Category Archives: Government/Research

TBI Beyond the Brain: Intestinal Impact

The brain maintains executive function over the entire body.  As we have all learned, when someone has the flu, it’s really the brain that “tells” them that their stomach hurts.  However, what happens when the brain and its functioning therein are injured?

The medical field has been studying this for some time.  About a decade ago, for example, the NIH concluded that a traumatic brain injury brings an increase in intestinal permeability.*  (Beyond TBI, increased intestinal permeability can be cause by such things as excess alcohol consumption.)  “Intestinal permeability is a barrier feature closely linked to the intestinal commensal microbiota as well as to the elements of the mucosal immune system.”  The term is often used synonymously with “intestinal barrier,” even though the two do not have the same exact definition.

 

In 2015, the NIH found, “Deficits in intestinal permeability may underpin the chronic low-grade inflammation observed in disorders such as depression.”  Depression is, of course, all too common among those with brain injury, so discovering one of the causes and perhaps finding a cure could be of extreme benefit.  Last year, the University of Maryland again studied the correlation between traumatic brain injury and intestinal damage.  (This study only examined the effects in mice.)  To summarize their findings into one sentence, scientists now recognize that, “brain trauma can make the colon more permeable, potentially allowing harmful microbes to migrate from the intestine to other areas of the body, causing infection.”  In essence, they found it to be a two-way street: the brain can “harm” the gastro system and the intestinal system can do the same to the brain.  (At the moment, damage discovery seems to be the only goal.  Perhaps fixing the problem and preventing later brain damage will come next.)

* As interesting as the above results are, traumatic brain injury is so named because it is severe and the resulting health problems likely go beyond the brain.  Other internal and external organs may be affected by the incident.  If the gastrointestinal system is physically harmed, it will no longer function in an optimal manner.  Digestion may no longer be such an easy/painfree activity.   Absorption of all nutrients may no longer be possible.

Mercury on the Mind – 2

Following the posting of my last article, I found additional interesting information about mercury and dentistry (dentistry may not be the primary use of mercury, but it is the most visible one).  Although mercury is no longer toxic once it is absorbed into a compound in a dental filling, laws regarding the use, particularly the dental use, of mercury exist.  For example, in New York, the environmental conservation law was amended in 2002 to state, “no dentist shall use or possess elemental mercury in the practice of dentistry unless such elemental mercury is contained in appropriate pre-encapsulated capsules.”

As it relates to a medical procedure that many brain injury survivors undergo, this summer the journal Radiology published an article: High-Strength MRI May Release Mercury from Amalgam Dental Fillings.  Further study of the possible effects of MRIs and mercury, show that while MRIs on someone who has mercury in their body may not cause or cause harm to a brain injury per se, NIH studies, “provide further support for the noxious effect of MRI (exposure to strong magnetic field) and release of mercury from dental amalgam fillings.”  (Additionally, MRIs can harm implants, such as brain stimulators, which may contain mercury.)

(In relation to the use of the ten chemicals of health public concern, particularly as it relates to dentistry, I would also advice people to be wary of fluoride.  The World Health Organization warns of both inadequate or excess fluoride intake.  Just like mercury, fluoride can help teeth at certain levels, but overexposure can lead to such things as tooth decay and skeletal fluorosis.  Smile! New water fluoridation level called for by government read the title of a CNBC article related to the 2015 federal increase in the amount of fluoride allowed in drinking water.  In fact, all articles I found related to this increase were positive.)

Mercury on the Mind – 1

In Thursday’s article related to brain injury and mercury, I see that some may have found the title derogatory towards dentists.  As someone who had braces in middle school and yearly gets regular checkups, I see the benefit of dentistry.  In addition, I understand that doctors and individuals recognize the benefit of treatment and care with mercury on certain conditions.  For these reasons, I have changed the title of this article.

Mercury Can Cause Brain Damage in Kids read the headline in the Huffington Post earlier this year.  Mercury (Hg) is a naturally-occurring, odorless silver metallic trace element that is liquid at room temperature.  It comes in three forms: elemental mercury, which is the form of mercury found on in teeth fillings, inorganic mercury, and methylmercury, also known as organic mercury found in such things as fish.  Its safety has long been disputed.  For example, while many people have amalgam teeth fillings that contain mercury, batteries, which are filled with mercury, are known to be unsafe. In medicine, it has been used as a purgative, disinfectant, astringent and particular as an antisyphilitics treatment.

Mercury is a neurotoxin.  Ingestion, absorption and fume inhalation of mercury can cause mercury poisoning.  The complications of mercury poisoning are numerous and can happen to people of all ages: weakness, fatigue, headaches, lower back pain, ataxia, slurred speech, tremor, somnolence, and mental disturbances, such as hallucinations and psychosis.  In fetuses and young children, Hg exposure, “may delay developmental milestones,” the NIH found 20 years ago.  For these reasons, mercury has been named one of the ten chemicals of major public health concern by the World Health Organization.  Additionally, its application in medical/dental care and in such products as fertilizers and pesticides has been lessening through the years.  One of the concerns scientists and people, in general, have with consumption of tap water is the possible additional consumption of mercury.

