Archive for December, 2009
A doctor in Pequannock, New Jersey has been instructing high school and middle school teachers how to identify and properly handle students who may suffer from brain injuries such as concussions. Dr. Paul Ostergaard, the doctor for Pequannock High School’s sports teams, told teachers that students in recovery from head injuries require complete brain rest, a Pequannock Daily Record article reported.
Complete brain rest means limiting homework, TV and video games, physical exercise, and anything else that might agitate youthful brain tissue in recovery. Ostergaard said, “Mental rest is just as important as physical rest,” in the article. Ostergaard was invited to speak with teachers and staff after many of them inquired about how to better deal with students with concussions and head injuries.
The Pequannock high school nurse, Susan DeBell, started a support group for students who continue to suffer from lingering symptoms of their head injuries, such as depression, headache, dizziness, lack of focus, loss of motivation and organizational skills, and difficulties with memorization.
A representative of the Brain Injury Association of New Jersey, Karen Mian, also spoke to Pequannock teachers. She suggested strategies for teachers to discretely and respectfully assist students recovering from brain injuries. Some of the strategies included moving students’ desks closer to the front of the room to aid in concentration, allowing students to take breaks when overwhelmed, and recognizing symptoms of brain injuries the students with the injuries may be unaware of.
Ostergaard said in the Daily Record article that many student athletes endure concussions without the injury ever being diagnosed as such. He highlighted the teachers’ unique position to observe sudden declines in students’ academic performance, changes in ability to concentrate, and the emergence of other difficulties related to head injuries.
Many of the students with head injuries were injured while playing sports, but not all of them. One student was reported to have incurred a brain injury from being hit in the head by a door. It is important for teachers to know that all studentsnot only athletesare at risk for traumatic brain injury and should be carefully observed if symptoms are evident.
As more and more attention is drawn to the recognition of the signs of brain injuries, especially concussions, in American youth, perhaps many more schools with take inspiration from the Pequannock school district. In doing so, teachers will be able to play a major role in assisting students with brain injuries in their healing and rehabilitation processes.
References:
Bruno, Laura. (December 14, 2009) “In our schools: Pequannock teachers learn to spot head injury symptoms.” Retrieved December 18, 2009 from the Daily Record website: http://www.dailyrecord.com/article/20091214/COMMUNITIES/91210037/1005/news01/In-our-schools–Pequannock-teachers-learn-to-spot-head-injury-symptoms
Following a groundbreaking congressional hearing last October on the danger of concussions in the NCAA and NFL, the House Judiciary Committee has set a date for a follow-up hearing. The hearingLegal Issues Relating to Football Head Injuries, Part IIwill take place on January 4 in Detroit, MI. The purpose of the second hearing is to ensure that the NFL is doing enough to ensure the safety of its players and to assess head-injury protocols, or lack thereof, in place for college and high school football players.
Since the initial hearing in October, NFL Commissioner Roger Goodell made known that the NFL has made it more difficult for players to get back in the game after a head injury. In addition, each team in the NFL has enlisted an independent neurologist for the team to consult in case of concussions and head injuries.
The office of the committee chairman, Representative John Conyers, D-Michigan, issued a witness list last Thursday. The list includes former NFL neurologist Ira Casson, who was not in attendance at the October hearing. Casson resigned from the NFL’s concussion committee recently, and is expected to testify at the January 4 hearing in Detroit.
At the October hearing, Representative Linda Sanchez of California exhibited a TV interview with Casson. In the clip, Casson denied any connection between repeated football head injuries and brain disorders. “Sanchez said that reminded her of tobacco companies denying a link between smoking and health damage in the 1990s,” an Associated Press article reported.
Other expected attendees at next month’s hearing include NFL Players Association executive director DeMaurice Smith, NCAA director of health and safety David Klossner, and Wayne State assistant professor of neurology Randall Benson. The hearing is expected to focus not only on the NFL, but on high school and college football as well.
In anticipation of the upcoming hearing, the NCAA recommended a rule that would require an athlete to be removed from the rest of the game in the case of concussion, loss of consciousness, or other signs of brain injury during play. If the rule is adopted, it will include football and all other NCAA sports.
