There is No Concussion Proof Helmet

In cases where a bike rider suffered a TBI from a fall or crash caused by someone else’s negligence but the rider was not wearing a helmet, the defense will always claim that but for the rider’s failure to wear a helmet the TBI would not have occurred. Sometimes this is blatantly false, as where the impact occurs to the rider’s face, a place that no helmet covers. But what about cases where the impact occurs to a place on the rider’s head that would have been covered? Can any helmet prevent a concussion? One of American’s leading experts on the neurological effects of head trauma in sports, Dr. Barry D. Jordan of the Burke Rehabilitation Hospital in NY, says no.

In an interview with The Guardian here is what Dr. Jordan said when asked whether improved helmet design for NFL players had helped reduce concussions, “Probably not, because there is no concussion proof helmets. The mechanism of a concussion is really rapid acceleration deceleration of the head and the head will accelerate or decelerate regardless if you have a helmet on or not. The helmet is helpful in protecting against more serious brain injuries such as intracranial hemorrhages and skull fractures. There is no concussion proof helmet.” While I am in favor of bicycle riders ALWAYS wearing a helmet, even on a two minute trip to the corner grocery store, it’s important to remember that no helmet can completely protect the brain from trauma.

Rate of Depression Within 1 Year of TBI is 8 Times the National Norm

More than half of all people who suffer a traumatic brain injury will become depressed in the year after the injury, a rate eight times higher than in the general population, according to a new study in the Journal of the American Medical Association. And only about 45 percent of those who do become depressed are likely to receive adequate treatment. The lead author of the study Charles Bombardier, Ph.D., professor of rehabilitation medicine at the University of Washington School of Medicine said that: “Symptoms to watch for include low mood, low energy, feelings of worthlessness or guilt, difficulty concentrating, acting restless or slowing down, and thoughts of death.”

Medical Caution Against Driving 6-12 Months Post-TBI

In the United States if a person loses consciousness due to a brain injury his driver’s license can be suspended. However, many physicians will not report the incident to the DMV unless they believe the loss of consciousness is likely to recur as when a patient has epilepsy. Therefore, it is often up to the injured person how soon to resume driving after a TBI. What is safe? A study done in Summer 2013 at the University of Warwick in Coventry, England, showed that it may be unwise for a person with a TBI to return right away to driving because of psychological, emotional or cognitive problems. The researchers recommended a waiting period of 6-12 months for persons who are showing impairment. For persons who aren’t sure taking a field test with a private driving instructor or even a trusted friend might be a good idea.

Marked Behavioral Changes After Repeated Brain Trauma

Some people who sue for a TBI incurred in one incident (such as a car crash) have had prior TBIs. Even though the most recent TBI is not severe, the person may undergo radical changes in personality (exhibiting impulsivity, explosive anger, and violence) or mood (depression and hopelessness). What could be going on here?

According to a study published in 2013 in Neurology online by Robert Stern, PhD, of Boston University and colleagues, the answer may be CTE or chronic traumatic encephalopathy. This is a distinctive condition resulting from cumulative, separate incidents of TBI.

TBI Doubles the Rate of Homelessness, Alcoholism, and Drug Abuse

Dr. Wayne Gordon, an expert in the medical rehabilitation of persons with TBI, says that approximately 7-8% of people in the U.S. are living with the residuals of a TBI and many of them do not even know it. According to Dr. Gordon (who is the director of the Brain Injury Research Center at Mount Sinai School of Medicine in New York), untreated TBI doubles the rate of learning disability, alcohol and drug abuse, and homelessness.

If you have a new TBI I encourage you to get treatment any way you can – be it through private health insurance, workers compensation, Medicare, a not-for-profit charity or even a medical study at a respected academic medical center.If you are fortunate enough to win a lawsuit for compensatory damages for your TBI, then you can apply part of your settlement to treatment.The important thing is not to tough it out. Brain injuries do not heal themselves and in the absence of treatment some very bad consequences can result.

Could Brain Ultrasound Improve Mood in Depressed TBI Patients?

