Author Archives: tbionthehill

To Rest or Not To Rest? That is the question…

“It is good news that the brain can recover from a hit if given enough time to rest and recover,” stated a Georgetown University-based research team member regarding the results of a 2016 study.  Two years ago, this medical study was seen as state-of-the-art and ‘first-of-its-kind’.  Early last month, the newly updated mild tbi guidelines released by the CDC retained the advisement that ‘brain rest’ is necessary for successful recovery.  The New York State Department of Health online recommends that adults with brain injuries get plenty of sleep and plenty of rest and avoid physically and mentally demanding activity.  Rest has always been the key word in every recovery advisory.

Doctors and the government, though, seem to be just as perplexed about how to optimize recovery as survivors do: three days before the recommendation for ‘brain rest’ came out, the CDC advised, “Counsel patients and their parents/caregivers to return gradually to non-sports activities after NO MORE than 2-3 days of rest.”  Another 2016 study found that children recover from mild brain injury faster when they are physically active.  Last month, Discover magazine published the results of a Columbia University study of brain injury recovery in mice, which found early reintroduction to activity sped recovery.  This multi-year study on the cerebral cortex of the brain found that this more primitive region of the brain may be more involved/important that previously thought.

However, the results of this study are not all encompassing.  The rats were given a brain injury similar to that of a stroke.  A stroke is just one form of brain injury.  Additionally, while the brain has a “remarkable capacity to adapt in response to trauma,” physical injury or other traumas to the brain, such as coma, may prevent early activity.  The Columbia University scientists note that the results of their study may be groundbreaking for patients “in some cases”.  Given the number of brain injuries incurred annually, “some cases” may be able to help many patients.

The Positive Side of Brain Injury (What?)

When I was in brain injury rehabilitation, all I knew and strived for was to return to my “old self”.  I saw my disability as an almost impassable obstacle in the road of my life, filled with negative consequences.  However, more recently, I have identified mental growth in myself due to my injury.  Researching into this, I discovered the idea of post-traumatic growth (PTG):

Brain injury is a life-changing event.  For those who have or know someone who has a brain injury, the effects of it are all too apparent and can include such things as post-traumatic stress disorder, depression, etc.  The negative effects of brain injury are what is published and talked about but are too numerous to list entirely in this article.  What is less discussed, though, is that brain injury can also have a positive effect and be, “a catalyst for positive change,” in an effect known as post-traumatic growth (PTG).

PTG was first recognized as a theory in 1995 by Richard Tedeschi, PhD and Lawrence Calhoun, PhD, both from The University of North Carolina at Charlotte, as something that lets survivors see “new opportunities as possible in life, an increased sense of personal strength, a greater appreciation for life in general and a deepening of spiritual life,” among other such positive effects.  In this millennium, the idea of PTG has gained popularity and has been further explored.  In 2015, for example, the NIH published a study that found that while effects of brain injury related to employment, depression, relationship status, one’s subjective beliefs about their own post-injury recovery and other such factors do have an effect on the possibility of developing PTG, none of them have a large effect on it.

Perhaps the greatest way to study the development PTG is to study the emotional effects that can result from brain injury, such as the best predictor of PTG: “having a high level of ‘purpose’”.  Some studies report that 30 to 80 percent of those with a brain injury identify themselves has having some form of PTG.  While other studies find this percentage lower, the subjective belief of having grown from a brain injury is something that the NIH finds a good predictor.  Believing in yourself is necessary to grow.

Rehabilitation facilities have started to promote this mental growth into rehabilitation, as the theory of PTG has become more widespread.  This year, a study titled Post-traumatic growth in adult survivors found, “a greater understanding of the development of PTG following ABI may help rehabilitation clinicians to promote better adjustment by focusing on a clients’ potential.”  Also this year, a study called The relations between post-traumatic grown and return to work following mild traumatic brain injury discovered that PTG also occurs in those with mild brain injury.  According to the NIH report, this has, “important implications for rehabilitation planning, individual and family adjustment, and the prediction of long-term outcome as it pertains to return to work, in particular.”

