Author Archives: tbionthehill

Tragedy Yields Action from Senate Sergeant-at-Arms

On September 11, 2001, Frank J. Larkin was working at the Secret Service’s New York City headquarters in the World Trade Center.  “[I was] dodging, unfortunately, folks who were jumping to their deaths, you know, witnessing that, which is something you just never forget,” he recalls.  A Navy SEAL, with nearly a decade in combat, Larkin has also worked for the Maryland State Police, in association with the Department of Defense, and as a Secret Agent for the US Secret Service.  Then, on January 6, 2015, he was nominated and appointed by Mitch McConnell to the position of Senate Sergeant-at-Arms, “its chief law enforcement officer, protocol officer, and executive officer.”

His son, Ryan F. Larkin, also felt this need to serve, following in his father’s footsteps and enlisting in the Navy in 2006.  Once enrolled, Ryan was deployed twice to Iraq, twice to Afghanistan and completed missions in Lebanon and Honduras.  Considered “a renaissance man,” he received many awards.  In March 2016, Ryan received an Honorable Discharge from the Navy.  While he stayed active post-deployment by, for example, attending college, his discharge was assumedly given at least partially because of a recognized brain injury.  On April 23, 2017, Ryan Larkin took his own life.

As someone without children, I cannot imagine what the loss of a child feels like.  However, I have always heard that it is the worst thing that can ever happen to a parent. Specifically related to Sergeant-at-Arms Larkin, it upended his life, including his career.  In March, he sent notice of retirement.  “Now I feel this obligation to help others…. These men and women volunteered to go in harm’s way to protect this nation, and we promised that we’d take care of them.  But we’re not living up to that promise.”  Upon leaving his job, he intends to spend his time advocating for projects related to traumatic brain injury research, particularly research related to military blast exposure, like that experienced by his son.

A VA study, published in September 2017, reported that the suicide rate for veterans is about 20 percent higher than the rate for non-veterans.  (That statistic is debatable.  Some say its lower and others have said its as high as 22 percent.)  “These findings are deeply concerning,” said VA Secretary Dr. David J. Shulkin at that time.  “What’s more, they report that veterans’ suicides account for 18% of the suicide deaths in the country, while they only make up 8.5% of the adult population.”  The National Center for PTSD, part of the VA, knows and notes the relationship between PTSD and suicide.  On January 10, 2017, Rep. Peter King (NY) introduced H.R. 411, the Veteran Suicide Prevention Act.  This bill was referred to the Subcommittee of Health on February 3, 2017 and it seems nothing has been done with it since that time.

[As of April 2018, Larkin is still in office and he has stated that he will not retire until his replacement is found.]

Rep. Smucker Joins Congressional Brain Injury Task Force

The Congressional Brain Injury Task Force states that its mission is, “to increase awareness of brain injury in the United States, supports research initiatives for rehabilitation and potential cures, and strives to address the effects such injuries have on families, children, education, and the workforce.”  This seems that it would be a unifying goal, going beyond political partisanship, and for that reason, most states have one or more Congressman serving on the Committee.  At the beginning of this year, Pennsylvania had 5 Congressmen serving as members.  Now, during Brain Injury Awareness Month and just after the Congressional Brain Injury Fair, Rep. Lloyd Smucker (PA-16) joined.  (Congressman Lou Barletta, who represents Carlisle, PA in the 11th district, where the Brain Injury Association of Pennsylvania is located, is not a member, though that does not mean that he does nothing to support those with tbi.)  At the moment, Smucker’s website does not mention his involvement with the task force and critics cite his support for and from the NRA as an indication of his disregard for American lives.  However, Smucker is a Congressional Republican, so his support for the NRA should be of no surprise.  He should not be told he cannot help brain injured Americans for that reason.   (More members may mean more ideas and more action from the Committee.)

(Above picture, originally published on March 29, 2018, is courtesy of the Facebook page of the Brain Injury Association of Pennsylvania.)

