Although individuals who have been afflicted with TBI are thought to be at higher risk of depression, a recent research article published in the Journal of Psychopharamcology reports that anti-depressants aren't of much use in this particular type of depression.

This Canadian study, which assessed the type of antidepresssent most often prescribed to patients with severe or major depression (SSRI's), found that despite initial good effects from the medication, there was a decline in mood from six to ten weeks after reassessment.

The researchers noted that "major depression is a complication seen in about one-third of patients within the first year of TBI and, when present, is associated with poor psychosocial functioning and persisting post-concussive symptoms.”

Recently there has been an increase in reported numbers of TBI patients with concurrent PTSD (post-traumatic stress disorder), as soldiers return from the wars in Iraq and Afghanistan.

Signs and Symptoms of Traumatic Brain Injury

The following 10 symptoms among adults that may indicate a brain injury has occurred:

* headaches and neck pain that does not dissipate

* difficulty remembering, concentrating or developing their own decisions

* unusual behavior or personality changes begin to develop

* vomiting beginning 1 to 2 hours following the injury

* difficulty walking

* seizures begin to occur or sudden onset of fixed stares

* blurred and/or double vision

* the pupils of the eyes are not equal in size

* loss of smell, taste and ringing in the ears

* blood or clear fluid begins to flow from eyes and nose

If you or a loved one presents with any of the above symptoms, it is imperative to seek medical attention as, sometimes, a person can be unaware that a brain injury has occurred.

A screening tool from the Pennsylvania Department of Health which you may find useful.

Brain Safety

Posted by Dianne Sandland at 05:27 AM | Permalink

Just an interesting link for you today.

When Sgt Sam Nichols was on convoy duty in Iraq his Humvee was hit by an IED and he sustained a traumatic brain injury.

Sam's father, together with his father-in-law, started keeping a blog, which is written as only somebody caring for a TBI patient could write it; it is a searingly honest and accurate portrayal of life with TBI.

If you or a loved one have sustained a TBI with which you are now trying to come to terms, this blog is an outstanding resource.

Posted by Dianne Sandland at 08:42 AM | Permalink

According to expert on veteran mental health, Monica Matthieu, Ph.D., who is also an assistant professor of social work at Washington University in St. Louis:

The increasing number of veterans with post-traumatic stress disorder (PTSD) raises the risk of domestic violence and its consequences on families and children in communities across the United States.

Matthieu and Peter Hovmand, Ph.D., domestic violence expert and assistant professor of social work at Washington University, concur with this view, saying:

The increasing prevalence of traumatic brain injury and substance use disorders along with PTSD among veterans poses some unique challenges to existing community responses to domestic violence.

The VA's own research shows that male veterans with PTSD are two to three times more likely than veterans without PTSD to engage in intimate partner violence and more likely to be involved in the legal system.

All of which supports an argument for veterans to receive care from multiple providers, who would coordinate care, with each provider working on one treatment goal.

Such Coordinated community response efforts would be designed to bring together law enforcement, the courts, social service agencies, together with advocates for women to address the problem of domestic violence.

Inter-agency working is always fraught with difficulties, and providing a joined-up system isn't as easy as it sounds; it is, however, an achievable goal that would provide the very best care for all concerned.

Womensphere

Posted by Dianne Sandland at 05:39 AM | Permalink

Following on from my last post, which looked with a rather jaundiced eye at 'brain-training' for TBI patients, I've just found the following on Federal Telemedicine News:

Specific Defense Health Program Biomedical Technology topics with an emphasis on TBI are:

Army (OSD09-H01) to develop a highly interactive PC or web-based videogame application using a videogame console platform to improve cognitive, motor, and sensory performance following traumatic brain injury

Army (OSD09-H02) to prototype or refine and test a portable system to provide battlefield triage and monitoring of traumatic brain injuries. The system needs to provide complete diagnostic data

Army (OSD09-H03) to develop a highly interactive PC or web-based application to allow family members to verbally interact with virtually with deployed service members

Army (OSD09-H04) to design, prototype, and provide preliminary validation data for a virtual reality based assessment tool to use to determine return-to-duty status of patients diagnosed with mild traumatic brain injury

Army (OSD09-H05) to develop a computing interface to be used for cognitive and physical rehabilitation of victims with traumatic brain injuries. The interface needs to be interoperable with new and existing cognitive and physical rehabilitation tools

I obviously have an over-developed cynicism gland...

Posted by Dianne Sandland at 03:30 AM | Permalink

According to Posit Science, cognitive training as provided by its Brain Fitness Program(TM) and Insight(TM) products has been shown to improve cognitive function in healthy adults in a number of published studies.

