Weighing In On Insomnia

Sleep is crucial for humans to survive and thrive.  “Emerging evidence implicates sleep in the most basic of neurological functions, namely the exchange of metabolic wastes associated with neurological homeostasis…  sleep is integral in the function of the glymphatic system… Natural sleep or anesthesia accounts for an increase in interstitial space that facilitates the subsequent exchange of cerebrospinal fluid (CSF) with interstitial fluid.”  All people have been told to get at least 8 hours of sleep a night.  While this number is actually higher for the young, 7-8 hours is the recommended hours of sleep needed for those 18 and up.  For those with brain injuries, an energized brain is necessary to perform at their best.  However, about 30 to 70 percent of those with brain injuries have sleep disorders including deprivation, deficiency, disruption, etc.  (Although fatigue may be the most obvious side effect of a sleep disorder, “the consequences of disrupted sleep following injury range from deranged metabolomics and blood brain barrier compromise to altered neuroplasticity and degeneration.”)

The above links are all from government studies into brain injury and sleep disorders.  While they may be interesting and informative, methods of curing these sleep disorders are what really matter to those afflicted with them.  So far, many means to induce sleep and reduce the activity of a restless mind have been explored and written about, such as cognitive behavioral therapy, the use of activities, etc.

My advice is to read the results of these studies while you’re in bed, using one of the recommended sleep aids: a weighted blanket.  Weighted blankets have gained popularity in the past few years.  So named because the weight of the blanket equals about 10 percent of the user’s weight, the extra weight that this blanket provides the user is soothing, rather than encapsulating.  They are a form of deep pressure touch stimulation, which can help with one of the more common symptoms of TBI, anxiety, among other things.  (I am not promoting weighted blankets more than cognitive behavior therapy or any other means of ridding one’s self of a sleep disorder, I’m just on the search for a new sleep strategy.)

Government Studies Brain Injury in the Bible

America is, and should be, a country of religious freedom.  The roots of the winter holiday season, though, are based on the beliefs of Judaism and Christianity expressed in the Bible.  (Currently, more than 70 percent of Americans consider themselves either Christian or Jewish and all but two of our Presidents have been officially affiliated with some form of Christianity.)

Although the Bible is seen as the word of God by many, according to the American government, “the Bible is not just a religious text.  It is also a historical account.”  Taking this point of view, the government has studied the existence of brain injury in the Old Testament.  In 1995 and 1997, the NIH reviewed, “the death of Sisera by the hand of Jael (Judges 4: 21; 5: 25); the skull fractures of Avimelech incurred at the tower of Tevetz, (Judges, 9: 53, 54); and the slaying of Goliath by David, (Samuel I 17: 49-51).”  In addition, the government studied the child of the Shunammite woman in II Kings 4.  They determined that the child had a subarachnoid hemorrhage, also known as bleeding around the brain.  In 2010, an NIH study entitled New insights to the neurological diseases among biblical characters of old testament found evidence of stroke in 1 Samuel, Psalms 137 5-6 and Ezekiel.

Notwithstanding the conclusions of these new studies, the Hebrew and Christian Bibles are ultimately religious books – the government calls them books of love, peace and hope.  Searching through the Bible, I discovered a quote that expresses love, peace and hope to all brain injury survivors: “More than that, we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope, and hope does not put us to shame,” (Romans 5:3-5).

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.

Happy and Safe Halloween!!!

Halloween may not be an officially recognized federal holiday, but for many schools and millions of children it may as well be.  While many towns have already celebrated Halloween with trick-or-treating this past weekend, today is the day of costume and candy for the majority of American children.

Online the CDC has “safe and healthy” recommendations for Halloween, which primarily apply to adults.  Related to children, they advise trick-or-treaters to “take precautions to stay safe while trick-or-treating on Halloween night. Watch out for cars, use reflective gear, walk with a group, and carry a flash light.”  Many publications focus on the negative possible consequences of trick-or-treating, particularly that of night trick-or-treating when vision is limited, and adult intoxication is more likely.  A head injury is not something a child should receive from Halloween, so properly accompanying a child or thoroughly teaching an older child to trick-or-treat safely is necessary.

But even though there is parental worry, trick-or-treating is an enjoyable part of being a youth.  After a child has a brain injury that should not be taken away from them.  In Middletown, OH, police delivered Halloween candy to the disabled last week.  (While the article related to this event does not state if the police delivered candy to those with brain injury, one can assume they did, as they did for all children who had limited ability to trick-or-treat.)  Related specifically to brain injury, a UK-based website warns of the issues that Halloween can cause for those with sensory issues (costumes) and noise problems (fireworks).  For those with issues that make trick-or-treating impossible, a Parents magazine online also provides ideas for other ways to celebrate the day.

