster was homeless, living in a truck, one of its windows replaced with a garbage bag and tape.

It bothered Omalu to hear this kind of chatter—especially about a dead guy. But Omalu had always fancied himself an advocate for the dead. That’s how he viewed his job: a calling. A forensic pathologist was charged with defending and speaking for the departed—a translator for those still here. A corpse held a story, told in tissue, patterns of trauma, and secrets in cells.

In the autopsy room, Omalu snapped on his gloves and approached the slab. He noted that Mike Webster’s body was sixty-nine inches long and weighed 244 pounds. He propped up the head and picked up his scalpel and sliced open the chest and cracked open the ribs. He took out the heart and found everything he expected of a man who was believed to have died of a heart attack, as was the case with Webster. Then he made a cut from behind the right ear, across the forehead, to the other ear and around. He peeled the scalp away from the skull in two flaps. With the electric saw he carefully cut a cap out of the skull, pulled off the cap, and gently, like approaching a baby in the birth canal, he reached for the brain.

Omalu loved the brain. Of all the organs in the body, it was easily his favorite. He thought of it sort of like Miss America. Such a diva! So high-maintenance: It requires more energy to operate than any other organ. The brain! That was his love and that was his joy, and that’s why his specialty was neuropathology.

Omalu stared at Mike Webster’s brain. He kept thinking, How did this big athletic man end up so crazy in the head? He was thinking about football and brain trauma. The leap in logic was hardly extreme. He was thinking, Dementia pugilistica? “Punch-drunk syndrome,” they called it in boxers. The clinical picture was somewhat like Mike Webster’s: severe dementia—delusion, paranoia, explosive behavior, loss of memory—caused by repeated blows to the head. Omalu figured if chronic bashing of the head could destroy a boxer’s brain, couldn’t it also destroy a football player’s brain? Could that be what made Mike Webster crazy?

Of course, football players wear helmets, good protection for the skull. But the brain? Floating around inside that skull and, upon impact, sloshing into its walls. Omalu thought: I’ve seen so many cases of people like motorcyclists wearing helmets. On the surface is nothing, but you open the skull and the brain is mush.

So Omalu carried Mike Webster’s brain to the cutting board and turned it upside down and on its side and then over again. It appeared utterly normal. Regular folds of gray matter. No mush. No obvious contusions, like in dementia pugilistica. No shrinkage like you would see in Alzheimer’s disease. He reviewed the CT and MRI scans. Normal. That might have been the end of it. He already had a cause of death. But Omalu couldn’t let it go. He wanted to know more about the brain. There had to be an answer. People don’t go crazy for no reason.

He went to his boss, pathologist Cyril Wecht, and asked if he could study the brain, run special tests, a microscopic analysis of the brain tissue, where there might be a hidden story.

There was nothing routine about this request. Another boss might have said, “Stick with the protocol,” especially to a rookie such as Omalu, who had not yet earned a track record, who was acting only on a hunch. But Wecht was famously never one to shy away from a high-profile case—he had examined JFK, Elvis, JonBenét Ramsey—and he said, “Fine.” He said, “Do what you need to do.”

A deeply religious man, Omalu regarded Wecht’s permission as a kind of blessing.

*****

It was late, maybe midnight, when Bob Fitzsimmons, a lawyer working in a renovated firehouse in Wheeling, West Virginia, got a call from the Pittsburgh coroner’s office. It was not unusual for him to be at the office that late; he was having a bad week. He struggled to understand the man’s accent on the phone.

Read Morehttp://www.gq.com/sports/profiles/200909/nfl-players-brain-dementia-study-memory-concussions#ixzz1KiJHRyIP