It remains to be seen whether or not the NFL will send any representatives to the January hearing. No NFL employees appeared on the witness list released by Conyer’s office, although NFL spokesman Greg Aiello told the Associated Press that the NFL “will be able to tell the committee soon whether we will have a witness attend.”
Americans have to wonder how the face of football will change as congressional action draws increasing attention to the danger of traumatic brain injury in football and other sports. Hopefully, all of the attention will result in more healthy players, while still keeping fans excited about the game.
References:
Associated Press. December 17, 2009. “House committee to hold 2nd concussion hearing.” Retrieved December 17, 2009 from the Sports Illustrated website: http://sportsillustrated.cnn.com/2009/football/nfl/wires/12/17/2020.ap.fbn.nfl.concussions.congress.2nd.ld.writethru.0541/
Congress continues to focus attention on the high incidence of traumatic brain injuries and subsequent brain dysfunction in current and former NFL players.
Representative John Conyers, D-Michigan, recently declared that, “We need an expeditious and independent review of all the data,” an Associated Press article reported. Conyers said, “I say this not simply because of the impact of these injuries on the 2,000 current players and more than 10,000 retirees associated with the NFL and their families,” … “I say it because of the effect on the millions of players at the college, high school and youth levels,” he added.
While some members of congress, including Representative Lamar Smith from Texas, feel that football is an issue best left alone by the government, Conyers believes it is the government’s duty to scrutinize the potential dangers of football and make it safer for American citizens.
The NFL has take action in relation to the heightened government attention and subsequent public awareness of brain injuries incurred in football. The NFL promised to provide free medical care to 56 former players who suffer from various brain disorders such as Alzheimer’s disease, dementia, Parkinson’s disease, and memory related problems. The NFL also provides the 88 Plan, which gives up to $88,000 per year for medical care for players who suffer from brain-related disorders.
NFL scientists recently conducted a study at the University of Michigan that found a potentially higher than normal rate of Alzheimer’s disease and memory related disorders in retired football players. The author of the study noted that further research would be necessary before declaring a conclusive link between football and brain dysfunction.
The NFL has established a hotline for players who feel they’re being pressured into playing before they have fully recovered from brain injuries. A doctor’s OK is required before any NFL player is allowed to play after a concussion.
Much further research and attention will be dedicated to the study of traumatic brain injury and brain related disorders in retired football players as the sport matures and more accurate data is gathered and analyzed. American culture may be forced to reconsider the costs involved in many of its favorite pastimes, from war to football, to keep healthy the brains of its citizenry.
References:
Associated Press. (October 28, 2009). “Conyers wants review of football head injury data.” Retrieved December 15, 2009 from the Long Island Press website: http://www.longislandpress.com/2009/10/28/conyers-wants-review-of-football-head-injury-data/
A teen girl from Marlboro, New Jersey who suffered 11 concussions is now encouraging Congress to create laws to protect other young athletes from brain injury and subsequent brain disorders. Niki Popyer, 16, said in an Associated Press article that her first few concussions were not even diagnosed correctly until a neurologist reviewed her medical records and affirmed the seriousness of the Popyer’s brain injuries.
Popyer suffered her first concussion after hitting her head on the hard floor of a basketball court while diving for the ball. 7 of her 11 concussions happened while she was playing high school sports.
Now, Popyer, two former NFL football players, and two congressmen are lobbying for the passage into law of the Concussion Treatment and Care Tools Act, also known as the ConTACT Act. Senator Robert Menendez and Representative Bill Pascrell, both of New Jersey, are helping to raise awareness of the dangers inherent not only in the NFL, but in youth sports as well. Pascrell, the co-founder of the Congressional Brain Injury Task Force, has been publicly highlighting the ConTACT bill’s promise to provide funds for more advanced student testing before and after head injuries.
Abby Calahan, 13, of Baltimore, Maryland joined Popyer’s crusade for increased awareness and legislation to prevent brain injuries. Calahan was forced to abandon soccer after suffering a concussion while playing in 2008.
Congress held a hearing in October on football head injuries, but since then, many congresspeople have drawn attention to the high rate of concussions and head injuries in youth sports as well.
If the ConTACT bill becomes law, it will result in the development of Federal concussion management guidelines and would offer grants to states to provide funding for the prevention, diagnosis, and treatment of concussions incurred during school sporting events.
