NeuroNotes: NRI's Brain Injury Blog

Veterans and Mild Brain Injury: The Debate Continues

2008-05-15T18:21:00.001-05:00

In the Correspondence section of the New England Journal of Medicine, Volume 358:2177-2179, May 15, 2008, Number 20, the issue of diagnosing Mild Brain Injury in U.S. soldiers continues. Dr. Hoge and his colleagues defend their position from their January 31st article in the NEJM. Yet, we as brain injury professionals have recognized for years that Mild TBI is difficult to diagnosis and often co-exists with other psychiatric symptoms which serve to complicate it's diagnosis. Doctors Xydakis and Robbins, in response to Dr.Hoge, wisely point to the diagnosis of Mild TBI as one which can only be made over time.They clearly understand the deficits may not be identified without the person and their physicians being able to notice functional changes. Dr. Stonesifer, in his response to Dr. Hoge, raised the issue of pituitary dysfunction in a large number of brain injury cases as causing neuropsychological and neurobehavioral deficits.

The issue of Mild Brain Injury in the population of returning veterans who were exposed to IED explosions should not be a matter of deciding that PTSD is a more likely diagnosis or one that exists to the exclusion of TBI. Untreated Mild Traumatic Brain Injury will have a very serious effect on the individual and will produce a significant psychological response.

There are great advances being made in screening for Diffuse Axonal Injury which need to be applied to our returning soldiers. We cannot allow a debate to continue over Mild Brain Injury vs. PTSD while veterans either accidentally or intentionally die from overdoses while attending marginal outpatient services as have 15 soldiers at the Brooke Army Hospital over recent months. Our troops need to be afforded the best diagnostic and restorative services available. The hospital at Balad is amazingly capable of saving lives. We could, at least, extend that capability to identifying and appropriately treating Traumatic Brain Injury at all levels.

Young People with TBI in Nursing Homes

2008-05-15T16:38:00.001-05:00

The magic of 18 is more than a coming of age event for a young person with a brain injury living in a residential care facility. That birthday may signal placement in a skilled nursing facility filled with older adults, isolating them from peers, school, family and the community. Young people with severe disabilities resulting from traumatic brain injury may require a level of care which can only be funded in a nursing home facility based on the current restrictions in funding. At this point there are few other options available for a growing number of young people who face a lifetime of disability and require significant physical care.

The odds favor survival for young people involved in serious accidents and medical advancements are allowing more individuals to survive. Unfortunately, the options for placement other than home are limited to facilities where there may be few other young adults and little in the way of programs and services which can sustain progress. A far cry from the school programs and pediatric facilities designed to serve young people with disabilities.

There is a need for specialized facilities and programs which can serve young people with severe disabilities from brain injury. These places don't have to be nursing homes and, in fact, other care environments may enhance independence and community participation and add to a quality of life. In order to create alternatives we need to revise the restrictions placed by Medicare and Medicaid. Some states have implemented brain injury waiver programs to support home, community and specialized services and have fostered the development of effective alternatives. A story in the New York Times of May 15, 2008 addresses the needs of people with severe disabilities who are turning 18 and frames out the issues.

To read the NY Times story: http://www.nytimes.com/2008/05/14/nyregion/14nursing.html?_r=1&ref=health&oref=slogin

New Measures for Brain Injury

2008-05-13T10:03:00.001-05:00

Medpage today’s John Gever reports that a new MRI innovation called diffusion tensor tractography will allow for improved measurements of multifocal nerve damage within the brain. Researchers share that this technology may help track the progress and help predict outcomes after severe traumatic brain injury. Gever (2008) reports:

In an interview, Dr. Diaz-Arrastia said the goal is to find a good measure for diffuse axonal injury, an "overlooked and understudied" phenomenon that increasingly appears to be an important factor in head-injured patients.

He said it used to be considered a rare form of injury, but mainly because it was hard to see with technologies such as CT imaging.

