brain injury

House Again Passes Thompson’s Bipartisan Amendment to Improve TBI, PTSD Treatment For Troops & Veterans

Washington, DC, Jul 18 – Congressman Mike Thompson (CA-1), co-chair of the bipartisan Military Veterans Caucus, today again secured the passage of his bipartisan amendment with Congressman Pete Sessions (TX-32) to expedite new and innovative treatments to our nations’ veterans and active duty soldiers suffering from Traumatic Brain Injuries (TBI) and Post-Traumatic Stress Disorder (PTSD). This is the second time the House has passed the amendment. In May, the TBI treatment expansion initiative was adopted as a House amendment to the National Defense Authorization Act (NDAA) for Fiscal Year 2013 (H.R. 4310), however the Senate has yet to take up this bill. Today it was passed as an amendment to H.R. 5856, the Department of Defense (DOD) Appropriations Act for Fiscal Year 2013. The amendment passed by voice vote. The House will vote on H.R. 5856 later this week.

“Our troops and veterans have earned the very best treatment and care that we can provide,” said Thompson. “But sometimes the best treatments aren’t available at military and veteran medical facilities. My amendment will make sure that our heroes who return from combat with TBI or PTSD have access to the highest quality care our nation has to offer. I will keep introducing this legislation until it is law. It’s what our heroes have earned.”

“I am pleased that our colleagues have joined us in recognizing the importance of providing treatment options not currently available within military and veteran medical facilities to those who return from combat with TBI or PTSD,” said Sessions. “As we approach the Memorial Day holiday, I believe we can best honor our nation’s active duty soldiers and veterans by ensuring that their health is a top priority and that they have access to the most effective treatments available.”

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Head Impact Exposure in Youth Football

Ray W. Daniel1, Steven Rowson1  and Stefan M. Duma1

(1) Center for Injury Biomechanics, Virginia Tech-Wake Forest University, 440 ICTAS Building, Stanger St., Blacksburg, VA, 24061, USA
Steven Rowson Email: srowson@vt.edu

Received: 1 February 2012  Accepted: 3 February 2012  Published online: 15 February 2012

Associate Editor K. A. Athanasiou oversaw the review of this article.

Abstract

The head impact exposure for athletes involved in football at the college and high school levels has been well documented; however, the head impact exposure of the youth population involved with football has yet to be investigated, despite its dramatically larger population. The objective of this study was to investigate the head impact exposure in youth football. Impacts were monitored using a custom 12 accelerometer array equipped inside the helmets of seven players aged 7–8 years old during each game and practice for an entire season. A total of 748 impacts were collected from the 7 participating players during the season, with an average of 107 impacts per player. Linear accelerations ranged from 10 to 100 g, and the rotational accelerations ranged from 52 to 7694 rad/s2. The majority of the high level impacts occurred during practices, with 29 of the 38 impacts above 40 g occurring in practices. Although less frequent, youth football can produce high head accelerations in the range of concussion causing impacts measured in adults. In order to minimize these most severe head impacts, youth football practices should be modified to eliminate high impact drills that do not replicate the game situations.

Introduction

Sports related concussions have received increased public awareness, with many states considering or implementing laws directing the response to suspected brain injury. This is a result new research suggesting possible links to long-term consequences from repetitive concussions.13,21,22 Emergency department visits for concussions increased 62% between 2001 and 2009, and researchers estimate that between 1.6 and 3.8 million sports related concussion occur each year in the United States.5,19 Of all sports, football accounts for the highest incidence of concussion, and therefore receives the most attention.34 One of the leading thoughts to minimize the incidence of concussion in football is to limit players’ exposure to head impacts.9 Strategies to reduce a player’s exposure to head impact include teaching proper tackling techniques and modifying the rules of the game.  

