Pilot Program Aims To Help Vets Live With TBI

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Posted on 30th October 2011 by Gordon Johnson in Brain Injury

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“Brain injury is … a lifelong condition.”

Truer words have never been spoken.

In this case, the quote is from Cynthia Boyer, senior clinical director for Bancroft NeuroHealth in Haddonfield, N.J. Her remark comes from a Page One story that The Star-Ledger of Newark published earlier this month on a pilot rehab program for veterans who have suffered traumatic brain injury (TBI). 

http://www.nj.com/news/index.ssf/2011/10/for_nj_vets_with_traumatic_bra.html

The article is about Bancroft NeuroHealth, which is one of 21 nationally accredited agencies that was awarded a federal contract this summer from the U.S. Department of Veterans Affairs to participate in a pilot program. 

The $23.5 million Assisted Living-Traumatic Brain Injury pilot program, according to The Ledger,  is trying to assist veterans adjust to life after their TBI, and to become self-sufficient again, to whatever extent they can.

Vietnam veteran Ronald Sharpe is profiled in the story. He survived combat as a Marine, only to return to the United States and years later get into a horrific car accident. Sharpe was in a coma for a few months, and when he came out of it he was blind “and the parts of his brain that enabled him to speak clearly, walk effortlessly and retain short-term memory were irreparably damaged,” according to The Ledger.

But under Bancroft’s rehab program, Sharpe got a job, was able to walk again and learned Braille. He lives in a group home now, and gets his rehab from Bancroft’s Cherry Hill facility.

Pilot programs like the one Bancroft is participating in are crucial in these times, when TBI has been described “the signature wound” of veterans of the wars in Iraq and Afghanistan.

Sharpe’s rehab includes classes on managing his finances; cooking classes; and speech therapy. The Ledger also reported that Sharpe lives in a home with three other people who have TBI, and he is doing well.

It would be great if this pilot program is deemed a success, and can made permanent to help vets with TBI. So far, so good.

In a sad footnote regarding Sharpe, The Ledger reported that he recently was diagnosed with prostate cancer. But he is still in good spirits. I wish him well.  

 

 

NFL Claims Its New Concussion Study Will Be More Scientific Than Prior Research

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Posted on 22nd October 2011 by Gordon Johnson in Brain Injury

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The National Football League’s next study of the long-term impact of concussions on players will be more expansive than its first effort, which was lambasted by Congress and independent physicians, according to The New York Times. In fact, one of the doctors leading the new research initiative joined the chorus of critics of the prior research.

http://www.nytimes.com/2011/10/04/sports/football/nfl-plans-more-scientific-study-of-concussions.html?_r=1&scp=1&sq=mitchel%20s.%20berger&st=cse

The Times, in a story headlined “NFL Plans Broader Concussion Research,” got its information from Dr. Mitchel S. Berger, a leader of the NFL committee and subcommittee on brain injuries. Berger is chairman of the neurological surgery department of the University of California San Francisco, and made his remarks at the 2011 Congress of Neurological Surgeons in Washington earlier this month.

Berger said that the NFL’s subcommittee on brain and spine injury has been conducting conference calls with the players’ union and is aiming to have a presentation ready for NFL Commissioner Roger Goodell soon, according to The Times.

The prior NFL research was led by Dr. Ira Casson, and Berger seems to echo what a Congressional committee believed about Casson’s work.

“There’s really nothing we can do with that data in terms of how it was collected and assessed,” Berger was quoted saying by The Times.

The new study will encompass 1,400 people aged 45 to 59, according to The Times. They will be divided into three groups: retired NFL players; those who only played college football; and a control group of non-athletes.

Berger explained that baseline tests for the three groups will be done, followed by exams every three years.

In addition, there will be a parallel study with three groups in the same categories as the subjects 45 to 59, but they will be older, 60 to 75, The Times reported. That parallel study will involve 400 subjects.

Goodell also addressed the surgeons’ convention, saying that nothing was more important to the league than the safety of its players. 

