Monthly Archives: January 2010
Long-term consequences of traumatic brain injury: A review of social, cognitive, neurological, and psychiatric outcomes
It is recognized that survivors of traumatic brain injury have to cope with numerous life challenges. The growing concern for the number of veterans returning with a brain injury has prompted a tremendous influx of research. These new studies contribute to the understanding of brain injury in both civilian and military populations.
The Institute of Medicine recently created a Committee on Gulf War and Health for Brain Injury in Veterans and Long-Term Health Outcomes. The results of their research reviews were published in the December 2009 issue of the Journal of Head Trauma Rehabilitation.
While many of the results should come as no surprise to people dealing with traumatic brain injury (for instance that TBI is associated with unemployment, depression, or cognitive deficits), the Committee also outlined health trends that are not as well known. Here we present a short summary of the Committee’s findings on the social, cognitive, neurological, and psychiatric long-term outcomes after traumatic brain injury.
Social functioning describes the ability to maintain social relationships, employment, independent living, and leisure activities. Moderate, severe, and penetrating brain injury is well associated with problems maintaining long-term employment and adverse social function outcomes.
Cognitive outcomes describe potential difficulties in thought processes such as attention, memory, initiation, planning, or problem solving. Severe brain injury and penetrating brain injury are well associated with cognitive impairments that correspond to the injured brain area. Moderate brain injury is somewhat associated with cognitive impairments.
Neurological outcome refers to disorders of the brain such as seizures, Alzheimer’s type dementia, parkinsonism (a combination of symptoms similar to Parkinson’s disease), endocrine disorders, or visual problems. Moderate and severe brain injuries are well associated with:
- Dementia of the Alzheimer’s type
- Parkinsonism
- Unprovoked seizures
- Endocrine dysfunction, especially hypopituitarism
- Growth hormone insufficiency, and
- Diabetes insipidus.
Mild brain injury is somewhat associated with dementia of the Alzheimer’s type and parkinsonism (when there is loss of consciousness). Severe brain injury is somewhat associated with the development of ocular/visual motor deterioration.
Psychiatric outcomes describe mood disorders such as depression or anxiety, as well as behaviors such as aggression or drug and alcohol use. Mild, moderate, and severe brain injuries are well associated with mood disorders and aggressive behaviors. Additionally, brain injury of any severity is somewhat associated with drug and alcohol use.
While several past studies have focused on immediate or short-term effects of brain injury, these reviews focus on studies of outcomes several months after injury. The most critical point made by the Committee is that traumatic brain injury can lead to chronic health conditions and needs long-term management in order to avoid potential consequences.
Severity of brain injury seemed to show differences in how well associated it was with a long-term outcome (particularly in mild TBI, where there were few strong associations). However, there were inconsistencies in how individual studies diagnosed mild and moderate brain injury, leading to difficulties when reviewing several studies as a whole.
It is likely that the more severe the brain injury, the more severe the long-term outcomes will be. But further research needs to be conducted in the field of mild brain injury in order to clarify some of the diagnostic inconsistencies and the controversial conflicts in past study results.
Bazarian JJ, Cernak I, Noble-Haesslein L, et al. Long-term neurologic outcomes after traumatic brain injury. Journal of Head Trauma Rehabilitation. (December 2009).
Dikmen SS, Corrigan JD, Levin HS, et al. Cognitive outcome following traumatic brain injury. Journal of Head Trauma Rehabilitation. (December 2009).
Hesdorffer DC, Rauch SL, & Tamminga CA. Long-term psychiatric outcomes following traumatic brain injury: A review of the literature. Journal of Head Trauma Rehabilitation. (December 2009).
Temkin NR, Corrigan JD, Dikmen SS, & Machamer J. Social functioning after traumatic brain injury. Journal of Head Trauma Rehabilitation. (December 2009).
Sleeping drug impairs recovery after traumatic brain injury
Insomnia is common after traumatic brain injury and many survivors rely on medication to get to sleep. However, animal studies and studies of healthy individuals show that the use of benzodiazepines (a commonly prescribed sleep aid) reduces cognition, interferes with neural plasticity, and slows recovery. Therefore, many clinicians have discouraged the use of benzodiazepines in traumatic brain injury survivors.
