New Study Walks Fast to Prove Benefit of Exercise after TBI

Rebecca M.

The National Institute of Health recently completed a study on the role of exercise in memory and cognitive skills for those with a traumatic brain injury.  Specifically, the goal of this study was to look at the benefits of exercise in 18-45 year old individuals with a TBI, at least 2 months after their injury and otherwise healthy.  Completed this summer at the main NIH Clinical Research site, this study was an exploration of previous findings that exercise after exposure to images enhances the participant’s subsequent recall and extended the study to include recall of words and logical cognition.  Notably, this study also looked at new ways to measure progress after a brain injury by examining the mechanism of the effect of using exercise biomarkers and the relatively new technology of fMRI.  In a parallel fMRI experiment, intended to explore the brain basis of the effect of exercise on memory, healthy volunteers viewed pictures, exercised at a high or low intensity, and then performed a recall task while in the scanner.

As of yet, the NIH has not published the study’s results.  However, this new study may well have similar findings to past ones.  Additionally, the use of newer biological tools will make an even stronger case that exercise, even walking fast, is well worth the time for adults living with a TBI to enhance their cognitive skills.

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Extreme Weather Has Traumatic Results in Carolinas

Though severe weather affects all of America, in the continental United States hurricane season (June – November) comes with specific concern for the coastal states from Virginia to Texas.  During the past few days, the Carolina’s have been dealing with the wind, water, power outages and trauma caused by Hurricane Florence.  Because of the extreme weather, head injuries are more common.  However, because extreme weather limits one’s ability to exit the house and get access to medical facilities, the exact amount of trauma caused by a sudden-onset disaster like a hurricane is not known.  (As the NIH notes, “Injury patterns during storms are not much studied and lack uniformity.”)

Online, brain injury experts have presented lists of what safety precautions should be taken for those who live with a brain injury or who get a brain injury during the storm.  The Center for Disease Control briefed medical experts and hospitals on what injuries they are likely to face because of Florence and how to deal with them.  The Federal Department of Health and Human Services online provides a list of resources specific to Emergency/Crisis and Disaster Settings.  In preparation for Florence, the CDC set up a small temporary medical facility in Atlanta.  They also have a webpage detailing emergency wound care after a natural disaster and a pamphlet online providing tips for safety, though these tips don’t seem to address prevention of head trauma beyond DON’T DRIVE.  The states provide information online regarding what those with disabilities and their caregivers should do in the event of a natural disaster, with 10 states offering brochures, booklets, guides and other material.

No matter how much people and hospitals prepare for the negative effects of natural disasters, or how much natural disasters bring out the more considerate side of people, there will always be injuries and possible deaths.  For Florence, the death toll is now 23.  Often, “outside assistance arrives later, and transportation to functional hospitals is too long to save lives of the most critically injured.”  The public is horrified by the news that a mother and her infant were crushed and killed by a tree on Friday, September 14, the first known fatalities from the storm.

The NIH notes the challenges of diagnosis, treatment and prevention of a brain injury during a sudden-onset disaster: immediate emergency medical response, long-term care, and prevention of post-event increases in pediatric TBIs because of abuse when rapid-onset natural disasters occur.  With such a natural disaster, though, trauma is all too common and hospitals are limited due to weather, which presents an ethical quandary for medical professionals – immediate action is necessary for brain injury, but should a hospital first care for someone who may not survive?  (The development of telemedicine for those who do not need or do not have access to immediate care may help answer this question for doctors.)

A medical professional, however, notes about such emergency circumstances, “this is what we train for.”  For example, a North Carolina deputy got a head injury while responding to calls for service.  A North Carolina teen and his father were transported to the hospital with a fractured skull/bleeding on the brain and an injury that required 12 staples in his head, respectively, after a tree fell on them while they were removing debris from the road.

Today, September 17, the extreme weather has subsided in the Carolinas.  However, according to the National Hurricane Center, the flooding, power outages and road closures continue.  Those that evaluated due to the storm, including those with brain injuries and their caregivers, will soon return.  Some hospitals have reopened in the past few days.  Now, though, the residents of the Carolinas are coping with extreme flooding.  Medical care is not yet easily accessible and it is still difficult to communicate with medical professionals.  Also, “evacuees have [now] been exposed to potentially contaminated flood waters and crowded living conditions and have had many opportunities for traumatic injury.”  Among the mentioned injuries is traumatic brain injury.

 

Preventing Pesticides from Killing Bugs and Brain Cells

A pesticide is “any substance used to kill, repel, or control certain forms of plant or animal life that are considered to be pests.”  No one denies the harm in ingestion of a pesticide.  However, the legality of using certain chemicals in pesticides has been long debated – at present, the chemical chlorpyrifos is of particular concern.