Fixing Grey and White Matter Isn’t So Black and White

Grey matter may be the most explored and discussed part of the brain, as it is involved in “muscle control and sensory perception, such as seeing and hearing, memory, emotions, speech, decision making, and self-control.”  Additionally, grey matter refers to the cells that are on the surface of the brain and, therefore, most associated with it.  Grey matter, however, is only half of the story – found inside the brain is the other half, white matter.  Until recently, white matter was simply thought to control the brain’s executive functioning.  While executive functions are definitely necessary, research within the past decade has found, “the role of the brain’s white matter in active learning and memory may be underestimated.”  In particular, its role in spatial memory, the memory one uses to return to rewarding locations, may be underestimated.  “Learning a new skill is [also] associated with altered white matter structure in mature brains.”

White matter gets its color from its coating with myelin.  Myelin, “allows electrical impulses to transmit quickly and efficiently along the nerve cells.”  Demyelination is the death of brain axons, nerve fibers in the brain that conduct electrical impulses away from the neuron’s cell body.  Neurological disorders are known to induce white matter dysfunction and demyelination.  For example, ischemic strokes, which involve the narrowing or blocking of arteries to the brain and accounts for 80 percent of strokes, are associated with the death of white matter and demyelination.

To prevent this demyelination, medical professionals use recombinant tissue plasminogen activator [rtPA], “a form of tissue plasminogen activator that is made in the laboratory… [and] helps dissolve blood clots.”  (tPA is, “an enzyme made in the body that helps dissolve blood clots.”)  In 1996, rtPA was approved by the FDA to treat stroke patients and it is now also used to treat heart attacks and clots in the lungs.  Brain injury can cause demyelination, as it is described as damage to myelin around nerves.  Given the previous success with rtPA, government-funded studies are now looking to see if it can help repair white matter following a brain injury.

The first study related to white matter damage and cognitive impairment following brain injury occurred in 2011 and found that, “white matter disruption is an important determinant of cognitive impairment after brain injury.”  Given this result, it is surprise that I cannot find another study on the topic until now.  This study, which was published on September 25, 2018, evaluated through electrophysiology the white matter in mice after a brain injury and then after treatment for that brain injury with tPA or rtPA.  Conducted at the public University of Pittsburgh, the Albert Einstein College of Medicine and at the Veterans Administration laboratory, the scientists found that tPA improved long-term special memory.  Specifically, “rtPA treatment makes up for a lack of endogenous tPA and prevents long-term demyelination.”

This scientific finding related to brain cell stability and cell regeneration is important.  However, recovery is never that easy.   “There are conflicting reports of harmful versus neuroprotective effects of tPA in acute brain injury models,“ states the NIH report.  Though a thorough Google search found no studies that found harmful effects, a Google search is far from a professional medical search.  A new, more neurologically-complete recovery from brain injury could soon be available.

NDEAM: Brain Injury Survivors Adapt, Businesses Must Too

 

Employment has the ability to make you feel like a contributing member of society; the right job has the ability to make you feel generally happy.  Because of the importance of employment for all people, including those with disabilities, National Disability Employment Awareness Month is recognized in October.  However, for about 60 percent of those who acquire a brain injury, starting or returning to work does not occur.  For a variety of reasons, they remain unemployed, a status that promotes such things as depression, already a symptom of brain injury.

The government recognizes this issue, as, if nothing else, it results in fewer taxes paid and more government monetary benefits provided.  Perhaps because of this, but most likely not wholly for this reason, they have funded multiple studies related to employment following brain injury.  After years of study that seem to have concentrated on the neurological and medical difficulty of returning to work for individuals after a brain injury, in 2016 the NIH focused on the employers and completed a study that concluded, “stigma and discrimination in mental health conditions may have an impact on expectations of RTW [return to work], and on RTW outcomes.”

