The C.D.C. has begun funding studies of TBI's in prisons, another of Jack's interests. He has long believed that all prisoners should get a neuro-psych evaluation as part of their exit routine before being released. The prison environment is ripe for TBI's, and it's also probable that a fair percentage of inmates had a TBI long before being sentenced. (Remember that one of Jack's doctors, Jonathan H. Pincus, in his 2002 book (Base Instincts: What Makes Killers Kill?) theorized, "It is the interaction of childhood abuse with neurologic disturbances and psychiatric illnesses that explains murder.") TBI's fall under the classification of neurologic disturbances, and it makes sense to study their prevalence in the prison population.

Labels: Jonathan H. Pincus, prisons, TBI, TBI research, traumatic brain injury

If you've read this blog much at all, you already know that Jack believes that TBI is a contributing factor to homelessness. He's just not sure how much it contributes because there have been no studies done to check this. One of Jack's ongoing efforts has been to initiate a study to test a sample homeless population for TBI. He is still hopeful that his contacts at Harvard University will bring this plan to fruition.

Jack is a longtime admirer of Mel Eby, the Director of Tallahassee's homeless facility, The Shelter, for more than 20 years. Here's a video that was filmed for Mel's 20th anniversary.

Labels: homeless, homeless shelter, mel eby, TBI, traumatic brain injury

According to the BBC News, "Failure to control type 2 diabetes may have a long-term impact on the brain, research has suggested."

Severe hypoglycaemic episodes - hypos - occur when blood sugar levels drop dangerously low. A University of Edinburgh team found they may lead to poorer memory and diminished brain power. The study, based on 1,066 people with type 2 diabetes aged between 60 and 75, was presented at a conference of the charity Diabetes UK.

The volunteers completed seven tests assessing mental abilities such as memory, logic and concentration. The 113 people who had previously experienced severe hypos scored lower than the rest of the group. They performed poorly in tests of their general mental ability, and vocabulary.

Lead researcher Dr Jackie Price said: "Either hypos lead to cognitive decline, or cognitive decline makes it more difficult for people to manage their diabetes, which in turn causes more hypos.

"A third explanation could be that a third unidentified factor is causing both the hypos and the cognitive decline."

We will continue tracking this research. Because diabetes affects so many people, a direct correlation between it and brain function has staggering implications:

Diabetes now affects nearly 24 million people in the United States, an increase of more than 3 million in approximately two years, according to new 2007 prevalence data estimates released today by the Centers for Disease Control and Prevention (CDC). This means that nearly 8 percent of the U.S. population has diabetes.

In addition to the 24 million with diabetes, another 57 million people are estimated to have pre-diabetes, a condition that puts people at increased risk for diabetes. Among people with diabetes, those who do not know they have the disease decreased from 30 percent to 25 percent over a two-year period.

Read BBC article.

Read more on diabetes.

Labels: Diabetes, TBI, TBI research, traumatic brain injury

From ScienceDaily (Apr. 2, 2009) —

A blood test that can help predict the seriousness of a head injury and detect the status of the blood-brain barrier is a step closer to reality, according to two recently published studies involving University of Rochester Medical Center researchers.

News stories about tragic head injuries – from the death of actress Natasha Richardson to brain-injured Iraq war soldiers and young athletes – certainly underscore the need for a simpler, faster, accurate screening tool, said brain injury expert Jeffrey Bazarian, M.D., M.P.H., associate professor of Emergency Medicine, Neurology and Neurosurgery at URMC, and a co-author on both studies.

The S-100B blood test recently cleared a significant hurdle when a panel of national experts, including Bazarian, agreed for the first time that it could be a useful tool for patients with a mild injury, allowing them to safely avoid a CT scan.

Previous studies have shown the S-100B serum protein biomarker to increase rapidly after an injury. If measured within four hours of the injury, the S-100B test accurately predicts which head injury patients will have a traumatic abnormality such as hemorrhage or skull fracture on a head CT scan. It takes about 20 minutes to get results and could spare many patients unnecessary radiation exposure.

Physicians at six Emergency Departments in upstate New York, including the ED at Strong Memorial Hospital in Rochester, this year will continue to study the accuracy of the test among 1,500 patients. Scientists plan to use the data to apply for U.S. Food and Drug Administration approval.

Read article.

Labels: brain damage, Iraq veterans, Natasha Richardson, TBI, traumatic brain injury

From the Tallahassee Democrat:

Unemployment, incarceration and divorce can all be experienced by those suffering from traumatic brain injury.

To address this, the state Department of Health recently developed a five-year plan to help people suffering from these and other problems resulting from TBI.

The plan was created as a way to enhance the traumatic brain injury system of care currently in existence and to increase advocacy, education and funding.

We'll try to get a copy of the five-year-plan and let you know more about it when we do.

Thom DeLilla, bureau chief of the Florida Department of Health Brain and Spinal Cord Injury Program, said a lack of knowledge about the injury is another important issue that needs to be solved by the five-year plan.

"Generally most people are not aware of TBI, the consequences of brain injury or resources available throughout the state," DeLilla said.

Well, Jack has been saying that since the mid 1980s. In fact, there were little or no resources available when Jack had his TBI. Although increased awareness and treatment options are what Jack's been fighting for these many years, it's a bittersweet victory that positive change, however delayed, is now in sight.

Labels: brain damage, Florida, TBI, traumatic brain injury

From The Frederick News Post
(Originally published March 31, 2009)

In July 1995, Jean Berube's father, a professor at Old Dominion University, was involved in a car accident. Soon after, he appeared completely recovered from relatively minor injuries.

"It was months later, in October, when he started slurring his words and showed symptoms that looked like he was having a stroke," Berube said. "My mother knew something was wrong."

Rushed to Virginia Beach General Hospital, Berube's father underwent emergency brain surgery. A subdural hematoma, as a result of brain injury, after weeks of slow, undetected bleeding, suddenly reached a critical mass.

"It took months, but my dad got better and eventually went back to work," she said. "In the end, he was fortunate."

The event changed her life.

A lawyer and legislative assistant working on health care issues, among others, on Capitol Hill for former Virginia congressman Owen Pickett, Berube returned home to Virginia briefly to take care of her family. She, of course, became very interested in what had happened to her dad, and in the nature of brain injury itself.

In 1997, she left Pickett's office to become director of public policy and government relations for the Brain Injury Association in Alexandria. Since, Berube, who now lives in Frederick , has been an independent consultant and lobbyist for a variety of brain injury organizations, including the International Brain Injury Association and the National Brain Injury Research, Treatment and Training Foundation.

Today she's recognized as a leading lobbyist specializing in work on behalf of nonprofits providing research and care in the traumatic brain injury field. She works with everyone from Dr. Rick Hunt, director for injury response at the Center for Disease Control, to Col. Michael Jaffe, M.D., the national director of the Defense and Veterans Brain Injury Center, to leaders of health care reform and the Wounded Warriors Project, to congressmen such as Rep. Bill Pascrell Jr., a leading advocate for brain injury research, and Frederick Rep. Roscoe Bartlett, who joined the Congressional Brain Injury Task Force last summer.

March is Brain Injury Awareness Month and the all-day fair March 25 featured presentations on mild traumatic brain injuries from the battlefield to the football field, a congressional briefing and reception. The next day an all-day seminar included panels on the costs of brain injury from the National Center for Injury Prevention and Control, health care reform and preventing disparity in civilian, military and veterans health care.

National Guard troops, for example, Berube said, once their tour of duty is done, often visit civilian doctors unfamiliar with diagnosing and treating issues such as mild traumatic brain injury.

Even before actress Natasha Richardson died earlier this month after initially rejecting medical attention following a seemingly minor fall while skiing, traumatic brain injury research and care has been receiving more attention in recent years because of the wars in Iraq and Afghanistan.

Continue reading the article.

Labels: Natasha Richardson, TBI, traumatic brain injury, Veterans

From the Navy Times, Kelly Kennedy - Staff writer, Friday Feb 22, 2008:

After months of military officials and medical personnel lamenting the lack of an immediate, unequivocal, physical proof of mild traumatic brain injury, an anesthesiologist thinks he has found a solution.

And it may be as simple as two sensors and a BlackBerry.

Dr. Richard Dutton heads up trauma anesthesiology at the R. Adams Cowley Shock Trauma Center at the University of Maryland and sees about 4,000 people a year who doctors believe have a brain injury. But without a CT scan or an MRI, it’s hard to immediately tell for sure — especially if, as is the case in most trauma situations, doctors are also worried about broken bones, ruptured organs or heavy bleeding. And about 3,000 of those cases are mild TBI, which doesn’t show up on a scan.

So Dutton and a team of engineers decided to see if they could use sonar to “listen” for differences in healthy brains and injured brains. They used a headband with sensors to pick up the sound transmitted through the brain with sonar and then analyzed the data fed back into a computer. The Air Force paid for the research.

-----

Doctors typically can’t see mild TBI, even with a scan. But they know it’s important not to send a service member back out on patrol with a mild TBI because injuries caused by mild TBI are cumulative; even a slight second head injury can cause death for someone with an already damaged brain, and no one wants to go on patrol with someone whose vision is blurry or who has short-term memory loss.

When Dutton and the engineers tried out their equipment on people they believed to have mild TBIs, they found turbulent blood flow — or irregular bandwidths — on the Brain Acoustic Monitor.

“You hit your head, your BAM becomes abnormal,” Dutton said. “We think we may have an objective marker for brain injury. This is pretty exciting stuff.”

And it’s completely portable, which could be good news for troops in Iraq and Afghanistan. In Iraq, there’s one CT scan — in Balad — and no MRI machine. Medics don’t have access to the heavy, expensive equipment.

Read the entire article. This could be a huge diagnostic breakthrough for TBI's.

Labels: military, TBI, traumatic brain injury

Years ago, I remember, I read some quotation to the effect that "just because somebody's handicapped doesn't mean he can't be a jerk."

I myself am hearing-impaired, and understood exactly what the quotation meant: the handicapped, or the disabled, or the special-needs individual, or whatever polite term you want to use -- all such people are people first, and handicapped second. They have the same kinds of neuroses that other people have; the same things (plus a whole lot more) make them angry; and so on. They can be just really difficult to live with.

Ditto, those who live with them. Being a caretaker doesn't somehow magically endow you with superhuman powers of forgiveness, patience, generosity. It doesn't require you to be a saint, and it won't make you one.

Graphic evidence of the clash of human failings -- exaggerated by a disability -- comes from Jacqueline L'Heureux's article, "Do We Have to Crash Our Marriage, Too?" from the Fall 2007 issue of The Challenge, a print publication of the Brain Injury Association of America (BIAA). BIA has graciously permitted us to post a copy of that article (599KB PDF) here on sossisson.com. The article begins:

I never saw the truck coming, stopped on a freeway under a knock-your-eye-out blue sky. My back would freeze for months from the monster grille I never felt mount our car.

I want that day back, to live repeatedly, like the characters in "Our Town" -- every part of it right until the crash. Not because it was special, but because it was so ordinary, effortless -- as no day has been since. I want to start with rising early, clear-minded and happy to make breakfast for my son, who hardly ever touches it, then joke quietly, scruff his hair and send him off to school. I want to say the same thing I have said as he leaves every day since preschool (and his three brothers before him). "Remember, no matter what happens out there, you are loved." He waves me off, smiling at the silly ritual that he is too old for on this day his mother changes forever.

After that day, I was in rehab most of the rest of his high school in another city. His father swung from being angry to coldly withdrawn in response to my traumatic brain injury (TBI), seizure disorder, and chronic pain from my injuries. Rubble continued to rise under the truck long after that Indian summer evening. The debris eventually included my clinical practice as a Ph.D. family therapist, my life's work treating post-traumatic stress disorder (PTSD) patients and their families, a center I founded and directed, my university teaching, and the necessary, but wrenching dissolution of my 33-year marriage.

Think non-TBI'd family relationships are harrowing? Wait till you read the rest of L'Heureux's story.

Note, though, that the piece is not unrelievedly grim. L'Heureux concludes with some helpful tips, among them these:

If You Have a TBI and Your Marriage Is in Trouble:

• Find a therapist -- it's okay if it takes several tries before you find a fit.
• In the first 24 months post-injury, advocating for yourself in your marriage, or even using sessions well in therapy, is difficult. You will have problems processing and retrieving information, assessing your own experience, using judgment and finding energy. If your spouse is angry, and the therapist does not monitor the stimulation in the room, you can be "cooked" easily. The most important thing is to ask for help from others. Ask for help in all tasks. Things will get better.
• Many changes happen in the first two years after the injury and sometimes after that. Don't try to judge how things will be in your marriage by how things are now. Your brain is still healing (and body, if physical injuries are present). You may not be stable on medications due to the changes. If you have PTSD symptoms, get help. It is highly treatable. Look up EMDR [certified clinicians] on the web. Ask if they work in stages, starting with grounding and stabilization.
• If you are working with a couples' therapist who has no brain injury experience and your therapy is not progressing, call your state brain injury association for mental health providers who work with brain-injured patients.
• When you call, ask the therapist to send intake forms before the visit. Write things down between sessions as you think of them. Speak up as soon as you get lost in the processing part of couples' sessions -- it's too important. If you need a short break, that's okay, too.

Labels: caregivers, symptoms, TBI, traumatic brain injury

St. Petersburg Times, By William R. Levesque, Times Staff Writer, February 12, 2008 --

TAMPA - The James A. Haley VA Medical Center and the University of South Florida announced on Monday that they are entering into a partnership to research traumatic brain injury.

Traumatic brain injury is considered the signature wound of soldiers serving in Iraq who are often exposed to explosions. Up to 20 percent of all returning troops exhibited symptoms of the injury.

Congress last year set aside $450-million for research on the condition, which is still poorly understood by the medical community. [This is something Jack has complained about for years. The extremely poor care he received immediately following his own injury inspired a lifelong crusade to have doctors better informed about brain injury. He believes even psychologists, although they are not medical doctors, would benefit from learning more about brain injury. And he's convinced their patients would. How can they expect therapy to be successful if part of the patient's problem is a brain injury that the therapist either doesn't recognize or knows little about?]

