Brain Injury Blog

Prisoners suffer disproportionately from past traumatic brain injuries. Researchers are hunting for the best tools to treat this population in an effort to help them reintegrate into society–and avoid re-incarceration

HITTING PRISONERS HARD

Traumatic brain injuries, including previous concussions, affect a disproportionate segment of incarcerated adults and might be to blame for behavioral issues and many cases of re-arrest.

A car accident, a rough tackle, an unexpected tumble. The number of ways to bang up the brain are almost as numerous as the people who sustain these injuries. And only recently has it become clear just how damaging a seemingly minor knock can be. Traumatic brain injury (T.B.I.) is no longer just a condition acknowledged in military personnel or football players and other professional athletes. Each year some 1.7 million civilians will suffer an injury that disrupts the function of their brains, qualifying it as a T.B.I.

About 8.5 percent of U.S. non-incarcerated adults have a history of T.B.I., and about 2 percent of the greater population is currently suffering from some sort of disability because of their injury.  In prisons, however, approximately 60 percent of adults have had at least one T.B.I. and even higher prevalence has been reported in some systems. These injuries, which can alter behavior, emotion and impulse control, can keep prisoners behind bars longer and increases the odds they will end up there again. Although the majority of people who suffer a T.B.I. will not end up in the criminal justice system, each one which does costs states an average of $29,000 a year.

With more than two million people in the U.S. currently locked up—and millions more lingering in the justice system on probation or supervision—the widespread issue of T.B.I. in prison populations is starting to gain wider attention.

A few pioneering programs offering rehabilitation to prisoners—and education to families and correctional staff about T.B.I. are underway around the country. And several studies aim to ascertain the best ways to handle this huge population. “It’s not as cut-and-dry as a lot of people think,” says Elisabeth Pickelsimer, an associate professor at the Medical University of South Carolina. Some of the best options so far include cognitive therapy for prisoners and education for the people around them. The kicker seems clear to many researchers: “If we don’t help individuals specifically who have significant brain injuries that have impacted their criminal behavior, then we’re missing an opportunity to short-circuit a cycle,” says Peter Klinkhammer, associate director of services at the Brain Injury Association of Minnesota.

ONE HARD KNOCK
Concussions are the most common type of brain injury, and about 85 percent of people who suffer one will more or less fully recover within a year. But for those who do not, lingering symptoms, such as headaches or increased irritability, can get in the way of everyday functioning. Many of the behavioral issues that result from a T.B.I. are due to the nature of the impact itself. In an accident or altercation, the brunt of the blow is often borne by the front or top of the head—right around the frontal lobes where behavior is regulated

One of the big challenges in addressing T.B.I. in prison populations, and beyond, is that it is not as easy to diagnose as a broken bone or a blood-borne illness. Symptoms are by no means unique to the injury and can be co-occurring with other mental health conditions. To make things even tougher for those hoping to track the disability, no two brain injuries are alike. “Two people can have the same injury and have a totally different set of impairments,” Gordon says. “One can be fine, and one can be not so fine—but we don’t know why that is yet.” He suggests that differential responses could be due to a combination of physical, genetic, contextual and social factors, such as skull thickness, the magnitude of g-forces involved in the impact or past history of more minor, sub-concussive injuries.

Due in part to these variables, not all T.B.I.s result in a medical paper trail. Doctors treating people with serious wounds might miss diagnosing a brain injury, and hospitals do not always code for every presenting condition. Also, many people who suffer a head injury, especially a milder one, such as a concussion, might not seek medical attention at all.

Researchers have started using detailed interviews with prisoners to get a better sense of how many have suffered from a brain injury. In a recent South Carolina survey of 636 prisoners, some 65 percent of males and 73 percent of females reported having sustained TBIs at some point in their lives. Injury counts are likely underestimated. Many people, for example, are unaware of injuries that they might have sustained when they were babies or young children. And even adulthood injuries were not entirely clear to prisoners. “They were told they had their bell rung—they got knocked out,” says Rebecca Desrocher, assistant program director at the U.S. Department of Health and Human Services’ Federal Traumatic Brain Injury Program.