Recent studies suggest it plays a role in at least half of fatal head injuries," he added. Diffuse axonal injury may also explain puzzling cases in which people with apparently mild head injuries suffer lingering disability.

Diffusion tensor tractography measures water movement within tissues on the basis of MRI data. When nerve cell axons are damaged, as they frequently are in severe head trauma, they swell, absorbing water from surrounding tissues. That reduces movement of extracellular water.

On the other hand, when axons later die, they release water, thereby increasing extracellular water flows.

Click here to read the full article in MedPage Today

Ingredients for the Perfect Storm

2008-05-07T15:13:00.001-05:00

On a daily basis, through the newspapers and television, we hear and read stories about the problems faced by veterans returning from Iraq and Afghanistan with physical and psychological problems. At the APA conference this week the problem of 300,000 military members with PTSD was presented. Last week the number of drug overdoses, intentional and accidental, in wounded military personnel undergoing outpatient rehabilitation and other treatment was revealed. These soldiers are housed in transitional quarters on military bases, away from family, receiving limited services and case management. Many of these soldiers are disabled from traumatic brain injury and have other physical and psychological problems. Another story focused on the high number of suicides in military exceeding the number of war related deaths. The picture being painted for us is bleak and dangerous. Our soldiers need immediate help. The hidden psychological injuries must be identified and treated. The overt injuries and related disabilities cannot continue to be shuttled off into waiting lines and minimal treatment while task forces and committees are convened.

Disabilities from any cause affect every aspect of a person's life and treatment cannot be deferred. We need to move rapidly to bring the resources that are available in the civilian world to the members of our military who need help.

Treatment Concerns for Returning Soldiers Continue

2008-05-02T12:50:00.001-05:00

Returning soldiers with brain injuries and other disabilities, Post Traumatic Stress Disorder (PTSD) and mental health problems are at risk while they are in treatment at Walter Reed Army Medical Center and other military hospitals. At the Army hospitals serving our injured military personnel there have been 15 deaths of soldiers due to drug overdoses in recent months. The Army, through it's Surgeon General, Lt. General Eric Schoonmaker, is looking into the deaths as is a Congressional panel. It appears that many of the soldiers who have overdosed have been prescribed multiple medications with often limited communication between physicians and a lack of case management and coordination of care. In some cases, the soldiers had consumed alcohol which may have exacerbated the effects of the prescribed medications. There is also the unanswered issue of suicide which is known to be prevalent as a risk for traumatic brain injury and PTSD. The soldiers housed in Warrior Transition Units are a group at risk due to the low supervision and oversight of their care.

The problem underscores the need for integrated care and comprehensive case management. The Army must consider what services are needed by people with brain injuries, physical disabilities and mental health problems which affect their cognitive abilities and capacities to live independently. Currently the Army has banned alcohol in these Warrior Transition Units, but still has not provided the level of supervision that many of these individuals need to maintain safety and well being. Investigations and inquiries are important, but we do know the solution to the problem. Simply banning alcohol in a residence will not prevent soldiers from drinking there or in the community. The returning soldiers need program services and case management which are designed to meet their needs. We have those programs in the civilian world. Why wait for more overdoses and deaths?

VA Still Experiencing Problems Meeting the Needs of Veterans with Brain Injury

2008-05-01T16:13:00.001-05:00

A recent story by Hope Yen, states that veteran’s needs post-TBI are still not being met. After a study of 52 VA TBI patients during a seven month post injury period in 2004, and the 2006 IG review which found problems 16 months post injury, the VA had promised to address the shortcomings.

The article shares “10 of the 41 veterans who agreed to be interviewed said they weren't getting needed help for health care, vocational rehabilitation, family support or housing. At least four patients specifically cited trouble in getting primary or specialty eye care, while others reported gaps with family counseling for problems such as depression and anger”.

Yen reports:

"This is very troubling," said Michael O'Rourke, assistant director for veterans health policy at Veterans of Foreign Wars. "The fact of the matter is from the very beginning VA and Defense went in with too little, too short (on resources), because they weren't expecting this to be a prolonged conflict of war.

