June is… National Aphasia Awareness Month

The National Institute of Health defines aphasia as, “a disorder that results from damage to portions of the brain that are responsible for language… The disorder impairs the expression and understanding of language as well as reading and writing. Aphasia may co-occur with speech disorders, such as dysarthria or apraxia of speech, which also result from brain damage.”  Brain damage is, of course, the defining effect of a traumatic brain injury and other neurological disorders.

The United States government has designated June as National Aphasia Awareness Month.  The subtitle of an article from yesterday’s Huffington Post states what I see as the main purpose of the Month: “Just because you have word-finding problems does not mean you have diminished intelligence!”  Educating the public is the key to Aphasia Awareness, so that those who have a neurological disorder and those who know an individual who has a neurological disorder recognize that their innate intelligence is still very much present.

Advertisements

Update: North Korean Trauma

Yesterday, June 19, 2017, Otto Warmbier succumb to the trauma he suffered for a year and a half while detained in North Korea.  Though Warmbier’s condition has generated more concern over international travel, his comatose mental state is curious.

He shows no signs of understanding language, responding to verbal commands or awareness of his surroundings,” said Kanter, Warmbier’s neurologist at the University of Cincinnati Medical Center.  However, “He was home and we believe he could sense that,” said his father.

Warmbier’s death, and particularly the fact that it happened almost immediately after he was reunited with his family, begs the question: Does the unconscious brain have more of a sense of self than currently believed?

North Korean Trauma

An American university student who was returned to the United States this week after being held in North Korea for 17 months has a severe brain injury and is in a state of ‘unresponsive wakefulness’,” doctors told Reuters yesterday.  Specifically, Otto Warmbier, a 22-year-old student of the University of Virginia, was returned to America and is now a patient at the University of Cincinnati Medical Center, where he shows no understanding of any communication around him.  Given the limited amount of information provided by Kim Jong Un’s Korean military, the exact cause of Warmbier’s comatose state is not known.  However, one of the top assumptions is that his condition is the result of a traumatic brain injury.

Warmbier, originally from Wyoming, Ohio, has been in a coma for more than a year, shortly after he was sentenced to 15 years of hard labor for stealing a propaganda sign in North Korea, where he was a tourist.  (I assume that Warmbier stole the sign as a unique type of memorabilia, so he would always remember his once-in-a-lifetime trip.)

This week, the Warmbier family received a call from President Trump, which they termed “kind” of him.  On Wednesday, Secretary of State Tillerson said that America is now considering travel visa restrictions for North Korea.  (Before all of this, last month, a bill was introduced that would ban United States citizens from traveling to North Korea.)  The United Nations human rights division is also carrying out a thorough investigation into North Korea’s actions.

Linking Li to the Brain

In 2014, the National Institute of Health deemed lithium (Li) to be of medical assistance in the treatment of traumatic brain injury.  However, the NIH determination came only from the promising results of a preclinical study.  Now, Rutgers University has released the findings of a three year study, funded by the New Jersey Commission of Brain Injury Research, that corroborates the NIH’s findings.

Commonly used to treat bipolar disorder, “Rutgers researchers discovered that lithium, as well as rapamycin (an immunosuppressant used to treat cancer), protects healthy brain cells from a toxic buildup of a chemical.”  Specifically, this study identified the massive buildup of glutamate.  Glutamate is a chemical in the body that, in healthy doses, promotes learning and memory.  However, in the high doses that can result from the body’s innate response to brain injury, it can be toxic to the cells.

The current results apply to recovery only from concussion.  However, given the positive results thus far, further studies are likely to be in the works.

Legislature Acts to Put Paddling Out to Sea

“The use of any form of corporal punishment is prohibited in any public or secondary school.”  While this statement should be true everywhere, in 18 states the barbaric act of harsh corporal punishment (HCP) is still legal.  However, this exact quote comes from a bill that was presented for vote last month to the Louisiana State Legislature.  Sponsored by Barbara Norton (D-Shreveport), Louisiana House Bill 497 passed the Louisiana House Education Committee on April 26 with a vote of 6 – 5.  (Two Republicans and fours Democrats voted for it.)

Besides Louisiana, state law still permits harsh corporal punishment in Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas and Wyoming.  (It is prohibited in many school districts, though, largely because of fear of costly lawsuits.)  Specifically, the legality of HCP in some states comes under the protection of states’ rights and under the protection of particular school districts.  Some parents, some states and some school districts believe HCP to be an effective method of controlling a classroom.  The continued use of paddling can be evidenced by the fact that you can buy a paddle online.  (Some of the posted comments on the purchase page of this item are evidence that it is marketed for use on a child.)