Since this discovery from the NIH, which may be all too obvious to many brain injury survivors, government study has continued.  However, from what I can determine, these new studies again focus on the capabilities of those with brain injury, not on the behavior and practices of employers.  In a small 2017 study titled Opportunities and barriers for successful return to work after acquired brain injury: a patient perspective, “the aim was to increase knowledge of opportunities and barriers for a successful return to work in patients with [acquired brain injury].”  It focused on the need for individually adapted rehabilitation, survivor motivation to return to work and the survivor’s cognitive and social abilities.

Again looking at the abilities of the survivor/jobseeker, this time through medical scans and evaluation, recently a government-funded study by the Kessler Foundation was published: Impact of frontal neurobehavioral symptoms on employment individuals with TBI.  The frontal lobes of the brain are the short-term memory storage sites, direct the motor area [voluntary movement], allow the brain to transfer thoughts into words, among other important things.  “Our results indicate that frontal neurobehavioral symptoms may be predictive of the ability to achieve and maintain employment after TBI… Developing rehabilitative strategies that address these behaviors could improve employment outcomes.”  While Kessler’s conclusion may be important, taking action on the 2016 NIH findings seems just as, if not more, important.  The opportunity for meaningful employment must be there before someone can determine if they are capable of pursuing it.

(The above picture is the official Department of Labor poster for 2018 NDEAM.)

New School Year Brings New Athletic Guidelines

The new school year is well on its way and youth athletics have begun, including for “about 1 million youth between the ages of 6 and 12 [who] play tackle [football].”  However, even though this number may seem high, youth athletic participation has continued its decade-long decline again this year.  Head trauma, specifically concussions, are the major worry.

In response, the CDC has authorized new guidelines on the diagnosis and treatment of concussions and other such mild traumatic brain injuries in children. Published in the medical journal JAMA Pediatrics, and referenced by other publications nationwide since, the guidelines encompass over 25 years of research and include, “19 sets of recommendations on the diagnosis, prognosis, and management/treatment of pediatric mTBI that were assigned a level of obligation (i.e., must, should, or may) based on confidence in the evidence.”

Noting the decline in participation and increased parental concern, many states and school districts have updated their guidelines on concussion protocol.  This year, New York State Education Department stated that, “Local boards of education are strongly advised to develop a written concussion management policy.”  In Scarsdale, NY, for example, the school district announced, “the establishment of a Concussion Management Team, training for the Team and appropriate staff, protocol for student evaluation and return to play or activity, accommodations if necessary in academic areas, and a set of procedures that outline the role and responsibilities of all concerned.”  The website of the Central Valley District, NY has a thorough webpage regarding concussion protocol, as “[the] School District recognizes that protecting students from head injuries is one of the most important ways of preventing a concussion.”  (A list of all the webpages dedicated to concussion protocol, and a list of all the concussion protocols that have been recently altered due to increased public concern, is too lengthy to individually recognize.)

* It should also be noted that even with all the negative media coverage and medical concern, many school districts, parents and some publications still see the benefits of organized athletics in a child’s physical and social development.

New Research Center Focuses on Care to Givers

Caregivers and family members play a critical role in the “health and well-being” of traumatic brain injury survivors.  However, this medical and personal care of another can result in an additional toll, specifically on the health and well-being of the caregivers.  Last year, for example, the NIH published a report that concluded, “There is a definitive existence of psychological problems in overburdened caregivers.”  This understanding is why, last month, the VA established a new Center of Excellence focused on caregivers.  “Advocates say [that this Center] could significantly boost research and support for families caring for ailing veterans.”  There are an estimated 5.5 million veteran caregivers in the United States and an unknown millions of other citizen caregivers.

In actuality, this Center is located at four VA sites – Texas, Florida, Utah, California.  Steve Schwab, the Executive Director of the Elizabeth Dole Foundation, whose mission is to “strengthen and empower America’s military caregivers and their families by raising public awareness, driving research, championing policy, and leading collaborations that make a significant impact on their lives,” has high hopes and believes, “This Center is going to own the research in this area and a lot of areas that are still undiscovered.”