At a news conference outside Haley, Rep. Kathy Castor, D-Tampa, said she recently inserted language in the National Defense Authorization Act that gives the Haley-USF partnership "a leg up" in getting some of that $450-million.

How soon or how much of the money will come to Tampa is not immediately clear.

"We have unique assets here," Castor said. "So we're going to use all that leverage to draw down as much of those research dollars that we can."

She said it was unique set of circumstances having a major veterans hospital sitting side by side with a major research university like USF. And both are a short drive from MacDill Air Force Base.

Also, Haley is home to a polytrauma center, one of just four in the nation where physicians treat some of the most severely wounded veterans.

Haley doctors said the partnership contains an education component that allows researchers to "export" their knowledge on treating traumatic brain injury to hospitals around the nation.

Continue reading.

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

We've posted a lot about TBI injuries in the military over the past year or so, sadly because it's the sheer number of TBIs suffered in the Iraq War that has drawn so much needed attention to this once silent epidemic.

Well, it's silent no more. Congress and the military have gotten heavily involved. The Centers for Disease Control in Atlanta are sponsoring studies of TBI in prisons. Others are beefing up studies of TBI in homeless populations. In fact, Jack is meeting this month with a representative from Harvard to discuss studying TBI's impact on the homeless. The NFL has completed intensive studies on TBI in professional football. For a topic that rarely saw the light of day, it would now be hard to find someone who had NOT heard about TBI in the past year.

And speaking of the past year, the Surgeon General has just praised the improvements in the way Army medicine assists and transitions its wounded and ill. If you'll remember, it was not so long ago that the Army was on the receiving end of a lot of criticism in this very area.

Coupled with those improvements,

Col. Loree Sutton, head of the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury, spoke at the [same] media roundtable about improvements in mental health and brain injury research and treatment.

"There have been numerous advancements in the last few months with respect to mild traumatic brain injuries, Post Traumatic Stress Disorder, depression and anxiety," she said. Mental health professionals, both Army and civilian, will continue to cooperate and share information regarding mental health and brain injuries and the risks associated with them.

Sutton added that a scientific working group would convene later this month to review all areas and discuss ways to better serve affected Soldiers and their families.

"We are looking to take a holistic approach (when dealing with) injury and trauma," she said.

Read more about the roundtable here.

Labels: Army, military, TBI, traumatic brain injury, Veterans

From Injuryboard.com:

Researchers studying brain injury believe that people with unrelated social or cognitive problems may have something in common: a long-forgotten blow to the head. It is widely accepted that severe head injuries can lead to cognitive and behavioral problems. What is new, according to brain researchers Wayne A. Gordan, M.D. and Mary Hibbard, Ph.D., is the contention that there are many other cases where a past blow to the head resulting in unconsciousness or confusion is the unrecognized source of such problems. These problems include learning disabilities, alcoholism, drug abuse, and depression.
----------------------
Dr Gordon, director of Brain Injury Research Center at Mount Sinaii School of Medicine in New York, says, "[unidentified traumatic brain injury is an unrecognized major source of social and vocational failure." According to one researcher, "[when you look at children with learning disabilities or behavior problems, there's often an underlying high percentage of children with traumatic brain injury. We're looking at about 20%."

Continue reading.

Labels: concussion, TBI, traumatic brain injury

From PressRepublican.com -- published January 28, 2008 -- Vicki Chaffee, who suffered a traumatic brain injury in a car accident in 2002, has helped a young kitten that has the same kind of injury survive, but Chaffee says the kitten has given her inspiration.

PLATTSBURGH, NY -- Dale Chaffee rolled the tiny plastic ball along the kitchen floor.

The small black cat pounced on it, striking it with her paw and renewing the chase when it ricocheted against the nearby wall.

But this cat, named Rosa, moved differently from most.

She swayed on her legs, as if they didn't have the strength to hold her body, and at times she would stumble and lose her balance, only to rise quickly and continue her never-ending effort to corral the tiny ball.

Rosa is about a year old, ... [and] she suffers from traumatic brain injury, a condition her owner knows only too well.

FRAGILE KITTEN

"One day, this little black kitty came to me, no more than four weeks old," said Dale's wife, Vicki Chaffee, who is a victim of traumatic brain injury. "She was so tiny and so fragile. She had to be bottle fed."

Vicki brought the animal to the vet's office, where it was determined that the kitten had suffered the debilitating injury sometime during those first four weeks of life.

----------

Vicki's own story started just under six years ago, in April 2002, when a car accident changed her life in an instant.

Because of the brain injury she suffered, she doesn't remember a lot about the accident, but the year that followed -- when she sought answers for the mental and physical changes she was experiencing -- turned her life into a nightmare.

----------

Vicki had undergone several tests -- MRIs, CAT scans -- but doctors did not find any specific cause for her problems.

"We were told nothing was wrong," Dale said, as Vicki fought back tears from the memory of those months of not knowing.

Finally, a friend mentioned the possibility of a brain injury and suggested Vicki go to the Traumatic Brain Injury Center at Plattsburgh State. There, the brain injury that was robbing her of her past existence was verified.

"In some cases, brain injury is clear cut, but then there are others that are not as easily diagnosed," said Melissa Mose from the Traumatic Brain Injury Center. "It's a silent epidemic that often remains hidden."

----------

The Chaffees named their furry friend after the African-American civil-rights activist who, in 1955, refused to give up her seat on a Montgomery, Ala., bus to a white passenger.

"Rosa (the activist) refused to give up, and this kitty has done the same thing," Vicki said.

The cat will sometimes prop herself against the wall as she walks from one area to another. Vicki noticed that technique and uses it herself when she's tired but wants to move from one room to another.

Read entire article.

Labels: cat, kitten, TBI, traumatic brain injury

Here on Jack's TBI Blog, as on just about every other site which focuses on TBI, you don't find a lot to celebrate in the traumatic-brain-injury experience. Things which make you smile, sure, even laugh out loud -- you can find them. But the smiles and laughter always overlay the crushing sobriety of the subject.

But exceptional people can find exceptional strength, wisdom, and hope in the unlikeliest corners of life. One such person, clearly, is the author of the nancynewfreedom blog:

I was injured in an automobile accident and sustained a traumatic head injury approximently four (4) years ago. Pre-accident I was best described as a real workaholic 24/7 and thought I was on top of the world. I have had some very well paid careers, facilitated workshops and training seminars and was one of few females at that level in the industry. From self assured, over confident, over-achiever, outgoing and assertive, and quite proudly referred to as a "Corporate Bitch" ....

And then a few seconds in time made that life stop... and a new one awaited me.

...I am feeling lonely as I try to understand and appreciate this new me... and I am kind of scared.

I think I liked this new me... but I still felt very vulnerable! I want to experience life without feeling afraid or self-conscious... and I want to celebrate this "new me" every chance I get.
...
The learning will never stop and but I believe now that the recovery process ends and you enter the "development process" as you rebuild you life and re-evaluate your existence.

I am a much kinder and gentler soul, and I must admit a much happier one as well, despite my cognitive difficulties and the challenges of trying to relearn the necessary skills to become more independent.

And I have begun to think of myself less as a "new me" and more like the "true me" that was never fully developed.

I myself have never suffered a TBI. But I must say that reading Nancy's blog, suffused in the spirit expressed in the above excerpt from her blog's "About" page -- well, it just reinforces what I've always believed: TBI or no TBI, the things we have in common, can have in common, are way more important than all the things we keep furiously inventing to keep us apart. Extreme experiences, sure -- they can break us. Taken from the right starting point, though, they can also propel us forward into new exciting futures.

Make it a point to stop by and visit Nancy as she explores the "true me" she's discovering. No matter how positive an experience, it's always better when shared.

Labels: Blessing, loneliness, support groups, TBI

From the ImPACT Web site:

In the United States, the annual incidence of sports-related concussion is estimated at 300,000. Estimates regarding the likelihood of an athlete in a contact sport experiencing a concussion may be as high as 19% per season. Although the majority of athletes who experience a concussion are likely to recover, an as yet unknown number of these individuals may experience chronic cognitive and neurobehavioral difficulties related to recurrent injury. Such symptoms may include chronic headaches, fatigue, sleep difficulties, personality change (e.g. increased irritability, emotionality), sensitivity to light/noise, dizziness when standing quickly, and deficits in short-term memory, problem solving and general academic functioning. This constellation of symptoms is referred to "Post-Concussion Syndrome" and can be quite disabling for an athlete. In some cases, such difficulties can be permanent and disabling. In addition to Post-Concussion Syndrome, suffering a second blow to the head while recovering from an initial concussion can have catastrophic consequences as in the case of "Second Impact Syndrome," which has led to approximately 30-40 deaths over the past decade.

In summary, athletes that are not fully recovered from an initial concussion are significantly vulnerable for recurrent, cumulative, and even catastrophic consequences of a second concussive injury. Such difficulties are prevented if the athlete is allowed time to recover from concussion and return to play decisions are carefully made. No athlete should return to sport or other at-risk participation when symptoms of concussion are present and recovery is ongoing. In summary, the best way to prevent difficulties with concussion is to manage the injury properly when it does occur.

--------------------

ImPACT 2005 is a user-friendly, Windows-based computer program that can be administered by a team coach, athletic trainer or physician with minimal training. Reaction time is reliably measured to one hundredth of a second across individual test modules (10 modules total) and allows for an assessment of processing speed as the player fatigues. The test battery consists of a near infinite number of alternate forms by randomly varying the stimulus array for each administration. This feature was built in to the program to minimize the "practice effects" that have limited the usefulness of more traditional neurocognitive tests. ImPACT takes approximately 20 minutes to complete. The program measures multiple aspects of cognitive functioning in athletes, including:

• Test Section 1: Subject Profile and Health History Questionnaire
• Test Section 2: Current Symptoms and Conditions
• Test Section 3: Neuropsychological Tests (Baseline and Post-Concussion)
• Module 1 (Word Discrimination)
• Module 2 (Design Memory)
• Module 3 (X's and O's)
• Module 4x (Visual Attention Span)
  ImPACT 1.0 only-This module has been removed for version 2.0.
• Module 4 (Symbol Matching)
• Module 5 (Color Match)
• Module 6 (Three letters)
• IV. Injury Description
• V. Graphic Display of Data

--------------------

For more information on this exciting diagnostic tool, visit ImPACT's comprehensive Web site.

Labels: concussion, ImPACT, sports injuries, TBI

Sedona, AZ - TBI, FMS, CFS… For some of us, these are only random groups of letters. For others, they represent acronyms for “mysterious” diseases, conditions or syndromes. Sometimes, the way Traumatic Brain Injury, Fibromyalgia, Chronic Fatigue Syndrome manifest in patients brings up more questions than answers; therefore, it’s not uncommon for even medical practitioners to misdiagnose them.

But these “mysterious” conditions have the power to challenge and forever change the lives of those they touch.

TBI, FMS, CFS also Lyme disease and brain cancer affect many individuals, famous and not so famous, on a daily basis. These diseases, syndromes and conditions pertain to the life-challenging and life-threatening experiences that can turn individuals into surrenders or survivors.

For Laura Bruno, an intuitive life coach, Reiki Master Teacher and writer, her TBI diagnosis—the result of a seemingly insignificant car accident—changed her life from the path of achieving her doctoral degree and a successful career to the path of recovery. Laura Bruno’s TBI diagnosis didn’t only show her what’s most important in life, but also helped her discover her own “yellow brick road” to recovery and to a relatively normal life.

Continue reading.

Laura Bruno has written and published an e-book about her TBI and recovery. You can find out more (or buy the book) here.

Labels: caregivers, TBI, traumatic brain injury

The Buffalo News, by Lou Michel, Wednesday, December 19, 2007 --

You can see the cost of the wars in Iraq and Afghanistan in their empty shirt sleeves, the scars on their heads, in their eyes so weary from sleepless nights.

They return to their homes, trying to fit in again. Most will. Too many will not.

At least 25 local soldiers, four Marines and one sailor have been killed overseas since the war on terror began. Less known are the local veterans returning home with broken bodies or troubled souls.

Some 30,434 men and women in uniform have been wounded in Iraq and Afghanistan, but the Pentagon does not say where they are from, so it’s unclear exactly how many of the wounded hail from Western New York.

Almost 1,700 of those veterans have sought medical treatment at the Veteran Affairs Medical Center in Buffalo since 2003, with a majority seeking help for war-related injuries.

There are probably many more local veterans seeking medical treatment who are not counted in VA enrollment figures because of their status as citizen soldiers. Reservists and National Guard members often have access to private health insurance provided by from their civilian employers, according to VA officials in Washington, D.C.

But for the veterans who are trying to adjust while under the care of the local VA, the navigation of a sometimes unresponsive bureaucracy adds to the pain of life beyond the combat zone.

More than 600 of the 1,659 veterans treated here sought assistance for posttraumatic stress and other psychological readjustment troubles, according to the Department of Veterans Affairs.

“It is a full-time job working on getting whole, getting medical treatment and benefits,” said Bill Biondolillo, who served two combat tours in Iraq for a total of 14 months.

“We go and do the dirty work and we have to carry that, while the rest of the country goes on with life,” said Biondolillo, a major in the Reserves.

The list of injuries local veterans seek treatment for is frightening:

• Exposure to Russian-made bullets with depleted uranium in the shell casings. This can cause tumors, skin ailments and respiratory problems.

• Traumatic brain injuries and concussions from blasts, as well as shrapnel from explosive devices.

• Damage to the neck, back and hips from carrying as much as 100 extra pounds of body armor, ammo and other equipment.

• Irritable bowel syndrome and gastric illnesses caused by stress and living in unsanitary conditions.

Continue reading the article.

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

Nurse.com, by Kurt Butzbach,RN, Monday December 17, 2007 -- I am a nurse on the brain injury unit at the Rehabilitation Institute of Chicago (RIC). This job means a lot to me because at one time I was the patient.

More than 22 years ago, I had an accident while working in a steel fabrication shop. I fell more than 15 feet from a ladder to the floor. While one coworker called 911, another coworker held my unresponsive body. I started to turn blue, so while he waited for help, he put me in a bear hug and squeezed me, "the way they do on TV," he said. I started breathing again, but to his surprise blood started gushing out through my left ear. He didn't know if he had saved me or helped kill me.