The very nature of brain injuries can also make tracking them—and figuring out how many an individual might have suffered—especially difficult. As Pickelsimer points out, “after you’ve had some, you don’t remember them as clearly.” These injuries are additive, with each assault to the brain compounding damage from the previous ones. The average reported number of T.B.I.s for an individual prisoner was about four, Pickelsimer says. And some reported up to a dozen.

Through these interviews, Pickelsimer says, another thing became clear: prisoners were often not aware that a single event—or a series of them—could be making it harder for them to earn a ticket out of jail, or avoid being sent back in the future.

BAD BEHAVIOR As much as T.B.I. seems to increase the likelihood that a person will wind up in prison, it also seems to make the corrections environment that much more difficult to navigate. In prison, “there’s so much that goes on a day-to-day basis: ‘Line up over here; do this; do that,’” says David Maltman, a policy analyst at the Washington State Developmental Disabilities Council. When a prisoner with T.B.I. is misremembering rules or is slow in responding to instruction, many prison staff are likely to see a prisoner as noncompliant or intentionally defiant, provoking situations that can lead to further injury—or at least poorer chances at an early release.

Brian injury also increases the likelihood that people will have other mental health troubles, including substance abuse, and can also make it more difficult to overcome additional conditions. In a survey of adults enrolled in a New York State substance abuse program, about half had a record of T.B.I., Gordon says. The screening that Pickelsimer and her colleagues have done in South Carolina found that for both men and women, alcohol and crack cocaine were among the most common substances to which T.B.I. prisoners were addicted. And these habits can cloud a person’s memory of brain injuries they might have suffered in accidents, altercations or other incidents, which makes accurate diagnosis even more challenging. For those getting substance abuse treatment, a T.B.I. can also make traditional rehab programs less effective. With the “reduced processing speed and their memory challenges,” Gordon says, lessons might need to be altered or even repeated for enrolled prisoners with a history of T.B.I.. The behavioral and other cognitive changes that T.B.I. can bring, “if left unaddressed, are apt to provide challenges to the offender post-release as they attempt to reintegrate into their respective communities,” notes Adam Piccolino, a neuropsychologist for the Minnesota Department of Corrections.

BRIDGE TO THE OUTSIDE Treating T.B.I. in the broad adult population is not a perfect science. The goal is to “supply them with skills they need to better regulate their behavior and process information,” Gordon explains. It often involves cognitive retraining and rehabilitation—and has imperfect results. And as he points out, these therapies have yet to be thoroughly tested on incarcerated populations. Others argue that tools that seem to work in the broader population should be used in prisons as well. Cognitive rehabilitation therapy is one such tool that seems to be gaining traction in the T.B.I. field. It aims to help those T.B.I. sufferers make better-informed choices and to improve memory. And with such minimal knowledge about T.B.I. and its symptoms, simply educating inmates about their—and others’—condition might go a long way in helping them cope with related challenges, Desrocher says.

Even with proper education and therapy, though, people with T.B.I. will often experience behavioral issues. So many groups have put an emphasis on training staff—and even arresting officers—to handle these sorts of prisoners better in hopes that they “can recognize a behavior for what it is—and not defiance of an infraction of the rules,” Maltman says. Resulting altercations can put law and corrections staff—and fellow prisoners—at risk for injury. But knowing which prisoners might benefit from alternative approaches requires thorough screening processes that are either highly variable across institutions or entirely absent. “Additionally,” Piccolino notes, “once an offender is identified with having incurred a T.B.I., the process of knowing whether they also experience ongoing complications related to their TBI is challenging.”

Some organizations, such as the Brain Injury Association of Minnesota, have gone a step further and are also working with prisoners’ family members, probation officers and outside support services to ready ex-convicts for release. Klinkhammer notes that for prisoners with T.B.I., returning to the outside world can be an extremely difficult transition. Once predictable prison routines disappear, he explains, it’s almost like Dorothy going from her black-and-white reality in Kansas to the colorized world in Oz. Although that shift might sound like a blessing, for those with a brain injury who have difficulty managing their reactions or processing a lot of incoming information quickly, the new environment can be too much. “It can be very overwhelming, and it could result in one or more reason for a person to ‘recidivize’”— do something that will land them back in jail, even if they had no intention of breaking the law— Klinkhammer says.