An active ingredient in some pesticides since 1965, chlorpyrifos is “used primarily to control foliage and soil-borne insect pests on a variety of food and feed crops.”  A Google search shows that it is sold under a variety of brand names.  In the past few years, chlorpyrifos has been a focus of concern because of a government-supported study conducted by the Columbia Center for Children’s Environmental Health at Columbia University.  One of the findings of this study confirms, “Children with high pesticide exposure cluster together to form a distinct behavioral phenotype… Cognitive and behavioral deficits associated with this phenotype may be mapped to alterations in brain regions and function.”

Legislation related to pesticide control was first introduced in Congress over a century ago in the Federal Insecticide, Fungicide, and Rodenticide Act.  Since its enactment in 1910, this legislation has been amended and new legislation regulating pesticide use has passed, such as the Food Quality Protection Act in 1996.  In November 2015, the EPA, with former head Gina McCarthy, proposed a ban on the use of neurotoxic chemical chlorpyifos on all food crops.  What then happened to this proposal is unclear.

During the tumultuous tenure of former EPA head Scott Pruitt, in 2017 and 2018, chlorpyrifos came to the pesticide forefront.  In 2017, Pruitt refused to sign off on a ban of the use of chlorpyrifos as a pesticide on food crops.  This decision, many say, is a sign of Pruitt siding with the “Pesticide Lobby”.  Groups such as the Environmental Working Group (EWG) have denounced and fought against Pruitt’s action, noting that, “The evidence is overwhelming that even small doses of chlorpyrifos can damage parts of the brain that control language, memory, behavior and emotion.”  Finally, last month, Pruitt’s decision was reversed by the United States Court of Appeals for the Ninth Circuit – the EPA now bans the use of chlorpyrifos on food crops.

While the above decision is a victory for food safety, the results of this legislation are not immediate.  Additionally, fruits and vegetables must still be washed before eaten both to eliminate any residual pesticide and to better the taste.  On the positive note, though, the EWG notes that, “the agency [has] put children’s health, strong science and the letter of the law above corporate interests.”

U.S. Diplomats Ailments Possibly Explained

Almost a year ago, I reported on the search for the culprit of mysterious ailments on American diplomats in Cuba; this year, I reported that diplomats in China were experiencing the same symptoms and that a cause had not yet been determined.  Last Saturday, September 1, the New York Times published the results of various studies that searched for the cause of brain damage in so many diplomats and their families: Microwave Weapons Are Prime Suspect in Ills of U.S. Embassy Workers.  Of course, microwave weapons do not refer to the most common “microwave”, the microwave oven, but “[any] electromagnetic wave with wavelength between that of  infrared light and radio waves.”  (Microwave weapons are not a new phenomenon.  As these ailments show, other countries use this method of attack and, for over a decade, the American military has been searching for ways to use it in battle.)  However, even after a year of study, as to what caused so many to experience the so-called Frey Effect, nothing is conclusive.

McCain’s Posthumous Charitable Hopes

In 2002, Senator John McCain was instrumental in establishing the Arizona-based nonprofit Translational Genomics Research Institute (TGen),  “a one-of-a-kind genomics research institute.” Unfortunately, the research focus of this institute later became all too important for McCain, as his diagnosis of brain cancer was announced last year.  After losing this year-long battle with glioblastoma*, Senator McCain was laid to rest near the US Naval Academy in Annapolis, Maryland on Sunday, September 2, 2018.  However, his service to America has not ended.

A visit to the memorial webpage of the late Senator provides not only a history of the man and synopses of the moments of honor that have occurred since his death on August 25, 2018, but also gives the visitor an opportunity to donate to two nonprofits specifically selected by McCain: The McCain Institute Foundation and the Translational Genomics Research Institute (TGen).

*According to the NIH, glioblastoma is, “the most common and aggressive malignant brain tumor in adults.”  As previously reported on this site, symptoms of brain malignancy, a.k.a. brain cancer, include headaches, seizures, speech difficulty, weakness and double vision – symptoms that can also be found following a traumatic brain injury.  The question as to whether there is a link between brain injury and brain cancer has been “long-debated”, as was remarked on in a 1979 NIH report.  Today the NIH continues this investigation.  Two years ago, they reported, “Epidemiological studies are equivocal on the possible link between trauma and increased risk of malignant glioblastoma… We propose a putative pathogenesis model that connects post-traumatic inflammation, stem and progenitor cell transformation, and glioblastoma.”