Let’s hope he’s telling the truth.          

Indie 500 Winner Dan Weldon Died Of Blunt Head Injury From Crash

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Posted on 19th October 2011 by Gordon Johnson in Brain Injury

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So it wasn’t the inferno of flames that killed Indianapolis 500 winner Dan Weldon when he was in the middle of a fiery 15-car pile-up last Sunday in Last Vegas. It was traumatic brain injury.

The Clark County Office of Coroner/Medical Examiner (CCOCME) performed an autopsy on Wheldon earlier this week, and ”determined the cause of death to be blunt head trauma due to motor vehicle collision,” according to a press release issued by the office.

“The manner of death was ruled accidental,” the release said.  

 http://www.clarkcountynv.gov/News/Pages/ClarkCountyCoronerDeterminesRaceCarDriver’sCauseofDeath.aspx

Wheldon was pronounced dead Sunday at 1:54 p.m. at University Medical Center in Las Vegas. 

The death of 33-year-old Wheldon, a popular figure with race fans and his colleagues, has sparked a debate about the safety of races such as the one at the Las Vegas Motor Speedway, where Wheldon was killed. Reportedly, Wheldon got caught up in a wreck that took place when two race cars touched tires and crashed.  

http://aol.sportingnews.com/sport/story/2011-10-16/dan-wheldon-dies-from-injuries-in-indycar-crash?icid=maing-grid7%7Cmain5%7Cdl1%7Csec1_lnk2%7C104830

There has been endless press coverage about racing safety issues in the media. NASCAR winner Jimmie Johnson immediately called for IndyCars to stop racing on ovals like the Las Vegas Motor Speedway, described as “a high-banked, 1.5-mile oval” by the Associated Press. Those cars should be limited to road courses, according to Johnson.

http://blog.syracuse.com/motorsports//print.html

Johnson pointed out the dangers: IndyCars have an open cockpit and open wheels “that can’t withstand the bumping that occurs on ovals,” according to AP; and these cars average 225 mph during these races.

“I’ve never been 225 mph in my life,” Johnson, a veteran race car driver, told AP.

The New York Times also wrote a detailed story on the dangers of IndyCar racing in a story with the headline “Worries Circles Las Vegas Track Before a Pileup.”

http://www.nytimes.com/2011/10/17/sports/death-of-phoenix-player-raises-questions.html?scp=1&sq=ridge%20barden&st=cse

IndyCar races on oval tracks such as the one in Las Vegas leave no margin for error. And racers apparently had apparently complained that the Vegas raceway had odd banking and angles, according to The Times.

“Drivers complained of not being able to find a smooth, safe driving line,” the paper wrote.

Weldon was lured to Las Vegas by the $5 million purse for Sunday’s race.   

The Las Vegas Coroner’s Office said that it  ”with permission from the Wheldon family will work closely with race officials, safety equipment personnel and the attending physicians to fully review this case in a continuing effort to help increase safety for drivers.”

Let’s hope there are some answers, suggestions that are heeded.   

  

 

Man Who Wrote Book, ‘My Life, Deleted,’ Accused Of Making Up Amnesia Claim

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Posted on 9th October 2011 by Gordon Johnson in Brain Injury

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It looks like Scott Bolzan, the Arizona man who wrote a book about the amnesia he suffered after a fall  — appearing on national TV shows such as “Good Morning America”  last week to tout it — may be a fraud.

http://www.nypost.com/p/news/national/memory_loss_is_hi_gain_gHTv07ubLO3cwLjCKygq7L

The New York Post reported Sunday that neurologists are raising questions about Bolzan, an ex-NFL player who just authored “My Life, Deleted.” Bolzan, who had been head of a plane company, claimed that after he fell and hit his head in 2008 in his office, he suffered long-term memory loss. For example, Bolzan said he couldn’t remember his own name or his wife and family.

