What is the best prescription for a traumatic brain injury (TBI)? It may be a pattern of uninterrupted sleep.
Brain concussions and the potential for long lasting effects of a mild brain injury are not always obvious to healthcare providers at the time of injury. But recent advances are being made to create tools and tests to assess the potential for long term post-concussion symptoms (PCS) in patients. This is particularly important because recent studies have shown that even mild traumatic brain injuries (TBI) can cause long term healthcare problems.
A recently published study at the University of Cincinnati involved the use of robotic tests to evaluate the risk of long term healthcare problems in ER patients with concussion symptoms. The tests (KINARM Standard Tests) tracked specific body movements and behavior, e.g., evaluating a patient’s “position sense” in relationship to arm movement. The study outcomes showed that the robotic tests, created by BKIN Technologies Ltd. in Canada, were able to “discriminate between subjects who developed post-concussion syndrome and those who did not.” It was evident in performance data that patients with poor results in “visuomotor and proprioceptive” were more likely to suffer from post-concussion syndrome. The short videos below demonstrate how test results differ between a healthy patient and one who has suffered a brain injury.
Currently the KINARM Labs are only available in research, but if additional studies support the results, robotic movement and behavioral tools may soon become available in emergency rooms to help predict long term outcomes for patients with mild traumatic brain injuries.
If you or someone in your family has had a concussive episode or other type of Traumatic Brain Injury (TBI), you should consult an experienced attorney to assess your eligibility for financial assistance from medical or other insurance carriers. Consultations are usually free and services are often offered on a contingency basis.
On August 10, 2011, United States Navel Petty Officer KY, age 26, was stopped in traffic on Route 206 in Bordentown, New Jersey, when her vehicle was rear-ended by a Ford 350 pickup operated by Mr. Avisai Pantle-Aguirre and owned by H&H Landscape Management, LLC. The force of the crash spun KY’s vehicle, causing it to collide with the vehicle stopped in front of her.
KY was initially diagnosed with having sustained a concussion and a neck injury. MRI’s of her brain, neck and low back revealed two small lesions in her left parietal lobe, three herniated discs in her neck and a bulging disc in her low back. Continue Reading
BlueCross BlueShield just released its Health of America Report showing that concussion diagnoses have increased 43% from 2010-2015. The rise was particularly marked in children and teens with a 71% rise in diagnosed incidences. Not surprisingly the rate in male patients during the fall season was double that of females. “Connecticut, Pennsylvania and Massachusetts had the highest rates of concussion diagnoses for patients 10-19. The study also reported an increase of 84% in post-concussion syndrome diagnoses with an interesting split–“more females then males ages 20-64 experienced post-concussion syndrome (61.3% vs. 38.7%).”
Some percentage of the increase could be attributed to a growing recognition of the long term impact of concussion, particularly the increased rate of suicide linked to the condition. However, it is disturbing that the concussion diagnoses increased in nearly every state from 2010-2015. The significant change raises questions on causation and indicates the need for more research.
In 2001, Teasdale and Engberg published an article in the Journal of Neurology, Neurosurgery and Psychiatry, entitled Suicide after Traumatic Brain Injury: A Population Study. The researchers reviewed data from Danish hospital admissions covering the years 1979-93 and found that patients who had sustained a TBI had an increased risk of suicide. The authors in that study concluded, “The increased risk of suicide among patients who had an MTBI may result from concomitant risk factors such as psychiatric conditions and psychosocial disadvantage. The greater risk among the more serious cases implicates additionally physical, physiological, and social consequences of the injuries as directly contributing to…suicide.”
In a recent research article, Lauren B. Fisher, et al. evaluated data from a brain injury-focused database, the BI Model Systems National Database, to further evaluate whether or not suicide rates are higher in TBI patients. Using patient health questionnaires detailing self-reported suicide attempts over a period of twenty years, the authors concluded that those who suffer a TBI are indeed at “greater risk for depression and suicidal behavior.” The outcome of the study indicates the need for “routine screening and mental health treatment in this population.”
An exciting new technology received FDA clearance according to a press release put out by BrainScope on September 26, 2016. According to the press release, BrainScope announced that the FDA has cleared the company to market the Ahead 300, “its most advanced medical device for use in assessing traumatic brain injury.” The product was developed in partnership with the US Department of Defense.
According to the release, 95% of people who go to the emergency room have mild symptoms. These are not always diagnosed as a concussion or Traumatic Brain Injury (TBI.) As we discussed in other posts even mild concussions can cause long term effects in injured patients, particularly children. The Ahead 300 advances diagnosis of TBI using proprietary smart phone and electroencephalography (EEG) technology. It allows for fast indication of TBI so that treatment can be administered immediately in the ER or at the doctor’s office. The tool also provides “clinicians with a digitized, streamline report delivering a comprehensive an objective panel of results to facilitate their differential diagnosis.”
On Monday, September 26, 2016, I had the pleasure of giving a presentation entitled “Dispelling the Myths of a Mild Traumatic Brain Injury: All Traumatic Brain Injury is Serious.”
My presentation addressed 10 myths surrounding Mild Traumatic Brain Injury, such as concussions are not serious, everyone recovers from mild TBI, mild TBI is not permanently disabling, one does not need to lose consciousness, and conventional neuroimaging is sensitive to mild TBI. The three day event in Nashville brought together some of the country’s leading trial attorneys and medical experts who presented on a myriad of medical and legal issues surrounding the preparation of a TBI case.
The symposium was sponsored by the Brain Injury Association of Tennessee and the Tennessee Trial Lawyers Association.
The theory of neuroplasticity holds that the brain will change and adapt to different conditions including to childhood injuries. This theory is often challenged and sometimes referred to as a “myth.” However, a new study by Seena Fazel and colleagues from the Department of Psychiatry at University of Oxford in the United Kingdom delivered data that supports the claims of neuroplasticity theorists. Fazel’s conclusions reveal that the later a mild TBI is sustained, the worse the health and social outcome is for the patient. The study also found a causal effect between childhood Traumatic Brain Injuries (TBIs) and the risk of brain impairment and social dysfunction at later stages in life.
Brain tsunamis are seizure-like waves of electrical activity in the brain caused by Traumatic Brain Injuries (TBIs) and strokes. Much like a tidal wave in the ocean, brain tsunamis build power, wash through the brain, and subside, leaving behind a path of destruction. The waves exhibit electrical signal voltage up to ten times that of normal causing changes to chemistry balance, blood flow, and transfer of oxygen through the brain. During the ebb of the wave, they also cause the brain to short-circuit as evidenced by a period of “dead air” in audio recordings. Doctors have been able to track the process of brain tsunamis for several years but only recently have been able to identify the extent of damage.
A new study published in the Journal of Head Trauma Rehabilitation calls into question whether acute cognitive and physical rest improves concussion recovery times. Thomas A. Buckley, EdD, ATC of the Department Kinesiology and Applied Physiology at the University of Delaware conducted a study to determine if rest after concussion would result in a shorter recovery time in a population of college-aged student-athletes.
This hypothesis was based on the 4th International Consensus Statement on Concussion in Sport which recommends rest after injury as “a corner stone for acute concussion treatment” and outcomes. The authors noted that “rest” was achieved by discontinuing “school attendance, academic work, electronics usage and [any] exercise.” Prescribing rest was also believed to reduce the risk of repeated concussion and the “rare, but potentially fatal, second-impact syndrome.”