Much of his group’s efforts come down to education and helping family and other community members learn how to support a prisoner with T.B.I. returning to the outside world. And oftentimes just explaining to them that an old injury might be contributing to unpredictable behavior is a big help. “People know that their loved one’s been knocked out” or were in a car accident years before, Klinkhammer says. “But the thought that the outcome of that may result in disinhibition or that it could be an aggravating factor to a person’s criminal behavior gets lost.” The group does not yet have formal data on the success of the program, but from his observations, Klinkhammer says, “individuals are doing better when they are able to dovetail back into society in a way that they’re supported.” The key is “making sure that when people step out into the community they’re not falling into an abyss,” he says. And “in doing that, we’re also helping society at large stay safer.”

EARLIER INTERVENTION Once a person with T.B.I. is behind bars, arguing for a chunk of shrinking budgets to help them out is not always an easy sell. In South Carolina, for example, once a person is identified as having T.B.I., the department of corrections is obligated to provide extra resources for them. “It’s cheaper for them to just lock them up,” Pickelsimer says. In her estimation, “the intervention has to be when they are much younger”—before they commit a crime, by encouraging teenagers to stay in school and not have children until they are prepared to provide and care for them. By doing that, she says, the next generation will be less likely to fall into a cycle of injury and crime.

Gordon would extend this early intervention to screening, too. In his research on T.B.I. in substance abusers, participants who had multiple brain injuries tended to be in their 30s. But, he says, “the average age when they had their first injury was 14.” If their injury had been identified—and they had received any necessary assistance—earlier, future substance abuse and behavioral issues might have been avoided altogether. This, he says, is an example of “using screening and identification as prevention—and what you’re preventing is social failure.” That social failure due to T.B.I. is not limited to the corrections world, he notes: “In any group of folks who are failing—substance abuse, the hardcore unemployed—I would say, the prevalence of T.B.I. is very high.” Early diagnosis does not necessarily require expensive intervention, he says.

Treatment for those already in trouble can also start younger. An experimental program in El Paso, Texas, adapted a T.B.I. cognitive treatment program for juvenile offenders. The goal was “to try to teach them how to be in touch with their own sensations and activities so they can learn to stop and think before they act—and then consciously choose a choice and evaluate whether that was the right choice,” Gordon explains. When administered to kids—both those who had a history of T.B.I. and those who did not—there was a fivefold reduction in recidivism, he reports.

The Traumatic Brain Injury Act of 1996 carried provisions to help reduce the incidence of T.B.I. and improve psychological treatment, and in 2000 it was expanded to include education about prevention—especially to parents. A 2008 reauthorization of the act added a mandate to study T.B.I. prevalence among institutionalized populations, which includes prisons but also nursing homes and other institutions where people reside. But studies have been slow to materialize. Minnesota is currently assessing data from their prison population to determine how much T.B.I. affects substance abuse treatment completion, use of medical and mental health resources, and rates of recidivism.

One of the first steps to better understanding T.B.I. in these populations, however, is to boost screening—as well as ensure that such monitoring is scientifically sound and widespread. And just demonstrating the value of screening might take years, Desrocher says. Her hope is that down the road, the data show that it is “not only of clinical value for the individual—but also a value for society.”

Source: Scientific America 02.04.2012

A SPECIALLY-made recumbent tricycle has given Tasmanian acquired brain injury sufferer Dave Lewis his independence back.

So this year, the 30-year-old is planning to ride around Australia to help other people with disabilities, particularly young people who may be forced to live in nursing homes.

Today, Mr Lewis sets out on a ride around Tasmania, in preparation for his 17,000km Down Low Down Under ride around Australia, due to begin in May. The ride will be a special achievement for Mr Lewis, who eight years ago was involved in a motorcycle crash in Queensland.

After a 42-day coma and 131 days of post traumatic amnesia, came a long period of rehabilitation.”Without the rehabilitation I received, I wouldn’t be where I am now,” he said.

Mr Lewis’s father, Rob, said his son wanted to raise money for and awareness of the plight of brain injury victims, and other disability sufferers.

To follow or donate: downlowdownunder.org or “like” the Facebook Down Low Downunder Facebook page.

