Emergency treatment guidelines improve survival of people with severe head injury

A large study of more than 21,000 people finds that training emergency medical services (EMS) agencies to implement prehospital guidelines for traumatic brain injury (TBI) may help improve survival in patients with severe head trauma. The findings were published in JAMA Surgery, and the study was supported by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health.

“This demonstrates the significance of conducting studies in real-world settings and brings a strong evidence base to the guidelines,” said Patrick Bellgowan, Ph.D., program director at NINDS. “It suggests we can systematically increase the chances of saving lives of thousands of people who suffer severe traumatic brain injuries.”

Based on scores of observational studies, guidelines for prehospital management of TBI that were developed in 2000, and updated in 2007, focused on preventing low oxygen, low blood pressure, and hyperventilation in people with head injury. Collectively, the studies suggested that controlling those factors before patients arrived at the hospital could improve survival, but actual adherence to the guidelines had not been examined.

Full story at nih.gov

Study reveals no benefit to costly and risky brain cooling after brain injury

The study, published today, in the Journal of the American Medical Association and presented at the same time at the Congress of European Society of Intensive Care Medicine in Paris by lead authors, Professors Jamie Cooper and Alistair Nichol, looked at the outcomes for 511 patients across six countries who had traumatic brain injury (TBI).

An estimated 50-60 million people, worldwide, will suffer a TBI this year and more than half of the world’s population will suffer at least one TBI during their lifetime. There has long been controversy around the benefits of brain cooling in the Intensive Care Unit following a TBI, in the belief the cooling or hypothermia reduces brain inflammation and consequent brain damage.

Professors Cooper, and Nichol, together with Lisa Higgins, and Tony Trapani, Dr. Dashiell Gantner, Profs Michael Bailey, Stephen Bernard, Peter Cameron Jeffrey Rosenfeld and Andrew Forbes all from Monash, together with colleagues in Queensland, Western Australia, New Zealand, France, Qatar, and Saudi Arabia, divided the TBI patients into two groups: those that received hypothermia treatment as soon as possible post-injury, often in the ambulance on the way to an emergency department, and half who did not receive the therapy. The study, called POLAR (Prophylactic hypothermia to lessen traumatic brain injury) ran from seven years from 2010.

Full story at Medical Xpress

‘Concussion pill’ shows promise in pre-clinical pilot study

In 2016, funded by a $16 million grant from Scythian, the multidisciplinary Miller School team embarked on a five-year study to examine the effects of combining CBD (a cannabinoid derivative of hemp) with an NMDA antagonist (an anesthetic used in animals and humans) for the treatment of traumatic brain injury and concussion. The researchers believed the combination could reduce post-injury brain cell inflammation, headache, pain and other symptoms associated with concussion.

The findings of a pre-clinical pilot study were recently released, and they show that the combination therapy improved the cognitive functions of animals, compared with those treated with a single vehicle. In addition, there were no adverse effects from either the combination therapy or the individual components.

“There needs to be more systematic research in this field in order to study the neuroprotective properties of CBD, and to improve treatment for those sustaining mild-to-moderate TBI (traumatic brain injury) and concussion,” said Gillian A. Hotz, Ph.D., professor of neurological surgery, and director of the KiDZ Neuroscience Center at The Miami Project and the University of Miami Sports Medicine Institute concussion program.

Full story at Medical Xpress

Prior TBI Diagnosis Increases Risk of Parkinson’s Disease

Recently, there has been attention on the association of traumatic brain injury (TBI) with progressive neurodegenerative diseases; such as, Parkinson’s disease. However, the association between mild TBI and Parkinson’s remains unclear. Therefore, the authors used 3 nationwide Veterans Health Administration databases (Comprehensive TBI Evaluation, National Patient Care Databases, Vital Status File Database) of inpatients and outpatients seen between 2002-2014 to determine the risk of developing Parkinson’s disease following a TBI. Authors age-matched 162,935 patients (~48 years of age) with TBI diagnosis without dementia, Parkinson’s disease, or secondary parkinsonism at baseline to a random sample of patients without any of the aforementioned conditions. The authors defined TBI exposure as a diagnosis of TBI after a comprehensive neurological assessment or by at least one inpatient or outpatient TBI diagnosis from a list of ICD-9 codes. Parkinson’s disease was defined as any inpatient or outpatient diagnosis of ICD-9 332.0 at least 1 year after TBI. The average follow-up was ~5 years. The authors found that a veteran with a prior TBI (0.6%) is >56% more likely to develop Parkinson’s disease than a veteran without a prior TBI (0.3%). This finding was consistent even after accounting for factors such as medical comorbidities (diabetes, hypertension, cerebrovascular disease) and psychiatric disorders (anxiety, post-traumatic stress, drug/alcohol use). Furthermore, this finding was consistent among people with mild or moderate-severe TBI.

