Category Archives: Brain Trauma

Traumatic Brain Injuries Alliance Seeks To Raise Awareness


By: Kafi Drexe
11:24 am

Dozens of athletes and luminaries – including ABC journalist Bob Woodruff, known for his own rehabilitation from traumatic brain injury after being wounded by a roadside bomb in Iraq – will gather Tuesday to launch a national alliance to help raise awareness and research funds toward treating the condition. NY1’s Kafi Drexel filed the following report.You hear about it increasingly with famous sports stars and war heroes returning home. But unless you hear their stories its still hard to believe. Nick Colgin, a 27-year-old Afghanistan war veteran, has one of those stories.

“I helped rescue a friend who has been shot in the head. I rescued 42 local Afghans from a flooding river and I earned a bronze star,” recalls Colgin. “But at the same time, a few weeks later, hit off the right side of my humvee, it kind of dazed me, knocked me out, broke my nose. But the worst part was I didn’t know how it affected me, affected my brain.”

As a result, years later, Colgin says he can no longer read or write. He suffers from traumatic brain injury, or TBI, something that impacts about 1.7 million Americans a year. It can happen anytime anyone experiences a bump, blow, or any other injury to the head and can lead to irreversible brain damage or death.

“Traumatic Brain Injury isn’t recognized sufficiently in terms of the types of problems that it causes,” notes Dr. Bruce Schwartz, Chairman of the Professional Advisory Board at the Mental Health Alliance.

As a result, the Mental Health Association of New York City is working with partners to form the National TBI and Emotional Wellness Alliance.

“The overall goal of this initiative is really to build awareness, disseminate science-based information and develop sound policy initiatives around this convergence of traumatic brain injury and emotional well being,” says Kimberly Williams, Director of the Center for Policy Advocacy and Education at the Mental Health Association of New York City.

Because sports athletes and war veterans make up a concentrated pool of patients who experience TBI, the alliance will focus its research on them to gather information and help improve services for those in need.

To find out more about the alliance, visit mha-nyc.org.

Source:  http://brooklyn.ny1.com/content/ny1_living/health/162418/traumatic-brain-injuries-alliance-seeks-to-raise-awareness

 

 

Natasha Richardson’s death and what you should know about brain injuries


This story about Natasha Richardson‘s death is from 2009 but relevant to understanding the nature of brain injuries. What appeared to be a fall in the snow on a bunny skiing slope ended up with Natasha’s untimely passing. Please scroll down to read more.

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Natasha Richardson’s death and what you should know about brain injuries

By Susan Perry | 03/19/09
Natasha Richardson

REUTERS/Lucas Jackson
Natasha Richardson at a Metropolitan Museum of
Art Costume Institute Gala in New York last year.

Initial reports of Natasha Richardson’s tragic skiing accident, which led to her death yesterday, offered two bits of information that had many people perplexed.

First, the actress’ fall had been onto the snow-covered ground. She hadn’t run into a hard upright object, like a tree, a building, or even another skier.

And second, Richardson had walked away from the accident seemingly unscathed. She was even heard joking about her fall. Not until an hour or so later, when she started having headaches, did the seriousness of the situation become apparent.

How can that be? How can someone tumble down a beginner’s ski slope, appear fine, and yet within hours be fighting for her life in a hospital’s ICU?”Natasha Richardson’s example sadly shows how devastating an innocuous brain injury can be,” says David King, executive director of the Brain Injury Association of Minnesota.

A major health problem
Many traumatic brain injuries (TBIs) — injuries severe enough to disrupt how the brain functions—have such harmless-appearing beginnings. Symptoms, such as headache, nausea, ringing in the ears, impaired vision, irritability and confusion, may take some time to develop. Or they may be ignored until they become severe — and life threatening.

TBIs are much more common than most people think. In the United States, one occurs every 15 seconds, and every five minutes someone dies from such an injury. Although people with TBIs can recover, particularly if they receive medical treatment early enough, many experience lasting and life-altering impairments.

Source: click to read more…

http://www.minnpost.com/politics-policy/2009/03/natasha-richardsons-death-and-what-you-should-know-about-brain-injuries

MacArthur ‘Genuis’ Tackles Concussions In Football


MacArthur ‘genius’ tackles concussions in football

By Melissa Healy / Los Angeles Times / For the Booster Shots blog
September 20, 2011, 5:30 a.m.
Kevin Guskiewicz, one of the winners of the MacArthur Foundation award  announced Tuesday, was long a thorn in the side of the National Football League.

Since 1999, he has wired the helmets of about 700 college football players with accelerometers to study what kinds of hits result in concussions, which kinds of players get them, and what the long-term consequences of those brain injuries can be. He was among the first to find a strong link between multiple concussions and later dementiadepression and memory and intellectual deficits that often lead to Alzheimer’s disease.

When a 2005 report prepared for the NFL asserted that a player who had sustained a concussion could safely be returned to play on the same day, Guskiewicz begged to differ. In an interview on National Public Radio, he suggested that those drafting the NFL report “are more interested in trying to protect the game or the league rather than taking a more responsible approach.”

But by 2010, a lot had changed. A mountain of research — much of it by Guskiewicz but also by Boston University’s Center for the Study of Traumatic Encephalopathy — had made clear even to the most hard-core football fans that concussions could not just be “shaken off.” The military’s experience with widespread trauma among troops in Iraq and Afghanistan, and numerous cases of suicides and dementia among recently retired football heroes, underscored that “getting your bell run” several times was likely to have long-term repercussions.