Minibus to Provide Relief and Research

Last week, President Trump signed into law a bipartisan minibus of “two critically important funding bills” for fiscal year 2019.  Specifically, the bills cover the financing of the Departments of Defense, the Labor, Health and Human Services and Education.  Included is a $2 billion budget increase for the NIH, which is 5.4 percent raise from the 2018 fiscal year.  The funding for the BRAIN Initiative, under the 21st Century Cures Act, is now set at $429.4 million.

New Jersey Congressman Bill Pascrell, Jr., co-chair of the Congressional Traumatic Brain Injury Task Force (along with Florida Congressman Thomas Rooney), released a statement, in which he notes that his funding requests related to brain injury had been met: “$125 million for the Psychological Health/Traumatic Brain Injury Congressionally-Directed Medical Research Program… as well as $6.75 million for the TBI Act programs.”  (Though the starting paragraphs of Pascrell’s press release follow party lines, the headline on his website expresses the broader view: Pascrell Highlights Budget Victories.)  Congressman Pascrell also cited the increase of brain injury research funding both for the military and the general population, which he championed.

As the Chairman of the House Appropriates Committee Congressman Rodney Frelinghuysen (NJ) remarked, “[This] legislation funds critical programs that will protect and save lives both now and in the future.”

KO the KD? Results of Keto Diet for TBI Inconclusive

“Dinner today is going to be a big steak and, for dessert, a huge bowl of ice cream.”

The above meal may seem like a recipe for weight gain, but it is also a meal in tune with the ketogenic diet.  A diet trend for about a decade, the ketogenic diet (KD) seeks to, “mimic biochemical changes associated with starvation,” states the NIH. The basic idea of this diet is to limit the carbohydrates one consumes, and eat a diet of 80 – 90% fat, in order to put the body into a starvation state.  This extreme limitation of foods that are turned into glucose means that the metabolic source used for energy production must be changed by the body, so that it goes into a ketonic state.

People with chronic diseases/conditions have said that KD promotes their overall health, reduces their symptoms, slows their diseases progression and even may be a treatment for it.  In a 2008 study, titled Diet, Ketones and Neurotrauma, scientists noted, “This altered dietary approach may have tremendous therapeutic potential for both the pediatric and adult head injured populations.”  Since that time, over 20 studies have been done that show that KD both helps you lose weight and improves your health.  This year, in fact, the NIH reviewed past studies and performed new animal studies that showed, “The KD is an effective treatment for TBI recovery in rats and shows potential in humans… [however] the human trials did not establish much evidence with respect to the KD as a treatment for TBI.”  Again, the NIH concluded that further research is needed.

What has been determined is that the ketogenic diet is beneficial for some people who have particular neurological disorders – specifically children with epilepsy.  As far back as 1921, the KD diet was used as a treatment for epilepsy in children with positive results.  Since the diet is very strict it may be the last option, but it is still an option, especially for epilepsy – a disorder that can be caused or exasperated by traumatic brain injury.  Additionally, it seems that the ketogenic diet may be beneficial for treatment of diabetes, as it lowers blood sugar.  Diabetes has been shown both to be a possible consequence of brain injury or a possible cause of brain injury.  Even if a brain injury is not involved, the symptoms of hyperglycemia, the identifying mark of diabetes and other disorders, mimic those of TBI.  In fact, “Among the secondary complications, hyperglycemia (both peak glucose and persistent hyperglycemia) in TBI patients is one of the most common and correlates with the severity of the injury and clinical outcome.”  (However, the Cleveland Clinic notes that, “Eating a lot of sugar can lead to tooth decay, but it does not cause diabetes.”)

In reality, most people will embark on a diet at some point in their lives.  Even with all this inconsistent evidence, the ketogenic diet is still on trend, largely because of celebrity endorsements by such people as Kim and Kourtney Kardashian, Halle Berry, Gwyneth Paltrow and LeBron James.  Be aware though, that whenever you intake a greater amount of calories than your body needs, you will gain weight.  And even if you intake the correct number of calories, but not the right nutrients, your body will suffer.  This is even more true for those with severe and/or ongoing disorders/diseases, such as brain injury.