The Company, understandably, are keen to tell us that research has been expanded to a wide range of neurological conditions, including traumatic brain injury, schizophrenia, stroke, geriatric depression, mild cognitive impairment, dementia, and chemobrain.

Before reading on - keep in mind that this is a company with a product to sell. Nevertheless, there does seem to be some substance to the claims.

There are, apparently, 30 peer-reviewed articles reporting on the results of randomized controlled trials using the Company's technologies. These articles show that cognitive training enables most people to think faster, focus better and remember more.

Posit says they believe there is great promise in using this non--invasive technology to address many cognitive impairments.

There's nothing here that makes me think this is the new savior for TBI afflicted patients, however, there's nothing there to harm either so, perhaps, its worth a try.

Marketwatch

Posted by Dianne Sandland at 03:55 AM | Permalink

One problem among many suffered by people affected by traumatic brain injury is the blunting of their emotions and, more to the point, the ability to detect emotional shifts and signposting in others.

However, a new study published in the Journal of Head Trauma Rehabilitation, contends that appropriate training can result in significant regaining of "emotional perception."

The study, which involved 18 TBI affected participants, used photographs and videos to monitor changes in a variety of skills after what is termed "the new program."

Outcomes measured were: independent living skills, psycho-social health, and emotional discrimination tasks requiring them to identify emotions such as happiness, sadness, anger, anxiety, disgust and surprise.

Earlier research had suggested that the accurate perception of emotional cues requires a variety of cognitive skills involving several brain regions and pathways, which are yet to be clearly defined. Dr Bornhofen and her co-researcher, Professor Skye McDonald, therefore compared two broadly different treatment regimes, randomly assigning program participants to each treatment.

The first treatment, which goes under the name of "self instruction training," teaches patients to negotiate everyday social tasks by asking themselves a set of questions, such as, "what am I deciding about?" The inner responses to these questions keep the patient to task and helps them to negotiate social minefields. Sometimes.

The second treatment, errorless learning, takes participants through a set of drawn facial expressions and other mannerisms that signify different emotions. In this method, participants learn to recognize social cues and prompts almost by rote.

Results from the self instruction training group were better than those from the errorless learning group in terms of participants' ability to understand the emotional state of others during day-to-day interactions.

I can't help feeling that the sub-heading to the press blurb about this study - Brain-injured recover emotional perception skills - is in danger of building false hope. Yes, self instruction training did have some success but then so did errorless learning. And neither of the methods could be described as "a new program."

Every little helps, but there's a way to go yet.

Posted by Dianne Sandland at 10:05 AM | Permalink

The question that everybody wants answered when somebody they love sustains a traumatic brain injury is "how will s/he come out of this." To be honest, up until now the only answer given by any of the professionals involved in a persons care had to be a rather haunting and very subjective, 'time will tell.'

Now, however, researchers and clinicians at McGill University Health Center, have published a study that promises more objective answers.

The study, published in a recent edition of Journal of Head Trauma Rehabilitation, describes a set of tools that might provide a more objective answer to this question almost as soon as patients leave intensive care.

The findings from this study are both unique and important, the uniqueness comes from the fact that not just one discipline was involved in the search for answers, the whole multi-disciplinary team responsible for TBI care were able to contribute. The important outcome is that in addition to the advice given to families, carers can now implement a comprehensive program in the continuum of care based on more objective and scientific principles.

When patients with a TBI leave acute care hospitals (generally between 20 to 29 days after the accident), they undergo standard tests to assess their overall level of functioning and to orientate them to appropriate resources to optimize their recovery.

This study proves that the results can also be used to predict the future development of the patient's general condition.

For more information about the study and details about how it was undertaken, go to the McGill University Health Center website.

Posted by Dianne Sandland at 02:12 AM | Permalink

Just some 'useful addresses' today:

The National Center for Injury Prevention and Control produce an excellent section of informative publications dealing with Traumatic Brain Injury.

The mission of the Defense and Veterans Brain Injury Center (DVBIC) is to serve active duty military, their dependents and veterans with traumatic brain injury (TBI) through state of the art medical care, innovative clinical research initiatives and educational programs.

The mission of the National Association of State Head Injury Administrators (NASHIA) is to assist state government in promoting partnerships and building systems to meet the needs of individuals with brain injury and their families.

The National Brain Injury Research, Treatment, and Training Foundation (NBIRTT) is a national, not for profit foundation that supports research, treatment, and training in brain injury through individual research grants, contracts, and small business grants. NBIRTT's primary goal is to find a 'cure' for brain injury.

Check them out - they're worth a look. More tomorrow.