Source: The Mercury.com  02.01.2012

Over the weekend it was learned that Sidney Crosby was diagnosed with an apparent neck injury involving the C1 and C2 vertebrae, an injury that went unnoticed until Crosby sought second opinions from doctors in Utah and California.

While great strides have been made to diagnose concussions, little attention has been paid to the neck, which can take substantial stress from head trauma. We spoke with Dr. David Harper, a chiropractor and director of Mosaic LifeCARE & SportsCARE Institute in Toronto for insight on Crosby’s injury and its possible relationship to concussions.

Q: What are the C1 and C2 vertebrae?

A: The C1 and C2 are the top two cervical vertebrae in the neck, right under the base of the skull, and they’re the most different of all of the vertebral segments within the spine. The shape of them, the arrangement, the type of bones that they are -  they are the most dynamic. The rest of the spinal vertebrae are similar except for size. There’s a typical style of what the vertebrae looks like as a bone, but the top two are the most unique compared to the rest of the spine.

Q: What does that mean for people who have their C1 and C2 vertebrae injured?

A: There’s a lot of activity up there, there’s a lot of neurology, there’s a lot of muscularity, there’s fine small muscles that help to manage rotation of the head, which is where a lot of the rotation in your neck occurs. And as the head rotates on the neck, a lot of it happens in that upper cervical area. It’s a very charged area with unique dynamics. The cord comes out of the skull from the brain at that area. There’s a lot of joint receptor feedback in that area of the spine that help with balance and perception of body motion, and knowing where the body is in space. There are nerve centres in that region that affect vision and hearing and other functions called the cranial nerves that may also experience impact.

Q: Could you see a relation between a neck injury and concussions?

A: A concussion injury has traditionally been restricted to comments around the brain. In my opinion, a head injury is never unique to the rest of the spine. There’s a cascade of stress that can happen down the spine. Nothing is not connected — everything is interconnected. It’s not unique and separate. You can’t take the head off the spine, give it a whack, put it back on and say you’ve just got a head injury. You can’t have one without the other. This has been my contention in clinical practice when I work with young athletes, because, while you can have a concussion to the brain, what has been ignored until now has been the relationship to the whiplash that occurs in the neck when the head gets contacted and then abruptly stopped in any form.

Q: What kind of problems do neck injuries create?

A: It can be dizziness, it can be challenges in balance, it can be neck pain, it can be headaches, it can be consequences to any of the cranial nerves, vision. It can be any of those.

Q: Those sound a lot like concussion symptoms.

A: They can, and this has been the challenge. In my clinical practice, we have a difficult time trying to communicate that because it’s difficult to see the neck. You can’t see it because it’s inside your skin, but it’s completely consistent with brain injuries because it’s all part of the cord. It’s all part of the central nervous system.

Q: Have there been any substantial links to spinal injuries and concussion in your practice?

A: I haven’t seen any research on that, to tell you the truth. I just know that clinically when I have a young athlete — which is typically my passion area — I don’t distinguish between there being one or the other. It’s a complete neck-head injury complex. You can’t have one without the other, in my mind. That’s the way I treat it clinically, and that’s the way I’ve been trained to treat it.

Q: What’s the healing timeframe for an injury like that?

A: It depends on the person, and it depends what the injuries are. I mean, there are ligaments that hold your neck together. There are ligaments that hold your skull onto your spine, and just like you can have a ligament injury in the knee with knee trauma, you can have an injury to the ligament in neck trauma. For the longest time I’ve been trying to challenge very different communities to consider such a technology as dynamic motion X-ray, which I don’t have, but I have samples of it and it’d be a dream to have it in my clinic. But dynamic motion X-ray demonstrates ligament weaknesses and fractures that cannot be seen all the time with MRIs, CTs and X-rays.

Q: What can happen if it heals incorrectly?

A: Like everything else, it affects optimal performance. If a fracture doesn’t heal correctly it affects the performance of that area that’s been fractured.

Source: CBC.CA 01.31.2012

Brain Injury Awareness February 2012 Poster Message “ Protect Your Noggin When You Toboggan “ Wear a Helmet has been co-created by Caroline C. age 9 of Ontario, Canada.

Caroline and BRAININJURYFORUM.com co-created this month’s (February 2012) poster message to help support the continuance of raising greater awareness about the impact of a preventable brain injury, the long term affects and challenges after the injury.