He had ruptured my ear drum, which allowed the blood and cerebral fluid that was building pressure in my head to escape, quite possibly saving my life. I had suffered a traumatic brain injury, caused by a basal skull fracture, in addition to a separated shoulder.

My short-term memory and speech were affected, and I suffered some left-sided paralysis. So, following my hospital stay, I started rehabilitation through outpatient therapy. I participated in cognitive therapy and physical and occupational therapies and admired the therapists and nurses who helped me find my way back.

After I was released from the hospital and went through ongoing rehabilitation, I was able to fine-tune some of the more creative skills I hadn't been using for a while, such as carving, woodworking, and music.

I started a small wood shop in my garage, and I started playing my guitar more, which was an escape from the daily challenges of recovering from a brain injury.

Continue reading the article.

Labels: brain injury, TBI, traumatic brain injury

WASHINGTON, Dec. 13 /PRNewswire-USNewswire/ -- "The American Veteran," a monthly half-hour news magazine from the Department of Veterans Affairs (VA), spends a full third of it's January edition on two of the most talked about health problems of combat veterans -- traumatic brain injury (TBI) and post traumatic stress disorder (PTSD).

"We are committed to informing veterans and military personnel about the VA programs and staff dedicated to helping these warriors recover from their physical and mental injuries," said Acting Secretary of Veterans Affairs Gordon H. Mansfield. "These stories put a spotlight on the determination, commitment, and discipline of these combat veterans and the support provided by earlier generations."

One feature looks at the state-of-the-art technologies used to assess and treat even the unseen damage done to the brain by the weapons and tactics of the current conflicts in Iraq and Afghanistan. A second feature looks at the services available to any combat veteran suffering from the often debilitating effects of PTSD, as well as the benefits of having veterans of previous wars available as a support network for veterans recently returned from combat. A third story examines the benefits of alternative therapies, including the use of horses in helping veterans to re-engage in managing their lives successfully.

The series is designed to inform active duty members, veterans, their families and their communities about the services and benefits they have earned and to recognize and honor them. VA's Office of Public Affairs and the VA Learning University/Employee Education System (VALU/EES) produce the program and broadcast it to VA facilities on the department's own internal network, around the world on The Pentagon Channel and to community cable outlets.

The VA Office of Public Affairs offers the program to local broadcasters and cable outlets and makes it available for viewing on the VA Web site, www.va.gov. Just click on "Public Affairs" and then "Featured Items."

Continue reading the article.

Labels: TBI, traumatic brain injury, V.A., VA, Veterans

Kaiser Daily Health Policy Report Capitol Hill Watch --
Lawmakers Pass Measures To Improve Veterans' Health Care Services

Dec 12, 2007 -- House and Senate lawmakers recently passed measures addressing veterans' health. Summaries of news about the legislation appear below:

* Traumatic brain injury: The Senate on Tuesday by voice vote passed a bill (S 793) sponsored by Sen. Orrin Hatch (R-Utah) intended to improve treatment of traumatic brain injuries in veterans returning from Iraq and Afghanistan, CQ Today reports. The bill would require CDC and NIH to conduct research to improve treatment techniques for traumatic brain injuries and also would mandate that CDC monitor brain injury cases. In addition, the legislation would reauthorize and expand programs established by a 1996 law that permits CDC to grant states funds for brain injury patients to enter treatment and rehabilitation programs (Hunter, CQ Today, 12/11).

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

Reuters, By Anne Harding, NEW YORK (Reuters Health) - The effects of a methamphetamine overdose are very similar to those seen after a traumatic brain injury, according to researchers who examined the effects of "club drugs" in rats.

"We showed that a single overdose of meth can be as damaging as a head-on motor vehicle collision in the brain," co-author Matthew Warren, of the University of Florida in Gainesville, told Reuters Health.

Methamphetamine is a highly addictive stimulant that is chemically related to amphetamine, but is more potent and more harmful to the central nervous system.

Warren and his associates analyzed changes in the proteins in rodents' brains after traumatic injury and decided to investigate whether methamphetamine and MDMA, also known as Ecstasy, might cause similar changes.

MDMA is a psychoactive drug that is chemically similar to methamphetamine and the hallucinogen mescaline. The results of animal studies have also shown it has toxic effects on the nervous system.

NEW YORK (Reuters Health) - The effects of a methamphetamine overdose are very similar to those seen after a traumatic brain injury, according to researchers who examined the effects of "club drugs" in rats.

"We showed that a single overdose of meth can be as damaging as a head-on motor vehicle collision in the brain," co-author Matthew Warren, of the University of Florida in Gainesville, told Reuters Health.

Methamphetamine is a highly addictive stimulant that is chemically related to amphetamine, but is more potent and more harmful to the central nervous system.

Warren and his associates analyzed changes in the proteins in rodents' brains after traumatic injury and decided to investigate whether methamphetamine and MDMA, also known as Ecstasy, might cause similar changes.

MDMA is a psychoactive drug that is chemically similar to methamphetamine and the hallucinogen mescaline. The results of animal studies have also shown it has toxic effects on the nervous system.

Continue reading.

Labels: Ecstasy, MDMA, meth, TBI, traumatic brain injury

Along with 20,000 other veterans, he's not included in the Pentagon's official count of U.S. troops wounded in Iraq and Afghanistan.

That's because Landrus' wound was to his brain and hidden from view. Landrus, 24, of Clarkston, Wash., says he did not realize the nausea, dizziness, memory loss and headaches he suffered after the blast were signs of a lasting brain injury.

Army medics who examined him in the field didn't find the wound either. "They wanted to know if we had any holes in us, or if we were bleeding. We were in and out of there (the aid station) in 10 to 15 minutes," Landrus remembers.

For the balance of his combat tour, he tried to shake off the blast's effects and keep going. Now, "my goal is to get back to a normal life," he says.

A USA TODAY survey of four military installations and the Department of Veterans Affairs, where combat veterans are routinely screened for brain injury, has found that about 20,000 people show signs of damage. They are not counted in the Pentagon's official tally of 30,000 war wounded.

The military lacks "a standardized definition of traumatic injury or a uniform process to report all TBI (traumatic brain injury) cases," Assistant Secretary of Defense Ellen Embrey wrote in a memo last month. As a result, it is hard to determine the scope of the problem, she wrote.

Continue reading article.

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

ATLANTA, Nov. 20 /PRNewswire/ -- Georgia is not the place to get long-term help for a traumatic brain injury. Just ask Ben Fuller, the young father in North Georgia who, after being injured in a car accident, has spent more than two years shuttled between hospitals, unable to return to home. During his odyssey, more than 117 Georgia nursing homes have denied him admission because staff wasn't trained to handle his behavioral issues. More than anything Ben wants to be with his family, yet there are insufficient community services to support him there. He is not alone. Up to 18,000 people are suffering similar fates, according to a new report that evaluates the costs and gaps in care for Georgians with neurobehavioral issues.

The study, "Georgia's Neurobehavioral Crisis: Lack of Coordinated Care, Inappropriate Institutionalizations," reveals the alarming extent to which Georgians with traumatic brain injuries fail to receive appropriate care. The report was conducted by the Brain and Spinal Injury Trust Fund Commission, the state's only funding source dedicated to meeting the needs of people with traumatic brain injury (TBI).

At the heart of the problem is Georgia's lack of a coordinated system of care for people suffering from neurobehavioral issues stemming from TBIs. Too often, people with TBI are not identified and diagnosed properly, do not receive basic rehabilitation and end up in nursing homes, out-of-state programs, state hospitals, prison or become homeless-at tremendous cost to individuals, families and the state. For example, when a person with a severe TBI is sent to a state mental hospital -- at a cost of $178,000 a year - both the person and the facility suffer. The facility is not equipped to provide the type of medical care needed for neurobehavioral rehabilitation.

Continue reading article.

Or read the full story in the Atlanta Journal-Constitution.

Labels: Georgia, TBI, traumatic brain injury

The Atlanta Journal-Constitution, By ANDY MILLER, 11/20/07 --

Room 491, where Ben Fuller lives, has filled with family.

Fuller's parents and older brother are there. His son, Logan, romps about the Floyd Medical Center room, crawling under furniture and playing with an inflated medical glove.

Fuller is slow to react to the action. Sitting in a wheelchair, he stares out into space for long periods of time. His mother asks him occasional questions, and each answer seems a struggle.

The Fullers have spent three frustrating years searching for needed services for Ben, who suffered a traumatic brain injury at 24 that left him prone to profane and violent outbursts. At each turn, they seem to run into roadblocks. It's estimated that thousands of other Georgia families have encountered similar problems.

A new report says Georgia lacks services for patients like Fuller, whose behavioral problems are linked to jarring blows to the head.

An estimated 187,000 Georgians have a disability related to a traumatic brain injury (TBI), and up to 10 percent of those may need ongoing care for TBI-related behavioral problems, according to the report from the Brain and Spinal Injury Trust Fund Commission. Those problems can include physical aggression and an inability to communicate and control emotions.

Because of that, many of those TBI victims end up institutionalized: in jails, prisons, even the state's mental hospitals. Some become homeless.

The absence of a coordinated system of rehabilitative care for these brain injury victims is largely due to a lack of public and private funding, according to the report, which calls the situation "a crisis."

Money is scarce because of a lack of understanding by lawmakers and insurers, experts say. Private insurers, as well as Medicare and Medicaid, "don't see these services as medically necessary," says Susan Johnson, director of brain injury services at Shepherd Center in Atlanta and a commission member.

The report calls for more training and support for caregivers, better screening of TBI-related behavioral problems and more funding for rehabilitation. Often, residential and community services for TBI patients are either too expensive or don't exist. The report also calls for the Georgia General Assembly to look into the state's deficiencies in dealing with traumatic brain injury.

Continue reading the article.

Labels: brain damage, brain injury research, TBI, traumatic brain injury

The New York Times

FEELING a little less mentally quick than you did a few years ago? Maybe you are among the many people who do “brain exercises” like sudoku to slow the cognitive decline associated with aging. We’ve got a better suggestion.

Computer programs to improve brain performance are a booming business. In the United States, consumers are expected to spend $80 million this year on brain exercise products, up from $2 million in 2005. Advertising for these products often emphasizes the claim that they are designed by scientists or based on scientific research. To be charitable, we might call them inspired by science — not to be confused with actually proven by science...

...One form of training, however, has been shown to maintain and improve brain health — physical exercise. In humans, exercise improves what scientists call “executive function,” the set of abilities that allows you to select behavior that’s appropriate to the situation, inhibit inappropriate behavior and focus on the job at hand in spite of distractions. Executive function includes basic functions like processing speed, response speed and working memory, the type used to remember a house number while walking from the car to a party...

...Exercise is also strongly associated with a reduced risk of dementia late in life. People who exercise regularly in middle age are one-third as likely to get Alzheimer’s disease in their 70s as those who did not exercise. Even people who begin exercising in their 60s have their risk reduced by half.

Read the entire article.

NOTE: If you're a regular reader of this blog, you know that we've long promoted physical exercise as one of the best things you can do for your brain. Jack himself (81 years old) is proof-positive. He showed tremendous improvement in memory and impulse control after getting back into tennis and playing regularly several times a week. Within a year's time, Jack's friends began to notice the difference. Nothing short of amazing. Please, please get up and move. Walk, ride a stationary bike, play tennis, swim, dance, whatever. Just get that body moving. Brain improvement will follow.

Labels: alzheimer's, brain exercises, TBI, traumatic brain injury

There's almost too much to blog about here -- and there's certainly too much to blog about in detail -- at the page on NASHIA's recent 2007 State-of-the-States conference.

What is NASHIA? It's the National Association of State Head Injury Administrators (and I bet you didn't know there was even one state head injury administrator, let alone a whole national association):

TBI is a complex disability that challenges States’ ability to respond to the needs of persons with TBI and their families. These individuals need services that cross multiple programs including Medicaid, vocational rehabilitation, employment, education, home health care, mental health, substance abuse, and long-term care programs. Without coordinated systems of care, individuals are often placed inappropriately into nursing homes or left to the families to care for without much support or assistance. When families are no longer able to care for these individuals, the families turn to the State, which is generally the only resource for these crisis situations.

In 1990 NASHIA became the first and remains the only forum addressing State government’s significant role in brain injury. NASHIA is the premier source of information and education for State Agency employees who are responsible for public brain injury policies, programs, and services. NASHIA is also the voice of State government in Federal TBI policy issues.

NASHIA reaches out to all State Agency employees who interact with individuals with brain injury and welcomes membership by advocates, professionals, and organizations with an interest in State and local policy and service delivery.

(From the About NASHIA page)

The theme of the September conference this year was "Gateway to Solutions: Doing What Works." Many presentations from the conference are available as (often large) MS Powerpoint files and/or Adobe Acrobat (.pdf) documents.

The first day's presentations focused largely on TBI and the military (a subject which we've covered here regularly). Topics:

• Veterans and TBI
• Department of Veterans Affairs
• The True Welcome Home (Missouri's State Veterans Ombudsman and "Operation Outreach" program)
• Heart of a Hero
• States Panel ("how four States have encountered challenges and opportunities in bridging the gap between current systems for veterans with TBI")

Day 2 moved on to some other topics:

• CDC Update: TBI Resources from the CDC and How You Can Use Them
• TBI in Jails and Prisons: Ethics and Implications of Screening
• TBI and Aging
• Behavioral Issues after Brain Injury: Where To From Here?
• TBI and the Substance Abuse System
• Domestic Violence and the Link to the World of TBI
• Assistive Technology and Employment
• Having Our Say: Consumer-Directed Services and People with Brain Injury
• Mining the Online TBI Collaboration Space (TBICS) to Find Publication Gems
• Homelessness and Acquired Brain Injury: Identification, Needs Assessment, and Case Management
• TBI is a Community Health Issue
• Protection and Advocacy Work with Veterans
• Shaken Baby Prevention Initiatives

...and there were still Friday and Saturday to come!

Visit the NASHIA conference page for links to the presentations themselves. And while you're there, also see their page of information on yet more conferences which they sponsor. Excellent resource.

