Top Three Things to Know for New Brain Injury Patients

The time following a brain injury can be confusing, overwhelming, and emotional. There are three things that new brain injury patients should be aware of to help them through this difficult time.

1. You Are Not Alone

Every year 1.4 million people in the United States seek medical care for traumatic brain injury. Survivors should be willing to ask for—and receive—help from family, friends, and other loved ones when needed. Support groups, resources, and the survivor’s medical team are all there to help the patient navigate the time following traumatic brain injury. If the patient is not able to advocate for himself or herself, caregivers should be willing to call on the medical team, support groups, and other resources for help.

2. There are Different Types of Treatment and Rehabilitation

Survivors should be aware that there are a variety of types of treatments and rehabilitation available, depending upon individual needs, as well as where they are in the recovery process. No two treatment and rehabilitation programs are the same. Instead, they are individualized based on the location and severity of the injury. The goal of treatment and rehabilitation is to restore as much function to the survivor as possible. The plan should be to focus on the particular issues the survivor faces, and to structure therapies accordingly.

3. Recovery Will Be a Challenge

There’s nothing easy about recovery, and the new brain injury patient should realize this. As a matter of fact, without the many “challenges” that go hand-in-hand with recovery, the brain can’t rewire itself. While recovery can be extremely frustrating—with the gains offset by steps backward—perseverance, patience, and celebrating all forward progress, no matter how small, can keep the survivor in a positive frame of mind.

Due to the U.S.’s continued military presence in Iraq, we have seen a lot of attention paid to the increasing numbers of soldiers returning with head injuries from bomb blasts. These injuries are often hard to detect and too many times go unreported.

Luckily, both for the soldiers and for civilians who have sustained brain injuries, there has been a correlating increase in research into preventing and curing traumatic brain injuries (TBI).

The latest study that has caught our attention is focused on the use of crystals to detect and report a TBI. Shu Yang, one of the researchers who developed the device, says that the amount of damage sustained from an impact such as a soldier would get from an explosion, can be registered by crystals.

The crystal structure changes depending on the level of shock it experiences, changing its color. Scientists are working on developing a method that will allow doctors to translate a particular color into a level of neurological damage.

According to a NewScientist article, the blast waves from large roadside bombs “stretch and shear the brain, damaging the long nerve cells connecting the different regions of the brain”. The damage can only be detected with a specialized MRI scan, until now. With these crystal stickers, the hope is that the degree of damage will be apparent with a quick visual check, allowing the necessary level of care to be ascertained immediately.

When attached to a uniform or helmet in the form of a think sticker strip, these crystals can potentially be incredibly useful on the battlefield, helping to bring more of our soldiers home after receiving proper and beneficial TBI care.

Researchers at Johns Hopkins University are helping U.S. soldiers with early detection and timely treatment of traumatic brain injuries.

A prototype software has been designed to “integrate in real time data provided by medics on the battlefield with information from the patient’s electronic medical record, filter them through a template and present a visualization over a network to a physician in a remote location who could then diagnose TBI and direct treatment.”

This means that a soldier who is injured in some remote location like Iraq can have the needed brain injury information ready and waiting to put into play once the patient arrives.

This system uses data such as the injured soldier’s heart rate, respiration rate and blood pressure that is added to the patient’s medical history to determine the degree of the injury and the next needed step.

As traumatic brain injuries need to be treated as soon as possible, this software’s ability to “visually transfer the physician to the battle” will greatly increase a soldier’s chance of survival and recovery after sustaining a TBI.

How far will $1.7 million go when applied towards research on traumatic brain injuries (TBI)? Far enough to help progress ground breaking research in the areas of neuropsychology, rehabilitation psychology and physical medicine and rehabilitation at the Southeastern Michigan Traumatic Brain Injury System (SEMTBIS).

The DMC Rehabilitation Institute of Michigan and the Department of Physical Medicine and Rehabilitation at Wayne State University was awarded a 5-year grant totaling $1.7 million from the U.S. Department of Education’s National Institute on Disability and Rehabilitation Research (NIDRR).

SEMTBIS will be able to apply this funding towards cutting-edge research focused on the clinical care of patients with TBI. Specifically, they are concentrating on “Full Access to Community Life”, a project that looks at priority areas such as employment of people with disabilities and the community integration of TBI survivors and their family members.

For more information on SEMTBIS, visit their Website.

Bicycle helmet studies - how seriously can you take them? We are aware that there are contradictory studies that benefit both those for and those against the use of helmets, and each one states that its conclusions are the right ones. Knowing of these biases, how can you determine whether wearing a helmet will benefit you or not?

Ignoring case-control studies, where those with head injuries are compared to cyclists without, and anecdotal evidence, we are left with the actual hard research regarding a helmet’s ability to protect your head in a crash.

Helmets are designed to handle crash energy - when your helmet sustains an impact, the foam crushes decreasing the energy and extending the time in which your head stops moving forward. This reduces the impact force to your brain. A good helmet won’t shatter or break, and a great one will be made with foam that can stiffen or yield depending on the degree of impact.

The goal is for the foam to be thick enough that it won’t bottom out on impact, but not so thick that it contributes to neck strain. The rounded shape isn’t just to fit to your head, its to help reduce impact even more by easily skidding when it comes into contact with the pavement.