Full story at Sports Medicine Research

TBI Reauthorization Now Approved by Both Houses of Congress

Government-sponsored research and data collection on traumatic brain injury (TBI) has support from both houses of Congress, now that the US Senate has approved the TBI Reauthorization Act. The House passed its version of the legislation earlier this summer. APTA was among the organizations advocating for the bills.

The measure passed in the Senate is substantially similar to the House version, with some differences in funding amounts and a Senate request that the US Centers for Disease Control and Prevention (CDC) review evidence on management of TBI in children. If the bills are reconciled and signed into law, the act will provide funding to the CDC, the National Institutes of Health, and the Health Resources and Services Administration for programs supporting TBI research and individuals with brain injury.

Full story of TBI Reauthorization at APTA

PT’s Movie Review on ESPN Also Educates on Consecutive TBI

An APTA member’s review of a new documentary on traumatic brain injury (TBI) has been featured on ESPN. Stephania Bell, PT, CSCS, OCS, senior writer for ESPN, gave a strong, positive review for the new documentary “The Crash Reel,” but perhaps just as important, seized the opportunity to provide readers with valuable education on consecutive TBI and its impact on developing brains.

“The Crash Reel” follows the rise, devastating injury, and recovery of elite snowboarder Kevin Pearce, who at age 22 suffered a head injury during training for the 2010 Vancouver Olympics. Pearce’s recovery continues, and he is now a motivational speaker and sports equipment consultant. Earlier this month he carried the torch at the opening ceremonies of the Winter Olympics in Sochi.

Full story on the movie review and TBI at APTA

Returning to work after a brain injury

Concussions in the National Football League (NFL) and military have received a lot of attention lately. But traumatic brain injury is a much larger issue, affecting at least 1.5 million Americans each year.

As the impact of brain injuries becomes clearer, some experts say they are noticing a pattern. Many people with brain injuries are struggling in their efforts to return to work or get the accommodations from their employers to deal with the aftermath.

Carey Gelfand lives in Glencoe, Ill., one of Chicago’s North Shore suburbs. In 2006, she was working at an art consulting company. She traveled with her boss to New York City to attend an art expo. She was wearing a pair of flat-bottom cowboy boots when the temperature dropped and the rain-slicked streets froze over.

“My feet went out from under me and my head just hit the pavement,” said Gelfand.

Gelfand did what many of us do when we get embarrassed after a fall, she stood up and brushed herself off, declaring, “I’m fine, I’m fine…”  She kept walking with her colleagues and then boarded a bus. “And I looked out the window and I was thinking, ‘I’m here, but I’m not,’” said Gelfand.

Full story of working after brain injuries at WBEZ

A traumatic brain injury can instantly impact a person’s life

Traumatic brain injuries often occur when a victim suffers a violent blow to the head or when a foreign object penetrates his or her skull. For instance, TBIs are commonly suffered during severe car accidents as victims are flung about the wreckage.

According to the Centers for Disease Control and Prevention (CDC), an estimated 1.7 million people sustain traumatic brain injuries every year in the United States.

Otherwise known as TBIs, traumatic brain injuries are a factor in almost one-third of all injury-related fatalities in the U.S. In fact, the CDC reports that from 2002 through 2006, there were 52,000 deaths each year, on average, attributed to TBIs. However, even in instances in which TBIs do not lead to death, many victims face a lifetime of TBI-related disabilities – including roughly 5.3 million people in the U.S. alone.