Labels: conferences, government, Iraq veterans, resources, TBI

The U.S. has some catching up to do. In England, "the Children's Trust wants to raise awareness of acquired brain injury (ABI) among parents and teachers because the effects can be misdiagnosed or just seen as bad behaviour." In launching their campaign, they stated that "some bad behaviour may be a result of an undiagnosed brain injury...the effects can be more noticeable at times of stress, like the move from primary to secondary school. It can affect a child's memory, alter their personality, affect physical skills and reduce their ability to concentrate in class or to develop relationships with peers and teachers."

I'm not aware of any program in the U.S. that seeks to identify ABI or TBI in schoolchildren, although, according to a 2006 CDC study, "The two age groups at highest risk for TBI are 0 to 4 year olds and 15 to 19 year olds." Surely someone has thought of this and there's a program out there that I just haven't heard about. But maybe not. We're only now getting serious about studying TBI in our military (due, of course, to the large number of TBI victims returning from the Iraq War) and in our prisons, two populations obviously at risk.

Where TBI is concerned, seems like we've been content with merely reacting, rather than taking a proactive approach.

Labels: cdc, TBI, TBI research, traumatic brain injury

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.

Keep reading this article.

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.

Keep reading this article.

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.

Keep reading.

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.

Keep reading article.

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

Labels: head injuries, TBI, traumatic brain injury

Earlier this week, Gregg Zoroya in USA TODAY wrote:

Scientists trying to understand traumatic brain injury from bomb blasts are finding the wound more insidious than they once thought.

They find that even when there are no outward signs of injury from the blast, cells deep within the brain can be altered, their metabolism changed, causing them to die, says Geoff Ling, an advance-research scientist with the Pentagon.

The new findings are the result of blast experiments in recent years on animals, followed by microscopic examination of brain tissue. The findings could mean that the number of brain-injured soldiers and Marines — many of whom appear unhurt after exposure to a blast — may be far greater than reported, says Ibolja Cernak, a scientist with the Johns Hopkins University Applied Physics Laboratory.

This cellular death leads to symptoms that may not surface for months or years, Cernak says. The symptoms can include memory deficit, headaches, vertigo, anxiety and apathy or lethargy. "These soldiers could have hidden injuries with long-term consequences," he says.

Physicians and scientists are calling TBI the "signature wound" of the Iraq war because of its increasing prevalence among troops.

Continue reading the article.

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

On Friday, Sept. 28, 2007, The Brown Daily Herald published the following story about a Brown University alumnus who, after suffering a TBI in 2004, started a foundation for brain injury patients. From the article:

A month after his graduation, Charlie Maddock '04 was hit by a car and suffered an often-fatal traumatic brain injury. Two years later, in 2006, he founded the Charles Maddock Foundation, a nonprofit foundation that supports patients who have suffered brain trauma.

Maddock was crossing the street in New York City when he was hit by a taxi cab and crashed through its windshield. He received several severe physical injuries, including a fractured jaw and shattered pelvis. The most critical injury, however, was the trauma to his brain, which swelled due to the impact of hitting the cab.

Maddock was taken to New York Presbyterian Hospital, where he underwent surgery to reduce the intracranial pressure in his skull.

According to the National Center for Injury Prevention and Control, approximately 1.4 million people sustain a traumatic brain injury, or TBI, in the United States annually. Of that number, 50,000 die. Other long-term effects of TBI can include epilepsy and a greater risk of Alzheimer's and Parkinson's diseases.

"I was one of the lucky ones," Maddock told The Herald.

After leaving the hospital, Maddock still had the difficult task of rehabilitating from the physical and emotional pain of his TBI. The affliction is often called an "invisible epidemic," Maddock said, because people who survive a TBI are forever changed.

The story later notes:

TBI has recently received national media due to the increasing amount of head injuries for soldiers stationed in Iraq. About 10 to 20 percent of the 35,000 screened "health returnees" from Iraq and Afghanistan had "experienced a mild TBI during deployment," the New York Times reported in July.

And:

TBI has also made the national news because of the large number of NFL players with head trauma. In June 2007, late Pittsburgh Steelers offensive lineman Justin Strzelczyk was found to have signs of a condition associated with the elderly or boxers with dementia. Strzelczyk is the fourth NFL player to be found with this condition, which is thought to be caused by repeated concussions on the football field.

Read the article.

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

Ever since O.J. Simpson almost assuredly got away with murder, Jack has wondered if all of those years of football contributed to brain injury. We know that brain injury alone doesn't necessarily make one violent, but coupled with existing mental illness and/or child abuse, you end up fitting the model for one of Jonathan H. Pincus's violent killers.

Pincus and his colleague Dr. Dorothy Lewis, a child psychiatrist, developed the view that murderers, and especially the most notorious kind, such as serial killers, are the product of the combination of child abuse with neurological damage and psychiatric illness. The three factors interact, as childhood abuse creates enormous anger, while neurologic and psychiatric diseases of the brain damage the capacity to stop urges to violence. A supplementary disinhibiting factor is the abuse of alcohol and drugs, involved in an estimated 70 percent of violent crimes.

You can read more here.

So, with all of that in mind, here's an article from "Slate" that explores the same question -- could football have contributed to O.J.'s behavior?

Slate by Chadwick Matlin, Sept. 21, 2007 -- With the murder trial, the "hypothetical" outline of how he would have killed his ex-wife, and now his "sting operation" in a Las Vegas hotel room, it's hard to remember that O.J. Simpson used to play football. He was actually pretty good at it, running away with the Heisman Trophy in 1968 and making the Pro Bowl five times in his NFL career. As a pro, Simpson carried the ball more than 2,400 times. As the evidence mounts that football can cause massive head trauma, it's worth wondering: Could O.J.'s erratic behavior have something to do with taking too many gridiron collisions?

After former Eagles defensive back Andre Waters committed suicide last year, the Waters family sent pieces of his brain to a forensic pathologist. The doctor reported that damage sustained while playing football had made Waters' brain similar to that of "an octogenarian Alzheimer's patient." According to his doctors, Hall of Fame center Mike Webster suffered frontal lobe damage due to repeated head injuries; he was suffering from dementia when he died at age 50. A post-mortem analysis of Chris Benoit, the professional wrestler who killed his wife and son and then committed suicide, revealed massive brain damage. Diaries were also found with cryptic, disturbing passages that suggested Benoit's behavior wasn't a result of steroid-induced rage, but rather a gradual decline into violence and dementia.

All of these athletes sustained traumatic brain injuries that killed brain cells and left them permanently impaired. Dr. David Hovda, a neurosurgeon at UCLA told me that any altered consciousness—seeing stars, dizziness, or feeling dazed after a hit—is considered a mild TBI. Even a mild concussion causes damage. With football's macho culture, players often pick themselves up and stay in the game, leaving themselves open to more serious harm. But repeated TBIs can lead to an altered frontal and temporal lobe, which can cause heightened anxiety and a loss of emotional control. Football players tend to damage their temporal lobe, which controls feeding, fighting, fleeing, and the person's sex drive.

Keep reading.

Labels: brain injury, football, O.J. Simpson, TBI

Fighting Brain Injury in Iraq
The war in Iraq is bringing a well-documented but hardly understood battlefield injury into the limelight: traumatic brain injury (TBI). In an effort to learn more about the injury, the U.S. Army awarded Simbex, of Lebanon, NH, a million-dollar contract to develop sensor-studded helmets for combat soldiers. The army is currently testing the helmet technology, which could be deployed as early as December of this year.
Keep reading.

DOD, VA medical programs too complex for those with brain-damage
The bureaucracies that are supposed to help brain-injured war veterans are too complex for them to navigate, a panel of military and medical experts concluded at a meeting Tuesday.

Specifically, the departments of Veterans Affairs and Defense need better coordination of their programs, according to the panel, which was part of a daylong Washington Defense Forum sponsored by the U.S. Naval Institute and the Military Officers Association of America.

The panel included two military officers, a doctor, a lobbyist and the chief executive officer of the Brain Injury Association of America.

"The systems in the VA and DOD seem to be against what brain injury can handle," said Susan Connor, chief executive officer the Brain Injury Association. "Because the frontal lobe controls memory, thinking, judgment and processing ... if you shove paperwork in front of someone with sustained brain injury or put them in a large group with scripted instructions, they can't follow it."
Keep reading.

Nonfatal TBIs From Sports and Recreation Activities
Each year in the United States, an estimated 38 million children and adolescents participate in organized sports,1 and approximately 170 million adults participate in some type of physical activity not related to work.2 The health benefits of these activities are tempered by the risk for injury, including traumatic brain injury (TBI). CDC estimates that 1.1 million persons with TBIs are treated and released from U.S. hospital emergency departments (EDs) each year, and an additional 235,000 are hospitalized for these injuries.3 TBIs can result in long-term, negative health effects (e.g., memory loss and behavioral changes).3 To characterize sports- and recreation-related (SR-related) TBIs among patients treated in U.S. hospital EDs, CDC analyzed data from the National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP) for the period 2001-2005. This report summarizes the results of that analysis, which indicated that an estimated 207,830 patients with nonfatal SR-related TBIs were treated in EDs each year during this period. The highest rates of SR-related TBI ED visits for both males and females occurred among those aged 10-14 years. Increased awareness of TBI risks, prevention strategies, and the importance of timely identification and management is essential for reducing the incidence, severity, and long-term negative health effects of this type of injury.
Keep reading.

Labels: Iraq War, TBI, traumatic brain injury

"Executive Function" is a term used to describe a set of mental processes that helps us connect past experience with present action. We use executive function when we perform such activities as planning, organizing, strategizing and paying attention to details. Some of the problems associated with compromised Executive Function include:

*difficult to plan projects
*hard to estimate how much time projects will take
*difficult to communicate details in an organized, sequential manner
*hard to memorize and retrieve information from memory
*difficult to remember information while doing something with it, like remembering a phone number while dialing it.

According to the Encyclopedia of Mental Disorders:

Executive functions are high-level abilities that influence more basic abilities like attention, memory and motor skills. Most people who study these abilities agree that the frontal lobes of the brain play a major role in executive function. People with frontal lobe injuries have difficulty with the higher level processing that underlies executive functions. Because of its complexity, the frontal cortex develops more slowly than other parts of the brain, and not surprisingly, many executive functions do not fully develop until adolescence. Some executive functions also appear to decline in old age, and some executive function deficits may be useful in early detection of mild dementia.

Read the complete entry here.

Executive Function covers so many areas, it would be nearly impossible for one test to cover all of them. However, there are many tests and batteries of tests that professionals use to measure Executive Function and/or its loss. One of these is the Delis-Kaplan Executive Function System (D-KEFS; Delis, Kaplan, & Kramer, 2001). This system was designed exclusively for the assessment of executive functions, including:

*flexibility of thinking,
*inhibition,
*problem solving,
*planning,
*impulse control,
*concept formation,
*abstract thinking, and
*creativity.

The system utilizes a "cognitive-process approach," and it is composed of nine stand-alone tests. These tests provide a standardized assessment of executive functions in children and adults between the ages of 8 and 89. Proponents of the D-KEFS believe it also holds much promise as a research tool for increasing knowledge of frontal-lobe functions.

We'll look at some other tests of Executive Function, including the Wisconsin Card Sorting Task, in another post.

Labels: executive function, frontal lobe, TBI, traumatic brain injury

Verbal memory refers to memory of words and verbal items. Since we process most verbal information with the left side of our brain, damage to that side of the brain can impair verbal memory and even the ability to talk and understand speech.

The California Verbal Learning Test is one way to assess verbal memory. The tester reads aloud “Monday’s shopping list,” which is a list containing sixteen items, each belonging to one of four categories. So there might be four fruits, four vegetables, four spices, etc. The person being tested then tries to remember as many items as possible.

The tester will repeat this exercise several times, making note of how many items the person being tested remembers, and also whether he is using the categories. For example, if the test subject remembers only three vegetables but guesses that the remaining item is a vegetable, then he probably understands categories. If he guesses something entirely different, like chocolate syrup, then he probably doesn’t understand the categories.

Sometimes a tester will read from a second list, “Tuesday’s shopping list,” to see if the person can keep items from the two lists separate, or if he confuses the lists. Then, for 20 minutes or so, the tester distracts the person by giving him other things to do, and then asks him to try to remember Monday’s list.

Women often perform better on this test, especially with the categories. And, according to Memory Loss and the Brain , “patients with different kinds of brain damage or disorder also show reliable patterns of performance. For example, patients with Alzheimer's Disease tend to be unable to make use of category information (and might recall: Apples, Bananas, Oranges, Chicken) while patients with Parkinson's Disease tend to make repetition errors (for example: Apples, Bananas, Oranges, Bananas).”

One other thing to consider is that some people naturally process information differently than others -- verbally (with words) versus visually (with pictures). A person who tends to think visually may not do well on a verbal memory test, and vice versa. Comprehensive memory tests will consider both types of memory to get a more thorough assessment of a person’s ability to remember.

Labels: alzheimer's, California Verbal Learning Test, neuropsych tests, Parkinson disease, TBI, traumatic brain injury

A 2006 Jason Polan cartoon from The New Yorker features two gerbils in conversation. In the background is one of those wire wheels you find in hamster/gerbil cages, and one of the two gerbils is saying with maybe a little more self-satisfaction than is warranted, "I usually do two hours of cardio and then four more of cardio and then two more of cardio." (You can see the cartoon, and obtain a copy of it in various forms, at The Cartoon Bank.)

It turns out that maybe the smug little creature was onto something after all (from "Lobes of Steel" in Play, The New York Times's "sports magazine"):

The Morris water maze is the rodent equivalent of an I.Q. test: mice are placed in a tank filled with water dyed an opaque color. Beneath a small area of the surface is a platform, which the mice can’t see. Despite what you’ve heard about rodents and sinking ships, mice hate water; those that blunder upon the platform climb onto it immediately. Scientists have long agreed that a mouse’s spatial memory can be inferred by how quickly the animal finds its way in subsequent dunkings. A “smart” mouse remembers the platform and swims right to it.

In the late 1990s, one group of mice at the Salk Institute for Biological Studies, near San Diego, blew away the others in the Morris maze. The difference between the smart mice and those that floundered? Exercise. The brainy mice had running wheels in their cages, and the others didn’t.

