ScienceDaily (Oct. 27, 2007) — Researchers report that diffusion tensor imaging can identify structural changes in the white matter of the brain that correlates to cognitive deficits even in patients with mild traumatic brain injury.

"We studied patients with all severities of traumatic brain injury -- mild to severe -- and found that abnormalities in white matter existed on the spectrum," said Dr. Marilyn Kraus, associate professor of psychiatry and neurology at the University of Illinois at Chicago College of Medicine and lead author of the study. "Even in patients with mild TBI -- those identified as having minimal or no loss of consciousness -- there were structural deficits."

Diffusion tensor imaging uses magnetic resonance imaging technology to examine the integrity of white matter that is especially vulnerable to traumatic brain injury. This imaging modality allows researchers to quantify and qualify structural changes in white matter, particularly in chronic TBI patients.

Thirty-seven TBI patients (20 mild and 17 moderate to severe) and 18 healthy volunteers underwent diffusion tensor imaging and neuropsychological testing to evaluate memory, attention, and executive function. All subjects were at least six months post-injury, and the majority were high-functioning people who were employed or in school at the time of evaluation.

The researchers found that structural changes in the white matter correlate to observable cognitive deficits related to thinking, memory and attention. Patients with more severe injuries had greater white matter abnormalities, representing a permanent change in the brain.

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In an article earlier this year, the magazine Discover asked, "What sort of future do brain-injured Iraq veterans face?" Read the following article to find out if they managed to answer that question:

Discover, 02.23.2007 -- In a flash, the blast incinerates air, sprays metal, burns flesh. Milliseconds after an improvised explosive device (IED) detonates, a blink after a mortar shell blows, an overpressurization wave engulfs the human body, and just as quickly, an underpressure wave follows and vanishes. Eardrums burst, bubbles appear in the bloodstream, the heart slows. A soldier—or a civilian—can survive the blast without a single penetrating wound and still receive the worst diagnosis: traumatic brain injury, or TBI, the signature injury of the Iraq War.

But in the same instant that the blast unleashes chaos, it also activates the most organized and sophisticated trauma care in history. Within a matter of hours, a soldier can be medevaced to a state-of-the-art field hospital, placed on a flying intensive care unit, and receive continuous critical care a sea away. (During Vietnam, it took an average of 15 days to receive that level of treatment. Today the military can deliver it in 13 hours.) Heroic measures may be yielding unprecedented survival rates, but they also carry a grim consequence: No other war has created so many seriously disabled veterans. Soldiers are surviving some brain injuries with only their brain stems unimpaired.

While the Pentagon has yet to release hard numbers on brain-injured troops, citing security issues, brain-injury professionals express concern about the range of numbers reported from other military-related sources like the Defense and Veterans Brain Injury Center, the Department of Defense, and the Department of Veterans Affairs (VA). One expert from the VA estimates the number of undiagnosed TBIs at over 7,500. Nearly 2,000 brain-injured soldiers have already received some level of care, but the TBIs—human beings reduced to an abbreviation—keep coming.

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Labels: Iraq veterans, Iraq War, TBI, traumatic brain injury

Washington Post

ROMNEY, W.VA., Sunday, October 14, 2007 -- Michelle Turner's husband sits in the recliner with the shades drawn. He washes down his Zoloft with Mountain Dew. On the phone in the other room, Michelle is pleading with the utility company to keep their power on.

"Can't you tell them I'm a veteran?" asks her husband, Troy, who served as an Army scout in Baghdad and came back with post-traumatic stress disorder.

"Troy, they don't care," Michelle says, her patience stretched.

The government's sweeping list of promises to make wounded Iraq war veterans whole, at least financially, has not reached this small house in the hills of rural West Virginia, where one vehicle has already been repossessed and the answering machine screens for bill collectors. The Turners have not been making it on an $860-a-month disability check from the Department of Veterans Affairs.

After revelations about the poor treatment of outpatient soldiers at Walter Reed Army Medical Center earlier this year, President Bush appointed a commission to study the care of the nation's war-wounded. The panel returned with bold recommendations, including the creation of a national cadre of caseworkers and a complete overhaul of the military's disability system that compensates wounded soldiers.

But so far, little has been done to sort out the mess of bureaucracy or put more money in the hands of newly disabled soldiers who are fending off evictions and foreclosures.

In the Turner house, that leaves an exhausted wife with chipped nail polish to hold up the family's collapsing world. "Stand Together," a banner at a local cafe reminds Michelle. But since Troy came back from Iraq in 2003, the burden of war is now hers.

Michelle has spent hundreds of hours at the library researching complicated VA policies and disability regulations. "You need two college degrees to understand any of it," she says, lacking both. She scavenges information where she can find it. A psychotic Vietnam vet she met in a VA hospital was the one who told her that Troy might be eligible for Social Security benefits.

Meanwhile, there are clothes to wash, meals to cook, kids to get ready for school and a husband who is placidly medicated or randomly explosive. Besides PTSD, Michelle suspects that Troy may have a brain injury, which could explain how a 38-year-old man who used to hunt and fish can lose himself in a three-day "Scooby-Doo" marathon on the Cartoon Network.

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Labels: Iraq veterans, Iraq War, TBI, traumatic brain injury

From the Brain Injury News and Information Blog:

Congratulations to New York City's Mount Sinai School of Medicine for being designated by the Centers for Disease Control and Prevention (CDC) as its newest Injury Control Research Center (ICRC). The new center will conduct research on persons with traumatic brain injuries in order to better understand the consequences of their injury and to help enhance the quality of their lives.

CDC’s Injury Control Research Centers (ICRC) are located at 13 universities throughout the United States. At each ICRC, scientists from a wide spectrum of disciplines focus upon discovering how to prevent and control injuries more effectively. They also work to identify critical knowledge gaps in injury risk and protection and also conduct research to address these gaps.

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Labels: head injuries, TBI, TBI research, traumatic brain injury

The following is from Medill Reports, a site written and produced by graduate journalism students at Northwestern University’s Medill school.

Professional boxers receive hundreds of neck-snapping, head-jarring blows per match on a regular basis.

Pitting a professional against an amateur would surely result in something straight out of a John Woo movie. However, amateur boxers could teach the professionals a thing or two, especially in regard to safety and traumatic brain injury.

Amateur boxers, according to a study released over the weekend in the British Journal of Medicine, appear not to suffer from any long-term lingering effects of brain trauma because of the safety precautions the International Boxing Association of Amateurs takes on behalf of its athletes.

An average punch to the head by a professional boxer has the equivalent effect as a 13-pound bowling bowl traveling 20 mph, according to the American Association of Neurological Surgeons.

Julie Goldsticker, director of media and public relations for USA Boxing, said the main objective of the organization is safety—period. “The safety of our athletes is the main priority of every official and coach in our sports. It’s something we do and want for each athlete.”

Many organizations like USA Boxing, which is the national governing body of amateur, Olympic-style boxing in the country, have safety regulations in place to physically protect its athletes. All boxers must wear protective head gear, specialized boxing gloves, waist belts indicating the punch above-and below-point, mouth pieces and t-shirts.

USA Boxing has undertaken a few different measures to ensure the utmost safety for its athletes, said Dr. Charles Butler, chief medical officer for USA Boxing.

The organization knocked down the time for each round from three minutes to two minutes because studies showed most concussions occurred in the last minute of each round. USA Boxing instituted more stringent mandatory leaves of absence for boxers who suffer concussions.

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Guess it's a pipe dream to hope that professional boxing will follow suit any time soon.

Labels: head injuries, TBI, traumatic brain injury