A research review conducted by Northwestern University in Chicago has shown that alternative drug treatments may be better suited for insomnia in traumatic brain injury. Trazodone, zopiclone, zolpidem, and zaleplon are believed to have fewer adverse effects on cognition than benzodiazepines. Melatonin or ramelteon (its synthetic double) can play a dual role by both replenishing lost hormone production in the brain and effectively treating insomnia.
Sleep itself is beneficial to recovery of motor skills and cognition after traumatic brain injury. However, sleep induced by benzodiazepines may slow this recovery and should be avoided. Alternative drug treatments may be safer and are available for traumatic brain injury survivors.
Larson EB & Zollman FS. The effect of sleep medications on cognitive recovery from traumatic brain injury. Journal of Head Trauma Rehabilitation. (January 2010).
Children who are slow to recover from sports-related concussion need specialized rehabilitation
Some children and adolescents who suffer from a sports-related concussion may recover more slowly than adults. Therefore, clinical professionals have long recommended that rehabilitation programs specific for children be developed.
The Montreal Children’s Hospital Trauma Programs developed a set of guidelines specific for children, called the Montreal Children’s Hospital Rehabilitation After Concussion (MCH-RAC). Instead of the typical path of physical and cognitive evaluations that may allow an adult athlete to return to the sport quickly, the MCH-RAC provides a gradually active and closely monitored program for children who are slow to recover.
A study of 16 children who were slow to recover (out of 142 who presented with sports-related concussion), showed that all 16 recovered significantly and quickly after participating in the MCH-RAC. Feelings of depression, headache, and fatigue rapidly improved, and the children were able to return to their normal lifestyle and sport.
Researchers at the Montreal Children’s Hospital therefore recommend a specialized treatment program of gradual, closely-supervised, active rehabilitation for children who are slow to recover from sports-related concussion.
Gagnon I, Galli C, Friedman D, et al. Active rehabilitation for children who are slow to recover following sport-related concussion. Brain Injury. (November 2009).
Dateline NBC Exposes Health Insurance Crisis
On January 24, 2010, Dateline NBC aired the compelling story of Patrick Gannon, a man who battled a severe anoxic brain injury and was then forced to wage war against his insurance company. The Dateline story accurately portrays how the health care system victimizes patients and families when they are most vulnerable.
The following letter from Susan H. Connors President/CEO urges action on the part of the BIAA and their members, please read and forward to your colleagues and friends.
January 27, 2010
Dear Advocates,
Health care reform at the federal level is officially on hold. Republican Scott Brown gained the Massachusetts seat vacated by the death of Edward Kennedy, thereby breaking the 60‐vote majority in the Senate. Democrats met privately in the days following the Massachusetts special election but were unable to cultivate a strategy for moving forward at this time.
A six‐week break is planned, and it is likely policymakers will be forced to accept a substantially scaled‐back package or abandon health care reform altogether.
The Brain Injury Association of America is deeply disappointed. Through our partnership with the Brain Injury Business & Professional Council, we made important gains in the proposed legislation. We cannot forgo this progress; we cannot quit now. We will continue to fight for access to the full continuum of brain injury treatment.
On January 24, 2010, Dateline NBC aired the compelling story of Patrick Gannon, a man who battled a severe anoxic brain injury and was then forced to wage war against his insurance company. The Dateline story accurately portrays how the health care system victimizes patients and families when they are most vulnerable.
I urge brain injury advocates everywhere to watch Patrick’s story and then write to Ann Curry, Dateline correspondent, to thank her for bringing national attention to the extraordinary challenges individuals with brain injury and their families face. I urge advocates to share their own stories with Ms. Curry and ask that she continue to educate the public about the rehabilitation needs of people with brain injury after their lives have been saved. Please address your letters to:
Ms. Ann Curry
Dateline / NBC News
30 Rockefeller Center, Studio 3B
New York, NY 10012
E‐mail: Dateline@NBCUNI.com
Once you’ve written your letter (and sent copies to your legislators and BIAA), I ask that you share the Dateline story with friends and neighbors and that you encourage them to spread the story to others. With your help, we can tell the public that a brain injury can happen to anyone at anytime and that having insurance doesn’t mean you’re covered!