Listening to the Benefit

Last week, an Arizona publication noted what too many TBI survivors know: brain injury can make certain sounds intolerable.  Hyperacusis, an extreme sensitivity to sound, is a common effect of a neurological disorder.  “In hyperacusis, the symptoms are ear pain, annoyance, and general intolerance to many sounds that most people are unaffected by.”  Additionally, hyperacusis is often accompanied by “the hearing of sound when no external sound is present,” known as tinnitus.  It has been found that about 20 percent of the population suffers from this debilitating condition and it is the top service-related compensation for the U.S. Department of Veteran Affairs.  Yes, tinnitus may go away for some, but it’s a lifelong condition for others.  (Notable individuals with tinnitus includes President Ronald Reagan.)

Given that, it’s a surprise that studies have found that music can actually help the brain heal from an injury.  “If you’re trying to restore neuroplasticity in the brain, to re-establish some of the connections that were there before the injury, music can be a big help,” said a neuroradiologist at Wake Forest Baptist Medical Center regarding a study at the hospital last year.  Multiple sources, though, note that what one listens to must already be a favorite tune or a favorite music genre to have the appropriate effect.  “If you love it, it loves you back. Signs of the musically activated brain included increasing the activity and connections in memory and emotional centers.”  With this in mind, the University of New Mexico has started a Neuro Choir that helps those with brain injuries work on their communication abilities, socialize with other members of the choir and gain the benefits of music therapy.  “One of the theories is that it helps to pull along the words especially if it’s been a highly learned song. Whereas if they were just trying to say the words in a conversation it may not come out,” said Richardson of music’s communications benefit.

Music therapy is already an accepted means of treatment for such conditions as autism and PTSD in the military.  Neurologic Music Therapy is still in its earlier stages, though government-based studies note that, “from a neuroscientific perspective, indulging in music is considered as one of the best cognitive exercises.”  (However, it is partially because it is such a cognitive activity that it can be intolerable for those with tbi.)  As doctors learn to better treat veterans and others with hearing problems/ear disorders, by testing such treatments as sleeping with white noise, perhaps the healing benefit of song will have the chance to be experienced by all tbi patients.

(The National Center for Biotechnology Information, part of the National Institute of Health, just posted the results of a study that shows that tbi can cause musical halluciations.  Tinnitus and music hallucinations have the commonality of “hearing” an often intolerable imagined sound, but both stop short of psychosis, as the patients ultimately realize the true source of the “sound”.)

Sit Down and Breathe

The easiest way to heal from a brain injury is simply to replace the injured parts of the brain.  Though this thought may seem both impossible and simply weird, scientists are now learning how to replace, or rather regrow, the brain in the healing of traumatic brain injury.

Specifically, it is well-known that human life depends of the inhalation of oxygen.  Oxygen also helps the body heal, as it is transported through the body in red blood cells.  Leveraging this healing process, hyperbaric oxygen therapy (HBOT) has been developed as a medical treatment in which one is encapsulated in a room or chamber filled with 100% oxygen.  (The air humans typically inhale is only about 20% oxygen.)  Additionally, HBOT has three times more air pressure than is typically experienced.  Increased inhalation of oxygen means that it is not only transported through red blood cells, but also, “into all of the body’s fluids, the plasma, the central nervous system fluids, the lymph, and the bone.”  More oxygen means more opportunities to aid healing, even while appropriate oxygen is still provided to the lungs.

Based on this evidence, it seems that HBOT would be a logical choice for professionals to treat those with certain injuries.  For example, Lake Regional Wound Healing Center in Missouri has been named a Center of Distinction, largely for its work with HBOT.. In New Mexico, a pickleball benefit  was recently held both to honor deceased veterans and to raise funds for Mission 22, an organization that offers HBOT to those with TBI.

More so, the federal government discovered these benefits a few years ago.  In June 2014, for example, the NIH published a study titled Red blood cell transfusion in patients with traumatic brain injury: a systematic review protocol.  In 2016, they published the results of a study titled Hyperbaric oxygen therapy for traumatic brain injury: bench-to-bedside, during which they concluded that, “HBOT has been demonstrated to have neuroprotective effects without increased oxygen toxicity in experimental TBI models when administered at pressures less than 3 ATA [atmospheric pressure].”

In recent days, a law to provide HBOT to veterans suffering from injury, including TBI and PTSD, was presented to the Arizona legislature.  Specifically, Hyperbaric Oxygenation Treatment for Veterans with Traumatic Brain Injury was sponsored by Mark Finchem and passed the State House and Senate unanimously.  On Thursday, March 29, HB 2513 was signed into law by Arizona Governor Doug Ducey.  Reading about Arizona’s action reminds one that many other states have also passed such legislation: Oklahoma, Texas, Indiana and Kentucky.