According to the Post, one doctor who had examined Bolzan said that his story didn’t add up. First of all, Bolzan’s cognitive  functions seemed undamaged and he was able to have new memories, the Post reported. And secondly, Bolzan didn’t seem to have any continuing brain issues: He was able t do things like drive and play golf again.

The Post called on Dr. William Barr, the chief of neurology at New York University Langone Medical Center, and Dr. Manfred Greiffenstein to ask their opinions of Bolzan’s case.

Greiffenstein alleged that Bolzan’s claim that he could not remember old memories was a red flag.

“Old memories are more resistant to brain damage that fresh ones,” the neuropsychologist told the Post.

Bolzan sued the owner of the building where he fell for more than $1 million, but the records in that suit were sealed. And Bolzan’s business financial difficulties, with a half dozen lawsuits filed against it in the past few years.          

New York City Hit For $19 Million Of $36 Million Verdict For Youth Brain-Damaged In Bike Accident

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Posted on 9th October 2011 by Gordon Johnson in Brain Injury

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New York City is liable for $19 million of a $36 million verdict awarded to a boy bicyclist who sustained brain damage when he was hit by a car, the New York Post reported Sunday. 

http://www.nypost.com/p/news/local/brooklyn/jury_hits_city_for_K4dhuTynjmBPy8cWP9omZP

The city’s responsbility for $19 million would be the biggest legal award paid by the city ever, according to the Post.

New York City has moved to have the verdict set aside, claiming that the fact that it didn’t install traffic-calming measures on Gerritsen Avenue, where the accident took place, was not a factor in the incident that forever changed the life Anthony Turturro. He was 12 when he was sustained brain injury as a result of the accident, and is now 19.  

A Brooklyn jury awarded Turturro the $36 million on May 26, the Post reported. The panel determined that the city was 40 percent liable and that the driver that hit Turturro, Louis Pascarella, was liable for 50 percent. The jury that the victim was 10 percent responsible for the accident.

Turturro had been on his way home from Christmas tree lighting Dec. 4, 2004 when he was hit by Pascarella, who had a suspended license, and was driving a red Honda 55 mph in a 30 mph zone, according to the Post,

The youth was in rehab fot two years at St. Mary’s Healthcare System  in Bayside, Queens, “learning how to walk and talk,” according to the Post. He is now at Adelphi Academy, a school for the disabled, and has a guide dog that helps him stay balanced.

Pascarella pleaded guilty to felony reckless assault, and was sentenced to probation, the Post reported. 

An Examination of Axonal Function and Damage

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Posted on 7th October 2011 by Gordon Johnson in Brain Injury

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CircuitAxonCells are Like Electrical Connections:

The diagram  demonstrates the similarity (although of course on a much different scale) of the structure and purpose of a brain cell and that of an electrical connection. The cell body is similar to the switch. The axon is similar to the wires that connect the switch to the light socket and the terminal end of the axon (the spot where the nerve impulse leaves one cell and enters another), is similar to the end of the wire that connects to the light socket.

 

 

NeuronWiresAxons are Similar to Electrical Wires:

The axon is the part of the nerve cell that transmits the nerve impulse from one nerve cell to another, in a similar way that electrical impulse are transferred down a wire. Like a wire, if the axon is torn or broken, the nerve impulse will not be transmitted. And like a wire, axons may have insulation, which when it becomes damaged as a result of forces placed against the axon, may cause serious problems to the nerve cell, even if the axon is not actually torn.

 

For more information please see http://www.subtlebraininjury.com

Axonal Injury Without a Blow to the Head

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Posted on 6th October 2011 by Gordon Johnson in Brain Injury

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Diffuse axonal injury can occur without any direct impact on the head, as it requires only the condition of rapid acceleration/deceleration such as takes place in whiplash injuries due to acceleration/deceleration resulting in rapid flexion-extension movement of the neck.

However, the likelihood of significant diffuse axonal injury increases when the head hits something, such as a windshield, as the change in momentum is greater because of the sudden stopping of the head. But in a shearing mechanism, it is not the contact phenomenon which cause the injury, but the change in momentum.