While youth interest and involvement in school sports show no sign of waning, much attention is being given to the high potential for traumatic brain injury. Popyer and Calahan’s cases are 2 among many more. With any luck, the ConTACT bill will help to prevent repetitions of these preventable injuries.
References:
Frommer, Frederick J. (December 15, 2009). “Girl who sustained 11 concussions seeks new law.” Retrieved December 15, 2009 from the Google News website: http://www.google.com/hostednews/ap/article/ALeqM5gawAqiybiHliMXqD3UKeBUGwkSQwD9CJVCR00
The Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine, the Sports Legacy Institute, and Aethlon Medical Inc. recently announced they would all be collaborating on a new biomarker discovery program. The collaborative will work together and share data to identify accurate and reliable biomarkers for diagnosing a heightened susceptibility to certain types of degenerative brain disorders.
The first study undertaken by Aethlon Medical Inc. and the collaborative will be to investigate donated brain tissue of athletes who suffered from Chronic Traumatic Encephalopathy (CTE) when they died. The group will compare the brain of CTE patients with those of patients who died without showing any evidence of brain disease.
A PRNewswire release described CTE as, “A progressive neurodegenerative disease caused by brain trauma but with unclear environmental and genetic risk factors.” The goal of the Aethlon collaboration is to “discover common biomarkers” in order to enable doctors to identify athletes who are at risk of developing CTE before they participate in football and other activities with high head trauma risk.
The disease has earned national attention since 10 former pro football players were diagnosed with CTE recently. Five of the former NFL players died under the age of 50 from complications of the disease. Jim Joyce, the Chairman and CEO of Aethlon, said in the report, “This collaboration is near and dear to my heart as CTE was identified in Tom McHale, a friend and former high school and college teammate who died at the age of 45 last year.”
Joyce added that Aethlon Medical has, “the opportunity to showcase that the scientific advancements underlying our infectious disease and cancer treatment devices provide the basis for new products to discover the presence of biomarkers associated with various medical conditions.” This means good news for many CTE patients and their families. With ever more research money being directed into collaborations such as Aethlon’s, CTE research will undoubtedly be advanced, and perhaps more effective treatments and preventative measures will arise out of the studies.
CSTE was excited about the collaborative effort and they championed Aethlon Medical for providing such an amazing opportunity to gather more data on CTE.
The CSTE and SCI have been in the news elsewhere recently as well. Representatives from both institutions were present to testify at a congressional judicial committee hearing on head injuries and their impacts on NFL players.
References:
PRNewswire Staff. (November 4, 2009). “Aethlon Medical Announces Collaboration to Identify Brain Trauma Biomarkers.” Retrieved December 15, 2009 from the Bioresearch Online website: http://www.bioresearchonline.com/article.mvc/Aethlon-Medical-Announces-Collaboration-To-0001?atc~c=771+s=773+r=001+l=a&VNETCOOKIE=NO
A team of researchers in Australia received a $755,000 grant to perform a study with the help of a radical new technology to improve the effectiveness of traumatic brain injury (TBI) rehabilitation efforts.
Associate Professor Leanne Togher from the Discipline of Speech Pathology in Sydney, Australia and her research team will use AphasiaBank¾a huge shared video and text database, data exchange, and analysis tool¾to conduct the “world’s first systematic and comprehensive analysis of speech and language recovery experienced by TBI sufferers whereby researchers will trace the changes in speech and language functioning of TBI patients over an extended three year, post trauma period,” a Health Canal article reported.
This is good news for the 10 million people a year suffering from TBIs. Until now, there has been a lack of data on the effectiveness of TBI treatment efforts at various stages of recovery. The groundbreaking study has the potential to differentiate between effective and ineffective treatments and treatment schedules, thus making it possible for TBI patients to receive more efficient and better treatments at the most beneficial times during their recovery.
Togher and her team’s efforts¾funded by the Australian National Health and Medical Research Council¾aims to identify exactly what types of treatments will be most effective at each stage of the recovery and rehabilitation process.
Togher said, “we’ve seen patients benefit from treatment at different and varying stages of their recovery. There still remains the question as to whether the greatest degree of improvement occurs in the early, middle or late phases of recovery,” in the Health Canal article. With the use of AphasiaBank, the researchers will have access to far more data than was previously available in a centralized form.