Posted by Dianne Sandland at 03:33 AM | Permalink

If you do, and if you're interested in setting up a TBI support group, the following will be of interest:

Brain injury support group

Arc/Rowan monthly seminar. The Arc/Rowan invites the public to attend the November seminar, "How to Start a Brain Injury Support Group" and to discuss the concerns of people with TBI in the Rowan County area.

The seminar will be held in the Hurley Room at Rowan Public Library Headquarters in Salisbury on Tuesday, Nov. 25, 7-8:30 p.m. There is no cost to attend.

This is also an opportunity for CEU credits for teachers.

Those who have questions or plan to attend are asked to call the Arc/Rowan office at 704-637-1521

If you don't live in NC and if you are looking for further support, chapters of the Brain Injury Association sponsor support groups in many cities. In addition, support groups are provided by medical and rehabilitation centers that provide services for their brain injury clients.

Many brain injury survivor groups have been established in recent years. They address a variety of issues and welcome new members. Many such organizations are listed in the Directory of Associations available in your local library.

Posted by Dianne Sandland at 03:49 AM | Permalink

No earth-shattering news in today's post, it was the title of this publication that caught my eye - it made me think of how many jobs and professions are high risk for TBI. The publication is The Lumberjack.

The author writes about the personal choice aspect of wearing personal protective gear, saying that "if personal choice is the power to control your destiny, then ignoring that choice is a decision to put yourself at risk."

I couldn't agree more. The problem is, when somebody makes the choice not to wear a protective helmet, its not just s/he who is at risk - it is family, friends, emergency room medics, carers...

In a 'previous life' I worked as a health professional. Our guiding mantra was 'informed choice and consent;' however, sometimes people have all the information they need and still make the wrong choice.

Ah well.

Posted by Dianne Sandland at 06:15 AM | Permalink

Oxygen Biotherapeutics, Inc. (OTCBB:OXBO) have had a study published in the October 2008 edition of the journal Neurosurgery demonstrating a positive effect from administering therapeutic oxygen to brain injured rats.

The company's perfluorocarbon therapeutic oxygen carrier and blood substitute, Oxycyte, increases the solubility of oxygen in the blood and thus improves oxygen delivery to the acutely injured brain following traumatic head injury.

The studied rats were divided into two groups plus a control group, with the rats being given low concentrations of oxygen in one group, high concentrates in the second group, and normal saline in the control group.

Results showed that both groups of rats receiving oxygen fared better than those receiving saline, the oxygen receiving rats being able to negotiate a standard maze better than the control group.

Moreover, injured animals receiving therapeutic oxygen had significantly less brain damage compared with saline-treated animals. The lower dose of Oxycyte significantly improved cells' ability to process and use oxygen.

The Company intends to submit an amended test protocol to the FDA to cover dose escalation studies of Oxycyte in TBI. However, this latest published animal study suggests that a lower dose of Oxycyte may have the same benefit as a larger one. More trials will follow.

Healthtorial Health Wire

Posted by Dianne Sandland at 07:36 AM | Permalink

Give an Hour is a non-profit group providing free counseling to US soldiers suffering from the psychological wounds of war. Founded three years ago by Barbara Romberg, a clinical psychologist, the charity wants to expand its current list of 3,000 volunteers from 3,000 to 40,000 - which graphically demonstrates the growing crisis represented by the growing numbers of veterans coming back from the Middle East with PTSD and/or TBI.

To help in their endeavor to grow the charity, on Monday four major US mental health organizations pledged to offer volunteer help. These organizations are:

The National Association of Social Workers
The American Association of Pastoral Counselors
The American Psychiatric Association
American Psychological Association

AFP

Posted by Dianne Sandland at 10:26 AM | Permalink

Nothing for me to say, this moving account of life following traumatic brain injury says it all.

Posted by Dianne Sandland at 08:10 AM | Permalink

Following the recent discovery that erythropoietin (EPO) can protect brain cells, an Australian hospital is to undertake the world's largest traumatic brain injury study to investigate the use of a synthetic EPO in TBI victims. The hope is that the hormone will be proved to reduce disabilities experienced in these patients.

The trial, which starts next year, will enroll nearly 600 severe TBI patients from the ER at 42 Australian hospitals, and will investigate whether administration of EPO in the early hours following TBI will prevent secondary damage.

Australian Herald-Sun

Posted by Dianne Sandland at 08:29 AM | Permalink

According to a research paper published in the November 8 edition of the British Medical Journal (BMJ), very young children who sustain a traumatic brain injury are at higher risk of being diagnosed as having ADHD (attention deficit hyperactivity disorder).