* Two relevant questions regarding HBOT, with helpful answers:

“How does hyperbaric oxygen help brain injury or stroke? When cells in the brain die, either from trauma or lack of oxygen, blood plasma leaks out into surrounding brain tissue causing swelling and reducing blood flow. These otherwise normal cells go dormant because they can’t function without the appropriate amount of oxygen. HBOT dramatically increases the oxygen carried in the blood plasma, making oxygen available to heal damaged capillary walls, preventing plasma leakage and reducing swelling. As the swelling decreases, blood flow can be restored to the dormant tissue (neovascularization) and these cells then have the potential to function again.”

“How does hyperbaric oxygen help a child with cerebral palsy (CP) or traumatic brain injury (TBI)? In CP and TBI patients, some of the injured brain tissues may be “dormant” and non-functioning. HBOT can stimulate these “dormant” tissues and return them to more normal function. In young children, cognitive function and spasticity can be improved.”

Update: Camps for a Cure

As reported in May 2017 as one of the West Coast facilities being built, the brain injury treatment center for military personnel near Naval Hospital Camp Pendleton will open its doors April 2 .  Operating as part of the Intrepid Spirit system, this is the first such facility to be opened on the West Coast.  Up until now, those in the military who sustain a brain injury in the call of duty generally must receive treatment at one of the 6 Intrepid Spirit centers, none of which is in the section of the country.  As David Winters, president of the Intrepid Fallen Heroes Fund, which funded this project, says, “We know that being able to be close to home, surrounded by loved ones, is a crucial part of the recovery process… so we are opening centers on the West Coast this spring… in order [so] that service members who need treatment do not have to uproot themselves and their families to get it.”  Currently, brain injured soldiers are treated at the Concussion Care Clinic at Camp Pendleton hospital, which was only opened in 2014.  However, this new facility can care for hundreds, if not thousands, of new patients.  (This new brain injury-specific facility will not only treat more soldiers, but will also teach prevention tactics and conduct brain/brain injury research.)

See also: Camps for a Cure

Brain Injury Awareness Month Across the Country: State Recognition

Brain injury has been an ongoing issue in America since its founding.  Though federally honored, BIAM is still finding legislative recognition on the state level.  For example, House Resolution 741 (HR 741), introduced by Pennsylvania’s Tina Pickett, was only introduced earlier this month and adopted (188-0) on March 14.  A similar bill will soon be voted on in the PA Senate.  (Though this marks the official recognition of the Month, the State has honored and provided education on brain injury at least since 2011.)  In 2013, New Jersey officially recognized it as a month-long state observance, whereas legislators in Alaska were relatively early adopters, passing a law to recognize the Month back in the 2007 – 2008 Congressional year.  (Some states still do not officially note Brain Injury Awareness Month.  However, groups in these states, such as the BIAA, do provide events specifically designed for the Month.)

As for events, New York State, in Tonawanda, located near Niagara Falls, lights the City Hall blue for the entire month to show solidarity and the need for public education on brain injury.  (Blue is the official color of Brain Injury Awareness Month, as designated by the Brain Injury Association of America.) On Brian Injury Advocacy Day, March 20, survivors/advocates met with members of the New York State Legislature to thank legislators for what they have done thus far and to teach them about the impact of brain injury, including how they can further help prevent it, as well as support those with brain injury.  While some legislators may have been tempted by the promise of pie, Kansas legislators and lawmakers met at the Topeka State House on March 21 to learn more about brain injury.  The Nebraska Brain Injury Advisory Council, which is sponsored by the Nebraska Department of Education, launched a mobile-responsive website that, “presents resources and reference information for anyone affected to assist in navigating for the best possible outcome.”

The above is just a short representation of activities throughout the country related to Brain Injury Awareness Month.  Please search online to find more past and upcoming local events.