Since in journalism, sensation traditionally brings in readership, most of the articles related to Halloween seem to focus on danger.  Many state websites note suggestions/guides for parents and children for safe trick-of-treating, such as HeadSmart, published by the Brain Injury Association if Utah.  For those who have a brain injury and have the ability to wear a costume and/or trick-or-treat, I hope you have the chance to do so today.  For those who are medically unable to do so, I hope you are still able to celebrate in a different, but equally enjoyable way.

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.

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.”

McCain’s Posthumous Charitable Hopes

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

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

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

Mitigation for Morality and Murder

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

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

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

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

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

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

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).


Illegal Immigrants and Brain Injury

A hot topic in the past few decades, illegal immigration has now come to the forefront because of America’s current president and his border wall.  (For the past 10 years, the estimated number of illegal immigrants in America has stayed relatively stable at about 11 million.  During the presidencies of Bill Clinton and George W. Bush, it was steadily rising.)  As for brain injury and undocumented residents, there are many cause-and-effect questions that, when answered, are quite sobering.

To begin, what if the illegal immigrant is the culprit?  What if the illegal immigrant causes someone to have a brain injury, either intentionally or inadvertently?  First, the police or whomever is pursuing the case must find them.  Since illegal immigrants are largely undocumented, this can be a hard task.  For better or worse, depending on your political ideology, a number of states are now allowing an illegal immigrant to legally obtain a driver’s license and register their car.  In January 2015, for example, California signed into law AB60, which, “requires the [DMV] to issue an original driver’s license to an applicant who is unable to submit satisfactory proof of legal presence in the United States.”  New Jersey, with the support of Governor Phil Murphy, is now preparing for a similar bill, Assembly Bill No. 1738, to pass.  If this bill passes, it will make New Jersey the 13th state, plus the District of Columbia, to allow this.  (What the consequences are for an illegal immigrant who inflicts injury on another person, such as through a car accident and even if they are legally licensed, is unclear.  They are subject to criminal charges, but civil action may be more difficult.  As they are illegal, and many do not submit tax returns, which would show their yearly income, monetary consequences to cover such things as rehabilitation costs are not possible.)

More so, the government does not seem to account for the economic costs of brain injury:  For the victim, there will be a lose of future wages as, even if the victim is able to return to work, they will be away for a bit.  Additionally, when returning to work, a brain injured individual may have to pursue a career that is less cognitively and/or physically demanding and often less lucrative than their previous occupation.  For the Internal Revenue Service (IRS), this means less taxable dollars are earned.  Also, the brain injured individual may stay longer or indefinitely on Medicare and/or Medicaid.  The government then is required to help pay for their doctors’ visits, their medication, etc.

But, how about when the illegal immigrant is the victim?  No one wants to see a person, legal or not, suffer or even die due to lack of medical care.  All told, the government is financing about $18.5 billion a year for medical care of unauthorized immigrants.  Of this total, “federal taxpayers provided $11.2 billion in subsidized care to unauthorized immigrants in 2016.”  (“A relatively small number of undocumented immigrants, perhaps in the tens of thousands, obtain health insurance through private employers,” states a 2016 article.)  However, a page on the NIH website, written by an individual who had authored other pages on ethics, as it relates to illegal immigrants, notes that, “the Patient Protection and Affordable Care Act of 2010 ignored the health care of undocumented immigrants and will not provide relief to undocumented patients with catastrophic illness like ESRD, cancer, or traumatic brain injuries.”

There are local health clinics, hospital emergency rooms and free medical school clinics that must treat everyone, regardless of legality.*  Additionally, some doctors will treat undocumented immigrants, off the record.  Treatment for brain injury though, requires more than a brief trip to the doctor.  As an article from 2009, when illegal immigrants were treated differently by the government than now, is titled, “Struggling to find post-acute care for undocumented and uninsured immigrants.”  Should ethics trump legality, no pun intended?

*Another article recounts the story of an illegal man, without insurance, who suffered a stroke.  Though the hospital legally had to treat him, his care would be uncertain the second he stepped out of the hospital grounds.  Would receiving care for his stroke result in a “medical deportation”?  Ultimately, the hospital was able to find the man’s family in Mexico, but the trip to return him to his family cost $50,000 and was paid entirely by the government.

Note: The above post is not a personal comment on illegal immigration.