Oh, well, that's mice, you say. People are a lot different, right? Er, not necessarily:

[Scientists] have been finding more evidence that the human brain is not only capable of renewing itself but that exercise speeds the process.
[...]
This spring, neuroscientists at Columbia University in New York City published a study in which a group of men and women, ranging in age from 21 to 45, began working out for one hour four times a week. After 12 weeks, the test subjects, predictably, became more fit. Their VO2 max, the standard measure of how much oxygen a person takes in while exercising, rose significantly.

But something else happened as a result of all those workouts: blood flowed at a much higher volume to a part of the brain responsible for neurogenesis. Functional M.R.I.’s showed that a portion of each person’s hippocampus received almost twice the blood volume as it did before. Scientists suspect that the blood pumping into that part of the brain was helping to produce fresh neurons.

The article doesn't address research (if there has been any) on the effects of exercise in the TBI-afflicted. But it doesn't seem like much of a stretch (no pun intended) to imagine that working out can help, and perhaps help a lot. (We've seen this with Jack himself, who had dropped tennis for a while but has recently gotten back into it -- as TLS mentioned in a post back in July.)

Labels: brain growth, exercise, fitness, TBI

The Murfreesboro Post By Dr. MARK KESTNER

A savant is a rare individual that possesses an extraordinary ability to perform mental tasks that seem superhuman. Savants are typically autistic people that are limited in some aspects of intellectual capacity, but perform like a genius in others. The most widely known example of a savant is the real person that inspired the movie, “Rainman.”

The movie was based upon a real man named Kim Peek...Now in his fifties, Kim is the most famous savant in the world. He can read a page of text in about 10 seconds.

( Click here to watch a short documentary on Kim Peek. If the link doesn't work, just go to www.youtube.com and type Kim Peek in the Search bar.)

Darold A. Treffert, a leading medical expert on autism, states that savants tend to have exceptional abilities in one of five areas: music, art, lightning calculations, calendar calculating and mechanical or spatial skills. Savants may be able to play a complete symphony after hearing it only once or draw an exact rendering of a city skyline with only a brief glance to record the vision.

It is even more astounding to realize that there is another type of savant … those known as acquired savants. These individuals were born and developed normally. They acquired astonishing skills usually after a traumatic brain injury. [emphasis added] Often they are left with a mental impairment, but are able to do calculations and exhibit near perfect recall of certain types of memory.

A most unusual case involved Orlando Serrell. Orlando was a normal 10-yeaold boy until he was hit in the head with a baseball. Within a few months of that injury Orlando began recalling such things as every license plate of the cars that had passed. Or, if you mention a date since his accident, he can effortlessly recall the weather and his whereabouts for that day. Unlike many autistic savants, however, Orlando still retains normal brain function.

Keep reading.

Labels: brain injury, Rainman, savant, TBI, traumatic brain injury

Dealing with a traumatic brain injury is difficult enough without dealing with one all by yourself. An obvious question, then, is "What support groups or online communities are there to help me cope?" And the answers are often obvious enough, too: Check with your local hospitals. Ask your doctor or other healthcare professional. Contact your local social-services organization for leads. And, of course, consult Google.

But there's one possibility you may have overlooked.

Meetup.com first achieved significant notice during the 2004 US Presidential campaign, particularly when Joe Trippi so brilliantly led Howard Dean's Democratic primary campaign straight to the people via the Worldwide Web. But it -- Meetup -- isn't and never was primarily a political tool; it just lent itself handily to that use. The idea is simple, on the face of it (from the "About Meetup" page at their site):

Meetup.com helps people find others who share their interest or cause, and form lasting, influential, local community groups that regularly meet face-to-face. We believe that the world will be a better place when everyone has access to a people-powered local Meetup Group. That's our goal.

Meetup Groups help people:

• Find others who share their interests
• Get involved locally
• Learn, teach, and share things
• Make friends and have fun
• Rise up, stand up, unite, and make a difference
• Be a part of something bigger — both locally and globally
  

We're proud to give more power to the people and we believe it's possible to make a profit and make a difference.

In general, Meetup provides a software and networking framework which makes it easy for people sharing similar interests to find one another. Of course, there are plenty of online fora, bulletin boards, newsgroups, and similar resources which serve as gathering places for like-minded groups. But importantly, the gathering places for meetups are off-line: in homes, meeting and conference rooms, schools... All that Meetup itself provides is a simple means to organize the gatherings.

After you've browsed around Meetup.com for even a few minutes, it becomes obvious how and why it's become a popular tool for this purpose; it becomes especially obvious how diverse are the interest groups that have come to depend on it.

So maybe it's not too surprising then to find that there are a lot of TBI-related meetups, not just in the United States but around the world.

Now, don't expect to find hundreds of participants in your city. You may find tens, or even less. (Here in our city, currently only a single person is seeking a meetup.) But such things always start small. And sharing with -- and supporting -- one another (to say nothing of not getting lost in a crowd) is a heck of a lot easier with smaller numbers anyway.

If your locale does not yet have a TBI meetup group of its own, consider starting one. Be patient. Someone out there, just a few miles away, is likewise hoping to meet you.

Labels: Joe Trippi, meetup.com, Meetups, organizing, support groups, TBI

The New York Times has established a "wall" around some of its content, requiring that you pay a fee in order to see that content. This brief article is behind the TimesSelect wall, but if you can get to it, it's an interesting illustration of how suddenly, unexpectedly, and, well, weirdly TBI can strike.

[A decade ago,] Philip Vanaria had gone for a walk in Greenwich Village, where he had lived most of his adult life. A friend wanted ideas for his birthday, which was coming up. At the corner of Hudson and Morton Streets, he called her from a pay phone.

"Hello," she said.

Something jolted Mr. Vanaria’s elbow. Then it shot into his arm. Waves of pain ran along his arm. He nested the phone on his left shoulder, cranked his ear down.

"I said, 'I think I’m having a heart attack,'" he recalled this week.

He was just about to turn 47, the hour of life when the body becomes a permanent suspect in acts of treachery. To calm himself, Mr. Vanaria reached for one of the posts next to the phone, and gripped it. He screamed. Someone was shooting him dead, a machine gun, it was the tail end of an era of drive-by killings, he was being riddled with bullets. He looked into the street to see his murderers.

No car. No gunmen. No one.

Then he realized that he could not let go of the post. Panic and pain ripped through his body. His arm fought with his fingers, which were locked onto the post by an invisible force. He unclenched his grip and pulled away.

A man stood nearby. "What’s happening?" he asked Mr. Vanaria.

"You don’t understand," Mr. Vanaria said. "I was being electrocuted."

In a daze, Mr. Vanaria walked away. Who do you tell? The police? The Fire Department? He walked to the firehouse of Engine 18 on 10th Street, spoke to a battalion chief, who brought a crew to the corner. Someone touched the phone with a metal tool, and it sparked. The firefighters cordoned the intersection and called Con Edison. The electricity was measured at 90 volts.

The fire chief urged Mr. Vanaria to go to the hospital. Instead, he wandered up to St. Francis Xavier church on West 16th Street. Later, he went to St. Vincent’s. They asked him his date of birth. It took him a while to come up with it.

He had, he learned, suffered a brain injury. He had literally been fried.

Lest you think a TBI comes just from obvious trauma: a gunshot wound; an automobile crash; the explosion of an IED beneath your armored car on a lonely road outside Baghdad... No, it can come at you just from the simple act of picking up a telephone receiver.

Labels: electrocution, TBI, traumatic brain injury

More on TBI and the military...

• The Army News Service reports that -- as announced a few weeks ago -- "The Army launched its Post Traumatic Stress Disorder and mild Traumatic Brain Injury chain-teaching program at the Pentagon last week." The program:

...is mandatory for all active-duty and reserve-component Soldiers, from the highest to lowest levels in the chain of command.
...
Lt. Gen. James L. Campbell, director of the Army Staff, opened the training by telling his peers that the biggest teaching point he wanted to get out to the Army's leaders involved a cultural shift in thought - that leaders shouldn't assume that because Soldiers have no visible injuries that all is well mentally.

• Good news no matter how you look at it, or from what portion of the political spectrum.

• And on the not-yet-dealt-with front, we have a report from NPR's KUOW (Seattle) of the experience of a local soldier, Staff Sgt. Richard Kellar, with the hell of TBI:

KELLAR: "Depression, anxiety and all the rest of that stuff. It's bad. They give you Zoloft and they try to monitor it. And all the rest of that."

REPORTER: "Does it help?"

KELLAR: "I don't know. I don't see a difference. I'm still depressed."

It's going to take years -- decades -- for the full impact of returning Iraq veterans' TBIs to be handled (well or at all) by US society, as Kellar's experience (and others like it) is already showing. But it's encouraging to see even the limited progress represented by the Army's joint PTSD/TBI educational program.

Labels: Army, Iraq War, PTSD, TBI, traumatic brain injury, US military

Jack can certainly speak on this topic. If you've read the beginning of his book, posted here online, you'll remember that, after his TBI, Jack was "fired" by his first doctor because of his behavior -- behavior he couldn't help.

From a recent article:

The council's study centers on the disruptive behaviors and emotional problems that brain-injury patients often exhibit and ways to help them, said Paul Aravich, a neuroscientist at Eastern Virginia Medical School and the council's past chairman.

Such problems often affect a person's impulse control, emotional skills and thinking skills and can be "the most disabling features of a brain injury," Aravich said. That's because the behavior, including anger and aggression, is often misunderstood, he said. The patient may be perceived as a "jerk" or as someone a nursing home or other center doesn't want to deal with, he said.

"If you are a person with a physical disability who is well-mannered and compliant, you can get help," he said. "But if you are a person with a challenging behavior, it is an entirely different problem. There is not a facility available to take care of them."

Read the whole article.

Labels: books, brain damage, TBI, traumatic brain injury

CHICAGO (Reuters) - A man with severe brain injuries who spent six years in a near-vegetative state can now chew his food, watch a movie and talk with family thanks to a brain pacemaker that may change the way such patients are treated, U.S. researchers said on Wednesday.

The 38-year-old man is the first person in a minimally conscious state to be treated with deep-brain stimulation, a treatment that uses a pacemaker and two electrodes to send impulses into a part of the brain regulating consciousness.

Keep reading.

Labels: coma, Neurology, pacemaker, TBI, traumatic brain injury

At the Franklin Institute Resources for Science Learning Online Web site, you can find some suggestions for brain exercises. For example, one exercise is to switch the hand you are using to control the computer mouse. According to the site, this exercise can strengthen neural connections and even create new ones. You can vary this exercise by switching to "the opposite hand to brush your teeth, dial the phone or operate the TV remote."

"Researchers at the Cleveland Clinic Foundation discovered that a muscle can be strengthened just by thinking about exercising it. The researchers said strength gains were due to improvements in the brain's ability to signal muscle."

Neurobics

"Neurobics™ is a unique system of brain exercises using your five physical senses and your emotional sense in unexpected ways that encourage you to shake up your everyday routines. They are designed to help your brain manufacture its own nutrients that strengthen, preserve, and grow brain cells.

Created by Lawrence C. Katz, Ph.D., a professor of neurobiology at Duke University Medical Center, neurobics can be done anywhere, anytime, in offbeat, fun and easy ways. Nevertheless, these exercises can activate underused nerve pathways and connections, helping you achieve a fit and flexible mind."

A few neurobic exercises:

Include one or more of your senses in an everyday task -- "Get dressed with your eyes closed."

Combine two senses -- "Listen to music and smell flowers / Listen to the rain and tap your fingers"

Break routines -- Go to work on a new route / Eat with your opposite hand / Shop at new grocery store

Benefits from Bingo:
"A cognitive psychologist in England found that when elderly people regularly played bingo, it helped minimize their memory loss and bolster their hand-eye coordination. Bingo seemed to help players of all ages remain mentally sharp."

Visit the Franklin Institute site for more ideas on exercising your brain.

Next time we'll look at more about Neurobics.

Labels: brain exercises, brain growth, TBI, traumatic brain injury

In my last post, I asked readers who'd had a TBI to submit brain exercises that helped them. Not surprising, Jack was the first to respond. He submitted juggling and video games. (He has personal experience with the former, and anecdotal evidence of the latter.) A regular visitor to one of Jack's support groups is an accomplished juggler, and he's been working with the group to improve their juggling skills. The exercise may prove to be more beneficial than originally thought. You can buy the book pictured here at Amazon.

"Street performers, circus entertainers and clowns: they can all juggle. Neuroscientists are now getting into the juggling act. Brain researchers at the University of Regensburg (Germany) have found that learning to juggle can change brain structure." Read more here.You can also buy a set of juggling balls at Amazon.

As for Video Games:

"These scholars are the first to admit that games can be addictive, and indeed part of their research explores how games connect to the reward circuits of the human brain. But they are now beginning to recognize the cognitive benefits of playing video games: pattern recognition, system thinking, even patience. Lurking in this research is the idea that gaming can exercise the mind the way physical activity exercises the body: It may be addictive because it’s challenging." Read more.

And this:

"In many circles, video games are still considered to be a waste of time. However, recent work in cognitive neuroscience has shown that certain types of video games can result in a variety of positive changes to visual attention, hand-eye coordination, and other perceptual skills.

As Green and Bavelier showed in an already-classic 2003 Nature article, action video game players (VGP's) were shown to have increased visual attention capacity on a flanker distractor task, as well as thought to show improvements in their ability to subitize (this is basically the process by which you can tell how many items are in a display without actually counting each item serially). In fact, VGP's could correctly subitize up to 5 items on average, while non-VGP's could subitize only three on average."

Read more on this study here.

We know that a TBI may result in loss of sense of time and space or spatial disorientation and difficulties with hand/eye coordination. Video games may help the brain to restore some of this loss. Video games are also assisting research activities:

"Clinical Neuropsychologist Dr. Maria Schultheis has discovered an unexpected admiration for the video game industry. More specifically, she appreciates the technical skills of their engineers, especially their ability to create realistic, incredibly complex interactive environments. And while it’s unlikely that she’ll be hooked on Grand Theft Auto anytime soon, Schultheis doesn’t hesitate to acknowledge that the gaming industry has been the driving force behind the rapid growth and sophistication of “virtual reality” systems, which she and a team of researchers are putting to unique new uses at the Kessler Medical Rehabilitation Research and Education Corporation (KMRREC) in West Orange, New Jersey." Read more.