This year, the above-mentioned Huffington Post headline continues: Mercury Can Cause Brain Damage in Kids, the EPA Wants to Weaken Rules On Its Emissions.  The article’s title relates specifically to a legal proposal the Environmental Protection Agency sent to the White House that they say would hobble the 2011 Mercury and Air Toxic Standards (MATS) rule.  It specifically refers to the mercury emitted in the production of coal.  (However, the article’s title simplifies the action they are requesting, in a negative manner.  The proposal wants to eliminate co-benefits, in order to save the coal industry billions.)  A win for the coal industry, the article continues, as power plants are the nation’s biggest emitter of mercury.  If the proposal is enacted, there will be additional health costs for the public.  While the financial burden to the public is much less than the current cost of implementation of the rule for the coal industry, is the outcome more important?

I see no legislative follow-up on the proposal.  Additionally, on the EPA webpage dedicated to MATS, it still states that the ruling has prevented thousands of premature deaths a year and has many health benefits, which seems to imply that the basic standards have stayed the same.  However, if the rules regarding mercury are lessened, critics call it a win for the coal industry, as MATS specifically sets limits on the amount of mercury, and other toxins, allowed in coal-fired power plants.

First Snowfall Peril on the Roads

Last week, much of the eastern United States (Illinois, Michigan, Indiana, Kentucky, Ohio, West Virginia, Pennsylvania, New Jersey, Maryland, New York, Connecticut, Rhode Island, Massachusetts. Vermont, New Hampshire) experienced its first snowfall of the year.  Given that winter does not officially begin until December 21, this snowfall was much earlier than expected, just as in March there was snow into the spring.  Because of governmental unpreparedness, states’ transportation systems became essentially paralyzed.  In my state of New Jersey, lack of governmental preparation meant that a trip that should have taken me 20 minutes, took 12 hours.  The government seems not to have been much involved at all, as it was fellow citizens who distributed water and snacks to others and offered their cell phones for use to those in need.

Ambulances, though, were present.  Unfortunately, as it was almost impossible to move one’s car, the ability for ambulances to get through traffic was difficult.  For those who sustained an injury during a snowfall-related accident, I can only imagine how horrific that must have been.  For those who live with brain injuries and were driving or were passengers in a car, the concern was great – would lack of medication result in negative outcomes, would fatigue overcome, etc.?

In 2005, the NIH reported, “To date, only 2 previous studies have examined the effects of the first snowfall of the season,” on collisions, injuries and fatalities.  Research shows that since that time, that number does not seem to have greatly increased.  However, all agree that the first snowfall of the year is substantially more dangerous.

Today, Thanksgiving, while snow may not be in the forecast, “The coldest Thanksgiving in over a century for millions plus traffic troubles,” is anticipated.  Typically, studies and articles that focus on driving difficulties during the holidays address the effects of driving under the influence of alcohol.  Add to that the hazardous effects of snowfall and the risk becomes even greater.

The Big Battle in the Brain

Just as a hematoma is the body’s response to a bump, so does the brain inflame following a TBI.  The cells that cause this inflammation of the nervous system are known as microglia, the brain’s innate immune cells.  The NIH already recognizes, “Innate immune cells clearly play a role in the etiology and disease course of… traumatic brain injury.”  Beyond that though, they say little, as the NIH states that the role of immune cells in brain injury is a “young field”.

The only information I could find on the NIH site related to inflammation and brain injury before 2018 presented disheartening results – “neuroinflammation may contribute to neurodegeneration” and “anti-inflammatory drugs shortly after TBI didn’t help.”  This information, though, comes from NIH findings in 2016.  As this has been a mostly unexplored area of study, it is not a surprise to find new studies that have results that conflict with these earlier findings.  For example, this past October, it was found by professors at the Australian National University and RMIT that seaweed sugar allows the immune system to turn on and off and, therefore, may help recovery from a brain injury.

As those in Australia were having their SUSHI and seaweed salad, in the United States, the Ohio State University published the results of their study: Traumatic brain injury-induced neuronal damage in the somatosensory cortex causes formation of rod-shaped microglia that promote astrogliosis and persistent neuroinflammation.  Specifically, this study focused on the, “formation of rod microglia in cerebral cortex.”  These rod formations that cause the inflammation further harm brain health and become a secondary injury.  As the study states, this secondary injury can persist by as much as a decade or more.  The OSU researchers looked for a drug to rid the brain of or block the activity of microglia.  A drug was found that rid the brain of microglia in mice.  Unfortunately, there is no drug for humans, as of yet.  Scientists at OSU, though, have hope and say, “Understanding the microglial response and relationship to neuronal injury is vital.”

International Support for Brain Injury “Research, Treatment and Care”

Brain injury is not just a traumatic issue that affects people in the United States, it is a global epidemic.  For that reason, the Unites States National Institute of Health has been partnering with the European Commission (EC) and the Canadian Institute of Health Research (CIHR) since 2011, “to advance clinical traumatic brain injury (TBI) research, treatment and care.”  Specifically, the EC and the NIH brought together politicians, scientists, and others, from the European Union, United States, Canada, China, and Australia in Brussels in October 2011 to discuss joining forces.  Ultimately, the EC, the CIHR and the NIH joined together, “to coordinate and leverage clinical research activities on traumatic brain injury research” and created the International Initiative for Traumatic Brain Injury Research (InTBIR).  Even though well-over 100 studies related to brain injury are completed in America every year, more than 100 people die of brain injury every day and over 2 million brain injuries occur in the U.S. every year.  The three who formed the InTBIR saw the definite benefit of being connected to additional research and other resources.  To this end, many of the links found on various posts on this blog have directed you to research done in Europe or in Canada, as well as links to American research.

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.)