Dangers associated with brain injuries

TBIs often occur when a victim suffers a violent blow to the head or when a foreign object penetrates his or her skull. For instance, TBIs are commonly suffered during severe car accidents as victims are flung about the wreckage. However, a traumatic brain injury can be caused during any type of serious accident.

Full story of traumatic brain injury at the Digital Journal

A Silent Epidemic: Minor Traumatic Brain Injury

In the United States, approximately 1.4 million people suffer a traumatic brain injury (TBI) each year. Of those injuries, three out of four are minor TBI (mTBI) — a head injury that causes a temporary change in mental status including confusion, an altered level of consciousness, or perceptual or behavioral impairments.

According to a literature review appearing in the October 2013 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), falls and motor vehicle accidents are responsible for most cases of mTBI and also are a common cause of bone and joint injuries. “Musculoskeletal injuries are often seen concurrently with some studies estimating that 50 percent of patients with orthopaedic injuries also sustain a mTBI,” says lead study author Richard L. Uhl, MD, an orthopaedic surgeon at Albany Medical Center in Albany, N.Y.

Approximately 80 percent of patients who sustain a mTBI can be safely discharged from the emergency department and will fully recover and return to their baseline mental status. However, mTBI often goes undiagnosed initially because symptoms do not appear until the patient resumes everyday life. Advanced imaging of the head such as CT scans is often of little use as the majority of patients with a mTBI will initially have a normal examination.

A Silent Epidemic: mTBI by the Numbers

  • The Centers for Disease Control and Prevention and the National Center for Injury Prevention and Control declared mTBI a major public health issue and a silent epidemic.

Full story of minor TBI at Science Daily

PTSD doesn’t cause mass shootings

With his death on Monday, Aaron Alexis took with him to the grave all the answers to what was going on his head before he opened fire at the Washington navy yard, killing 12 people. But in the wake of one of America’s deadliest mass shootings, the search for explanations is all but inevitable. And so, right on time, in the hours after the tragedy unfolded, reports quickly surfaced that Alexis had been suffering from post traumatic stress disorder. An anonymous law enforcement source told the Associated Press Tuesday that Alexis additionally had “a host of serious mental issues, including paranoia and a sleep disorder.” Which makes this a good time to talk about PTSD and the differences in various mental health issues, how grossly misunderstood the people struggling with them often are and how desperately we need better understanding of them.

Aaron Alexis and His PTSDMuch has already been uncovered about the 34 year-old Alexis’ seemingly contradictory history. A friend described for the AP Monday his faithful Buddhism. “We are all shocked,” the friend said. “We are nonviolent. Aaron was a very good practitioner of Buddhism. He could chant better than even some of the Thai congregants.” Alexis also served three years as a navy aviation electrician’s mate third class. He’d been involved in two previous minor shooting incidents. Nine years ago, he shot out a construction worker’s tires during what he called a “blackout.” His father reportedly told police at the time that Alexis “anger management problems associated with PTSD, and that Alexis had been an active participant in rescue attempts on September 11, 2001.”

But does the word of his father mean that Alexis had a clear diagnosis of PTSD? And is there a demonstrable link between PTSD and violence anyway? Not exactly. In 2012, when Sgt. Robert Bales was accused of killing 16 Afghan civilians, his attorneys pointed out his three prior tours in Iraq and said he may have been suffering PTSD or traumatic brain injury. But as Dr. Charles Raison explained to CNN at the time, having PTSD is not the same as having a psychotic break. And research on the subject, which the Washington Post last year aptly described as “voluminous and inadequate,” tells conflicting stories about what trauma does do. On the one hand, veterans with a PTSD diagnosis are “two to three times more likely to be physically abusive” to their wives and partners, and three times likelier to get into fistfights. But as Paula Schnurr, deputy director of the Department of Veterans Affairs’s National Center for PTSD, notes, “The closer we get to trying to understand how PTSD relates to extreme violence, the more we get anecdotal.” And in a post on PTSD awareness by Public Health Service Capt. Janet Hawkins just last month, she wrote that “The relationship between PTSD and interpersonal violence is not well understood.”

Full story on PTSD and acts of violence at  Salon.com

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