However, it the TBI is not a cause of the ADHD - it is more likely to be the result of the excessive risk-taking characteristic of ADHD children.

The study involved 62,088 children registered in a British health improvement network database. The researchers compared the children with head injuries to two other groups: children with a burn/scald injury before the age of 2, and all the other non-injured children.

The researchers found that children with early head injury had a 90 percent higher incidence of ADHD diagnosis before they were 10, compared with children in the general population. However, children with a scalding injury had a 70 percent higher chance of being diagnosed with ADHD, leading to the conclusion that the head injury was not the cause of the ADHD.

Health Central

Posted by Dianne Sandland at 08:12 AM | Permalink

Although back in 1996, Congress voted to expand VA healthcare for veterans, the agency has exercised its authority to suspend enrollments as needed. The President-Elect has commented that this led to 1 million veterans being turned away. He has promised to reverse the policy.

Obama also said he would improve screening and treatment for mental health conditions and traumatic brain injury; expand the number of housing vouchers and start a program to help veterans at risk of being homeless; add more rural veterans centers; create an electronic system to transfer medical records from the military; and improve preventative health options.

Obama vows change, agency by agency

Posted by Dianne Sandland at 08:08 AM | Permalink

Dr. John Parmentola, Director of Research and Laboratory Management with the Army's science and technology office, has said that the Army is turning science fiction into reality by creating realistic holographic images, generating virtual humans and diving into quantum computing.

It's the stuff of movieland made real: the fantasy idea of implanting specific memories or erasing damaging ones has now become fact.

Of course, the army doesn't do things just for the fun (or the sheer hell) of it, and there is a practical reason behind their research and experiments. For instance, it is now known that certain thoughts generate electrical impulses on the surface of the scalp, This knowledge means that stealth communications - without the use of voice - can lead to weapons that are controllable by thought over a wireless connection.

As far as TBI is concerned, one idea is to find a way to eliminate the grisly memories that come with PTSD and TBI. Looking at the headway already made in this area of military science, it won't be long until thought becomes reality.

Defensetech

Posted by Dianne Sandland at 07:58 AM | Permalink

Lauren's Hope Foundation:
610 703 2423

Brain Injury Association of Pennsylvania
866 635 7097

Brain Injury Association of New Jersey
732 745 0200

plus, or course, there is always:

Brain Injury Association of America: The leading national organization serving and representing individuals, families and professionals touched by traumatic brain injury. The organization provides information, education and support to assist the 5.3 million Americans living with traumatic brain injury.
Call 800 444 6443

lehighvalleylive

Posted by Dianne Sandland at 01:23 PM | Permalink

On Friday, at a conference in South Charleston sponsored by the Brain Injury Association of West Virginia, the prevalence of blast associated traumatic brain injuries outside of the military was highlighted.

Experts from across the country sought to educate the public about what victims commonly experience.

Clinical neuropsychologist, James Petrick said that, the most important first step was to recognize that this actually happens. Petrick said that "these are people who can walk and talk and therefore they're frequently not even thought of as being hurt." However, he went on to say that they are hurt and that we need to pay attention to that and help them.

Petrick says the key to helping victims cope can be as simple as taking time to listen. "Just understanding would make a big difference," agreed Jim Heston, who has been struggling for 16 years with the effects of a brain injury caused by an explosion.

The point is, Heston's injury didn't happen on active service with the military, it occurred in 1992 in a mine shaft explosion that killed four people. Heston was working on construction above the mine when the explosion happened.

Quite rightly, there has been a lot of exposure to the 'signature wound' of the Middle East war but let us not forget that TBI happens outside of military service too.

wowktv

Posted by Dianne Sandland at 07:42 AM | Permalink

Major depression is a complication seen in about one-third of patients within the first year of a TBI and when present, is associated with poor psychosocial functioning and persisting post-concussive symptoms. Major depression is associated with substantial psychosocial dysfunction and post-concussive symptomatology following traumatic brain injury.

In a recent Canadian study to examine the rates of response and remission in patients treated with a selective serotonin reuptake inhibitor (SSRI), citalopram in this case, for major depression following TBI, antidepressant medication was shown to lead to remission of symptoms in a only a minority of patients.

The study, published in the November 2008 issue of the Journal of Psychopharmacology, is the largest study of an SSRI for the treatment of major depression following TBI.

Results showed a rate of remission very similar after six and ten week trial periods,however four patients who had responded at six weeks were worse when reassessed at 10 weeks. This deterioration highlights the importance of a longer study period to allow for a more accurate determination of antidepressant response in the long term.

Details of this very important and interesting study can be found at Market Wire.

Posted by Dianne Sandland at 05:01 AM | Permalink