Posts from ‘Traumatic Brain Injury(TBI)’
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.
Military medical officials have expressed concern over an increase in spinal injuries among U.S. troops coming home from Afghanistan. Afghan insurgents have responded to the increased presence of heavily armored U.S. vehicles with larger and more powerful roadside explosives.
Roadside bombs have become the top killer of U.S. troops in Iraq and Afghanistan. Not only do the roadside bombs lead to crushed spines and other spinal injuries, they also result in traumatic brain injuries when soldiers are exposed to blasts, even with no impact to the head.
A USA Today story reported that the recent increase in spinal injuries occurred among soldiers in Afghanistan and not Iraq. The increase in spinal cord injuries among troops has arisen due to increased potency in roadside bombs used by insurgents. The U.S. Military issued 3500 Mine Resistant Ambush Protected (MRAP) vehicles as an attempt to deal with the roadside bombings. Unfortunately, Afghanistan insurgents responded with stronger and larger bombs.
Some of the 3500 MRAP vehicles deployed in Afghanistan have been lifted a few feet off the ground by roadside bomb explosions. Even though the MRAP vehicle may remain intact, some soldiers have suffered serious spinal cord injuries in the explosions. The MRAP vehicles cost about $1.4 million.
Medical professionals and Army engineers are comparing data to explore possible alterations and improvements to the MRAP vehicle design to make it safer for soldiers who are exposed to increasing roadside bomb possibilities. The MRAP vehicles, which cost about $1.4 million to make, have a hull designed in a V-shape, which helps to deflect the force of explosions away from the center of the vehicle, the USA Today article reported.
Since there are very few paved roads in Afghanistan, rebels can easily bury roadside explosives in the dirt roads, undetectable to soldiers driving along the roads at high speeds. Although the military has recently send over newer and lighter MRAP vehicles with better seating and harnesses, more improvements are still in the works to ensure the vehicles are safe for combat.
Doctors are matching up data on injuries with the victims’ positions in the vehicles at the time of the explosion and the vehicle type in which the accident occurred. Their hope is that engineers will be able to use the data to design more explosion-proof MRAP vehicles and to prevent any further incidence of spinal cord injuries if possible. USA Today reported that a doctor in Kandahar is currently at work designing a shock-absorbing seat that would provide a better guard against spinal cord injuries.
References:
- Zoroya, Gregg. (November 5, 2009). “Spinal Injuries Up Among Troops.” Retrieved December 6, 2009 from the USA Today website: http://www.usatoday.com/NEWS/usaedition/2009-11-04-1Aied04_ST_U.htm?csp=34
The NFL and high school football have come into focus in the traumatic brain injury world lately, as studies pile up demonstrating the serious risk of degenerative brain disease to players who suffer multiple concussions. The Boston Globe reported that the NFL’s own study showed that retired football players from age 30 to 49 had dementia rates 19 times greater than normal, and that retirees 50 and older had 5 times more incidence of memory-related disorders.
The Boston Globe also mentioned a University of North Carolina study saying that players who had suffered multiple concussions had “several times more prevalence of cognitive impairment” than those players who had never suffered brain injuries. The Boston Globe reported that 1.14 million kids play high school football and 3.2 million more play in youth leagues. New studies continue to be released revealing the serious danger inherent to the violent crashes between players in the sport.
Since it seems that football is not going to stop being a hugely popular sport, parents of young athletes are faced with the task of making the sport somehow safer for their young boys, or removing them from the sport altogether. After all, no matter how glorious it may feel to win games and make fantastic plays, living with degenerative brain disorder with a failing memory in a wheelchair is not glorious at all.
One solution some coaches and parents agree on is to not let boys continue playing after a concussion or head injury occurs until the child’s brain has had time to heal. The Globe article reported on a study from the journal Brain Injury that said 16% of student players in high school were returned to play after losing consciousness during a game. They added that most high school games do not have a certified athletic trainer in attendance on the sidelines.
A Harvard epidemiologist said to the Globe that the NFL should use footage of plays when injuries occur to make rule changes to ensure the safety of all players. Scientists at Boston University’s Center for the Study of Traumatic Encephalopathy told the Globe of incidents of degenerative brain disease in 18-year-old football players. They added that the brain continues to mature and develop well into the 20s and that football will have to change to make it safer for the youth.
60 Minutes reported that the impacts between football players, who can run at up to 20 miles per hour, are akin to a car hitting a brick wall at 40 miles per hour. Unfortunately, human heads are much more delicate than car bumpers. As the studies pile up that prove how dangerous football can be to the brains of the players, one must wonder what changes, if any, will be made to the sport to protect its players from serious injury.
Many times, athletes and their coaches and families are unaware that their brains have suffered serious injuries. Since degenerative brain disease eats away at brain cells slowly over time, it is easy to mistake the symptoms for psychological disorders or other issues. It is not until after a person dies and an autopsy is done on their brain that traumatic brain injuries and subsequent degeneration are revealed. Some scientists are working to improve diagnostic tools to better identify serious brain injuries in living patients while successful treatment remains possible.