"I've seen a lot of effort to correct problems that exist. But constant vigilance is required," he said. "Veterans deserve to be treated for problems they may or may not know of."

The report included a VA response in which the department acknowledged problems with case management but stated that with recent improvements it now had "systems in place to ensure that all veterans with TBI are being followed as their clinical needs require."

According to the article in an attempt to improve care the VA is proposing to call “570,000 recent combat veterans to make sure they know what services are available to them”.

Click here to read the full article

Deep Brain Stimulation Treats Depression

2008-05-01T07:49:00.000-05:00

John Gever reports in Medpage today that a recent study shows that deep brain stimulation may work to alleviate severe depression. In this study the 17 patients received a Medtronic Soletra implantable pulse generator, 1 of which did not complete the study. According to Ali R. Rezai, M.D. of the Cleveland Clinic, “eight of the 16 patients showed at least 50% improvement in depression scores… and had significant improvement in quality of life, returning back to work, getting engaged, dating”. Gever reports:

Two patients had a return of depressive symptoms and suicidal ideation when their pulse generators were accidentally turned off. Restarting them again led to symptom improvement, Dr. Rezai said.

The pulse generators can stop working when exposed to strong magnetic fields, such as in metal detectors, or when the batteries run out, he explained.

He said the next step would be a randomized, controlled trial.

He said Medtronic is currently sponsoring a double-blind, cross-over trial. All patients will have the devices implanted, but half the patients will not have the units switched on immediately so that they can serve as controls.

Click here to read the full article in MedPage Today

Mental Health and Brain Injury Issues for Returning Vets: Astonishing Numbers

2008-04-25T13:40:00.001-05:00

The RAND Institute issued a comprehensive study of mental health issues and brain injury problems experienced by Iraq and Afghanistan veterans. According to the study nearly 20% of the returning veterans (300,000 soldiers) report symptoms of PTSD or major depression. Slightly more than half have received treatment. The study also revealed that 19% report a possible brain injury and 7% report a probable brain injury with PTSD or major depression. The study noted that many service members do not seek treatment due to concerns with the recognition of psychological problems being a blemish on their careers. For those who seek treatment, the RANDS researchers consider the treatment to be "minimally adequate". Terri Taniellan, the RAND project co-leader, called the problem "a major health crisis facing the men and women who have served in Iraq and Afghanistan". The RAND project targeted three areas: to identify psychological and cognitive injuries among those who have served; to develop economic modeling to study the costs associated with providing treatment, lost productivity and suicide; and to assess the availability of existing treatment and the barriers to access. Lisa Jaycox, a RAND study co-leader, referred to untreated PTSD and depression as "a cascading set of consequences". The RAND study estimated that the two year cost of PTSD and depression post-deployment ranged from $6,000 to $25,000 per case. The societal cost was between $4 billion to $6.2 billion.

The RAND study identified 320,000 service members who may have received a traumatic brain injury during deployment. This includes the range from concussive injuries through severe and catastrophic injuries. Only 43% were ever evaluated by a physician for their injury. The one year costs associated with a Mild Brain Injury were $32,000 per case. The moderate to severe injuries ranged from $268,000 to $408,000 per case over the one year period. The one year societal impact for 2700 brain injury cases identified to date range from $591 million to $910 million. These numbers will increase significantly as more individuals are evaluated and deemed to have a brain injury. Over the course of the next fifty years, the societal costs for brain injury involving service members will be enormous.

The newly created Defense Center for Excellence for Psychological Health and Traumatic Brain Injury has a herculean task over the next few years. It can truly become a center of excellence with adequate funding, trained personnel and an agenda directed towards identifying problems and providing treatment.The needs of the returning service members with psychological and brain injury related problems requires a call to action in the newly organized Center.

The RAND report is entitled: Invisible Wounds of War:Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery" and may be found at rand.org.