Next time, a look at more brain exercises and what they are really doing to your brain.

Labels: brain exercises, juggling, TBI, traumatic brain injury, video games

I've known Jack for a little more than two years now. Close to a year ago I noticed something that is good news for TBI'ers. Other friends of Jack have since noticed the same thing. Jack's memory improved during that year. In fact, I believe his condition has improved in several ways since I first met him. (In case you don't know, Jack is over 80 years old and almost 20 years out from the automobile accident that caused most of the damage to his brain.)

I know the standard line is that most improvement will happen in the first year after the TBI. This is probably true, but that doesn't mean improvement will not continue. It just might happen at a slower rate. Jack is a perfect example of this. 20 years after his injury, his memory starts improving again. (Medical science still has an awful lot to learn about the brain.)

We're not sure to what we should attribute this improvement, but I do know that Jack continually pushes his brain to do more and more. He spends a lot of time on the computer; he stays up to date on his investments; he watches health shows on tv; he listens to NPR; but most of all, he stays involved in projects that interest him -- like this Web site, and digital canopies, the homeless, public tv, TBI's for a myriad of reasons, a national Web connection for the Society of Friends, the beginning of human life and its affect on stem-cell research and abortions, the importance of caregivers and physiatrists, and the list goes on.

Jack also gets a lot of physical exercise. He's an avid tennis player, and, weather permitting, he's on the courts several times a week. In fact, he got back into tennis about a year before we noticed the memory improvement. Coincidence? Maybe. But physical exercise is good for us for a lot of reasons. And if it turns out that it helps improve brain function, we'll be that much ahead of the game if we get started now.

If you've suffered a TBI and have used brain exercises that were helpful, we'd like to hear about them. Please use the Comments option to share your successful excercises with us and other readers. That's one of the main reasons Jack started this blog, to share information with people who live with a TBI. Please help us do that. What brain excercise(s) helped you?

Note: The picture with this post is from the Alzheimers Assisted Living Blog.

Labels: brain exercises, Memory, TBI, traumatic brain injury

$1.7 million NIH grant to UC Scientists

Cincinnati Business Courier - July 6, 2007, The National Institutes of Health has awarded $1.7 million to a University of Cincinnati scientist to do molecular research that could lead to better treatments for brain injury patients.

Kenneth Strauss will study two types of molecules known as eicosanoids, which are created by injured brain cells, to confirm that they can protect healthy brain cells from further damage.

If successful, Strauss's research could lead to a new class of drugs designed to enhance the levels of these helpful molecules, and thereby improve outcomes in patients who have suffered traumatic brain injury.

Traumatic brain injury is the leading cause of death and disability among people aged 16 to 45.

Read it here.


Diagnoses, treatments have changed
for some veterans' health problems

The Herald-Mail Online, Monday July 9, 2007,
Of approximately 686,000 troops who had returned from Iraq and Afghanistan and left the military, about 229,000 had gone to Veterans Affairs facilities as of April for health care, whether it was a veteran getting a flu shot or a quadriplegic receiving perpetual care, said VA spokesman Phil Budahn in Washington, D.C.

Budahn said he didn't have specific statistics for injuries caused by IEDs, but the VA was treating about 400 people for traumatic brain injuries. Such injuries could range from subtle symptoms such as loss of concentration all the way up to extreme personality changes and short-term memory loss.

In the past, everyone thought they understood the risks of traumatic brain injury to be obvious physical injury such as shrapnel, so traumatic brain injury wasn't always properly diagnosed, Budahn said.

But in 2003, a study out of the Tampa, Fla., VA hospital pointed out that people could experience a closed head trauma, or concussion, with no visible wounds, just from being close to a bomb going off, said Dr. John Sentell, chief of Mental Health Service at the Martinsburg VA Medical Center.

The brain can get injured from an IED blast without visible blood; even from the brain being jostled in the skull from the blast, Sentell said. These less obvious traumatic brain injuries are more common in today's wars and often make diagnosis difficult.

Read it here.


Illinois program first in the nation to provide
TBI screening for state’s returning Iraq and Afghanistan Veterans

July 3, 2007 -- CHICAGO – On the eve of Independence Day, Illinois Governor Rod R. Blagojevich was joined by Tammy Duckworth, Director of the Illinois Department of Veterans’ Affairs (IDVA) to announce a first-of-its-kind program to screen every returning Illinois National Guard member for traumatic brain injury (TBI), offer TBI screening to Illinois Veterans, and 24-hour toll-free psychological assistance for Veterans suffering from PTSD. The program increases health care benefits for Veterans and will later become part of the Governor’s Illinois Covered insurance plan.

The program will work in two parts: The TBI portion will mandate screening for all Illinois National Guard members returning from deployment and offer free screening to all Illinois Veterans, especially those returning from Operation Enduring Freedom and Operation Iraqi Freedom. The PTSD portion will offer 24-hour, toll-free psychological assistance to give Veterans suffering from PTSD a place to turn, day or night, for help.

Read it here.


Integra LifeSciences Supports Newest Edition
of Brain Trauma Foundation's Guidelines for
the Management of Severe Traumatic Brain Injury

CNN MONEY.com, PLAINSBORO, N.J., June 28, 2007 -- Integra LifeSciences Holdings Corporation (Nasdaq:IART) announced today its support for the third edition of the Brain Trauma Foundation's Guidelines for the Management of Severe Traumatic Brain Injury (Guidelines). The Guidelines are nationally recognized and referenced by many of the leading trauma centers in treatment of patients with traumatic brain injury. They are available for viewing at www.braintrauma.org.

The Guidelines were developed by the Brain Trauma Foundation (BTF) in association with the American Association of Neurological Surgeons (AANS), the Congress of Neurological Surgeons (CNS), and the AANS/CNS Joint Section on Neurotrauma and Critical Care, and incorporate the latest published research findings relevant to the diagnosis and treatment of severe traumatic brain injury.

Read it here.

Labels: military, TBI, TBI research, traumatic brain injury

Someday soon, we're hoping to unveil here at sossisson.com an online forum for discussions of Jack's two major interests -- TBI and the beginning of human life. Until then, if you're interested in reading about or discussing TBI issues within "a secure, reliable support community for people with neurological disorders and diseases," check out NeuroTalk's Traumatic Brain Injury and Post Concussion Syndrome forum.

A sampling of recent discussion topics, copied-and-pasted from the "thread list" (table of contents):

• TBi Resources-Reports
• TBi Survival Guide
• Common Problems following Brain Injury
• about Post Concussive Syndrome, Mild Traumatic Brain Injury & other Brain Injury
• Life after TBi ??
• Can concussions really do this much damage?
• Videos~ on brain, injury, effects, symptoms, diagnosis & more
• Brain Injury Symptoms

"Stickies" -- posts and discussions more or less permanently in place -- exist for "Post Concussion Syndrome Useful Links" and "TBI articles, research, & more useful links."

Labels: community, forum, TBI, traumatic brain injury

The number of TBI's caused by injuries in the Iraq War continues to stretch the government's ability to treat them. As the following excellent article points out, no one was prepared for the high number of wounded, kept alive by improved body armor. And no one really knows exactly how many of those wounded are TBI survivors:

Only an estimated 2,000 cases of brain injury have been treated, but doctors think many less obvious cases have gone undetected. One small study found that more than half of one group of wounded troops arriving at Walter Reed Army Medical Center had brain injuries. Around the nation, a new effort is under way to check every returning man and woman for this possibility.

Even with the continuing media coverage of the war's injured, and the recent flurry of interest by Congress, I still don't think the average American's knowledge (or even awareness) of TBI has increased by much. I hope I'm wrong. I know that Bob Woodruff got a lot of press, and that he made the rounds of television talk shows. I suppose we just need to be patient. Change takes time, and it will be a while before people's understanding of TBI increases appreciably. Here's an excerpt from the article:

Orangeburg Times Democrat, June 23,2007 -- These are America's war wounded, a toll that has received less attention than the 3,500 troops killed in Iraq. Depending on how you count them, they number between 35,000 and 53,000.

More of them are coming home, with injuries of a scope and magnitude the government did not predict and is now struggling to treat.

"If we left Iraq tomorrow, we would have the legacy of all these people for many years to come," said Dr. Jeffrey Drazen, editor-in-chief of the New England Journal of Medicine and an adviser to the U.S. Department of Veterans Affairs. "The military simply wasn't prepared for its own success" at keeping severely wounded soldiers alive, he said.

Continue here to read the entire article.

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

These are some TBI clinical trials now recruiting:

*Enhancing Performance of Persons With TBI

*Efficacy of Pharmacological Treatment of Working Memory Impairment

*Pharmacological Intervention in Depression After TBI

*Antidepressant Maintenance in Traumatic Brain Injury

Here's a link to the complete list.

Labels: clinical trials, TBI, TBI research, traumatic brain injury

N.Y. Times, June 10, 2007 --

For several years, many medical experts have maintained that high school football players who sustain concussions should not return to the games in which they are injured. So when doctors commissioned by the National Football League published a study two years ago concluding “it might be safe” for such players to do so, the assertion sparked widespread criticism. Now the criticism is coming from authors of the paper itself.

Two of the five authors of the paper published in the journal Neurosurgery, Dr. Henry Feuer of the Indiana University Medical Center and Dr. Cynthia Arfken of Wayne State University, said in telephone interviews last week that the paper’s conclusion was inappropriate, and that the research should not be applied to high school and college players.

Arfken also said the passage had been added without her knowledge.

The two principal authors, Dr. David Viano of Wayne State and Dr. Ira Casson of Long Island Jewish Medical Center, acknowledged that they had altered the conclusion but said that all authors had received proof copies before publication. They said the section in question was added to appease peer reviewers who asked for a discussion of high school and college players, and they continued to stand by what was written.

Arfken and Feuer disavowed the paper’s recommendation that high school and college medical personnel “keep an open mind” about the paper’s analysis of concussions, which deemed safe the league’s record of allowing half of the players with concussions to return to the same game. Arfken and Feuer thereby joined critics who had long claimed that such a suggestion was dangerous for younger players. Their less-developed brain tissue is believed to be more susceptible to short- and long-term damage than adults’. They also receive considerably less medical attention than players in the N.F.L.

Feuer said that he “would change that sentence; I’d eliminate it.” Regarding high school players, he added: “It’s been shown that they don’t seem to recover as fast. Period.”

Continuing reading the article.

Labels: concussion, NFL, TBI, traumatic brain injury

New York Times, May 31, 2007 --

The rate of diagnosed clinical depression among retired National Football League players is strongly correlated with the number of concussions they sustained, according to a study to be published today.

The study was conducted by the University of North Carolina’s Center for the Study of Retired Athletes and based on a general health survey of 2,552 retired N.F.L. players. It corroborates other findings regarding brain trauma and later-life depression in other subsets of the general population, but runs counter to longtime assertions by the N.F.L. that concussions in football have no long-term effects.

Later in the article:
While consistently defending its teams’ treatment of concussions and denying any relationship between players’ brain trauma and later neurocognitive decline, the N.F.L. has subsequently announced several related initiatives. The league and its players union recently created a fund to help pay the medical expenses of players suffering from Alzheimer’s disease or similar dementia. Last week, N.F.L. Commissioner Roger Goodell announced wide-ranging league guidelines regarding concussions, from obligatory neuropsychological testing for all players to what he called a “whistle-blower system” where players and doctors can anonymously report any coach’s attempt to override the wishes of concussed players or medical personnel.

Mr. Goodell said last week that the league’s concussion committee had just begun its own study “to determine if there are any long-term effects of concussions on retired N.F.L. players.”

Dr. Casson, the committee’s co-chair, said that players who retired from 1986 through 1996 would be randomly approached to undergo “a comprehensive neurological examination, and a comprehensive neurologic history, including a detailed concussion history,” using player recollection cross-referenced with old team injury reports. He said that the study would take two to three years to be completed and another year to be published.

Read the complete article here.

Also, don't miss this site for more information about head injuries and football (from youth ball to the NFL).

Labels: concussion, Depression, NFL, TBI, TBI research, traumatic brain injury

Much of the content here on the TBI blog -- especially lately -- focuses on attention devoted by the media to traumatic brain injuries suffered on the modern battlefield. But veterans' hospitals and medical tents are far from the most likely places where you'll encounter someone suffering from TBI. Indeed, you may have to look no further than the next cubicle, desk, assembly-line station.

That's part of the message of a brief publication put out by the Job Accommodation Network (JAN) at West Virginia University. (124KB PDF version also available.)

Never heard of JAN? From their "About" page (emphasis added):

The Job Accommodation Network is a service of the Office of Disability Employment Policy (ODEP) of the U.S. Department of Labor... JAN's mission is to facilitate the employment and retention of workers with disabilities by providing employers, employment providers, people with disabilities, their family members and other interested parties with information on job accommodations, self-employment and small business opportunities and related subjects. JAN's efforts are in support of the employment, including self-employment and small business ownership, of people with disabilities. JAN represents the most comprehensive resource for job accommodations available. JAN's work has greatly enhanced the job opportunities of people with disabilities by providing information on job accommodations since 1984. In 1991 JAN expanded to provide information on the Americans with Disabilities Act.

Yeah: since 1984. Twenty-three years of something very like invisibility, and darn those big-government bureaucracies anyway. [Sarcasm off.]

The invisibility of JAN parallels the invisibility, for the most part, of brain-injured workers. Someone who's been in an automobile accident or suffered a football or boxing injury may or may not evidence physical symptoms, like scars, broken limbs, and other alterations in their appearance. But there's nothing intrinsically visible about a TBI. From the JAN site:

...There are several different types of TBI (TBI Recovery Center, 2006):

Concussion: A concussion is the most minor and common type of TBI. A concussion is caused when the brain receives a somewhat minor trauma from an impact, such as a hit to the head by an object or person or from a sudden change in momentum, such as a fall. It may or may not result in a short loss of consciousness (not exceeding 20 minutes) and can be diagnosed by observing common symptoms such as headache, confusion, and vomiting. Difficulty with thinking skills (e.g., difficulty "thinking straight," memory problems, poor judgment, poor attention span, a slowed thought processing speed) (Brain Injury Association of America, 2006a; TBI Recovery Center, 2006).