In the May 2013 issue of the journal Brain Stimulation, Dr. Stuart Hameroff and colleagues at the University of AZ Medical Center published an article demonstrating that applying ultrasound to the brain improves mood in people depressed by chronic pain. The mechanism at work is not known. Researchers theorize the ultrasound could stretch neuronal membranes or stimulate microtubules in axons contributing to the repair, growth, and development of new synapses.

This technology has not yet been applied to TBI patients suffering from depression. TMS (transcranial magnetic stimulation) is another technique for improving mood in depressed patients which has actually been cleared by the FDA for that use. At this point in time I am not yet aware of any medical facilities using TMS to relieve depression in TBI patients. If anyone reading this blog entry knows of this please contact me.

Multiple Mild TBIs Greatly Increase Risk of Suicide

Soldiers who suffer more than one mild traumatic brain injury (MTBI) face a significantly higher risk of suicide, according to a new study published in JAMA by researchers from the National Center for Veterans Studies at the University of Utah. The researchers led by Craig J. Bryan, Ph.D. found that the risk for suicidal behaviors and thoughts increased not only in the short term, but during the soldier’s entire life.

During a six-month period in 2009, 161 patients who received a suspected brain injury while on duty in Iraq were referred to an outpatient TBI clinic at a combat support hospital. The researchers found that one in five (21.7 percent) who had sustained more than one TBI reported suicidal ideation, described as thoughts about or preoccupation with suicide. For those who had received one TBI, 6.9 percent reported having suicidal thoughts. Zero percent of those with no TBIs reported suicidal thoughts.

In evaluating the lifetime risk, researchers asked patients if they had ever experienced suicidal thoughts and behaviors up to the point they were assessed. The increases were similar for suicidal thoughts during the previous year rather than at any time, according to the researchers. They found that 12 percent of those with multiple TBIs had entertained suicidal ideas during the past year, compared with 3.4 percent with one TBI, and 0 percent for no TBIs.

One-Third of TBI Patients Have Depression

At any given time some 6-7% of all Americans suffer from depression. What is the incidence of depression in people who suffer a TBI? Researchers at the University of Iowa led by Dr. Ricardo E. Jorge compared 91 patients with TBI with 27 patients who suffered multiple trauma, but without any nervous system involvement. They found that a third of the TBI patients had clinical depression during the year after their injury. This was far more frequent than in the control group. Of the patients with TBI and depression, 77 per cent also reported anxiety and 57 per cent exhibited aggressive behavior. Major depression was also linked to poorer social functioning six and twelve months after the injury

Training Helper Dogs a Boon to People with TBI

An new organization called the Warrior Canine Connection, a Maryland-based nonprofit, is stimulating recovery in American war veterans with TBI by helping them to train puppies over a two year period to become dogs that can help injured service men and women. The project is based at Walter Reed National Medical Military Medical Center. Initial results are good. The soldiers with TBI are being challenged and also rewarded with the love of the dogs and a great sense of accomplishment. Programs like this should be adopted elsewhere in the United States.

Brain Rewires Itself After Damage From TBI or Stroke

The hippocampus (located deep within the temporal lobe) is the brain’s primary learning center, and is crucially involved with forming, storing, and accessing long term memories. The hippocampus is a delicate structure more vulnerable to damage from TBI or stroke than other brain areas. Neuroscientists led by Moriel Zelikowsky at UCLA’s Brain Research Institute have just discovered that in rats damage to the hippocampus that disables them temporarily from learning to solve problems can be reversed by spontaneous brain rewiring in the prefrontal cortex (PFC).

Apparently what happens is that one region in the PFC called the infralimbic cortex shuts down while another region in the PFC called the prelimbic cortex becomes activated and begins to form new circuits to compensate for hippocampal damage. Brain scanning of Alzheimer’s patients shows massive damage to the hippocampus with increased activation in the prelimbic cortex so a similar mechanism may be occurring there. The researchers found that activation of the rewiring process is strongest when the rats were taught to solve problems. The inference is that with brain injured people cognitive rehabilitation would spur rewiring in the PFC as well.