Brain Injury Awareness Month Across the Country: Capitol Hill

Brain injury affects America as a whole, and its importance should be recognized on Capitol Hill.  As part of this national recognition, on March 5, Press Secretary Sarah Sanders introduced Retired Marine Corps Sergeant John Peck to the press.   Peck’s story is remarkable and therefore must be noted in its entirety: “Sergeant Peck suffered a traumatic brain injury in Iraq during his first tour of duty.  Then, after two years of therapy, he re-enlisted and deployed to Afghanistan.  While there, he stepped on an IED and lost both arms and legs.  He spent two years at Walter Reed, and in 2016 received a double arm transplant.  He is now doing physical and occupational therapy at Walter Reed, and doing incredibly well.”

Earlier this week, our legislators further honored brain injured Americans at Brain Injury Awareness Day, which is always honored on Capitol Hill during Brain Injury Awareness Month.  Generally, from what I can determine, the day is simply associated with Brain Injury Awareness Month and, therefore, in March.  However, Brain Injury Awareness Day is not honored on a specific calendar day.  (For example, in 2017 it was on Wednesday, March 22.  This year it was on March 20.)  The point of the day, though, is unchanging: to increase knowledge and awareness of brain injury with our elected officials.

As noted in an earlier article, the theme of 2018 Brain Injury Awareness Month is Change Your Mind.  Scheduled by the Congressional Brain Injury Task Force, co-chaired by Reps. Bill Pascrell, Jr. (NJ) and Thomas J. Rooney (FL), the events this past Tuesday were a Brain Injury Awareness fair, a Congressional briefing and a reception celebrating Brain Injury Awareness Month.

When I can find the audio of the Capitol Hill Congressional briefing, I will post it on this site.  Additionally, as I find state events honoring the month, I will post them.

Caring for Man’s Best Friend

The benefits of dog ownership are well-known.  “Owning a dog can lift your mood or help you feel less stressed.”  For veterans and others with disabilities, the benefits of have a dog, specifically service dogs, go beyond this: dogs can serve by helping or even doing certain tasks that the handlers cannot do themselves.

However, what happens when the dog is the one with a brain injury?  Yes, dog’s skulls are harder than those of humans and surrounded by protective fluid, both of which make brain injuries less common in them.  (This is fortunate for animals who play/fight for fun, may bump into coffee tables as they chase after toys, etc.)  Canines though, can get brain injuries in the same ways that humans can: a car accident, a fall, etc.  The possible symptoms are also similar to those of humans:  bleeding from the nose or ears, coma, confusion, death, disorientation, facial weakness, lethargy, loss of consciousness, paralysis, pupil dilation, seizures, and stumbling.

Once these symptoms begin to occur what do you do?  For these members of the family, seeking medical help should be the next step.  Going to the local veterinarian is definitely the appropriate action, but there are also neuro-veterinarian specialists.  While this is a very limited profession, it’s not impossible to find.  It is fortuitous to an injured canine if their owner lives in Arizona, as they have access to this professional expertise.  (For example, Lucky, a dog found shot in the Arizona desert by border control officers earlier this year, was relatively fortunate that such help was available to him.)

One thing not to do is to abandon the dog.  This is what happened earlier this month to one dog in Sacramento, CA .  A woman, assuredly not the owner, found an injured dog on the streets and brought him to the Sacramento County Bradshaw Animal Shelter.  The dog, now named Thomas, has gone through multiple tests, yet the doctors still do not know what happened to him, just that it resulted in a severe brain injury.  “He is such a fighter… Baby Thomas wants everyone to know he is determined to heal, grow up and live a long, mischievous life!”  This and so many other examples show the need for Sacramento Counties non-profit T.E.A.M. – Teaching Everyone Animals Matter.  (As of March 16, the owner of Thomas has still not been found.  T.E.A.M. is now offering a $1,000 reward for information that leads to an arrest.)

(Most states have laws prohibiting animal cruelty.  For example, 3 weeks ago, a 27-year-old man was sentenced to 12 years in prison in Texas for abusing his boxer puppy.  Most of these states also have a law prohibiting animal abandonment.)

Simple Blood Test Detects Brain Injury

“Food and Drug Administration authorizes marketing of first blood test to aid in the evaluation of concussion in adults,” read the headline on the FDA’s website this Valentine’s Day.  On a day that promotes love and caring, the FDA announced approval for the use of the BTI (Brain Trauma Indicator), a blood test that can provide earlier detection of mTBI/concussions and, therefore, provide early caring and treatment for the patient.