Stroke Patients Under Neurologists’ Care Have Better Outcomes

2008-04-22T12:24:00.003-05:00

Medpage Today’s John Gever reports that individual’s suffering from stroke fair better if their primary care physician is a neurologist, stating they “were less likely to die or need a second hospitalization.”

While the study showed no significant differences in mortality rates while in the hospital, it did show that neurologists tend to keep patients in the hospital for a longer period than other physicians. Gever wrote “Neurologist-treated stroke patients had a 14% lower rate of 30-day mortality and a 7% lower rate of 30-day readmission, according to a review of Medicare records reported by Judith Lichtman, Ph.D., M.P.H., of Yale, at the American Academy of Neurology meeting.”

According to the article, "It's possible that [the patients cared for by other specialists] may be more complex cases, maybe they had other acute events that were going on at the same time. That we haven't been able to look at very closely," Dr. Lichtman said.

Click here to read the full article in MedPage Today

Progressive Inflammatory Neuropathy Syndrome

2008-04-21T08:51:00.001-05:00

Two dozen Midwestern pork plant workers have suffered from “mysterious neurological symptoms”. The workers were exposed to aerosolized pig brains, which appears to have caused an autoimmune reaction. This is not a localized event. The story, published in Med Page Today, reports that 18 workers in Minnesota, 5 in Indiana, and 1 in Nebraska have exhibited symptoms of leg pains, sensory disturbances, weakness and fatigue. Daniel Lachance, M.D. of the Mayo Clinic in Rochester, Minnesota led the clinical investigation into the outbreak; he believes the symptoms are induced by exposure to “something in to porcine brain tissue” which causes an immune reaction resulting in neural inflammation. Dr. Lachance continues to work on this investigation with the collaboration of officials at the CDC and the state health department.

Click here to read the full story in MedPage Today

The Brain Injury Association of Iowa says Thankyou

2008-04-21T07:30:00.002-05:00

Proof that advocacy works. In a recent Blog, I shared that BIA Iowa was asking for residents of Iowa to contact their state representatives to gather support for sufficient allocation of funds for survivors of brain injury. On that note I received the following email on Friday, showing that the voices of Iowa’s constituents were heard:

You DID it!

Brain Injury Advocates made their voices heard and the Iowa Senate today responded by allocating dollars equitably to the Medicaid waiver waiting lists. More to follow....

Thank You!
Brain Injury Association of Iowa

Caffeine May Protect Blood-Brain Barriers from Cholesterol Damage

2008-04-18T10:44:00.003-05:00

A recent study published in the Journal of Neuroinflammation has found that a single cup of coffee a day can cause a more intact blood-brain barrier. Authored by Jonathan D. Geiger, Ph.D., of the University of North Dakota and colleagues, the study was conducted over a 12 week period and compared the effects of caffeine in a cholesterol enriched diet verse a standard diet when administered to rabbits.

After the 12 week period, the authors examined the olfactory bulb (chosen because of its known dysfunction in Alzheimer’s patients and its intact blood-brain barrier) for evidence of leakage. It was determined that the cholesterol-enriched diet of the rabbits increased IgG and fibrinogen extravasations, while having no effect on rabbits with a controlled diet.

“High levels of cholesterol are a risk factor for Alzheimer’s disease, perhaps by compromising the protective nature of the blood-brain barrier, “said Dr. Geiger. “For the first time we have shown that chronic ingestion of caffeine protects the blood-brain barrier from cholesterol-induced leakage.”

Click here to read the full article

Constraint Induced Therapy Increases Gray Matter

2008-04-18T09:53:00.003-05:00

The University of Alabama developed Constraint Induced (CI) Therapy has been shown to produce structural brain changes, as well as increased gray matter. Constraint Induced Therapy requires intense practice of an activity over a relatively short period of consecutive days. Newswise (2008) reports:

The efficacy of CI therapy as a rehabilitation technique for stroke patients has been well documented. Taub and other researchers worldwide have seen remarkable clinical changes in patients, such as dramatically improved use of an affected arm or leg. They also have observed functional changes in the brain, such as increased blood flow or an increase in excitability of brain cells. The new study confirms what Taub and his colleagues have long suspected….that the brain also has the ability to remodel itself structurally.