The study will involve observation, treatment, and assessment of 200 TBI patients from 3 Sydney, Australia hospitals at intervals of 3, 6, and 9 months, and 1, 2, and 3 years after the injury occurred.
The research has potential to reduce some of the vast economic burden TBIs create by developing more efficient and effective treatment strategies and rejecting those treatments found to be ineffective and wasteful. The Health Canal articles reported that the lifetime costs of support and care for Australian TBI victims from 2008 alone would amount to $8.6 billion, while in the U.S., the total TBI care costs amounted to $60 billion in 1995. These figures do not include the harder to analyze costs such as lost employment and decreased productivity.
Togher’s study will prove important for the estimated 70% of TBI patients who will suffer from long-term communication problems. The types of speech issues brain injury patients might face range from dysarthria and aphasia to difficulty navigating social situations, excessive talking, lack of focus, and poor social-assessment skills. These patients then suffer further injury as they lose friends, family members, spouses, and jobs due to their difficulty communicating.
The AphasiaBank-assisted study holds immense promise for millions of TBI sufferers around the globe. Togher and her team’s efforts will hopefully lead to the creation of of highly effective and efficient treatments, helping TBI patients to live with a much higher quality of life than what is currently possible.
A recent BBC News piece highlighted the need in the U.K. for a full review of the treatment facilities and protocols for treating and supporting traumatic brain injury patients from injury, through rehabilitation, and return to life among the general community in proper supportive environments. Jim Stewart, a traumatic brain injury patient at the Musgrave Park Hospital Rehabilitation Center, awaits a return to his family’s home. Stewart cannot be placed with his family until the house is properly fitted with the equipment necessary for the specialized care his condition requires.
The Stewart family is one of many families struggling to support their loved ones with traumatic brain injuries. They have had to fight for assistance in restructuring their lives to be able to bring Jim Stewart back into their home. Their case underscores a community-wide lack of resources and strategies for caring for brain injury victims.
Stewart, like many other patients in the Regional Acquired Brain Injury Unit at Musgrave Park Hospital, has remained in the hospital long after he was authorized to be released into family or community care because there is nowhere for him to go to receive the support and care he needs. Nursing homes are not equipped to care for traumatic brain injury patients, and most families are even less so.
Traumatic brain injuries leave patients in a range of conditions¾from comatose and unresponsive, through a wide spectrum of physical and cognitive disabilities, to fully active and mobile with subtle cognitive dysfunctions. In more severe cases, families and hospital care staff are finding that most communities and family homes are completely unprepared to properly care for the brain injury victims over the long years of recovery.
Dr. John McCann of the Regional Acquired Brain Injury Unit at Musgrave lamented the lack of community institutions and support for brain injured patients. He called for the establishment of transitional care facilities to ease the transition from hospital to community living. Since brain injuries often leave both patients and their families “in a fog,” as McCann said, the navigation of the path from initial treatment to community placement can be especially treacherous, frustrating, and difficult.
“There is no nursing care home specifically for people with brain injuries and only a small number of homes are registered to provide the necessary care. However, these are full and there are waiting lists. It all puts pressure on patients’ families and on the availability of beds for other people who need specialized care,” the BBC News article reported.
These issues demonstrate a growing need for community education and awareness, a system-wide review of hospital and rehabilitation care, governmental support and assistance for families and patients, and the construction of transitional care facilities designed specifically for brain injury patients.
Study results published recently in the online journal Nature Medicine reveal the discovery of the specific mechanism responsible for the death of brain cells in stroke victims. Researchers had already known that brain cells continue to die even after blood flow had been returned to the brain due to a complex cascade of chemical reactions flows through the brain. What they didn’t know was exactly how and why the brain cells continued to die.
The study¾conducted by researchers at the Brain Research Center of British Columbia¾revealed in animal models that the over-activation of NMDA receptors on the surface of brain cells activates a protein known as SREBP-1, the main culprit responsible for the death of the cells. SREBP-1 is normally found throughout the brain, but is kept in check by another protein, Insig-1.
In the aftermath of a stroke, NMDA receptors become over activated, which leads to a fast breakdown of Insig-1 proteins. The decrease in the mediating presence of Insig-1 forces an increase and activation of SREBP-1, which was shown to be instrumental in the post-stroke death of brain cells. By inhibiting SREBP-1, the scientists involved in the study were able to halt further brain cell death in the animal models.