Caroline wishes to share this message with other kids her age and older as well as with parents about the importance of protecting the head and brain from injury regardless of what sport or recreational activity you are partaking in. A special thanks to Caroline for her interest and participation with this month’s poster message.

To preview the poster: http://www.flickr.com/photos/braininjuryforum/6802206031/in/photostream

To learn more about how you can spread and share the various messages or in to use any of our posters messages in your community or local arena or schools – please email us our Media Relations Manager at admin@braininjuryforum.com

Skiing, snowboarding injuries more common than hockey mishaps

Ryan Condon still wishes he had worn a helmet while snowboarding with friends four years ago. The 20-year-old was in Grade 11 when he was cut off coming down a hill at Brookvale Provincial Ski Park, then falling and being struck in the head by a friend.

Condon, who was 16 at the time, was rushed to a hospital in Moncton and went through more than two hours of brain surgery. While he’s regained most of his mobility, except five per cent usage of his right hand, Condon can’t play contact sports again.

Another head injury would likely mean more brain surgery or death. “If I had’ve worn a helmet that night, it (the injury) wouldn’t have been nearly as severe,” said Condon during an interview with The Guardian. Hockey is often portrayed as Canada’s most dangerous winter pastime, with a recent focus on head injuries such as concussions.

The high profile concussions suffered by Sidney Crosby and other elite NHL players have focused media attention on hockey injuries, but the facts indicate snowboarding and skiing pose much more of a danger to Canadians.

A study published by the Canadian Institute for Health Information suggests that a family trip to a ski hill is more likely to end in injury than lacing up skates and stepping onto an ice surface.

The study showed that 2010-11 saw 2,329 hospital admissions in Canada relating to a skiing or snowboarding fall or crash, about twice as many as the 1,114 hockey-related hospitalizations.

Half of those who suffered hockey injuries and about a third of the skiing and snowboarding injuries were ages 10-19, with most in the age group being boys.

There were 415 Canadians hospitalized with head injuries in 2010-11 relating to a winter sport or recreational activity, a number that has been pretty consistent since 2006-07.

Nearly a third of those head injuries occurred while skiing or snowboarding. Allan Matters, superintendent at Brookvale, said that he has seen injuries decline at the hill, as well as helmet use increase, since stepping into the position five years ago. “I would say it (injuries) has gone down,” said Matters during an interview with The Guardian. “There’s a lot more people wearing helmets. We’re up around 80 per cent (of users who wear helmets).”

It would be no surprise that helmet use has increased at the province’s only ski hill during the past four years. Much of that would be from Condon’s high-profile injury, as well as promotion by the park itself and the P.E.I. Brain Injury Association.

Condon himself has pushed for helmets to be made mandatory at the park through legislation.

“You’re going down a hill moving at a high rate of speed and you should protect your head. It just takes one little mess-up,” said Condon, who added that he hadn’t realized the importance of wearing a helmet before his own incident.

“If it didn’t happen to me, I still probably wouldn’t be wearing a helmet,” said Condon, who added that he hasn’t hit the slopes since the accident. The reason many provinces across Canada, including P.E.I., haven’t made helmet use mandatory is because of the lack of helmets made up to the CSA standard.

While the Canadian Standards Association did announce a skiing and snowboarding standard in March 2009, manufacturers have yet to make a helmet up to the standard. Many companies instead make helmets to meet American and European standards or self-regulate.

Despite the lack of CSA approved helmets, the Nova Scotia government announced plans last month to make helmets mandatory in the 2012-13 skiing season. The law would see skiers who don’t comply facing a $250 fine. That law has come under criticism by some, including in an editorial written and published by The Chronicle Herald.

Kenneth Murnaghan, President of the Brain Injury Association of P.E.I., helped promote helmet use last year by convincing Brookvale to start putting up signs encouraging individuals to buckle up.

Murnaghan has pushed for legislation making helmet use mandatory but wasn’t as convinced during a recent interview with The Guardian, saying that promoting safe helmet use was a better option.

“I don’t really know if that’s the right thing to make it mandatory. Some people are for it and some are against it,” he said. “The important thing is that they (Brookvale and the government) do promote helmet use.”

