A ketogenic diet (high fat, low protein and carbohydrates) can make significant changes to the way the brain metabolizes energy. It is well known that the ketogenic diet can reduce seizure activity, and more recent research has suggested that it also increases neuroprotective effects in brain injury.

In one animal study, the administration of a ketogenic diet after traumatic brain injury showed a reduction in secondary brain injuries such as neuronal death and brain edema (swelling). Secondary brain injuries can often cause more damage than the primary injury, and much brain injury research has focused on the reduction of these secondary processes.

A research review of the relationship between the ketogenic diet, the protein adenosine, and brain activity illustrated the metabolic process in which ketosis may effectively treat brain disorders. Ketosis can increase ATP and adenosine, both of which are important elements of brain activity. This change in brain activity could not only increase neuroprotective factors and decrease seizure activity, but also improve sleep quality, alleviate pain, and reduce rates of diabetes.

Although we still need clinical research in humans to verify the benefits of a ketogenic diet for traumatic brain injury, there is potential for a wide-range of benefits from a relatively simple therapy.

Hu Z-G, Wang H-D, Qiao L, et al. The protective effects of the ketogenic diet on traumatic brain injury-induced cell death in juvenile rats. Brain Injury. (May 2009).

Masino SA, Kawamura Jr. M, Wasser CA, Pomeroy LT, & Ruskin DN. Adenosine, ketogenic diet and epilepsy: The emerging therapeutic relationship between metabolism and brain activity. Current Neuropharmacology. (September 2009).

Complete spinal cord injuries do not often occur in professional sports, but they can produce devastating results when they do. Although the primary injury is serious, a substantial amount of damage occurs during the secondary response to the injury. Much research has focused on reducing this secondary response, by slowing inflammation, cell death, or bleeding.

One treatment that has been proven useful in reducing secondary damage in traumatic brain injury and stroke is hypothermia, or the cooling of body temperature. A well-timed treatment of hypothermia can lower metabolic demands, which helps to decrease inflammation and cell death—hopefully to stop further damage and aid in recovery.

A medical team recently reported a case study of an NFL football player who sustained a spinal injury during a helmet-to-helmet hit. The player had complete paralysis and sensory loss below the clavicles at his initial evaluation. His medical team applied a moderate hypothermia treatment during his ambulance ride, which was continued throughout his standard treatment.

Within 3 days, the player was showing considerable motor and sensory improvement, and continued to improve even after his subsequent discharge. Although the researchers noted that it was difficult to evaluate the amount of recovery directly related to the systemic hypothermia, they believe the treatment was a valuable one.

Cappuccino A, Bisson LJ, Carpenter B, et al. The use of systemic hypothermia for the treatment of an acute cervical spinal cord injury in a professional football player. Spine. (January 2010).

As some of you may know, this morning President Obama released his FY 2011 budget. Last week, the State of the Union address warned of spending freezes and tough decisions on what programs to keep and what programs to discontinue in the coming year.

BIAA is pleased to announce that the HRSA state grant program, authorized by the TBI Act, has been level funded in the President’s budget.

Although the appropriations process for 2011 is far from over, we are off to a good start. BIAA would like to make a push for increased appropriations for this program at the 2010 Brain Injury Awareness Day on March 17th on Capitol Hill. Please contact Sarah D’Orsie, Director of Government Affairs, BIAA at sdorsie@biausa.org if you are planning to attend.

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:

1. Dementia of the Alzheimer’s type
2. Parkinsonism
3. Unprovoked seizures
4. Endocrine dysfunction, especially hypopituitarism
5. Growth hormone insufficiency, and
6. 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).

House

After more contentious private and public negotiations on a health overhaul between House leaders and moderate Democrats, prospects are uncertain for a vote on the bill before lawmakers leave for a long August recess.

The Energy and Commerce Committee Chairman, Henry Waxman, is aiming to come to an agreement by Monday or Tuesday of this week in order to report the bill to the full house.

House Democratic leaders will attempt to convince their caucus of the merits of the legislation Monday evening, in the hope of holding a vote at the end of this week or early next week.

Majority Leader Steny Hoyer, had earlier dismissed the idea that Energy and Commerce might have to discharge the bill without voting on it — something Waxman said, in the heat of his dispute with moderate democrats, that he was considering himself. “I’m not interested in that, and I don’t think the Speaker is either,” Hoyer said. (CQ)

He said chances are “very small” they will take the bill to the floor before the House’s scheduled July 31 break for the August recess. However, he said it was possible the leadership would hold the chamber in session beyond that date.

Senate

Senate leaders last week abandoned plans to pass their own bill before August, but work continues among a bipartisan group of six Finance Committee members – backed by their leadership – to reach agreement on an overhaul.

On July 17, 2009, the House Appropriations Full Committee acted on legislation that would fund labor, health and education programs for Fiscal Year 2010. The overall numbers for this year’s reported bill are as follows:

Bill Total
2009 Comparable: $155.049 billion
President’s Request: $160.706 billion
Committee Mark: $160.654 billion

Currently, further details regarding TBI Act and TBI Model Systems of Care funding have not been released, however, look for a special edition of Policy Corner on Monday, July 27, 2009 for a special appropriations report. BIAA will continue to monitor the appropriations process closely and will be sure send out grassroots action instructions when the bill is scheduled for floor action.

House Considers FY10 TBI Act Appropriations, take action now!

Take Action!

Friday, July 24, 2009, the House of Representatives will be considering a bill which will provide the funding allocation for programs authorized through the TBI Act and for NIDRR’s TBI-related research programs, including TBI Model Systems of Care.

Federal funding for these important TBI programs has remained stagnant over the last several years, as Congress has not provided increases sufficient to keep up with the increasing cost of doing business. The urgent need for increased federal support for a national TBI public health infrastructure and TBI research is further heightened by the recognition of TBI as the signature wound of the wars in Iraq and Afghanistan.

The time is now to urge Members of Congress to adequately fund TBI programs!

On Thursday May 21, 2009, The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) launched a public awareness campaign focused on combating the stigma associated with seeking care and treatment for psychological health and Traumatic Brain Injury (TBI).

For more information, visit http://www.realwarriors.net/ . The Real Warriors Web site features articles and resources as well as video interviews with service members, their families and others dealing with psychological health and/or TBI.

BIAA has been an active partner in this campaign and will continue to work towards its success with the DCoE.

This week, BIAA submitted testimony to the House and Senate Appropriations Committees, Subcommittees on Labor, Health and Human Services, Education and Related Agencies.

http://www.biausa.org/

The testimony detailed the importance of appropriating $37 million to preserve and advance TBI Act Programs, as well as the need to designate $13.3 to sustain and bolster health and function research — including the TBI Model Systems of Care, Rehabilitation, Research & Training Centers; and field-initiated investigations—within the National Institute on Disability and Rehabilitation Research (NIDRR).

On Tuesday, March 3, 2009, the House Appropriations Subcommittee on Defense held a hearing to address the need to improve the quality of care for servicemembers suffering from traumatic brain injury.

The witness list included, Ellen Embry, the Deputy Assistant Secretary of Defense for Force Health Protection and Gen. Loree Sutton, the Special Assistant to the Assistant Secretary of Defense for Psychological Health and Traumatic Brain Injury.

General Sutton shared with the Committee that the Defense Centers of Excellence is committed to research that is aimed at understanding the differences between blast injuries that would occur on the battlefield and concussions that may be experienced on a football field or during civilian activities. The spectrum of ingredients that include life-threatening situations, psychological stressors, and moral conflicts are all factors that contribute to the unique nature of brain injury incurred through battle.