Lynne Gauthier, a graduate student working in Taub’s lab, took MRI images of 16 stroke patients who received CI therapy and 20 controls who received a comparison therapy.

Gauthier used a sophisticated analysis technique known as voxel-based morphometry (VBM) to measure the amount of gray matter in the outer layers of the brain and the hippocampus, a structure deep in the brain involved in learning and memory. The CI therapy group showed an increase in the amount of gray matter in areas of the brain responsible for motor skills while the comparison group had no increase. The gray matter increase corresponded to a similar increase in the ability of the patients to use the affected arm for activities of daily living in the home situation.

“Interestingly, the patients who demonstrated the greatest improvement in use of the affected arm also showed the greatest increase in the amount of gray matter,” Gauthier said.

Click here to read the full article

Click here to read A Placebo-Controlled Trial of Constraint-Induced Movement Therapy for Upper Extremity After Stroke

Click here to read Constraint-Induced Therapy of Chronic Aphasia After Stroke

New Brain Injury Treatment Device on the Horizon?

2008-04-16T14:30:00.001-05:00

Austin 8 News reports that a new medical device could improve brain injury treatment. The device created by PhotoThera is called NeuroThera and is currently undergoing clinical trials. The device is operated by a train clinician, and is used to stimulate the inactive mitochondria in brain cells via high-intensity infrared laser. The theory is that the mitochondria (the powerhouse of the cell) will be stimulated and when it starts working the rest of the cell will have energy and can resume functioning.

Click here to read the full story in News 8 Austin

Click here to go to PhotoThera’s website

Do Some Drugs Increase the Risk for Suicide?

2008-04-15T11:51:00.008-05:00

According to a recent article published in The New York Times, the debate over the potential suicidal side effects of drugs like Prozac, Paxil and anti-epileptics is still going on. Part of the problem is that, “the act itself is so rare – 1 in 10,000- that a series of drug trials cannot pickup enough cases to allow for adequate analysis" (Carey, 2008). There have been suggestions that the use of suicide markers may be beneficial in ferreting out which drugs may increase the risk of suicidality, as well as requiring drug manufacturers to track suicidal symptoms in their studies. Adding to the complexity of the issue is that suicide is a private affair – some will confide that they are having suicidal thoughts, others keep it to themselves; some will actually attempt suicide, others will not. Carey (2008) found another way to potentially tackle the problem:

In a paper in The Journal of the American Medical Association last year, the psychiatrists Dr. Donald Klein of Columbia University and Dr. Charles O’Brien of the University of Pennsylvania argued that the best way to study the risk of rare side effects was to establish large, linked databases of patients, including medical records and prescription histories. Such a system could be created in the United States in a short time, they wrote, but “the possibility has received almost no public discussion or legislative attention.”

Carey, B. (2008, February 10). Making sense of the great suicide debate. New York Times. Retrieved April 15, 2008, from http://www.nytimes.com/2008/02/10/weekinreview/10carey.html?emc=eta1

To Read the full article in the New York Times click here

Perception and Reality: Cultural Considerations

2008-04-15T11:19:00.003-05:00

A study published in the March 2008 issue of the Journal of Personality and Social Psychology by Dr. Masuda and his colleagues addresses the issues of cultural differences in perception. The study highlights the differences between a person-centric bias which we see in the United States from a group-centric bias seen in Japan. To read a brief summary of this interesting study click here for a link to a synopsis of the study from the New York Times.

Stories of Recovery

2008-04-15T10:59:00.002-05:00

I recently posted a lecture presentation by a neurologist and researcher on this blog of her personal experience with a stroke. Her story is a most unusual and compelling example of direct observation. In the New York Times of March 15, 2008, Health section, I found 7 stories of people who have fought hard to regain their lives following a stroke. These personal stories are candid and straightforward and certainly worth watching to better understand the process the processes of recovery, rehabilitation and returning to one's life following a neurological injury.