The axons within the brain are long thin nerve fibers that may extend across different layers of the brain, from example the cerebral cortex (the gray matter – on the outside of the brain) to the subcortical region (the white matter – deep inside the brain.) As these different layers of the brain have different densities (weight), and are located at varying distances from the center of a given rotation, they will be accelerated and decelerated at different speeds when a whiplash mechanism occurs. This results in different layers of the brain, sliding across each other, which can put unnatural stress on the axons, which extend across these layers.

This sliding of brain tissue, is illustrated by the next two graphics:

Shear between layers of the brain Axonal shearing

The Structure of the Neuron

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Posted on 4th October 2011 by Gordon Johnson in Brain Injury

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The neuron is made up of several different components, but the portion of it which is most exposed to injury in a shear mechanism is the axon, the long thin protrusion which can extend substantial distances across different layers of the brain.

The primary role of a neuron is for information transfer, both from one end of the individual neuron to the other and from one cell to another. Transfer of information within a cell is called intracellular signaling and between cells, intercellular signaling. The intracellular signal begins at the cell body, runs down the axon, to the synaptic terminal end. The intercellular transfer is across the synapse, where the signal jumps from one cell to another.

The Role of the Axon: The role that the axon plays is roughly equivalent to the wire that connects a light switch to a light fixture. Like the wires in your wall, it may run substantial distances, as long as a full meter. Like a wire, it is thin. And like a wire, it transfers its signal by use of electrical impulses.

Axons are vulnerable. The axon is particularly vulnerable to injury when the brain mass begins to move as a result of rotational forces placed upon it, because it typically will stretch across layers of different density within the brain. When rapid acceleration/deceleration forces are placed upon the brain, the different layers, at progressively further distances from the fulcrum of the rotation will move at different speeds, creating a sliding effect of these different layers across themselves.

The effect of this sliding is that the axon is rapidly stressed beyond its tolerance, which may result in the axon being torn or stretched. Even if the axon is not entirely severed as a result of such force, it may be significantly damaged.. Again like the electrical wire, to protect the axon from damage and to assure that its electrical impulse does not stray from the appropriate channel, the axon is protected by insulation, called the myelin sheath.

NeuronUnlike electrical insulation, the myelin sheath is not a continuous covering, but is made up of a series of glial cells, laid end to end over the length of the axon. The glial cells resemble rolls of paper towels, with the glial material wrapped many times around the core tube of the axon. And just as if you were to line up a row of paper towels across a room, at each juncture between one glial cell and another, there is a small gap in the insulation.

These gaps, called the Nodes of Ranvier, also serve an important purpose, allowing energy to enter the axon to boost the electrical signal as it traverses the length of the cell.

The potential harm to the neuron and the brain when this insulation is damaged, is discussed at The Neuron, at page 27:

“This multiple membrane layer, which also happens to be unusually rich in lipid, insulates the axonal cytoplasm (the axoplasm) from the extracellular fluid. This means that the electrical current can flow across the axonal plasma membrane only at the nodes, and as we shall see in Part II, this has profound implications for the speed of transmission of electrical signals along the axon.”

In other words, when the the axons insulation is disrupted, the speed of information processing within the brain can be profoundly effected.

Source: Levitan & Kaczmarek, The Neuron, ©1997, Oxford University Press

For more information see http://www.subtlebraininjury.com

 

Diffuse Brain Injury

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Posted on 3rd October 2011 by Gordon Johnson in Brain Injury

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Diffuse brain injury can exist in four principal forms, although only three of these forms involve patients who have any chance of survival.

  • Diffuse axonal brain injury;
  • Diffuse hypoxic/anoxic/ischemic injury;
  • Diffuse swelling and
  • Diffuse vascular injury.