Mitigation for Morality and Murder

In the modern world, our understanding of science changes rapidly.  Law, at large, does not change so rapidly.  What has changed, in the past 20 years, is that defense lawyers have begun, during the trial and/or sentencing phases of court, to use brain damage/injury as a mitigating factor for criminal acts.

Brain injury was first introduced as a defense in 1966 for Charles Whitman, the so-called Texas Tower Sniper.  (Whitman stabbed his mother and his wife, shot to death 16 people at the University of Texas at Austin and shot and injured 31 others.  An autopsy upon his death found a tumor in his brain.)  Since the start of this century, the exploration into the effects of brain injury on what some may see as moral quandaries for those with neurological deficits has broadened.  Generally, what has been found is that head injury, specifically a brain lesion, can hinder executive functioning, which governs the ability to plan ahead, think things through, manage impulse, etc.  However, this is basic knowledge that applies to all brain injury survivors; tests specifically related to the unique brains of those who commit criminal acts are inconsistent.

In 2015, the NIH published a report, Does TBI Lead to Criminality?.  Their conclusion states, “The results support a modest causal link between traumatic brain injury and criminality.”  Investigations have shown that while brain injury is not a sufficient defense for a criminal act, it may be a mitigating circumstance in the sentencing phase of a trial – treatment versus incarceration.

Since then, brain damage/injury has often been used as a defense, most recently earlier this month: a convicted murderer in Ohio said, during sentencing, “Not everyone is fortunate enough to have a caring family or outside guidance… I am proof [that] a young person – beaten and abused physically, emotionally, and mentally – becomes the abuser.”   Though the defendant now admits to the killing of five women, the testimony of one of two testifying doctors states that because Kirkland MAY have a brain injury, he should not receive the strictest punishment, the death penalty.

Perhaps, though, the “brain injury” defense will relatively soon become a thing of the past.  The above-mentioned NIH report further concludes, “Reducing the rate of TBI… might have benefits in terms of crime reduction.”  (Since this report was released, more defendants have used brain damage as a mitigating factor for criminal acts.)  According to a UK study, approximately 50 to 70% of the incarcerated population has a brain injury.  That percentage is thought to be in the same realm as those imprisoned in America.  Given these astonishing statistics and the continuing government-sponsored and private research on brain injury prevention and recovery, the NIH’s conclusion seems a definite possibility.

(See also Massachusetts General Hospital – Center for Law, Brain & Behavior, “an academic and professional resource for the education, research, and understanding of neuroscience and the law.”)

Link: Defense and Veterans Brain Injury Center

In the early 1990s, during the Gulf War, advances in weaponry and medical knowledge meant that injury, not death, was of foremost concern – included in this was brain injury, caused by both physical or chemical injury.  In response, in 1992, Congress created the Defense and Veterans Brain Injury Center (DVBIC) – an organization headquartered in Silver Springs, Maryland with 22 other locations around the continental United States of America.  According to their mission, “the Defense and Veterans Brain Injury Center promotes state-of-the-science care from point-of-injury to reintegration for service members, veterans, and their families to prevent and mitigate consequences of mild to severe TBI.”  Throughout its 26 years, their “science care” has extensively investigated, through research and sponsorship, what has been termed the signature wound of modern war.  In response to this, in 2007, “DVBIC [was] designated the primary operational TBI component of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE).”

(As of today, there will be a link to the DVBIC in the ADDITIONAL RESOURCES bar on the Home Page of this site.)

MS: Cause, Effect or Comorbidity

Multiple sclerosis (MS) is presumed to be an autoimmune disorder, but beyond that, is not fully understood.  What is understood is some of the terrible symptoms that can occur with MS, including: blurred or double vision, muscle weakness, lack of coordination, imbalance, impaired walking/standing, speech impediments, tremors, hearing loss, difficulties with concentration, attention, memory, and poor judgement.  To those who read this blog and/or have personal knowledge of brain injury, the symptoms should be apparent, but for the purpose of this article it is necessary to spell out some of the symptoms of moderate to severe brain injuries: dilations of the pupils, seizures, slurred speech, weakness, loss of coordination, restlessness or agitation, chronic headaches, increased confusion, lightheadedness, dizziness, blurred vision, ringing in the ears, fatigue, behavioral or mood changes and trouble with memory, concentration, attention, and thinking.  As can be seen, even in these abbreviated lists, MS and TBI exhibit many of the same symptoms.  For this reason, it is not a surprise to find that the two may have a connection – however, the results of multiple NIH-funded studies on the subject have not, as of yet, been able to determine what exactly is this connection.