Click here to connect to these stories

Rising Fatalities for Older Bikers

2008-04-15T10:29:00.002-05:00

Older motorcyclists are at a greater risk for having an accident which will result in injury or death and more of us are reliving our youth or getting on motorcycles for the first time. As we age, our reaction time slows down making those "skin of our teeth" escapes less likely to occur. Helmet use is also dropping in states where helmets are not required by law. Prevention of a brain injury or death involves safety. Cycle smart! Wear a helmet and protective gear, don't drink and drive, know your limits.

Click here to read the New York Times article on the older motorcyclist and accident risks:
http://well.blogs.nytimes.com/2008/04/10/a-new-risk-of-middle-age-dying-on-a-motorcycle/

Iowa Action Alert

2008-04-14T10:01:00.000-05:00

I just recently received an email from the Iowa Brain Injury Association sharing that Iowa legislation is proposing budget cuts that would put home and community based services for Iowan survivors of Brain Injury at risk. In order to prevent these reductions they are asking Iowans to contact their Senate Appropriations Subcommittee via phone calls and emails.

Here are some excerpts from the email:

The Issue:

Over the past weeks the Health and Human Services Appropriations Subcommittee have drafted a bill (now SSB 3297) that significantly changes the process and funding for services for Iowans with brain injury and their families.

In summary, the bill eliminates a portion of the Iowa Department of Public Health's Brain Injury Services Program, the Waiver Eligible Component, which has provided funding to hundreds of Medicaid Home and Community Based Services Brain Injury Waiver clients and provides no funding for the program's Cost Share Component.
It calls for a transfer of $2.5 million from the IDPH program to DHS/Medicaid to provide funding for those individuals who are currently being funded through the Waiver Eligible Component.
Additionally, it calls for the transfer of any carryover funding from the IDPH program, currently estimated at $2.6 million, to DHS.
The bill does not clearly state that this carryover would be used to support only Iowans with brain injury, who are on the brain injury waiver's waiting list, and your support is needed to ensure that it does.

The Message - Talking Points:

There are over 50,000 Iowans with long-term disability from brain injury and brain injury is THE signature wound of the current conflicts overseas.
The potential for minimizing long-term disability for many Iowans with brain injury depends on timely access to services and supports in the home and community.
Delaying such services and supports by being forced onto waiting lists for needed Medicaid Waiver services increases the risk of poor long-term outcomes for survivors of brain injury.
Please change Senate Study Bill 3297 to ensure that ALL funds previously designated for Iowa Department of Public Health brain injury services be used to cover those currently served, for the elimination of the current brain injury waiver waiting list and brain injury waiver growth.

Who to contact:

The members of the Iowa Senate Subcommittee reviewing this bill are:

Senator Jack Hatch (D-Polk County)
jack.hatch@legis.state.ia.us
Home Telephone: 515-243-2033

Senator Bob Dvorsky (D-Johnson County)
robert.dvorsky@legis.state.ia.us
Home Telephone: 319-351-0988

Senator David Johnson (R-Osceola County)
david.johnson@legis.state.ia.us
Home Telephone: 712-758-3280

Senator Amanda Ragan (D-Cerro Gordo County)
amanda.ragan@legis.state.ia.us
Home Telephone: 641-424-0874

Senator James Seymor (R-Harrison County)
james.seymour@legis.state.ia.us
Home Telephone: 712-647-2699

Iowa has been a leader in advocacy from people with brain injury and has established many legislative initiatives to increase community based services. They are committed to fighting for services which affect the quality of life for people living with a brain injury.

The Link Between FTD and Artistic Ability

2008-04-10T13:50:00.003-05:00

The New York Times recently published an article by Sandra Blakeslee called “ A Disease That Allowed Torrents of Creativity”. What disease are they writing about? FTD or Frontotemportal dementia, also referred to as Arnold Pick’s disease. Apparently, early stage FTD brings out the artistic side of some individuals, occurring as the frontal brain areas decline and the posterior regions take over.