The continued acceptance of corporal punishment in some schools is related to another horrifying statistic: “research shows that up to 90% of parents spank their children at least occasionally.”  The LA Times article, from which this statistic is taken, then showcases both the so-called PROs and CONs of mild HCP, spanking, with the divided points of view presented by different doctors.  The pro-spanking doctor states, “In reviewing all the literature, there’s one that leads to better outcomes, reduced defiance, reduced aggression in children, and that’s what I call backup spanking.”  On the other side, the doctor says that, “studies have shown that the more kids get spanked, the higher the child’s score on a post-traumatic stress test.”  More so, statistics demonstrate that spanking simply doesn’t work.  This article demonstrates that just as states and school districts have divided points of view regarding the use of corporal punishment, so do doctors, even with medical evidence at hand.

In addition to HB 497, this year, Louisiana Governor John Edwards declared, “Corporal punishment of children with disabilities should no longer be acceptable in Louisiana.”  In the 2015 – 2016 school year, for example, it is reported that 16% of students who were paddled had a disability.  (Unlike students without disabilities many disabled students are not in full mental control of their actions, particularly in their early years, such as preschool and kindergarten.)   The statement from the Governor specifically refers to HB 79, sponsored by Rep. Franklin Foil (R-Baton Rouge), which was also presented to the House this year at the same time as HB 497.  HB 79, which addresses students with disabilities including autism, intellectual disabilities, traumatic brain injury and others, passed the Committee unanimously.

The irony, for lack of a better word, is that though paddling and other forms of HCP may worsen the symptoms of an existing brain injury, it causes damage to the brain in those who are previously without such injury.  The title of a study conducted by the National Institute of Health provides evidence of this: “Reduced Prefrontal Cortical Grey Matter* Volume in Young Adults Exposed to Harsh Corporal Punishment.”  Specifically, beyond emotional and physical trauma, “HCP may be an aversive and stressful event for human beings that potentially alters the development trajectory of some brain regions in which abnormalities have been associated with major forms of psychopathology.”

* Grey matter in the brain is essentially necessary for everything.  “The grey matter includes regions of the brain involved in muscle control, and sensory perception such as seeing and hearing, memory, emotions, speech, decision making, and self-control.”  There is also grey matter in the spinal cord and, though it is not specifically mentioned, I’ve got to think that it is also compromised by HCP.

Camps for a Cure

Located in San Diego, CA, Camp Pendleton proclaims to be, “The West Coast’s Premier Expeditionary [Marines] Training Base.”  Last Tuesday, May 9, they broke ground on a $12 million, 25,000 square foot facility that aims to make the Camp a premier brain injury research and treatment center, too.  The funding needed to build the facility was raised through private donations and the funding of Arnold Fisher, a New York-based real estate tycoon.   Fisher says that he sees helping the troops as his duty as an American.

Part of the Department of Defense organization National Intrepid Center of Excellence (NICoE), which is headquartered in Maryland, the Camp Pendleton facility will be the seventh of nine planned NICoE facilities focused on brain injury and the first on the West Coast.  Presently, NICoE has erected facilities in Fort Belvoir, Virginia, Camp Lejeune, North Carolina, Fort Campbell, Kentucky, Fort Hood, Texas, and Fort Bragg, North Carolina.  A center at Joint Base Lewis-McChord, Washington, is still under construction and facilities are still to be built in Fort Carson, Colorado and Fort Blass, Texas.

Beyond Marine training, the Camp defines part of its vision to be, “providing superior service and support.”  Therefore, they also deal with the injuries that may come as a result of a brain injury or come in conjunction with it – specifically, physical and behavioral problems.  In fact, Camp Pendleton has been training and supporting the troops for 75 years.

So far, NICoE facilities have about a 90% rate for patients to return to duty.  Still, as Capt. Lisa Mulligan, commanding officer at the Camp Pendleton hospital, says, “Science as a whole remains in the infancy of its understanding of the potential for recovery after head injury.  This center will combine the resources of clinical, research and educational specialists to broaden our horizons.

‘There’s Always a Risk’

On March 6, one of the jewels of the Triple Crown, the Kentucky Derby, was run.  To coincide with this, on Friday, May 5, NBC did a story about injury and horse racing.  Specifically, the article begins by mentioning Rajiv Maragh, a jockey with 13 years of professional horse racing experience and 13 years of injury to show from it, including a concussion.  The article then speaks more of horse racing and injury.  True, all sports have injury, but horse racing does not have concussion protocol, as other sports do.  Last year, the Jockeys’ Guild and the University of Kentucky announced a three-year study that seeks to bridge this gap.

“I choose to be a jockey and there’s always a risk of danger,” says Maragh.  However, the Guild can learn how to better protect its athletes, as professional sport leagues have done.

Note: While horse racing and government may not seem to be related, most states do have a racing commission that is “responsible for regulating the safety and integrity of the horse racing industry through the conduct of investigations, prosecutions and via regular monitoring.”  Because horse racing is a revenue earner for states, state commissions also focus on ensuring the welfare of the horse.

Have a TBI?  Find out anytime, anyplace.