The BTI is a product of the Breakthrough Devices Program of the 21st Century Cures Act.  The research that developed into this product was completed by Banyan Biomarkers, Inc., in partnership with the U.S. Department of Defense and the U.S. Army Medical Research and Materiel Command.  Specifically, “Banyan BTI identifies two brain-specific protein biomarkers (Ubiquitin Carboxy-terminal Hydrolase-L1 or UCH-L1 and Glial Fibrilliary Acidic Protein or GFAP) that rapidly appear in the blood after a brain injury.”  A clinical study of the product, in which about 2,000 adults were tested, had over a 97% success rate.

The Banyan Indicator also has an additional benefit: reduced radiation exposure.  The FDA states that, “helping to deliver innovative testing technologies that minimize health impacts to patients while still providing accurate and reliable results to inform appropriate evaluation and treatment is… [a] priority.”  As testing is now, patients undergo an evaluation on a neurological scale (Glasgow Coma Scale), followed by a CT scan.  However, even the FDA acknowledges that “there are both benefits and risks associated with the use of CT.”  Beyond the reported risk of cancer through CT scans, under rare circumstances they can cause such effects as skin erythema (reddening), skin tissue injury, and birth defects following in-utero exposure.  (More so, a CT scan can sometimes show no brain dysfunction when TBI is present.)

The BTI is not without concerns.  Could there be false positives or negatives?  What will it cost, especially compared to a CT scan?  However, these are similar to the concerns given to all medical equipment and medications.  A quick and easy evaluation and diagnosis of a brain injury, through only a blood test, would be beneficial for patients and doctors’ alike.

SBS: The Horrific Easy Answer

Shaken baby syndrome (SBS) is a form of abusive head trauma inflicted on infants.  At least 1.400 babies die of SBS a year, studies show.  That exceedingly high number doesn’t even account for all the babies that are not killed but will live with the lifelong consequences of their parents’ bad actions.  Nor does it factor in all the babies that are shaken “in secret”, without a subsequent hospital visit, call to the police, etc.  According to the CDC, “Nearly all victims of AHT [Abusive Head Trauma} suffer serious, long-term health consequences such as vision problems, developmental delays, physical disabilities, and hearing loss.”

Just this month, March 2018, at least 3 people have been sentenced to jail for SBS:

  • On March 1, Montana resident Austin Blair Johnson, 27, received a 15-year sentence for shaking his 5-year-old son.  Presumably, Johnson received only 15 years, not the 20-year sentence called for by the prosecutors, because he plead guilty.  Johnson sobbed during the sentencing. However, remorse, for his actions or for the result, doesn’t change that 15 years seems like nothing for someone who gave his son a life sentence.
  • This past week, 30-year-old Delavon Domique Johnson was sent to jail for 30 years for inflicting such severe brain injury in his 3-month-old daughter that it caused intracranial hemorrhaging.
  • In Oregon, January Neatherlin was sentenced on March 9 to over 20 years for child abuse.  Though this abuse mostly involved drugging the children and abandoning her daycare facility while children were present, which is in no way better than physical abuse, “One family said their daughter suffered a brain injury, consistent with shaken baby syndrome, while in Neatherlin’s care.”

In 2001, the US government issued a statement, co-signed by Canada, on Shaken Baby Syndrome.  Nearly 20 years later, the statement’s recommendations are just as relevant and important: data collection and surveillance, further research (general knowledge, psychosocial and long-term), prevention, care and treatment, further education (primarily for child protection personnel, police, medical examiners and coroners, prosecutors, lawyers and judges), community response (including services and support) and professional training.  The CDC also notes the need for prevention, providing PDFs on prevention.

In 2014, however, the Washington Post cited a study that questions these almost universal beliefs: “most humans aren’t capable of shaking an infant hard enough to produce the symptoms in SBS.”  (Presumably, this means that SBS must often be accompanied by a secondary injury, such as the head also hitting the floor.)  New scientific research doesn’t prove that SBS is not the cause, just that it may not be in some cases.  Though diagnosing a child’s brain injury as caused by SBS may be a knee-jerk reaction, obvious isn’t always true or correct.  Hopefully, with continued education for both the parents/caregivers and members of the justice system, it will become a less common and a less possible culprit.  More so, hopefully fewer parents will find shaking a legitimate means of punishment.