This story focuses on Dr. Anne Adams, who was diagnosed with FTD. She was trained in mathematics, chemistry and biology and left her career to care for her son in 1986. After her son’s recovery, she decided to leave the world of science behind and invested her time and energy in art – particularly painting. During the course of her disease she became engrossed with the music of Maurice Ravel (who had also had suffered from FTD). She took Ravel’s “Bolero” music and translated it into visual art. Blakeslee (2008) writes:

Dr. Adams, who was also drawn to themes of repetition, painted one upright rectangular figure for each bar of “Bolero.” The figures are arranged in an orderly manner like the music, countered by a zigzag winding scheme, Dr. Miller said. The transformation of sound to visual form is clear and structured. Height corresponds to volume, shape to note quality and color to pitch. The colors remain unified until the surprise key change in bar 326 that is marked with a run of orange and pink figures that herald the conclusion.
An article by Dr. Miller and colleagues describing how FTD can release new artistic talents was published online in December 2007 by the journal Brain. FTD refers to a group of diseases often misdiagnosed as Alzheimer’s disease, in that patients become increasingly demented, Dr. Miller said. But the course and behavioral manifestations of FTD are different.
In the most common variant, patients undergo gradual personality changes. They grow apathetic, become slovenly and typically gain 20 pounds. They behave like 3-year-olds in public, asking embarrassing questions in a loud voice. All along, they deny anything is wrong.
Two other variants of FTD involve loss of language. In one, patients have trouble finding words, Dr. Miller said. When someone says to the patients, “Pass the broccoli,” they might reply, “What is broccoli?”
In another, PPA or primary progressive aphasia, the spoken-language network disintegrates. Patients lose the ability to speak.
All three variants share the same underlying pathology. The disease, which has no cure, can progress quickly or, as in the case of Senator Pete V. Domenici, Republican of New Mexico, who announced his retirement last fall because of an FTD diagnosis, over many years.

Click here to read the full article in the New York Times

Traveling with a Disability Information

2008-04-10T07:49:00.002-05:00

Traveling with a disability can place barriers in front of the traveler. Information on transportation, hotel, dining and community access can be hard to find. In a recent edition of a newsletter from Gluckstein and Associates, the issue of travel was featured with specific guidance from two disability consultants. The newsletter provided sound basic information and identified other travel resources which contain a wealth of information. To access the newsletter click here: http://www.gluckstein.com/E-News.html. Another site with travel and vacation planning information is Disaboom.com

Happy travels!

Something to Enjoy

2008-04-09T10:17:00.001-05:00

We all need to laugh. The blog "Of Two Minds" provides great material for laughing. Enjoy!

http://scienceblogs.com/twominds/

Head Cases: More than just a book

2008-04-04T09:35:00.001-05:00

Last night I went to the book launch event for Michael Paul Mason's book, Head Cases: Stories of Brain Injury and Its Aftermath. The event was to benefit the Oklahoma Brain Injury Association and was supported by donations from the proceeds of the book sales at the event which went to the Oklahoma Brain Injury Association. Other sponsors included Brookhaven Hospital's Neurologic Rehabilitation Institute. The evening was held at Tulsa's Harwelden Mansion and it served as a great backdrop for the evening. The visitors to the event came from as far away as Spain and from coast-to-coast locations. The entire evening was a time to remember highlighted by Mike's reading from the book a brief story about Marilyn Price-Spivack, the founder of the national Brain Injury Association and the motivating force in the public recognition of brain injury and the lifelong needs of survivors.

For the hundred or so of us in the room, we each connected to each other through Mike Mason. In the room was Mike's family represented by multiple generations, his friends and colleagues from many aspects of his life, prior employers, his agent and editor, brain injury professionals and many others. As we talked about our connections with Mike I was reminded how each of us is like the people whose stories are told in book. We are only marginally separated from brain injury at best.