Skull Fracture: A skull fracture occurs when the skull cracks or breaks. A depressed skull fracture occurs when pieces of broken skull press into the tissue of the brain. A penetrating skull fracture occurs when something pierces the skull and injures the brain (Brain Injury Association of America, 2006a; TBI Recovery Center, 2006).

Contusion: A contusion is bruising or bleeding of the brain (Brain Injury Association of America, 2006a; TBI Recovery Center, 2006).

Hematoma: A hematoma is a collection of blood inside the body (Brain Injury Association of America, 2006a; TBI Recovery Center, 2006).

With the possible exception of a skull fracture, in other words, everything going "wrong" with a TBI victim is going wrong inside:

...Symptoms of mild TBI include headache; confusion; lightheadedness; dizziness; blurred vision or tired eyes; ringing in the ears; bad taste in the mouth; fatigue; a change in sleep patterns; mood changes; and trouble with memory, concentration, attention, or thinking. The injury may or may not result in a brief period of unconsciousness.

...Symptoms of moderate to severe TBI may be similar to symptoms of mild TBI, but they may also include a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the arms or legs, loss of coordination, increased confusion, restlessness, or agitation.

Even those TBI symptoms which are observable can be easily dismissed as symptoms of something else: not enough sleep, drunkenness or hangover, a bad chunk of pork in the lunchtime takeout.

Furthermore, the above list scarcely addresses the most potentially debilitating conditions resulting from a TBI:

• Depression about not being able to get help with your problem.
  
• Depression, for that matter, about not being able to describe your problem adequately so help can be obtained in the first place.
  
• The misery of knowing that you know something critical to your job function but can't quite put your finger on it, and the guilt and embarrassment that may go along with that failure.
  
• Isolation from your co-workers who have no notion of what you're experiencing.

The JAN site's page on TBI-disabled workers is meant to assist supervisors in making accommodations for these employees. That said, it's worth a visit by anyone with an interest in TBI. It's brief, but eye-opening. And -- not to put too fine a point on it -- you won't be able to see anything at all as long as your eyes are closed.

Labels: ADA, disability, employment, symptoms, TBI, traumatic brain injury, work

ABC30.com, 05/24/2007 - As many as 20% of service members returning from duty in Iraq and Afghanistan will have some level of traumatic brain injury.

This spring the Department of Defense acknowledged traumatic brain injury as a "significant health concern" and vowed to identify it among active duty troops. But many new cases are likely to emerge as troops transition to civilian life as veterans.

Military records show that 60% of the 25,000 war injuries to date resulted from explosive blasts like IED's or roadside bombs. And nearly 3,000 of the wounded are currently being treated for severe traumatic brain injury or TBI.

Fresno V.A. Hospital emergency room doctor James Lindsay says injuries in this war are different from other wars when bullets did the majority of the damage.

Dr. Lindsay, Fresno V.A. E.R. physician, says "there's less ballistic wounding from actual gunfire and more blast injuries and blast injuries typically produce traumatic brain injuries." And those blasts can leave an injury without ever breaking the skin.

Read the article here.

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

News about brain injuries in Iraq doesn't stop:

Frontline combat troops in the Iraq war have at least a one in five chance of coming home with a brain injury, according to Chris Elia, a Veterans Affairs psychologist who spoke Friday about traumatic brain injuries in veterans at the second annual Black Hills Brain Injury Conference in Rapid City.

“And I suspect it’s a much higher chance than that,” Elia said, presenting an array of statistics about what has become the “signature wound” of the wars in Iraq and Afghanistan.

Of the 23,000 U.S. soldiers, marines and other military personnel who have been wounded in Iraq and Afghanistan since 2002, more than 6,500 have been diagnosed with traumatic brain injury, according to military figures. Elia said those numbers are probably low, given what today’s war is still teaching medical experts about blast injuries.

What a shame that it's literally taken a war to bring TBI front and center. Hardly a day goes by now that TBI is not in the news, and word of advances in TBI research hits the media with unusual frequency. Advocates for brain injury research have wanted this for a long time, but who could have forseen that a war would be necessary to accomplish it? The universe does indeed work in mysterious ways, but I can't imagine anyone who'd have chosen this route to brain-injury awareness.

Read the complete article here.

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

Child Health News Wednesday, May 16, 2007 -- Traumatic brain injury is the leading cause of abusive death in children and is especially common in abused children under the age of 4. Fifteen hundred children a year in U.S. are killed because of traumatic brain injury and those who survive are often devastated.

It is impossible to do randomized controlled studies of abusive head trauma but researchers need to develop improved tools to correctly identify and ultimately prevent this abuse according to Dr. Laskey.

"We have to understand abusive head trauma. Research in the field is in its infancy compared to what we know about other pediatric conditions. We need to increase both the volume and the quality of what we know. We need to know more and we can't until we have pediatricians and pathologists, the doctors who see these children, speaking the same language," said Dr. Laskey.

Here's the complete article.

Labels: child abuse, TBI, traumatic brain injury

No matter your politics, I hope you'd agree that it's a strange world in which wars are said, dispassionately, to have "signature injuries." For the American Civil War, maybe this was battlefield amputations; for World War I, trench mouth or gas-attack symptoms; for Vietnam, I guess, post-traumatic stress; and for the original Gulf War, various Agent Orange-related afflictions.

Here at sossisson.com, we've noted before (recently, for example, here) that traumatic brain injury is widely regarded as the signature wound of the current war in Iraq. This sad state of affairs has at last received Federal attention, in the form of a Congressional ruling that soldiers must be tested for TBI before and after their Iraq deployments. This news came at the end of last week, in a report from USA Today. This comes roughly concurrently with a report from the Defense Department itself, per the Associated Press.

From USA Today:

The Pentagon must use computers to screen troops before and after they go to Iraq or Afghanistan to better determine whether they suffered traumatic brain damage in combat, according to a plan by a congressional brain-injury task force...

Congress has authorized a record $450 million for brain-injury treatment and research in the Iraq spending bill being negotiated by Congress and the White House. Legislators say the Pentagon acted slowly on this issue.

"The military was blindsided by the number of blast injury victims in Iraq and Afghanistan, and it is clear that the proper resources were never in place to care for them," says Rep. Bill Pascrell, D-N.J., co-chairman and founder of the 112-member Congressional Brain Injury Task Force.

And from the Associated Press:

Issuing an urgent warning, the Defense Department's Task Force on Mental Health chaired by Navy Surgeon General Donald Arthur said more than one-third of troops and veterans currently suffer from problems such as traumatic brain injury and post-traumatic stress disorder.

With an escalating Iraq war, those numbers are expected to worsen, and current staffing and money for military health care won't be able to meet the need, the group said in a preliminary report released Thursday.

"The system of care for psychological health that has evolved in recent decades is not sufficient to meet the needs of today's forces and their beneficiaries, and will not be sufficient to meet the needs in the future," the 14-member group says.

There have also been a couple of other recent news items on this issue:

• From the The Blogging Curmudgeon (Curmudgette), "This Is Your Brain on Iraq":
  

As increasingly elaborate body armour protects the torso, and even the limbs, the brain is still vulnerable to shock waves that helmets cannot deter... And these "closed-head" injuries are harder to treat than even those commonly suffered by motorcyclists.

• From the San Antonio Express-News, "Troops living with brain injury":
  

  ...untold thousands of U.S. troops [are] returning from the Middle East with a brain injury, the signature wound of the war in Iraq and a rising challenge stateside for everyone from doctors to lawmakers.
  
  Overtaxed military medical facilities have farmed out many cases [...] to private rehabilitation centers at an unprecedented pace, raising questions about oversight and quality of care and forcing the military to rethink preventing and screening for such injuries, many of which are hidden...
  
  In Iraq, modern body armor protects troops from bullets and shrapnel. Not even a padded helmet can keep a riveting blast from pounding the brain against the ridges inside the skull, causing bruising or swelling or stretching its nerve fibers. The injuries often aren't seen on CT scans or MRIs.
  
  But they can cause a loss of balance, memory or cognitive skills that might not appear until a year after deployment. Even civilians who don't live by the tough-and-ready ethos of the military are hesitant to seek help.

  
  
• From Army Times, "Soldier says he was deployed with head injury":

An MRI later showed that Thurman had lesions on the right parietal lobe of his brain, a condition that led to a “don’t deploy” order — which the Army violated, according to Thurman. Worse, rather than providing compassionate understanding of the symptoms associated with traumatic brain injury, he said leaders at Fort Carson, Colo., have harassed him, refused him medication and pushed for an Article 15.

Thurman stepped forward Friday as one of the 18 soldiers whose cases were cited by six senators in a letter to the Government Accountability Office requesting a review of alleged improper handling of traumatic brain injuries, post-traumatic stress disorder and ungrounded personality disorder discharges.

The letter was sent after an Army surgeon general investigation into the cases said the soldiers were handled properly — but the soldiers involved said no one from the surgeon general’s office ever talked to them in the course of that investigation.

As an aside, if you -- like I -- were previously unfamiliar with the term "Article 15": It refers to a section of the Universal Code of Military Justice, or UCMJ. Generally, it's one of the UCMJ's "punitive articles." According to Rod Powers, about.com's "Guide to the US Military," Article 15 is one of several procedures

whereby the commanding officer or officer in charge may:

• Make inquiry into the facts surrounding minor offenses allegedly committed by a member of his command;
• afford the accused a hearing as to such offenses; and
• dispose of such charges by dismissing the charges, imposing punishment under the provisions of Art. 15, UCMJ, or referring the case to a court-martial.

To initiate Article 15 action, a commander must have reason to believe that a member of his/her command committed an offense under the UCMJ. Article 15 gives a commanding officer power to punish individuals for minor offenses... The term "minor offense" ordinarily does not include misconduct which, if tried by general court-martial, could be punished by a dishonorable discharge or confinement for more than one year. The military services, however, have taken the position that the final determination as to whether an offense is "minor" is within the sound discretion of the commanding officer.

Note that the soldier whose case is covered in the Army Times piece claims about his post-TBI treatment that his superiors have "pushed for an Article 15." I understand that the military code of justice must be different than the civilian. But if this claim is at all true, I hope the military at least stops to reflect on ways in which Article 15 can be abused -- if not outright criminalizes the abuse.

[Updated 2007-05-09 7:56 pm]

Labels: Article 15, Iraq veterans, Iraq War, military justice, TBI, traumatic brain injury

From The Saratogian:

April 29, 2007 -- Sgt. Ken Comstock, a 1999 graduate of Ballston Spa High School who went to Iraq with the National Guard, suffered more than 500 skull fractures in August 2004 when a roadside bomb exploded as he was returning from patrol in a Humvee.
Sgt. Comstock thankfully survived, but required extensive treatment abroad, and in the U.S. an estimated 1,600 veterans have required treatment through the nation's Veterans Affairs services for traumatic brain injuries and other severe wounds received while serving in Iraq and Afghanistan.

There is no easy, quick or cheap solution. But two U.S. senators, New York's Hillary Clinton and Indiana's Evan Bayh, have proposed what even they concede would be only a temporary solution to the problem. Their legislation would let soldiers with traumatic brain injury extend their active duty status for a year after suffering the injury....

Keeping them on active duty status would not send the soldiers back into combat, but it would enable them to continue receiving the best medical care for their injuries that the military can provide -- "from the Defense Department and from specialized private care centers, which would be better than care from the Department of Veterans Affairs."

As we all know, TBI is not something one recovers from overnight, so let's support this bill as a good first step.

Read the complete article.

Labels: Hillary Clinton, soldiers, TBI, traumatic brain injury

I found this on ABC 7 in San Francisco's Web site:

David Wright, MD, Emergency Physician: "Traumatic brain injury is a very significant problem in this country - over 1.2 million head injuries a year."

For ER doctors, it's frustrating.

David Wright, MD, Emergency Physician: "There have been over 100 studies looking for neuro-protectants, for drugs that would help patients after a head injury and absolutely none have been found in over 30 years of research."

That's why Dr. David Wright welcomed the chance to study the natural hormone -- progesterone. The first human studies with 100 patients looked at the safety of injecting the hormone right after an injury. The results were surprising.

David Wright, MD: "There was a 50-percent reduction in mortality, which was the thing that stood out, obviously, the most."

Read the complete article.

And here's a link to some basic TBI facts and a summary of the research.

Labels: hormones, progesterone, TBI, traumatic brain injury

FORT CARSON, Colo. — The Army, faced with thousands of cases of brain injury from the Iraq war, will soon begin testing brain-scanning equipment in hopes of finding a more accurate way to identify hard-to-diagnose wounds...

To date, the Army has not extensively used neuroimaging equipment to detect brain injuries in returning soldiers because not enough testing has been done to judge the

Read the rest of the article.

Labels: Iraq veterans, military, TBI, traumatic brain injury, Veterans

I love the CBS television show Without a Trace. There's the dramatic tension you might expect from a one-hour program about a search for a different missing person every week. But the writing is superb, the acting exceptional, and, as my wife could tell you, I often end up sniffling by the time the hour is up. Alas, this season, since they moved the show to Sunday nights -- where its airtime is frequently, unpredictably bumped by sports events -- I don't see it much anymore.

But I did for some reason catch the episode ("Crash and Burn") originally aired last Sunday, April 15. (Trailer here, on the ever-valuable YouTube.)

I won't detail the plot here, spoiling it for any of you who'd like to see it. But I can tell you that the plot hinged on a brain injury suffered by a veteran of the US Marines -- not in combat, but in a trail-bike accident.

Two items of interest about this episode:

• First, the storyline depended not just on the facts of the veteran's brain injury, but on what life was like for him afterwards. For instance, he recounted one particularly excruciating incident: He'd left his house to walk a couple of blocks to a store one night. When he came out of the store, he looked down the street to his house... and he didn't recognize it.
• Second, nowhere in the episode -- that I caught, anyway -- did the phrase "traumatic brain injury" appear (nor, of course, the abbreviation "TBI"). As Jack Sisson says in chapter 1 of his book here at sossisson.com:

It can be surprising to find TBI referenced in popular culture. More, it can be astonishing to find it referenced as TBI; I kind of wish one of my favorite show's writers had latched onto the term.