That’s one thing Brookvale has been doing. In addition to the association’s posters, helmets are offered with all rental packages and strongly promoted by staff, said Matters.

“We recommend that everyone wears one,” he said. “In the snowboard park it’s mandatory (to wear one), as well as in our lessons.” “It’s just another piece of your gear to protect yourself.”

Source: The Guardian PE 01.22.2012

Study: Recovery Plateaus, Then Gains Ground; Recovery Toughest for Severe Injuries

Jan. 24, 2012 — Serious head injuries in kids can affect development for years, and parents worry their child may never recover fully or get worse.

Now, Australian researchers who followed a small group of children for 10 years after head injuries from falls or car accidents have some answers.

They find, not surprisingly, that severe brain injury is associated with the poorest recovery.

However, they also find an ”injury threshold” beneath which children with less severe brain injuries may escape serious problems. They make developmental progress, although they may never catch up entirely with peers.

Environment matters in recovery, says study researcher Vicki Anderson, PhD, professor of pediatrics and psychology at the University of Melbourne.

“After injury, we can improve outcomes by optimizing the child’s environment,” Anderson tells WebMD. For instance, a stimulating home environment helped pave the way for a better recovery, says Anderson, who is also director of critical care and neuroscience research at Murdoch Children’s Research Institute at Royal Children’s Hospital.

The study is published online in Pediatrics.

Head Injuries in Kids: Study Details

About 1 in 30 newborns will have a traumatic brain injury by age 16, some researchers have found. Researchers also know that the impairments after these injuries persist until at least five years after the accident. However, less is known about which factors matter for recovery.

In this small study, Anderson’s team evaluated 40 children who had a traumatic brain injury. The accidents happened when they ranged in age from 2 to 7. They divided them into three groups depending on how bad the injury was:

· Seven had mild injuries.

· Twenty had moderate injuries.

· Thirteen had severe injuries.

A mild injury often results from a fall, Anderson tells WebMD. Motor vehicle accidents are a leading cause of severe brain injury.

The researchers compared the children with brain injuries to healthy children without them. At the study start, this comparison group had 32 children. By the 10-year mark, the comparison group only had 16.

They tested the children on several measures, including their IQ, thinking skills, and social and behavioral skills. They also measured their adaptive ability — such things as their response to daily demands and any learning difficulties.

They tested them after the accident and again after 12 months, 30 months, and 10 years.

Head Injuries in Children: ‘Kids Begin to Do Better’

As expected, those with the most severe injuries had the worst outcomes.

These severely injured children had problems with thinking skills especially, Anderson says.

Their IQ was affected, too. Those who had severe accidents had an IQ at the 10-year follow up that was at the lower end of average or low-average. Compared to the healthy children, their average IQ scores were 18 to 26 points lower, the researchers found.

Whatever the severity of the injuries, the children appeared to need time to recover, Anderson found. The recovery ”trajectories” plateau from five to 10 years, she says.

After that, the children stabilize and can make gains. This suggests that continued treatment can help, even many years later, Anderson says.

Although this was a relatively small study, the findings are different from what was previously thought.

The study results are at odds with some common beliefs. Many experts believe that children who suffer these brain injuries get worse as time goes on, Anderson says. Not true, she tells WebMD.

“The negative effects of these injuries stabilize after about two or three years and the injured kids begin to do better but never catch up to their healthy peers,” she says.

Being in a family that is psychologically healthy was linked with better outcomes, Anderson found.

Head Injuries in Kids: Suggestions for Parents

The study provides valuable information, says Doug Johnson-Greene, PhD, MPH, associate professor, director of neuropsychology, and vice chair of rehabilitation medicine at the University of Miami Miller School of Medicine. He reviewed the study findings for WebMD.

The new research has a longer follow-up than most studies, he tells WebMD. It also includes very young children, while other research has not.

For a long time, he agrees, the prevailing wisdom has been that recovery after childhood head injuries is never fully complete. It’s often said that kids ”grow into their impairments,” Johnson-Greene says. “That’s a fancy way of saying [the impairments] become more obvious.”

The bottom line from the new research? ”A head injury does not inevitably imply that your child will have impairments forever. This provides some added evidence that impairments may not be as persistent as we once thought,” he says.