Investigating the Zombies in the Brain

This summer, a film, titled Tau, was released to movie theaters and explored the human trappings of implantation of artificial intelligence.  In August, UT Health San Antonio, formerly The University of Texas Health San Antonio, reported the human trappings of human intelligence, specifically in the brain: “Tau protein accumulation is the most common pathology among degenerative brain diseases, including… traumatic brain injury (TBI) and over twenty others.”

Simply explained, tau proteins are, “proteins that stabilize microtubules [and]… are abundant in neurons of the central nervous system.”  Related to brain injury, a high level of tau proteins results in poor recovery and, therefore, can possibly result in an ongoing cognitive decline.  The title of a 2012 NIH study further explains, Tau elevators in the brain extracellular space correlate with reduced amyloid-B levels and predict adverse clinical outcomes after severe traumatic brain injury.  This study notes that it was only the second study that was done on the subject, at the time.  However, since then, tau protein studies have become much more common, as can be seen by the above-mentioned quote.

Scientists now refer to tau proteins as zombie cells, as they, “can’t die but are equally unable to perform the functions of a normal cell.”  Unfortunately, they live as stressed, toxic senescent cells in the extracellular space of the brain, which means that while they are interesting to investigate, they are difficult to access.  However, just as scientists have discovered that eating protein-filled food like sushi is beneficial to the brain, scientists have developed a new means of brain study, referred to as SUSHI (super-resolution shadow imaging) that can access the extracellular space.  With the use of SUSHI, UT Health is currently attempting to develop a drug that clears tau tangles and zombie cells to improve brain function and structure following a traumatic brain injury and other brain diseases.  To this point, “The scientists at UT Health used senolytic drugs… to clear the senescent cells and tau tangles in [neurologically damaged] mice.”

* Also, this summer, across the ocean, Mario Negri Institute for Pharmacological Research of Milan and the University of Glasgow published the results of a study in which they determined a single brain trauma could result in widespread tau deposition.  According to the study, this is, “the first evidence for how a mechanical brain injury might evolve into chronic degenerative brain disease, including CTE.”  CTE is, of course, associated with American football, though this conclusion seems to indicate that the concern may be even greater.

Yoga Stretches Your Legs to Strengthen Your Mind

 

It is widely known that, as remarked on by the NIH, “Exercise-based therapies can promote recovery of function and are easily implemented in the clinical rehabilitation setting.”  Since at least the turn of this century, the government has been studying the benefits of a certain type of exercise, yoga, within various segments of the population.  In September, federally-sanctioned National Yoga Awareness Month, one should look at the specific benefits of yoga for those who have suffered a brain injury.

Though there are benefits from the practice of yoga for all individuals, the above-quote comes from a current NIH study regarding the energizing effects of exercise for those with brain injuries.  That study is not set to end until 2022, however the researchers have already discovered, “Very early [post-brain injury] exercise seems to exacerbate brain injury, while later exercise seems to be beneficial.”  (The NIH does not state how one is to determine the appropriate time in one’s recovery to restart it.) Further governmental information is limited as, in a 2012 article titled The therapeutic value of yoga in neurological disorder, the NIH stated that the benefits of exercise for those with many neurological disorders is a “largely unexamined treatment”.

In the meantime, there are known benefits of yoga for the general population, including enhancing one’s quality of life and wellbeing, and benefits specifically for the brain injured/disabled population, such benefits as: strengthening muscle, increasing flexibility, increasing endurance, coping with setbacks, calming an active mind.  Previously-mentioned Former Rep. Gabby Giffords has remarked that her recovery from brain injury has been though, “Speech therapy. Physical therapy.  And YOGA, too.”

As the government states, “The purpose of this month is to promote the health and benefits of yoga and inspire a healthy lifestyle.”  In celebration, many yoga studios and gyms are offering free yoga classes this month.  Yoga can also be accessed through your television, computer and smart phone.

(However, if you do not begin to exercise or do not continue with your exercise/yoga schedule, do not fret.  Few people, with a TBI or not, adhere entirely to their workout schedules.  Additionally, the NIH found that, “Injury severity, age and pre-injury exercise history predict adherence to a home-based exercise program in adults with traumatic brain injury.”)