It seems that football’s popularity will continue to remain high, but with 60 Minutes reporting that “sports related concussions are an epidemic in this country,” one can only hope that parents take the lead in keeping their children’s developing brains safe from traumatic brain injuries, and that NFL players and coaches will take the hint and stop putting players with concussions back in the game.
Each player has to ask himself, “Is it worth losing my brain functions later in life to continue playing now?” If the answer is no, changes to the game and how concussions are dealt with will have to be made.
(pic from flickr.com/photos/aheram)
A senior at Troy High School in Detroit, Gayathri Kollipara, is the recipient of an immensely powerful and educational gift from assistant professor Christian Kreipke. Kreipke is employed as a cell biologist at Wayne State University’s medical school. In March, Kreipke began conducting a study on a new drug that may prove useful in the treatment of traumatic brain injuries (TBI). He invited Kollipara, whose long time dream has been to become a brain surgeon, to shadow him throughout the duration of his drug study.
The drug Kreipke was testing in animal trials is Clazosentan. It proved successful in the animal studies at preventing vasospasms blood vessel constrictions in the brain, which occur when the head has been impacted in an accident or other trauma.
Kollipara was extremely excited to have such a unique opportunity to observe up close the kinds of work she is looking forward to after another decade or so of schooling. She told the Chicago Tribune that her father’s death of lung cancer two years ago cemented her lifelong wish to become a brain surgeon. She said it has always been her dream to go into the medical field, but she knew for certain she would pursue it after her father died.
Over the course of Kreipke’s Clazosentan study, Kollipara was able to observe the surgeries the scientist performed on lab animals. She was also enlisted to assist Kreipke in the behavioral study portion of the research to measure the effectiveness of the novel drug.
Kreipke reported to the Tribune that he had a lot of trouble choosing a major and a career path – he changed his major seven times before completing his studies – so he was more than happy to grant Kollipara the chance to witness his research, since she knew exactly what career path she wanted to pursue, even at such a young age.
While other high schoolers go out partying or searching for minimum wage jobs, Kollipara was granted the opportunity to get a head start on her way to her dream career as a neurosurgeon.
(pic from ucdmc.ucdavis.edu)
Researchers at University College London (UCL), London, UK, published new brain wave research findings online October,1 in Current Biology, a Cell Press publication. The scientists were astounded to discover the powerful influence that brain waves exert on voluntary human motor functions. The EurekAlert report quoted Peter Brown of the Sobell Department of Motor Neuroscience and Movement Disorders in the Institute of Neurology, UCL, as saying, “At last we have some direct experimental proof that brain waves influence behavior in humans, in this case how fast a movement is performed,” … “The implication is that it is not just how active brain cells are that is important, but also how they couple their activity into patterns like beta activity.”
The team of scientists at UCL used an injection of a tiny electrical current through the scalps and into the brains of 14 study participants while the subjects moved a spot around a computer screen. The subjects were instructed to move the spot around the screen with a joystick as fast as they could.
The specific current employed by the scientists increased the normal beta brainwave activity in the subjects’ brains. Beta brainwaves have been linked in previous studies to prolonged muscle activities, such as holding up a book, the article reported.
The new study differed from similar studies in the past in that the scientists used an oscillating current similar to the currents in operation in normal brain activity. In earlier studies, constant brain stimulation current has been employed. Although the participants were unable to sense the tiny electrical current, the effects is produced were profound. The participants’ fastest times recorded on the computer and joystick task were 10% slower when the electrical current was administered.
Earlier studies have also shown that altered brain waves have an effect on memory, but not until this groundbreaking study has it been demonstrated conclusively that a causal link between and increase in beta waves and the slowing of voluntary movement in all study participants. The researchers hope their findings will lead to possible treatments for conditions that involve slowed or uncontrolled movements., perhaps even those caused by traumatic brain injuries.
Brown was further quoted in the article as saying, “If we know what patterns of brain activity slow voluntary movement, then we can try and boost these patterns in conditions like chorea and dystonia, where there is excessive and uncontrolled movement,” … “Conversely, we can try and suppress beta activity in conditions like Parkinson’s disease typified by slow movement.”
(pic from zatma.org)
In early September of 2009, The Department of Defense (DOD) Congressionally Directed Medical Research Programs (CDMRP) hosted the Military Health Research Forum (MHRF) in Kansas City, MO. The forum was dedicated to exploring new research on traumatic brain injury (TBI).
Military interest in brain injury research has increased dramatically over the past few years due to an alarming rate of servicemen and women who have suffered from TBI due to close range, non-impact exposure to explosive blasts and other combat-related injuries. The CDMRP estimates that about 20% of combat soldiers suffer from TBI.
Two programs of the CDMRP, the Psychological Health and Traumatic Brain Injury Research Program (PH/TBIRP) and the Peer Reviewed Medical Research Program (PRMRP), funded studies on various issues surrounding TBI in combat soldiers, such as prevention, diagnosis, and treatment of the condition. The researchers and funding agencies also hope the research will lead to improved care for civilians with TBI.