The research does reinforce what experts have believed, that the more severe the head injury, the tougher the recovery to normalcy, he says.

But parents can help their child, Johnson-Greene says, by asking for appropriate treatment from a board-certified neuropsychologist.

Providing the child with a stimulating and mentally healthy home environment can also help, he agrees. To do that, parents can schedule family outings and play board games with their children, among other activities, he says.

Patience is key, he tells WebMD: “For most head injuries, except mild ones, we talk about recovery that more commonly takes years as opposed to months.”

Source: WebMD 01.24.2012

Sarah Burke’s Death Reminds Skiers to Take Precautions Against Head Injuries

Fans were stunned with the news of X Games star Sarah Burke’s death. (See my article, “Olympic Favorite Sarah Burke Dies at 29 following Training Accident”) Burke died following a skiing accident in Utah on January 19th. Burke crashed, causing her vertebral artery to rupture. The ruptured artery triggered cardiac arrest and Burke’s brain was deprived of blood and oxygen, causing the irreversible brain damage that lead to her death. Burke died in a Utah hospital and her organs and tissues were donated as she had willed prior to her death. Burke was only 29-years-old at the time of her death.

Skiers are re-evaluating safety

Skiers everywhere are re-evaluating the safety of the sport as well as the precautions that skiers can take to prevent injuries. Despite claims that Burke’s accident was a “isolated incident” spectators are beginning to doubt the safety of free-skiing, however, as the International Ski Federation has stated, a skiers safety is ultimately the responsibility of the athlete. Athletes engaging in extreme sports such as free-skiing are well aware of the risks, but are also highly skilled in the sport. (See my article, “Skier Sarah Burke’s Death: A Safety Reminder for Winter Athletes”)

Preventing head injuries while skiing

The number of hospital emergency room visits resulting from skiing dropped from 114,400 to 84,200 between 1993 and 1997, most likely due to improvements in skiing equipment and safety gear. Even with these improvements in technology, it is important for skiers to take steps to protect themselves from injury.

Skiers should always use the correct equipment in the correct size. Equipment that does not fit properly can pose a safety hazard. Skiers should also recognize their own limits on the slopes and never try to ski beyond their own abilities. Skiers should never ski alone and should always use the buddy system to make sure someone will be there to help if an injury occurs.

Don’t forget a helmet

Although it is common for skiers to ski without a helmet, using a helmet while skiing has been shown to reduce the risk of a brain injury by up to 80%. Most professional skiers, such as Sarah Burke, wear helmets while competing, but many non-professional skiers fail to wear a helmet while on the hills. In recent years, the government has attempted to promote the use of helmets among winter athletes. It only takes one injury in a split second to cause irreversible brain damage and even death. Skiers of every skill level and ability should wear a helmet each and every time they hit the slopes.

*Samantha Van Vleet is a former high school athlete. She grew up in Alaska and has a special love for winter sports.

Source: Samantha Van Vleet – Yahoo Contributor Network 01.25.2012

In Canada and around the world, concussions resulting from accidents at home, play and work, auto collisions involving animals and/or vehicles, and infant and senior falls, are receiving increasing attention.

Concussions can elicit affective, neuropsychological, psychological, and physiological symptoms, social effects, and can cause enormous economic impacts. For many victims, the impacts of concussions are devastating, and each individual’s recovery is unique; return-to-play, school or work may take minutes to months to even years. Unfortunately, many research questions regarding concussions remain unanswered, impacting our ability to recognize, diagnose, treat, manage, and even prevent concussions. Regardless, Canadians suffering from concussions, their families, and their caregivers deserve increased support.

Over the past year, we’ve been developing a Private Member’s Bill proposal on a Comprehensive Strategy to Address Concussions in Canada with Member of Parliament Dr. Kirsty Duncan.

We are also grateful to have received valuable and helpful advice, input, and feedback from MP Dr. Kirsty Duncan, Executive Director Harry Zarins of the Brain Injury Association Canada, Dr. John Tucker of Chiropractic Canada, as well as various stakeholders involved in the area.

