R.I.P. President George H.W. Bush

Today, at 11:00am ET, former Presidents, dignitaries, family members and others pay tribute to the 41st President of the Unites States, George H.W. Bush.  For the purpose of this website, it is a day to remember all that President Bush did for those with brain injuries, and for those with disabilities, at large.

President Bush was America’s last president to serve in the military overseas at war.  (President Clinton, President Obama and President Trump did not serve.  President George W. Bush served stateside as a pilot during the Vietnam War.)  Specifically, as a 20-year-old man, he served as a pilot in the Pacific during World War II.  As detailed in the book Flyboys, on September 2, 1944, while targeting a Japanese radio transmitter on the island of Chichijima, his plane was shot over the Pacific Ocean.  Bush did not abandon his plane, instead continuing to fight until his plane went down.  One source states that his injuries from this combat tragedy, that took the lives of many of his squadron, included “bleeding from a headwound”.

“Why had I been spared and what did God have in store for me?… there’s got to be some kind of destiny and I was being spared for something of Earth,” Bush later said about his trauma in WWII.  For those with disabilities, part of that reason was definitely his signing of the American Disabilities Act on July 26, 1990.  Modeled after the Civil Rights Act of 1964, the ADA aimed for equal opportunity for those with disabilities.  While a list of what impairments constitute a disability is not defined in the Act, a disability is defined as, “a physical or mental impairment that substantially limits one or more major life activities of such individual.”  These limiting impairments include, “functions of the… neurological, brain…”

Following his presidency, President Bush continued to support those with brain injury.  For example, in 1996, President Bush created a PSA for the Pediatric Brain Injury Prevention Campaign.  Prior to the PSA, the Campaign had no association with President Bush.  He agreed to do the PSA simply based on a request submitted through letter.

Recently, President Bush suffered through his own trauma – vascular Parkinsonism.  Thought to be caused by a multitude of mini strokes, vascular Parkinsonism is so named because it shares many of the characteristics of Parkinson’s disease.  (Some dispute this correlation, as Parkinson’s can be helped by medication, but vascular Parkinsonism cannot.)  On Friday, November 30, 2018, President, Vice President, Congressman and CIA Director Bush passed away.  After his funeral, his body will travel to Texas where he will be laid to rest next to his wife of over 70 years, Barbara and his young daughter Robin.  For the disabled, his legacy of the ADA will continue.

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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 from 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 entitled 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.”

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 the past decade, the ketogenic diet (KD) seeks to, “mimic biochemical changes associated with starvation.”  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, entitled 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.

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.”

At Home Brain Care

Last week, the University of Arkansas for Medical Sciences received a three-year, $450,000 grant from the U.S. Department of Health and Human Services Administration for Community Living, in addition to the $75,000 annual gift they are receiving from the Arkansas Department of Health.  The federal grant is to be applied to the University’s Traumatic Brain Injury State Partnership Program State Funding Opportunity.  “Among the goals of the program… are incorporating telemedicine and other technologies into TBI services to survivors, raising awareness of clinical and educational services for survivors, caregivers and families…”  Telemedicine increases healthcare access for all, particularly those is rural areas and others that cannot easily visit medical facilities, such as those with tbi who need aid in transportation.

Although it may seem to be a relatively modern invention, forms of telemedicine have been in existence since man could verbally communicate.  The more modern view of telemedicine, involving both verbal and visual communication with the medic, was first seen in 1924 in, “an imaginative cover for the magazine Radio News foreshadowed telemedicine in its depiction of a ‘radio doctor’ linked to a patient not only by sound but also by a live picture.”  Though at the time, the ideas of television and telemedicine were merely fantasies, the first television transmission occurred only 3 years later.  Video communication between doctor and patient, however, is usually first dated to 1959.  1959 is also the year of the first neurologic examination through telemedicine, occurring at the University of Nebraska.  Five years later, means to treat patients with brain injury and neurological disorders were found, as, “they established a telemedicine link… to provide speech therapy, neurological examinations, diagnosis of difficult psychiatric cases, case consultations, research seminars, and education and training.”

The above paragraph primarily comes from information in a 1996 article that can be found on the site of the National Academy of Sciences.  In 1996, the government recognized that there was a vast need for telemedicine, since its envisionment to the present day.  With both new technology and increased forms of communication, telemedicine has gone far above what could have been imagined 22 years ago.  For example, a 71-page report penned by the Undersecretary of Defense to the House Chair of the Committee of Armed Services, states that, “the Department of Defense views telemedicine as an important set of tools to improve access to Psychological Health and TBI care services in both deployed and non-deployed settings.  In June 2018, the FDA approved the distribution of MindMotion GO, a type of mobile therapy that focuses on speech and task therapies.  As far as brain injury diagnosis, while CT scans and other such tests may need to occur at medical facilities, medical professionals are now using communication technology to diagnose another neurological disorder (autism) and to evaluate others (computerized concussion assessment).