What follows is a summary of the research presented at the MHRF.
The US Army Aeromedical Research Laboratory presented research that demonstrated the value of new Advanced Combat Helmets. Their research revealed that paratroopers wearing the older Personnel Armor System for Ground Troops Helmet were 2.3 times more likely to suffer brain injuries than those wearing the Advanced Combat Helmets. The researchers said further research to improve helmets and armor systems is underway.
Clemson University researchers presented data on their development of an injectable hydrogel to promote brain tissue regeneration at lesion cavity sites in rats given TBIs. Researchers funded by CDMRP also performed neural stem cell transplantation into the injury sites and used the hydrogel, which mimics native brain tissue, as a carrier. They reported that functional recovery was significant after eight weeks of treatment.
Finally, researchers at Duke University presented research on their testing of three different biomarkers used to better evaluate the severity of and diagnose mild traumatic brain injury (mTBI). Many patients with mTBI show no external signs of brain injury, thus a new method is needed to better diagnose the presence of brain injury in these cases. The researchers found that two of the three biomarkers, brain natriuretic peptide (BNP) and D-Dimer, showed a 92% sensitivity rate in determining the presence of intracranial abnormalities in diagnostic CT scans.
The vast and expansive collaboration of research and funding that went into all of the data presented at the MHRF will likely provide demonstrable advances toward the prevention, diagnosis, and treatment of TBI not only in military personnel, but in civilian populations as well.
Admiral Michael Mullen, the chairman of the Joint Chiefs of Staff, is promoting a new Army policy that would limit the number of mild traumatic brain injuries an Army combat soldier can suffer before being relieved of combat duty. The new policy would limit soldiers’ exposure to three mild brain injuries, after which they would be reassigned to non-combat positions on Army bases.
Mullen is motivated partially by a disturbing story of a soldier who was exposed to 30 explosions at close range before being removed from combat duty. USA Today reported that if the policy were enacted, it is estimated that only about 400 soldiers, out of the 20,000 troops deployed in Afghanistan, would be removed from combat and put to work on bases for the duration of their tour of duty.
Admiral Mullen is motivated also by data published in recent studies on multiple concussions and traumatic brain injuries experienced by football players. The studies, reported on here, demonstrated that people whose brains had suffered multiple concussions would heal more slowly from future injuries and would be more likely to have more serious future concussions. The same studies also showed that multiple brain injury sufferers have also been shown to be at a higher risk for long-term brain dysfunction and complications.
We have explored some of the recent research on the physiological effects on the brain of repeated exposure of military personnel to explosive blasts. While the injuries are similar to those experienced by football players, the exposure to bomb blasts has a distinctly different and less understood effect on the brain.
The USA Today article reported that, “up to 300,000 service members may have suffered a mild TBI in the Iraq and Afghanistan wars.” It is data like this that has spurred Admiral Mullen to take action to prevent soldiers from suffering serious long-term brain damage that could be prevented by a simple change in policy.
The U.S. Marines already operate under a policy that limits marines to three mild traumatic brain injuries before removal from combat, and the Army is currently designing a policy that will likely follow suit. Although further research is ongoing, the workings of the brain and how it reacts to injuries remain mysterious and not fully understood. Yet, as more and more studies are published, it’s inspiring to see military leaders using current scientific data in the design of their policies and protocols.
(pic from ameddcsdl.org)
Hundreds of thousands of CT scans are conducted every year on children who have hit their heads. The CT scans have been traditionally used to determine whether or not the children have incurred more serious brain injuries. A recently published study as well as recent discoveries of several more effective methods of diagnosing brain injuries may prove a vast number of CT scans to be unnecessary.
Previous studies mentioned in earlier blog posts on this site explored the use of monitoring NSE protein levels in the blood and DTI scans as possible diagnostic tools that reveal subtle data undetectable by the high radiation CT scans. Monitoring NSE protein levels in the blood enabled doctors to uncover subtle forms of brain damage in long-time boxers, while DTI scans revealed brain damage undetectable by CT scans in military personnel exposed to non-impact explosive blasts.
The recent CT scan research a vast study including over 42,000 children less than 19 years old evaluated the effectiveness of CT scans in detecting traumatic brain injury. The children had all bumped their heads or had accidents involving head impacts. About 15,000 of the sample group received CT scans, but less than a thousand of them actually detected signs of traumatic brain injury.
The results of the study were published online in the September issue of The Lancet. The authors of the study included six signs to use when determining whether or not a traumatic brain injury may be suspected and tested for traumatic brain injury using a CT scan. The New York Times article on the study reported the indicators as signs of a fractured skull, altered mental states, loss of consciousness, vomiting, headaches, and out-of-character behavior.
The principal investigator of the study, Dr. Nathan Kupperman, urged doctors to search for one or more of the six indicators of traumatic brain injury before blindly prescribing thousands more of unnecessary CT scans.
(pic from dbtechno.com)