Neurological injury is a significant health concern for military service members, recognizes the Department of Defense.  Last year, for example, 17,672 service members were diagnosed with a brain injury.  While the military may not be able to eliminate neurological injuries entirely, the DoD has granted $11.3 million to Abbott Laboratories for the development of a mobile device that allows one to determine if they have a traumatic brain injury, anytime and anyplace.  Interestingly, this product only relies on such things as the proteins in the blood to find brain injuries.  It will be developed in Princeton, New Jersey, with the assistance of the U.S. Army Medical Research Acquisition Activity in Frederick, Maryland, and has an estimated completion date of October 23, 2019.  (In 2014, the DoD awarded Abbott $19.5 million to develop a portable blood test to determine brain injury.  However, even then, Abbott said that the product being developed was, “the first phase of what… would be a multi-phased contract.”)

Update: Drones Promise Quick, Not Safe Delivery

Drones are on their way to becoming the preferred method of retail delivery and much more.  Currently, however, the air technology can only be used in a few limited locations.  Before they become ubiquitous, though, the Federal Aviation Administration (FAA) must assure that this way of delivery, that may weigh 50+ pounds, is safe for humans.  (Not just for airplane safety, the FAA is responsible for the safety of U.S. airspace from the ground up.)  Given their weight and their height of flight, head safety related to drones is of particular concern.

This has already been an issue this year.  On February 24, 2017, for example, a Seattle man was sentenced to a $500 fine and 30-days in jail because his drone hit a woman, causing her to lose consciousness.  However, current news also shows that drones can prove a benefit to those with a head injury.  In St. Louis, Minnesota the sheriff’s office is testing drones so, ultimately, they, “can look for missing persons, or a child, or maybe someone [who] was injured in an accident and sustained a head injury and wandered off.”

Federal-sponsored drone tests are also revealing.  At a government-approved test center at Virginia Tech, a drone is being tested again a crash-test dummy.  In testing, “the 21-pound drone tilted forward, accelerated sharply and slammed into [the drone’s] head, smacking the crash-test dummy’s neck backward and embedding shards of shattered propeller in his plastic face.”  Mark Black, director of the Virginia Tech drone test, asks, “When does the [head injury] threshold cross an unacceptable level?”

Although it is horrible to think of a head injury threshold, the Federal Aviation Administration knows that it can never make drones perfectly safe, just as airplanes will never be one hundred percent safe.  However, does the proposed FAA rule saying that, “Drones would have to fly 20 feet above people’s heads, and have a 10-foot buffer space on all sides,” satisfy the safety rules enough?

Update: Yesterday, an article appeared on the Fortune website regarding the safety of drones.  Specifically, it references and links to a research study conducted by the FAA that was released on Friday, April 28.  Generally, the research shows that, “both steel debris and the wood block caused significantly more damage to the dummy than the drone, which absorb much of the impact because it’s made of more flexible materials.”

Long-awaited, Expanded Research Facility Opens in Waco

For seven years, there have been high hopes and expectations that Waco, Texas would be host to a world-class VA research facility.  Consolidating the Austin-based Brain Injury Recovery Laboratory and Waco’s Center of Excellence into one facility, it was thought that, 1 “this program consolidation will enable [the] VA to meet its mission of better understanding brain injuries…”  Waco is right next to Fort Hood, so the high hopes seemed in tune with location reality.  Right before it opened, then-Rep. Chet Edwards (D-Waco) lauded it as, “one of the few programs in the country focused on the links between genes and brain anatomy in the development of PTSD and mental illness in our combat soldiers.”  The Center even had many designated areas of the building devoted to the study of TBI and PTSD.  However, after all the excitement of the opening of the facility ended, it seems that much of the research activity in it essentially did too.

Perhaps it was all of these high hopes, coupled with the new, expensive equipment,  that led to the program’s perceived failure.  In 2014, “a 10-month [local newspaper] investigation… found that the VA squandered millions of dollars and six years of research opportunity just as brain injuries were spiking among U.S. service members.”  (Of particular note was the finding that a MRI scanner that was purchased in 2008 for $3.6 million, had since stayed dormant.)  This investigation was noticed by Congress, who started an investigation of their own, launched by Rep. Bill Flores (R-Waco).

Last week, the VA debuted a new, expanded state-of-the-art research facility in Waco, Texas.  (This is very similar to the nomenclature that was used in 2009 for the facility’s original launch and, in fact, this new facility was originally planned to open in 2011.)  Housed in the Doris Miller Department of Veterans Affairs Medical Center, the VISN 17 Center of Excellence for Research on Returning War Veterans, as it’s known, employs 70 people from around the country.  These people must then find residence in Waco.  Waco Mayor Kyle Deaver says that, “attracting these well-paid professionals to Waco will ripple through the local economy,” which is an unexpected benefit of the Center.  Currently, a number of studies have already been planned, including Project Serve, SHE Study, the Moral Injury Project and treatment of traumatic brain injury using EEG neurofeedback.