Of these four, diffuse axonal injury is the one that is gaining the most attention. Part of the reason for the focus on the axonal injury is undoubtedly its relationship in its less severe forms, to the sequelae of subtle brain injury. The consequences of diffuse hypoxic/anoxic/ischemic brain injury are often catastrophic, although the degree to which non-severe occurrences of these phenomenon result in subtle sequelae is an area on which future research may shed light. Likewise, the effects of diffuse brain swelling can span the spectrum of severity, with little being understood about the interplay of subtle changes upon long term symptomatology.

The problem in understanding the nature of the pathology of diffuse injuries, is that as these injuries typically occur on the cellular level, which makes them far too small to be seen except under a microscope. A microscope can only be used to examine cells of the brain after death, meaning that scientists rarely get to examine brain cells of those with documented concussion.

Advances in functional imaging have increased the speed at which neuropathologists can learn about the subtlely injured living brain and it is hoped that in the next several years, much will be learned about these pathologies and how to prevent their potentially disabling effects. Progress in MRI is occurring rapidly, and some MRI centers are now able to find evidence on MRI of diffuse axonal injury. (This evidence is of correlative petechial hemorages, which are indicative of a shearing injury.) As the software to interpret the digital data generated by the newer, more powerful MRI magnets improves, a substantial percentage of concussions which were difficult to “objectively” prove, may result in clear cut MRI abnormalities.

To understand why concussion can have permanent deficits, it is important to understand diffuse axonal injury. The first step in understanding axonal injury, is understanding the microbiology of the brain and its core cell, the neuron.

Source: Greenfield’s Neuropathology, ©1997, Arnold, page 20

For more information go to http://www.subtlebraininjury.com

 

Books On The Biomechanics Of Head Injury Released

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Posted on 2nd October 2011 by Gordon Johnson in Brain Injury

For those interested in nuts-and-bolts information on the biomechanics of head injury, the publisher SAE International has released a three-volume work on the topic.

‘Head Injury Biomechanics,’ Edited by Jeffrey A. Pike, is aimed at those studying head injury from a broad range of causes, including transportation, falls, sports, personal violence and blast-related.

http://www.sacbee.com/2011/09/27/3942117/sae-international-releases-new.html

Nearly 50,000 Americans die from brain injuries annually, with about half of all traumatic brain injuries (TBI) being transportation-related, according to the publisher. TBI is an ever-evolving safety topic, with equally important components of injury prevention, consequences and treatment.

This compendium, available as individual volumes or as a set, includes three volumes: “Skull Fracture”; “Brain Injury”; and “Mitigation.” Each volume includes a new chapter that ties together the various aspects of anatomy, injury, and injury mechanisms that set the stage for the technical papers that follow, which Pike selected from published literature.

There is also a common bibliography of more than 250 resources, as well as a table that organizes them by topic; e.g., transportation mode or sport.

Volume 1, “Skull Fracture,” focuses on head impact injuries and features 13 technical papers. These publications are primarily related to head impact and the resulting injury to the outside of the head — the skin, the bones of the skull, and sensory organs.

Volume 2, “The Brain,” features 13 technical papers that are primarily related to injuries to the brain, its surrounding membranes and its blood supply.

Volume 3, “Mitigation,” covers the application of protective strategies to various injury scenarios, such as passenger vehicles, sports, and blast injuries, or to a particular demographic group, such as children or seniors. This volume features 14 technical papers.

Pike is president of  Biomechanics Consulting Inc., which provides research, education, and forensic biomechanics consulting services. He has worked at Ford Motor Co. and taught at Wayne State’s Biomedical Engineering Department. He consults to various agencies, including the Centers for Disease Control, National Academy of Sciences, the National Highway Transportation Safety Administration, and state and local governments.

The tomes are not cheap. The entrie set of three is $199.95, or $159.96 to $179.95 for SAE members. Volume 1 and Volume 2 are each $99.95, or $79.96 to $89.95 for SAE members. And Volume 3 is  $119.95, or 101.96 to $107.95 fro SAE members.

SAE is a global association of more than 128,000 engineers and related technical experts in the aerospace, automotive and commercial-vehicle industries.