In 2006, for example, in a study entitled “Risk of multiple sclerosis after head injury: record linkage study,” the NIH concluded: “There was no significant increase in the risk of MS at either short or long time periods after head injury.”  However, six years later, in 2012, the NIH released a study with the title: “Increased risk of multiple sclerosis after traumatic brain injury: a nationwide population-based study.”  In 2016, a study essentially took the middle-ground, concluding that, “The presence of comorbidities in patients with MS is associated with brain injury.”  (Therefore, they concluded that if someone has another disorder, as well as MS, they may be more likely to have a brain injury.)

The “cause or effect” confusion is recognized by researchers, as in 2017 a scientist at Harvard University remarked, “Some studies suggest that head injuries might be a risk factor for MS… On the other hand, it’s not an easy thing to study because researchers would never intentionally cause head injuries to see if they cause MS.”  However, this Harvard study did find that having a single concussion during childhood gave a person a 22% higher rate of MS and the percent was doubled for those who had more than one concussion.

Whether MS and TBI have a cause-and-effect relationship or not, their similar symptoms may mean that exercise is of particular benefit to those with multiple sclerosis, just as it is to those with brain injury.  To test this hypothesis, the NIH has funded a study at the University of Alabama at Birmingham and at the New Jersey-based Kessler Foundation specifically to determine the benefit of exercise training for cognitive deficits in MS.  The study will see if 3-months of treadmill walking for the participants improves their cognitive processing speed, brain volume, and functional connectivity.  “The study may provide the first Class 1 evidence for the effects of treadmill walking exercise training as a rehabilitative approach to cognitive deficits in people with multiple sclerosis,” says Brain Sandroff, PhD of UAB and principal investigator of the study.

Potential Biomarker of “Bad” Brain Injuries

Rebecca M.

It is often quite hard to determine how bad a brain injury is soon after it has happens, yet speed is needed for the best treatment of the injury, in order to have the best chance of recovery.  No one brain injury it quite like another.  Earlier this year, the National Institutes of Health (NIH) funded an important study about advances in the treatment of brain injuries.  Briefly, the study group identified that the brain lipid molecule, a type of fatty acid in brains, known as lysophosphatidic acid (LPA), significantly increased after a TBI in a preclinical animal model.  In general, fatty acids in the brain are thought to be important in brain function, but in excess, they are not healthy.  Moreover, the researchers found that LPA was elevated in areas associated with cell death and axonal injury, both major hallmarks of moderate and severe TBI.  The study was carried out at the David Geffen School of Medicine at UCLA.

If the results of this study holds for humans, it will give doctors a tool to ID right away if they are dealing with a moderate to severe brain injury, and not a mild one.  Though it has only been studied in animals, LPA could possibly be used as a biomarker of TBI, which could be particularly useful in cases when it is not clear if a brain injury has occurred.  (In some cases, such as a very bad car accidents, it is pretty clear that there has been a moderate to severe injury and cell death.  But that is not always the case, as with ABIs and other TBIs, it might less clear how bad the injury is without using a biomarker tool.)

Monitoring the LPA levels of a brain injury patient may allow neurologists to make smart and fast decisions with as many tools as needed medically, rather than having to guess about the severity, based on one factor – the amount of swelling.

New Technology, Same Problems

Last year, I reported on the secondary danger that can arise from using the shoulder-launched heavy artillery Carl Gustaf.  Carl Gustaf has a twin though – heavy artillery known as SMAW…  and, just like with Carl Gustaf, SMAW is strong enough both to blow up a tank and to cause severe brain injury to the shooter in the process.

Late last month, NPR reported on the effects the use of SMAW had on two former soldiers.  After every shot, you felt a “concussive wave”, one soldier said, before continuing to say “it’s an awesome thing”.  Based on this description, as well as these soldiers’ ongoing support for the military, one can see that “blaming” an institution that they love so much for their current deficits is a difficult thing for these soldiers.  For the same reason, many other soldiers find themselves in a conundrum when it comes to their opinion of the military.  (Statistics show, for example, that though enrollment in the military is at a low, retention is up.)  However, it seems that the military recognizes that, in some way, they, specifically their weaponry, are at fault for some injuries, as they keep putting more money into research (e.g. with animal models).  They also have set up a TBI Recovery Support Program and, as a member of that Program states, “If you talk to us in a year… I think we’re going to have exponential growth in our knowledge.”

However, is some of this concern over brain injury just unnecessary worry?  The soldiers NPR quotes in their article ask that question.  (This is very similar to the responses of some players, coaches and parents regarding brain injury in football.)

(Another interesting subject in the above-linked NPR article is the difficulty soldiers, who acquire a brain injury while not in combat, have in getting healthcare coverage for their recovery.)