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Electrophysiological assessments of cognition and sensory processing in TBI: Applications for diagnosis, prognosis and rehabilitation

This article from the International Journal of Psychophysiology shows the full acceptance of the use of EP and ERP testing to evaluate TBI. The paper is co-authored from the Defence Veterans Brain Injury Center (DVBIC), and this paper shows none of the quibbling or caveats about a lack of specificity or sensitivity in TBI. It is a paper that looks at full adoption for use, not a call for plenty of more studies and funding!

This ERP technology is ready for prime time in TBI. The peer review and publication process is how science moves forward, and the use of ERP for TBI evaluations is now accepted by the peer review process, but not the EEG/qEEG yet fully, and definitely not EEG based discriminants for TBI, which are now counseled against in the peer reviewed literature.

Jay

ABSTRACT

Traumatic brain injuries are often associated with damage to sensory and cognitive processing pathways. Because evoked potentials (EPs) and event-related potentials (ERPs) are generated by neuronal activity, they are useful for assessing the integrity of neural processing capabilities in patients with traumatic brain injury (TBI). This review of somatosensory, auditory and visual ERPs in assessments of TBI patients is provided with the hope that it will be of interest to clinicians and researchers who conduct or interpret electrophysiological evaluations of this population. Because this article reviews ERP studies conducted in three different sensory modalities, involving patients with a wide range of TBI severity ratings and circumstances, it is dif!cult to provide a coherent summary of !ndings. However, some general trends emerge that give rise to the following observations and recommendations:

1) bilateral absence of somatosensory evoked potentials (SEPs) is often associated with poor clinical prognosis and outcome;

2) the presence of normal ERPs does not guarantee favorable outcome;

3) ERPs evoked by a variety of sensory stimuli should be used to evaluate TBI patients, especially those with severe injuries;

4) time since onset of injury should be taken into account when conducting ERP evaluations of TBI patients or interpreting results;

5) because sensory de!cits (e.g., vision impairment or hearing loss) affect ERP results, tests of peripheral sensory integrity should be conducted in conjunction with ERP recordings; and

6) patients’ state of consciousness, physical and cognitive abilities to respond and follow directions should be considered when conducting or interpreting ERP evaluations.

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Current Research Regarding Blast Injuries in Veterans

This current research from the New England Journal of Medicine  – Detection of Blast-Related Traumatic Brain Injury in U.S. Military Personnel –  shows that Blast Injury is not at all like mild traumatic brain injury, since the mTBI does not involve white matter injuries. The research does show white matter changes during the medical evacuation, done in Germany using Diffusion Tensor Imaging, and also that the white matter changes continue to evolve. They also show that not all symptomatic blast injuries are seen with this technique.

No traditional structural neuroimaging was able to see this damage (like CT or routine MRI). The NY Times recently reported on soldiers injuries evading the M.R.I and CT Scans

The brain areas involved included the orbital surfaces of the frontal lobe and the temporal areas.

These results point to the need for a clinical diagnosis, not a reliance on any given technology to answer the clinical question.

The endocrine changes from supposed pituitary injury, and the presence of micro-emboli due to pressure wave impact on the thorax that are reported in blast injury is not at all dismissible with these findings.

VA Eases PTSD Claims Process

The Veterans Affairs Department has published a final regulation intended to ease the claims process and improve access to health care for veterans with post-traumatic stress disorder. Under the new rule, VA no longer will require substantiation of a stressor tied to fear of hostile military or terrorist activity if a VA psychiatrist or psychologist can confirm that the experience recalled by a veteran supports a PTSD diagnosis and the veteran’s symptoms are related to the stressor. The Veterans Affairs Department has posted a fact sheet including questions and answers about the new rule governing PTSD claims on the VA website or call VA’s toll free benefits number at 800-827-1000

The Art of Aging: Limitless Potential of the Brain

This is an excellent video talking about how seniors can help keep their brains young.

How can we live a fuller and healthier lifestyle as we get older? Perhaps keeping our body and brain engaged can help. That seems to be the case in Japan where the number of centegenarians is greater than 20,000.