Our bill proposal aims to translate concussion research into a practical, comprehensive strategy that the Government of Canada can enact to protect all Canadians. It is designed to address acquired brain injury (ABI) in Canada in order to improve recovery, as well as the quality of life for those living with this ABI. At the same time, it also focuses on preventing these injuries from occurring by implementing education and awareness programs to help reduce risk. These awareness initiatives target a broad range of populations, including sport and occupational populations, as well as adult and paediatric populations, in order to better help as many Canadians as possible.

Specifically, our bill proposal makes the following recommendations: a National Concussion Awareness Week; a National Strategy to Address Concussion in Canada focusing on prevention, diagnosis, management, and a government-initiated board; and a Centre for Excellence in Concussion Research.

The bill proposal is currently in the drafting stage, and we are excited as it progresses forward to the next steps.

Our ultimate goal for this Private Member’s Bill proposal is to improve prevention, awareness, management, and diagnosis of concussions in Canada. We look forward to moving our strategy further to achieve this goal and ultimately helping all Canadians who suffer from concussions, their families, and caregivers.

Source: Sandhya and Swapna Mylabathula 01.24.2012

Healthy aging clinic helps patients stay mentally fit

At the Healthy Aging and Memory Clinic’s Brain Gymnasium, computers are just as important as exercise bands for staying fit. The idea is that cognitive activity, followed by physical activity, will help maximize and maintain brain wellness. It’s one of the latest research concepts the West Des Moines clinic has put into practice, said Dr. Robert Bender, medical director of the nonprofit center formed in 2006 to provide services related to Alzheimer’s disease, dementia and diseases of the aging.

In Bender’s 30 years as a geriatrician, the most significant advancement he’s seen relates to neuroplasticity — the brain’s ability to grow. Previously, the thinking was that the brain was relatively fixed.

“Now we know that’s not true. We know we get new brain cells every day until the day we die. We know very definitely that the brain changes every day,” he said. Taking advantage of that concept as well as new medications can help slow the progression of dementia, Bender said.

The center uses a few key concepts in its treatment plan:

A Mediterranean diet, which is low in fat and provides high antioxidant levels.

Stress reduction.

Physical exercise, coupled with cognitive activity.

Socialization.

Meditation.

“Each of the pieces of brain wellness are important, but they seem to do better when they’re all put together and used as a whole,” Bender said. The concepts are emphasized at The Mather Brain Gymnasium, named after a patient who showed remarkable progress during a study pairing cognitive and physical activity. The patient’s son obtained a grant through the Rotary Club to offer the program to others. It is free to patients who can benefit from the service.

Marlys Scholtec, 80, of Clive, benefited from the brain gym after suffering a severe concussion from a fall two years ago. She was so impressed that she and a friend volunteered to lead the program twice a week.

Patients begin by working on computer software designed to build memory skills. Shortly after, they move on to physical activity using exercise bands. Scholtec leads patients in muscle relaxation and then plays music, dims the light and begins meditation. Every student comes away with something different from the experience, she said. “It incorporates mind, body and spirit. That’s an important factor,” she said. One student said she felt the program was helping build connections, and Scholtec said that she, too, noticed an improvement in her own problem solving.

The clinic sees about 30 to 40 new patients with dementia each month and has served patients from age 50 to 105, Bender said. Patients can be referred by physicians or family members or seek help on their own. The earlier patients are diagnosed the better, so treatment can begin.

Bender evaluates patients through a physical exam, lab work and imaging to rule out structural abnormalities. He can also order neuropsychological testing and a social worker directs a family care conference to discuss concerns.

Howard and Novalee Klein of West Des Moines began using Bender as their primary care physician when their physician retired. The couple received training at the brain gym and find ways to stay mentally and physically active. They’re involved in water aerobics, a discussion group, line dancing, church activities, yoga, ping-pong, billiards and a card club.

After experiencing some memory lapse, Howard, 87, underwent a memory evaluation. Medication has since slowed the progression of mild dementia for nearly eight years. Bender’s advice and having a full schedule helps, he admits.

Bender said he talks with patients about ways they can learn something new — cooking, artwork, language. Anything leading to the acquisition of information can help, he said.

With the input of colleagues who make up the center’s Aging Mind Think Tank, Bender hopes to someday apply similar concepts to assist those with traumatic brain injury, including soldiers wounded overseas.

Source: desmoinesregister 01.17.2012