If you're interested in the episode, again, the episode title is "Crash and Burn." It will no doubt be re-broadcast sometime between now and the start of next season; you might also watch for it on the TNT cable channel, which shows Without a Trace reruns.

Labels: brain injury, TBI, traumatic brain injury, Veterans, Without a Trace

Reuters last week reported that children who suffer a head injury are quite likely to have a similar injury subsequently.

"We do not really understand the mechanism behind repetitive head injuries in children," Dr. Bonnie R. Swaine, of the University of Montreal, Canada, told Reuters Health. "These results support anecdotal evidence of the phenomenon."

As for an explanation, Swaine continued, "It is reasonable that children with a head injury who do not regain their pre-injury state of health could be at risk for another injury."

Read the entire article.

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

The government is finally beginning to address the myriad problems faced by our returning wounded troops, including those with TBI. Found this at PostStar.com:

WASHINGTON - Injured soldiers returning home for medical treatment face an unacceptable maze of paperwork and bureaucracy, leaders of a presidential commission on veterans' health care said Saturday.

At its first public meeting, the nine-member panel heard from veterans, spouses and advocacy groups who decried what they said was a failed system. The commission pledged to work quickly to find solutions rather than assign blame.

"This is not going to be a witch hunt," said former GOP Sen. Bob Dole of Kansas, one of the heads of the Commission on Care for America's Returning Wounded Warriors.

Dole said the commission planned to build upon the work of at least nine congressional committees and other government panels that are investigating veterans' health care problems. Those inquiries followed disclosures in February of squalid conditions and poor outpatient treatment at Walter Reed Army Medical Center in Washington.

Their reviews in recent weeks have pointed to inadequacies with the treatment of brain injury and post-traumatic stress disorder, as well as outpatient care.

Read the entire article.

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

From ABC NEWs:

April 11, 2007— "Where do I go to get my brain back?"

That's what a member of the armed services recovering at Walter Reed Army Medical Center said when Sen. Hillary Clinton, D-N.Y., asked him how he was doing last week.

Clinton recounted the story Wednesday on a conference call with journalists to announce new legislation aimed at helping victims of traumatic brain injury.

The legislation, sponsored by Clinton and Sen. Evan Bayh, D-Ind., would allow TBI victims to extend their "active duty" status for up to one year from the date that their injury is determined.

Brain Injuries Plague Veterans

"We are not addressing the unique challenges posed by TBI in the way that we need to be," Clinton said.

Under the current system, those recovering from TBI are forced to choose between remaining on active duty and receiving the best state-of-the-art care from the Department of Defense or entering retired status and returning to their hometowns to receive care under the umbrella of the Department of Veterans Affairs.

Patient's Advocate for Victims

The bill would also provide that every TBI victim be given a "patient's advocate" to help the patient wade through what can be an enormously complicated and frustrating system.

All of this is very good news, of course, but a "patient's advocate" is a big step forward and a subject dear to Jack's heart. He believes that if he'd been given a "caretaker / advocate / physiatrist / case manager" -- whatever you want to call it -- his care and recovery during those first couple of years would have been much improved. Jack strongly believes this is necessary for all TBI patients.

Read the complete article.

Labels: Hillary Clinton, Iraq veterans, TBI, traumatic brain injury, V.A.

The following seems a little "after the fact," because Traumatic Brain Injury was labeled the signature wound of the Iraq War last year. Still, even if the military has been slow to fully address this issue, the following AP article from the "Boston Herald" sounds promising (except for identifying TBI as "military parlance"):

AUGUSTA, Maine - Traumatic brain injuries are common among wounded soldiers returning from Iraq, but they’re also commonly misdiagnosed or undetected, according veterans’ activists and Maine’s congressional delegation.

For some soldiers, the injury is graphically obvious.

”They’re the ones with part of their skull missing,” Ron Brodeur, state inspector for the Maine Department of Disabled American Veterans, said during a forum Wednesday on soldiers’ health care.

For others, the traumatic brain injury, or TBI in military parlance, presents itself in subtle ways, said Jack Sims, director of the Togus Veterans Administration Medical Center.

”Our providers are now aware of TBI and are on the lookout for it. We’re trying to be much more proactive in recognizing these things than we were in past conflicts,” he said.

Read the entire article.


Here's more from the "IndyStar":

WASHINGTON -- Sens. Evan Bayh and Hillary Rodham Clinton said Wednesday that soldiers with traumatic brain injuries should get extended treatment through the Defense Department instead of the Veterans Affairs Department, which they argued is less capable of handling such injuries.

The Democrats, who serve on the Senate Armed Services Committee, said they would pursue legislation to make that change.
"The VA does a great job," Bayh said. "But they've simply been overwhelmed by the number of these types of injuries and are still in transition in terms of how best to treat them.

Read the article.

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

From UCLA Healthcare:

The chemical lactate has gotten a bad rap. Conventional wisdom considered it to be little more than the bane of runners and other athletes, causing stiff muscles and fatigue, and the "sour" in sour milk.

It turns out that view may have been too narrow.

Neuroscientists at UCLA are now looking at lactate with a much more positive eye, considering it a possible replacement "fuel" for the brain in the immediate hours after a traumatic brain injury instead of glucose, the current standard. If they are right, it could change how emergency room physicians and intensive care physicians treat patients with brain injuries in the first critical hours after injury.

Read the entire article.

Labels: lactate, neuroscience, TBI, traumatic brain injury

Anyone who's read this blog for a while is probably aware that Jack's TBI (in the late 80's) caused numerous other conditions, including sleep apnea. That's why his TBI blog sometimes cover seemingly non-related topics. It's like two degrees of separation around here -- they're all related through Jack.

Here's some news on head injuries and sleep disorders:

Science Daily — A mild head injury can increase your chance of developing a sleep disorder, according to a study published in the April 3, 2007, issue of Neurology®, the scientific journal of the American Academy of Neurology. Researchers say these findings highlight the need for improved diagnosis and treatment of sleep disorders in mild traumatic brain injury patients who complain of insomnia.

"As many as 40 to 65 percent of people with mild traumatic brain injury complain of insomnia," said study author Liat Ayalon, PhD, with the University of California, San Diego. "This is concerning since sleeping problems may exacerbate other brain injury symptoms such as headache, emotional distress, and cognitive impairment, making the rehabilitation process much harder."

Read entire article here.

Labels: insomnia, sleep apnea, TBI, traumatic brain injury

Reuters, March 21, 2007.
More Americans are being hospitalized with very serious head injuries, and government statisticians say they don't know why. Statisticians on Wednesday reported a 38 percent increase in hospital admissions for the most serious kind of head injury, type 1 traumatic brain injury, between 2001 and 2004. The biggest single cause was falls.

The researchers found that in 2004, nearly 204,000 people were treated in hospitals for traumatic brain injury at a cost of $3.2 billion...The figures do not include military personnel or people treated at Veterans Affairs hospitals. Nor did they include people who died before they made it to the hospital.

Read the entire article.

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

We've posted the text of a statement from Florida State University at a 2006 ceremony, recognizing Jack's contributions to the university.

Jack has spent more than 17 years researching solutions for patients with TBI. His generous gifts will ensure that the educators and policy makers of tomorrow will be able to continue his work well into the future.

Labels: Florida State University, FSU, TBI, traumatic brain injury

In conjuction with Brain Injury Awareness Month, and to raise awareness about brain injury and its life-altering consequences, BIAA announces the availability of new materials for the public, those who have experienced a brain injury, their family members/caregivers, professionals and interested persons.

A new brain injury awareness packet and materials are now available.

The 2007 kit includes: (note - some of these are large PDF files)

Behavioral Challenges after Brain Injury booklet;

Challenges, Changes, and Choices: A Brain Injury Guide for Families and Caregivers booklet;

Driving After Brain Injury: Issues, Obstacles and Possibilities booklet;

Falls: The Leading Cause of Brain Injury booklet;

A Physician Talks about Severe Brain Injury. The Basics booklet;

A poster reflecting the diversity of traumatic brain injury across the United States;

Four fact sheets outlining personal stories of traumatic brain injury;

Centers for Disease Control and Prevention’s Facts about Traumatic Brain Injury fact sheet;

Directory of the Association’s Chartered State Affiliates;

Frequently Asked Questions about the Defense and Veterans Brain Injury Program;

BIAA Bookstore informational sheet

Visit the BIAA site for links to the above information.

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

Exercise boosts brainpower by building new brain cells in a brain region linked with memory and memory loss, U.S. researchers reported. Tests on mice showed they grew new brain cells in a brain region called the dentate gyrus, a part of the hippocampus that is known to be affected in the age-related memory decline that begins around age 30 for most humans.

Read about it here.

Labels: brain cells, brain exercises, memory loss, TBI

Visitors to this blog who are looking for further reading about TBI might be interested in visiting our new list of books on the subject.

Labels: books, reading, TBI, traumatic brain injury

How sad that it's taken someone famous to finally shine a spotlight on traumatic brain injury. It wasn't enough that every year "1.4 million Americans suffer a TBI — more than are struck by heart attacks." It also wasn't enough that more than a year ago TBI "officially" became the signature wound of the Iraq War.

I remember having a somewhat heated conversation with a producer for Larry King Live because she was adamant that they would only do a show on TBI if it was headline news. I questioned just exactly what more they wanted -- newspapers had reported that TBI was the war's signature wound. Hundreds of young Americans were being shipped home from Iraq with this life-altering injury that the general public apparently knew very little about. But that was not newsworthy enough, and very soon, even the few newspapers who'd carried stories were silent.

Now that Bob Woodruff has published a book on his own injury, TBI is all over the media. Television, radio, newspapers, magazines. It's what we've wanted for so long -- for people to recognize both its seriousness and pervasiveness. I'm relieved and grateful that the country's getting this education, but I still wonder what it says about us and our media that it took celebrity status to accomplish what TBI's millions of victims and the war's recent wounded could not -- get someone to listen.

Read a good MSNBC article here.

And go here for a New York Times piece on the problems our newest severely wounded veterans are facing.

Labels: Iraq veterans, TBI, traumatic brain injury, V.A.

The NFL's Committee on Mild Traumatic Brain Injury (TBI) has come under fire from several sources reports the Baltimore Sun. The flack started last fall when ESPN The Magazine published an article critical of the committee's report and said "the committee skewed its data to minimize the effect and nature of concussions," a charge rejected as "totally false" by Dr. Andrew Tucker, a member of the committee since 1994 and a Ravens team physician.

Among its criticisms, the magazine said Dr. Elliot Pellman, who recently resigned as committee chair, "omitted large numbers of baseline reports from neuropsychological testing in a six-year study to arrive at figures more favorable to the league."

"People on the outside see it as industry-funded research and research that is not as accurate or sound as it should be," said Dr. Kevin Guskiewicz, the research director of the Center for the Study of Retired Athletes at the University of North Carolina, which has been criticized by Pellman's group for some of its work.

"That was basically done to protect the image of the game, of the league. It's troubling to me and many others that there is all this work out on retired NFL players and they have chosen to ignore the findings."

Read the entire article here and then tell us what you think. Is the NFL doing enough to protect its players and provide for them long term?

Labels: brain injuries, concussion, NFL, TBI, traumatic brain injury

A group of German researchers say it can. They've found that odors reactivated new memories in people's brains while they slept. With their study showing that memories are consolidated during sleep, the researchers believe that "smells and perhaps other stiimuli can reinforce brain learning pathways."

Read the entire article.

Labels: brain function, lack of sleep, Memory, TBI

Here's a link to a Fox News transcript of Greta Van Susteren interviewing Bob Woodruff. The interview took place last night.

Good article in the Detroit News about Woodruff's growing influence on good medical care for TBI injuries.

Yesterday ABC News reported receiving over 1000 emails from wounded veterans and their families. The emails resulted from ABC's documentary about Woodruff, "To Iraq and Back," "with many claiming they have had problems dealing with the Veteran's Benefits Administration as they seek rehabilitation from injuries sustained in Iraq and Afghanistan." Read the article (and talk to the Woodruff family) here.

Labels: Bob Woodruff, Iraq War, TBI, VA, Veterans

The NY Times cited Bob Woodruff's contribution to public awareness about traumatic brain injury (TBI), called the signature wound of the Iraq War. All those "Support Our Troops" bumper stickers aside, how many people really knew that a number of our wounded will never be the same because they suffered a TBI? There are so many ugly things about this war that have been suppressed or cleaned up for public consumption, but now here is someone whose story no one can question because its truth has been well documented by the media. Maybe some of those wounded veterans will now have a chance at better medical care because of Woodruff. And maybe TBI sufferers everywhere will see improved funding for research because the public is more aware of this epidemic.

Read the entire article.

Labels: Bob Woodruff, Iraq War, TBI, traumatic brain injury

Those of us who have had a brain injury or who care about someone with a brain injury may never get the chance to personally thank Bob Woodruff for accomplishing what no one has been able to do before -- make millions of people around the world aware of just how serious and pervasive this condition is. Thank you, Mr. Woodruff, for your courage in fighting back from the seriousness of your injury and also for honestly telling your story and standing up for the veterans of the Iraq War whose injuries (both their number and seriousness), until now, have been the Administration's dirty little secret.

We in the brain-injury community all know the numbers. We all know the numerous ways one's brain can be injured. We know more about the brain than we ever thought we would or would need to. And we certainly know how life-changing a brain injury can be, not only for the person suffering the injury, but also for the people who love and will care for him or her.

It was many weeks before ABC’s Bob Woodruff realized how lucky he was to survive a roadside bomb explosion in Iraq in January 2006. It took months for him to understand how lucky he was to recover as fully as he did.

Few do. And that is one of the more sobering lessons of “To Iraq and Back,” Mr. Woodruff’s account of his ordeal on ABC tonight. Many veterans with similar traumatic brain injuries may never fully regain their ability to speak, walk or pick up a glass of water.

Here's ABC's intro into it's coverage of Bob Woodruff and his harrowing journey. Welcome back, Bob.

Labels: Bob Woodruff, TBI, traumatic brain injury

At the end of January, ABC ran some basic information about brain injury, probably as a prelude to Bob Woodruff's return after his serious injuries in Iraq. Here's a link to some questions and answers that might help some who are new to this topic.

Labels: Bob Woodruff, TBI, traumatic brain injury