Read more:
http://www.latimes.com/health/boostershots/cancer/la-heb-macarthur-concussions-football-20110919,0,1604791.story

Quote

“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/

Repeat Scans Urged for Head Injury When Blood Thinners Involved!


Repeat Scans Urged for Head Injury When Blood Thinners Involved
Italian study confirms recommendation for 2 CT scans 24 hours apart to detect bleeding in brain.

THURSDAY, Jan. 19 (HealthDay News) — People taking blood thinners who  suffer a minor head injury should undergo repeat CT scans, researchers say.

The new study included 87 patients taking warfarin (brand name Coumadin) who were treated for a minor head injury at an emergency department. Warfarin is widely prescribed to prevent blood clots.

Twenty-four hours after having a negative result on their first CT scan, hemorrhage lesions were seen in five of the patients on a repeat CT scan. Three of the patients were admitted to hospital and one underwent surgery for bleeding in the brain (subdural hematoma).

Two other patients who were discharged from hospital after two negative CT scans were later readmitted to the hospital for treatment of symptomatic subdural hematoma, according to the study published online Jan. 16 in the journal Annals of Emergency Medicine.

“Our study confirms the recommendation of the European Federation of Neurological Societies,” study author Dr. Vincenzo Menditto, of the Ospedali Riuniti di Ancona in Ancona, Italy, said in a journal news release.

“It recommends that all minor head injury patients on blood thinners should have an initial CT scan followed by admission for observation, followed by a second CT scan before discharge. This is important for the growing portion of the population that is 65 or older and on blood thinners,” Menditto said.

More information

The U.S. Agency for Healthcare Research and Quality has more about blood thinners.

(SOURCE: Annals of Emergency Medicine, news release, Jan. 17, 2012)

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HealthDayNews articles are derived from various sources and do not reflect federal policy. healthfinder.gov does not endorse opinions, products, or services that may appear in news stories. For more information on health topics in the news, visit Health News on healthfinder.gov.

Source: http://www.healthfinder.gov/news/newsstory.aspx?Docid=660821&source=govdelivery

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

Living With Traumatic Brain Injury


Giffords’s office seeks to close gap in traumatic brain-injury care


By N.C. Aizenman, Published: April 21

Staff members for Rep. Gabrielle Giffords (D-Ariz.) have emerged as key advocates in a campaign to ensure the new health-care law guarantees more Americans who suffer traumatic brain injuries the high quality of care the congresswoman is receiving to recover from a January shooting.

Earlier this month, Giffords’s chief of staff, Pia Carusone, released a letter urging Health and Human Services Secretary Kathleen Sebelius to make it a goal as she defines the minimum package of “essential benefits” the law will require insurance plans for individuals and small businesses to include in 2014.

Members of Giffords’s staff also plan to join advocates encouraging Defense Secretary Robert M. Gates to expand the range of cognitive rehabilitative therapies that Tricare, the military’s insurance program for nearly 4 million active-duty and retired service members, covers in case of brain injury.

In her letter to Sebelius, Carusone noted the disparities in the intensity, sophistication and duration of rehabilitative care that insurance plans provide the roughly 1.7 million Americans who annually suffer such injuries, as well as the tens of thousands of service members who have been wounded in recent years.

Susan Connors, president of the Brain Injury Association of America, which organized a news conference on the issue with Giffords’s office, said a person with a moderate to severe injury would likely need at least a month of continuous therapy at a rehabilitative hospital such as TIRR Memorial Hermann in Houston, where Giffords is recovering. Exercises would focus on restoring muscular and other physical functions, speech, psycho-social capacity and cognitive functions, such as forming memory and maintaining attention.

Next, a patient might spend six to eight weeks at a transitional rehabilitation unit, regaining life skills such as bathing and cooking. Once home, Connors said, he might need rehabilitative therapy three times a week for at least another month.

Such comprehensive rehabilitative care is expensive — $8,000 per day for hospital-based acute rehabilitation, up to $2,500 for post-acute residential care and as much as $1,000 per day for nonresidential treatment programs.

But Connors argued that intensive comprehensive rehabilitation is still “a bargain” compared with the long-term costs of caring for someone who remains severely disabled because of incomplete early intervention.

She said this may explain why workers’ compensation insurance, which generally is responsible for paying the cost of a work-related injury for the rest of a worker’s life, tends to provide generous coverage of brain-injury rehabilitation. Giffords, who was critically wounded by a gunman Jan. 8 while meeting with constituents in Tucson, is covered under such a plan.

By contrast, Connors said, it is not uncommon for patients with the most bare-bones insurance coverage to be discharged “to your couch” after a week or two in the hospital.

“As a result, you experience significant medical complications: Your muscles might begin to contract; you may have seizures,” Connors said.

Even Americans with more substantial insurance often get shortchanged, she added, reducing their likelihood of returning to work or otherwise making as complete a recovery as possible.

Tricare, which is not affected by the new health-care law, does not cover services billed under the umbrella term “cognitive rehabilitative therapy,” or CRT, citing a controversial 2009 study that the Defense Department commissioned to assess the efficacy of the therapy.

However, Tricare covers many of the component therapies that constitute CRT — memory training, for example.

C.J. Karamargin, Giffords’s communications director, said the congresswoman’s staff would be pushing the Defense Department to revise Tricare’s rules on CRT and to investigate other aspects of the military’s treatment of traumatic brain injury.

“This is a signature wound of current military conflict, and it’s unfortunately something we’ve gotten to know quite a bit about,” he said.

Source: http://www.washingtonpost.com/national/giffordss-office-seeks-to-close-gap-in-traumatic-brain-injury-care/2011/04/21/AFaQaKLE_story.html

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/