THE ART OF AGING:THE LIMITLESS POTENTIAL OF THE BRAIN introduces a number of these “super-seniors” who lead healthy lives at nearly 100-years-old and, through them,searches for the “keys” to living a healthy and vital life regardless of age.

[veoh]http://www.veoh.com/browse/videos/category/lifestyle/watch/v19832384XKk8wQ5m[/veoh]

Related article from BBC July 3,2013 Active brain ‘keeps dementia at bay’

AAPB 41st Annual Meeting : Personalized Medicine in the Age of Technology: Psychophysiology & Health

AAPB is traveling to San Diego, California for its 41st Annual Meeting. Mark your calendars for March 24-27, 2010 to attend this gathering of experts in biofeedback, neurofeedback, and applied psychophysiology. You won’t want to miss this educational event and the networking opportunities available!

We are honored to welcome several high-profile speakers, including:

  • Personalized Medicine in the Age of Technology – Vilayanur S. Ramachandran, MD, PhD; Director of the Center for Brain and Cognition and Professor with the Psychology Department and Neurosciences Program at the University of California, San Diego, and Adjunct Professor of Biology at the Salk Institute
  • Regeneration and Stress at Work: Strategies for Improved Employee Health – Tores Theorell, MD, PhD; Professor Emeritus at the University of Stockholm, Sweden
  • An Overview of Mind Body Healing – C. Norman Shealy, MD, PhD; founder of the American Holistic Medical Association, and past president of the International Society for the Study of Subtle Energies and Energy Medicine
  • Neurotherapy in the Treatment of Traumatic Brain Injury: A Physiological Hypothesis – Paul Rapp, PhD; Professor in the Department of Military and Emergency Medicine at the Uniformed Services University of the Health Sciences

Vilayanur S. Ramachandran MD, PhD Video Collection

A collection of great videos on the brain from Vilayanur S. Ramachandran MD, PhD

The Boy with the Incredible Brain

This is the breathtaking story of Daniel Tammet. A twenty-something with extraordinary mental abilities, Daniel is one of the world’s few savants. He can do calculations to 100 decimal places in his head, and learn a language in a week. This documentary follows Daniel as he travels to America to meet the scientists who are convinced he may hold the key to unlocking similar abilities in everyone.

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My dad’s subdural hematoma

On Saturday evening I spoke with my father, who just returned to Arizona from the Thanksgiving holiday back in North Dakota. I quickly noticed that he had trouble putting the ending to a thought, and specific words were difficult for him to “find”. I knew he had fallen about four weeks ago on the ice, and hit his head on the concrete. At the time they were worried about possible rib fractures, though they did suture his left eyebrow at the time.

I put two and two together, and figured he had a big likelihood of a subdural hematoma putting pressure on his language and speech motor areas on the left frontal dorso-lateral area. Subdurals are common in elderly individuals who fall and hit their head, and need to be ruled out if there is a recurrent or persistent complaint following TBI. He complained of headaches which were unrelenting, but they had not scanned him even with his returns to their medical plan 2-3 times in the weeks following the fall.

I figured it would be impossible for him to tell the ER what he needed (as CT or MRI to look for the subdural), so I wrote him an e-mail summary of the findings and pertinent history for my mother to print out and take with them. I sent my elderly father and mother off to the ER, and my dad didn’t want to go because he figured he would miss football games. By Sunday noon, he was in the neurosurgeon’s hands, and they removed a LARGE subdural of 150 Ccs. He is now fine, with all his language skills returned. He even caught the late game on the tube.

After the surgical prep my mother called, and I was asked to “call the doctor”, and I rang in on the neurosurgeon’s headset when he had my dad’s head open. It was a pretty routine evacuation of a subdural, but they were very happy to be handed the case on a platter with the e-mail. He said he was surprised at the “diagnosis” done via telephone and gut instinct, but even more by the accuracy of the localization of the subdural to the left dorso-lateral frontal as well as left temporal areas. The subdural was very large, and encompassed the entire area described.

I’ve had enough drama for the holidays. You would think maybe he will stop bugging me to be a doctor now.