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Jack Sisson's TBI Blog

A hug is duct tape for the soul.

 

One of Jack's concerns is the frequency of traumatic brain injuries in prisons and their affect on inmates in a prison environment. A few years ago, it would be almost impossible to find literature on this topic, but thanks to the growing body of knowledge about TBI, and its movement into the public consciousness (primarily due to the Iraq War), information on TBI is easier to find than ever before. To be sure, TBI and the Criminal Justice System is lagging somewhat behind other areas in terms of information available, but the field is steadily growing (as is TBI and the Homeless population).

The following is from the National Disability Rights Network:

Increasingly, large numbers of persons with mental illness, cognitive disabilities and/or physical disabilities are coming into contact with the adult correctional system. It is estimated that as many as 50 percent of prisoners have a mental illness or other type of disability. Jails and prisons have become the “new asylums” -- a costly response to mental health care.

From arrest through every phase of the criminal justice system, persons with disabilities encounter a system not designed to handle large numbers of persons with disabilities. Lack of access to community mental health treatment and other public services often results in people with disabilities being arrested and booked in jails where adequate treatment is unlikely. When competency is an issue, delays in transporting such individuals for treatment are commonplace. Those who are convicted and confined in penal facilities tend to serve longer sentences than others convicted of similar crimes, and prison conditions are harsher due to their disabilities.

Persons with disabilities often encounter an absence of justice in a system not designed to handle a large number of persons with disabilities.

Why are inmates with TBI or some form of mental illness not hospitalized in a state hospital? Why are they going to prison in ever increasing numbers?

A few years ago, Frontline produced an in-depth look at Ohio's prison system, and why it houses so many mentally ill individuals. Although this program focuses on mental illness, who's to say whether some of the prisoners filmed had also suffered a TBI. But mental illness or TBI, the sheer wrongness of incarcerating sufferers with either condition is obvious.

The opening sentences of the Frontline introduction:
Fewer than 55,000 Americans currently receive treatment in psychiatric hospitals. Meanwhile, almost 10 times that number -- nearly 500,000 -- mentally ill men and women are serving time in U.S. jails and prisons. As sheriffs and prison wardens become the unexpected and often ill-equipped caretakers of this burgeoning population, they raise a troubling new concern: Have America's jails and prisons become its new asylums?
You can watch the entire show here. Please let us know what you think. We'll be writing more about TBI and prisons this year.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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 Photo credit: U.S. Dept. of Veterans Affairsannounced 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.

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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.

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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.
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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.

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Photo credit: Michael Betts, The Press Republican
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.

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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.

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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."

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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.



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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.

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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.Photo credit: Medline Plus

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.

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


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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.

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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.

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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.

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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.

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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).

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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.

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USA TODAY, Gregg Zoroya, November 22, 2007 --Marine Lance Cpl. Gene Landrus was hurt in a roadside bomb attack outside Abu Ghraib, Iraq, on May 15, 2006, and faces medical separation from the Corps. He's also up for a Purple Heart.

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.

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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, impeachforpeace.orghas 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.

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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.

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NoMoreHeartDisease.net
The New York Times
Published: November 8, 2007

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.

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NASHIA logoThere'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.

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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.

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

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

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

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

Keep reading this article.

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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.

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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.

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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.

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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.

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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 FOX Newsbecause 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.

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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.

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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.http://www.bcrc.com/

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.

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"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.

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Tide Global Learning

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.

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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.)

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