Dr. Max Cyander, the co-lead of the study, said of the study results, “We developed a drug that can stabilize Insig-1, which in turn inhibits the activity of SREBP-1,” … “By doing so, we were able to prevent cell death,” a EurekAlert article reported.
Previous research focused on blocking the NMDA receptors but yielded limited results. The current study demonstrated in animal models that the new drug led to a decrease in the rate and quantity of brain cell death after one month when compared to the levels exhibited in a control group.
The research¾funded by the Heart and Stroke Foundation of BC and Yukon, the Canadian Institutes of Health Research, and the Cure Huntington’s Disease Initiative Foundation¾will be further explored to determine exactly how SREBP-1 leads to cell death, to identify other roles the protein may play in disorders such as Lou Gehrig’s disease, and to develop highly effective treatments for human stroke victims based on the results.
Josh Decker is an American soldier from Osage, Iowa who joined the ranks of the hundreds¾perhaps even thousands and more¾of U.S. Military personnel who have suffered from blast-induced traumatic brain injuries during tours of duty in Iraq and Afghanistan. Decker suffered, like many of his fellow soldiers, from a brain injury and the long-term effects that come with it after he survived a blast from running over a road mine with his truck in Iraq.
The Department of Defense (DOD) Congressionally Directed Medical Research Programs (CDMRP) reports that up to 20% of U.S. soldiers returning from Iraq and Afghanistan have suffered from some form of traumatic brain injury.
Although Decker told the Mitchell County Press that his current status with the military is inactive, he was recently notified that he was put on a list of potential candidates for deployment to Afghanistan with the Iowa National Guard. Decker said that he thought the deployment order may have been a mistake made with documents created prior to the update of his status to inactive.
The Mitchell County Press article reported that Decker’s father has been driving him to up to 4 doctors appointments per month for treatment and care for the soldier’s brain injury. While the deployment order may be mistaken, Decker will have to comply with it or face the consequences, unless his superiors discover they have made a mistake, or Decker proves he is unfit to serve in combat.
Earlier articles published on brainandspinalcord.org have reported on the suggestion that soldiers be removed from combat duty until fully recovered after suffering a traumatic brain injury, and that the soldiers be removed from combat forever after suffering 3 or more blast-induced or other brain injuries.
To attempt to fight and halt his potential deployment while suffering from a brain injury, Josh Decker must demonstrate in medical tests that he is 70% disabled in order to be classified by the military as non-deployable.
Decker’s parents told the Mitchell County Press that while their son seems completely normal at times and can still drive a car, he has had trouble remembering how to do simple tasks. They also said that he has temper flare ups and post traumatic stress disorder symptoms from his time in Iraq, which was made worse by an unfortunate house fire at his parents’ farm on the day Decker was released from the hospital following treatment for his brain injury.
The family hopes they can stop what they see as the senseless and dangerous deployment of their son into a combat while his brain may not be ready to handle it. The situation they face is one of many that are likely to be addressed directly by the military as it devotes record amounts of funding and attention to studying traumatic brain injuries in soldiers, football players, boxers, and car accident victims, etc. As they strive to develop better solutions for soldiers, civilians benefit from the research as well.
Researchers at the Children’s Hospital of Philadelphia have discovered positive evidence in animal research that reinforcing the diet of a victim of traumatic brain injury can produce positive results in the recovery process. Through a treatment of feeding amino acids to brain-injured mice, scientists found that the rodents were able to recover some of their cognitive brain functions as the added amino acids restore a balance in the brain’s neurochemicals.
This research isn’t unique, as past testing has proven that people with TBI have experienced mild improvements in their cognitive brain functions after having various amino acids administered intravenously. The research being conducted by the Children’s Hospital showed significant progress through the feeding of three specific branched chain amino acids in the water supply of the injured mice. The introduction of leucine, isoleucine, and valine helped balance the brain’s ability to stimulate and inhibit certain functions.
After one week of this amino acid treatment, the injured mice were beginning to show similar responsive traits – in this specific research it was fear – as healthy mice. This was a positive sign that the amino acids were returning their natural instincts back toward normal responsive behavior.
As additional research continues with the mice, the Philadelphia team hopes to begin human patient collaboration within the next year.