Very truly yours,
Susan H. Connors
President/CEO
Brain Injury Association of America Policy Corner E-Newsletter – January 29, 2010
A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________
In This Issue:
Health Care Reform Update
State Concussion Legislation
2010 Brain Injury Awareness Day
Policy Corner is made possible by the Centre for Neuro Skills, James F. Humphreys and Associates, and Lakeview. Brain Injury Association of America gratefully acknowledges their support for legislative action.
Health Care Reform Update
After the devastating Massachusetts special election, House and Senate leaders are expected to resume negotiations this week to attempt to finish the health care overhaul. Although a clear path is still unknown, BIAA will continue to monitor the situation closely. A big thank you to all of our grassroots advocates who answered the call last week to urge members of Congress to push forward on Health Care Reform!
State Concussion Legislation
Following the extraordinary success of BIA of Washington and BIA of Oregon in the adoption of state level sports concussion legislation, BIAA, in partnership with the Sports Legacy Institute, has become committed to encouraging, and assisting wherever possible, the enactment of sports concussion legislation in all states.
BIAA has developed a sample piece of legislation based on current laws and pending bills that exist throughout the country. This model legislation along with a sample testimony for use in state concussion hearings, distributed on January 25, 2010 to BIAA’s state affiliates, is a step foward in facilitating action in each state.
Due to the increased visibility of sports concussions within the National Football League in recent weeks, BIAA is encouraged that all states will be able to tip the scales in favor of protecting our youth athletes.
Brain Injury Awareness Day 2010
This year’s Brain Injury Awareness Day on Capitol Hill is set to take place on March, 17, 2010. BIAA will be unveiling our 2010 legislative agenda and encouraging the grassroots community along with state affiliates to participate in advocating for increased TBI Act appropriations, increased access to care, federal and state level concussion legislation, increased TBI research, military coverage of cognitive rehabilitation and caregiver assistance.
All issues mentioned will be outlined in fact sheets that advocates will receive that day and can use as reference during congressional visits and may leave behind for review by congressional staff.
Below is the schedule of events for the day:
10:00 AM – 1:00 PM – Brain Injury Awareness Fair, First Floor Foyer of the Rayburn House Office Building
2:30 PM – 4:00 PM – Briefing: “From the Playground to the Pros: A Heads-Up on
Concussion”, Capitol Visitors Center – Congressional Meeting Room South
5:30 PM – 7:30 PM - Reception Celebrating Brain Injury Awareness Month, First Floor Foyer of the Rayburn House Office Building
If you are planning to attend and need assistance scheduling congressional visits, please contact Sarah D’Orsie, sdorsie@biausa.org or 703-584-8637
What happens to the brain after electrical injury?
Even when the head is not in direct contact with an electrical power source, head injuries can occur by means of an electrical surge to the peripheral nervous system (from contact to an extremity such as arm or leg). Electrical injury survivors often show mental deficits and slowed motor skills as a result of the secondary head injury.
What predicts short and long term quality of life after spinal cord injury?
Quality of life describes a person’s sense of satisfaction in life and the ability to enjoy normal activities. Spinal cord injury may have tremendous impact on a person’s quality of life in general, and the specific factors that contribute most to quality of life were not previously well known. Additionally, it was not known if a person’s perception of quality of life after the injury changed over time.
Measuring apathy after traumatic brain injury: Two assessment scales
Apathy is defined as indifference, or a reduced emotional, cognitive, and behavioral state. Apathy is common after traumatic brain injury—somewhere between half and three-quarters of brain injury survivors show signs of it. Apathy is related to frontal lobe and limbic system damage, both of which are common areas of injury.
What can stem cells do for spinal cord injury?
One of the major consequences of spinal cord injury is death of neurons after the injury and the inability of surviving neurons to regenerate and repair their connections. This secondary injury can continue for even years after the incident and much research has been focused on promoting regeneration.
Grassroots: BIAA Policy Corner E
This week has been a critical one for Health Care Reform. As many of you may know, there was a special election held in Massachusetts this week to replace the late Senator Kennedy. The winner of the election is speculated to throw off the Senate voting pattern to derail final passage of the health care bill.