Helmet safety standards have been created to make sure that your helmet can be used as the manufacturer intends. The American Society for Testing Materials (ASTM) is the most commonly referred to standards organization today and publishes on a variety of sport helmets. They have impact tests, strap tests, coverage requirements, as well as performance standards for different temperatures and weather conditions. Check out the Snell Memorial Foundation site for detailed bicycle helmet standards or the US CPSC.

These standards include most of the following tests. Impact testing drops a headform wearing a helmet onto an anvil…the anvil will be in a variety of shapes, each one fit the particular test. The amount of shock that the headform sustains is measured and these measurements determine how well the helmet protected it. Some impact tests drop weights onto the helmet or an attempt is made to penetrate the helmet with a sharp, heavy object.

These same tests, among others, are carried out when the helmet is wet, hot, cold, dry, etc. The strap is tested as well, by being yanked either by a machine or by the attachment of a weight. This is done to measure how much it stretches or if it breaks.

Now, short of donning a helmet and riding your bike into a deliberate crash scenario, you will have to take this research along with the countless studies both advocating for and against helmet use and make up your own mind.

Helmets have been created to lower your risk of brain damage, not prevent it, not guarantee a complete recovery after a crash. They can help you to enjoy your time riding, knowing that in addition to taking careful stock of your surroundings and using safe riding habits, you are doing everything in your power to help prevent a traumatic brain injury.

It is of course, your choice.

It’s has to be incredibly difficult to be faced with the choice of ending the life of a non-responsive brain injury patient. As a parent, spouse, sibling or child, this choice can’t get any easier.

Now, with new information on the brain activity in patients who have been diagnosed as being vegetative, this decision has gotten even harder.

Niels Birbaumer, a neurobiologist at the University of Tubingen in Germany, found surprising levels of cortical activity after studying EEG recordings of the brain activity in vegetative patients. The cerebral cortex is the area of the brain associated with memory, attention, awareness, thought and language.

Since the vegetative state was first labeled and defined, there has been a great deal of argument among everyone from scientists to lawyers and family members over the point where it’s OK to finally make the decision to end a life. This has been so difficult due to the varying concepts of what determines that someone is “alive”.

If they are breathing and the body is able to sustain itself on IV-fed nutrition, does this mean the person is still living? If they have no response to verbal communication or physical stimulation, does this mean they are no longer conscious and hence no longer “with us”? Because of this blurry line, scientists have been working to find a definite way to determine “true” brain death.

Birbaumer’s EEG recordings are an example of the recent studies to clarify this difficult matter. In one, Birbaumer and colleagues looked for patterns in the brain’s electrical activity as patients with severe brain damage had sentences read to them. The patients ranged from completely vegetative to those who could still control their gaze or other physical abilities.

Of the 38 participants that were labeled persistently vegetative, a state that is usually considered irreversible, 22 percent responded to errors that were deliberately mixed in with the sentences. This suggests that these patients are able to process more than was previously assumed and creates further questions on what a person who is in a vegetative state is aware of internally, if unable to respond externally.

Hopefully studies such as this one will help doctors to determine if someone is truly non-functioning and unable to have any awareness of their surroundings. This would make it easier for those whose trial it is to make and end-of-life decision.

The Cleveland Clinic’s Neurological Center and Baylor University has been given a $1.4 million grant to study traumatic brain injuries.

This funding comes from the department of defense, and considering the amount of soldiers returning from war with mild to severe brain damage, this is a welcome development. The study will span three years and is headed by Dr. Stephen Rao. His team’s goal is to compare the differences between TBI and civilian TBI to better help doctors structure proper treatment.

The Army has issued new guidelines for traumatic brain injury care with the intention of catching and treating early symptoms. According to Kelly Kennedy, staff writer for ArmyTimes, this will also help catch soldiers who memorize the TBI tests in order to remain on the field by passing the concussion indicators test.

We have been learning a great deal more about TBI’s in the military as the Iraq war is sending home soldiers with all levels of brain injury. Concussions impair vital abilities such as concentration, memory, timing and marksmanship. These new guidelines require all soldiers who have been “involved in a blast, fall, vehicle crash or direct impact incident who lose consciousness or become dizzy afterward” to be seen by a doctor as soon as it’s possible.

This won’t prevent some soldiers from delaying their checkups, but at least it will still catch a significant portion of those with head injuries. While these guidelines increase the safety of soldiers returning to the field and those around them, they will also help to prevent some of the long-term effects that can become permanent with lack of care. Brain injuries can escalate from headaches and irritability to significant memory problems and even balance difficulties.

When prevention isn’t possible, immediate aftercare becomes crucial with a head injury.

Donald Stein is recognized by the Ladies Home Journal as one of four winners of the Health Breakthrough Award for 2008. Stein, the director of Emory’s Department of Emergency Medicine Brain Research Laboratory, has helped direct women’s health care.

It turns out that Stein has also discovered a way to lower the risk of death and disability after a traumatic brain injury through the use of progesterone.

Progesterone, a steroid hormone that helps with the development of the embryo, also works to protect injured brain tissue. Stein found that there was a 56% increase in brain function in the patients who took progesterone shortly after a TBI.

This study, available in the Annals of Emergency Medicine 2007 issue, pinpointed how critical progesterone is to the development of neurons.

Image credit here.