 

Revolutionary Treatment in the 18th Century

When one thinks of Revolutionary War combat injuries, one tends to think of physical trauma or even death.  Head injury is generally not considered, even though when one thinks of war injuries, head injuries are known to occur all too often.  Because of this reality, during the War of Independence, American doctors began to study neurosurgery and treat soldiers accordingly.  A manual, entitled Plain Concise Practical Remarks on the Treatment of Wounds and Fractures and authored by Dr. John Jones, was published in 1775, “to give the young unexperienced Surgeon, fome general and clear ideas of the nature and treatment of this difficult and dangerous brain of chirurgical difeafes” sic.  Dr. Jones’ experience included founding King’s College Medical School, now known as Columbia College of Physicians and Surgeons.  (Manual chapters include: Of Blows on the Head, Of Injuries Arifing from Concussion or Commotion, Of Injuries Arifing from Fracture of the Skull.)

Lincoln: America’s Great Leader & TBI Survivor

February 20 was President’s Day.  Before the end of the month, it is good to honor one of America’s most lauded presidents and brain injury survivor, Abraham Lincoln:

During his younger years, although he had little formal education, Lincoln was an avid reader.  He would have rather spent a day reading a book than outside riding a horse.  Perhaps because of his comparable inexperience with outdoor activities, Lincoln was thrown off a horse as a child.  Though the specifics of this event are murky (some articles/posts claim he was 9-years-old during the incident, some say 10.  Some say he was hurt by a horse, others say a mule), what is clear is that he remained unconscious for at least the rest of the day.

Later in his life, Lincoln had two bouts of malaria, in 1830 and 1835.  When parasite-filled blood cells block blood vessels, malaria can cause brain damage.  Also in 1835, some claim that Lincoln had the sexually transmitted disease syphilis.  Syphilis can cause neurological problems.

While both contracting malaria and syphilis may have heightened the severity of Lincoln’s brain injury, the most severe occurrence to Lincoln’s brain was, most likely, the aforementioned fall off a horse at a young age.  Given this historical information, it is clear the Lincoln had some sort of brain damage.  His recorded behavior further exhibits this.  Specifically, Lincoln is known to have had a prolonged struggle with severe depression.  Depression is, unfortunately, a common side effect of brain injury.

Whether knowing that Lincoln had some sort of neurological problem affects people’s views of him positively, negatively or not at all, is irrelevant.  People simply need to know that the president who brought our country back together had a brain injury.  Knowing this, the public may question and change their underestimation of and negative behavior towards brain injured classmates, neighbors, fellow employees, etc.

NDEAM: The Beginning

On September 2, 1945, WWII officially ended.  However, for many of the 670,846 wounded in the war, the struggle did not end there.  Discrimination, often unintentional, unknowing discrimination, was rampant against the disabled, meaning that their job prospects were limited.  (Discrimination was much more pervasive than it is now, though that is not to say that current job prospects for the disabled are good.)  Because of this, on September 21, 1945 by Act of Congress and Presidential proclamation, President Truman declared October 7-13, 1945 as National Employ the Physically Handicapped Week.  In Proclamation 2664, the President wrote, “I ask the governors of States, mayors of cities, heads of the various agencies of the Government, and other public officials, as well as leaders in industry, education, religion, and every other aspect of our common life, during the week and at all other suitable times, to exercise every appropriate effort to enlist public support of a sustained program for the employment and development of the abilities and capacities of those who are physically handicapped.”

In response to this, many Senators and Representatives expressed their support.  Given the number of wounded veterans returning home and others with physical disabilities, many of those in Government had a personal interest in aiding those who they knew to be capable individuals.  In particular, Representative Earl C. Michener expressed on the Congressional Record, “Just because one cannot see as others do, or walk as others do, or talk as others do, or hear as others do, is no indication that this person does not have a mission in life and a definite productive place in society and in our economy.  However, it is easy for the American people to forget, and the celebration of this particular week will not only stimulate the memory, but will impress the necessity of remembering that there are in every community some physically handicapped persons.”  When you eliminate the word “physically” from this remark, so that it applies to today’s broader definition of disability, Rep. Michener’s statement is just as relevant now, as it was over 70 years ago.