Mike's book is based on telling the human side of the story not the scientific side. In Head Cases he introduces us to twelve people who are so much more like us than unlike us. I appreciate Mike's way of telling of their stories and giving voice to an injury which has been poorly understood. In the course of the evening I spoke with a gentleman who had written a review of the book for the Tulsa World. In his review he highlighted the connection to the young people returning brain injured from the Iraq War, in most cases hidden from the public view as if the war and its aftermath just didn't exist.We talked about the coffins returning to home towns and we talked about the kids struggling in military hospitals to return home as well as those who have returned home with brain injuries from IED's, yet to be recognized.Those stories are in Mike's book, too, as well as his personal experience in the high tech environment of Balad Hospital in Iraq where miracles are being made daily; each miracle launching the survivor into a lifetime journey.

I have been involved in brain injury rehabilitation for over thirty years. It is a profession which is only slightly downstream from the neurosurgeons and trauma specialists who save lives. We saw that the physician soldiers who return from the Viet Nam war changed brain injury in the 60's and 70's creating opportunities to survive. Now, the doctors returning from Iraq will bring new skills to trauma care and will save more civilian lives and bring about new generations of brain injury survivors with a new host of lifelong problems. Each new person living with a brain injury will provide new challenges.

Mike Mason worked to get this Neuro Notes blog off the ground during his time at Brookhaven as a Brain Injury Case Manager. I think that he wanted to create a place where we could communicate about brain injury from the personal perspective and share information.Through his book, Head Cases, he shares the stories that connect us in other ways.

Thanks, Mike!

Wyoming Brain Injury Association Conference

2008-04-02T09:09:00.002-05:00

I recently attended the Wyoming Brain Injury Association's conference, held in Douglas, and it was amazing. The topic of this year’s conference was “Children & Brain Injury Strategies for All Ages”. One thing I found beneficial is that they did not limit their focus to just those with Brain Injury, they also had motivational sessions that were focused on the individuals providing services for those with Brain Injury.

While at the conference I also met some wonderful people that are doing amazing things. Ellen Baker, secretary for Wyoming’s Brain Injury Association, provided me with a study they just recently completed and published “Study of Undiagnosed Brain Injuries in Wyoming’s Prison Population”. To read the Wyoming in-state prison population study click here.

There were break out session on Teaching Strategies for Kids with Brain Injury presented by Marilyn Lash; Brain Injury 101 for Teachers facilitated by Mike Aurand; as well as Behavioral Interventions by Shawn Powell, PhD; and panel discussions on Services for Birth to 5 Years of Age as well as How to Get the Most Out of an IEP.

Mark Towers presented on “Strategies for Coping With Change”, and “How to Stay Up No Matter What Comes Down” which were well received by those in attendance. He kept the audience involved, using magic, humor, and exercises, truly an inspirational motivating speaker. He talked about coping with stress, self-talk, and the difference between recognition and praise. Sharing that recognition is the specifics or “what I like about you”, where as praise has a tendency to be “good job” without the specifics. He also shared that Elizabeth Kubler-Ross summarized her 40 year study of the cycle of grief and the meaning of life in three questions: 1) Did I give and receive love? 2) Did I become all that I could be? 3) Did I leave the planet a little better than I found it?

In Mr. Towers’ last session, he left us all with one challenge – and that was “The next time two paths show up – take the path of greater resistance” – sharing that in challenging ourselves we will live fuller lives. This hit me rather hard, the more I think on his parting statement, the more I realize just how true it is. It is so easy for us to continue to follow the path of least resistance. Making the decision to choose the less traveled path requires us to confront our own fears and insecurities, and open doors to new potentials that would have been missed.

Click here to check out Wyoming’s Brain Injury Association’s website

Brain Injury and the Prison Population

2008-04-01T15:03:00.001-05:00

Recently I had a chance to review a publication of the Brain Injury Association of Wyoming: Study of Undiagnosed Brain Injuries in Wyoming's Prison Population. The study, involving 195 inmates, used the Brain Injury Survey Questionnaire (BISQ), a reliable tool developed by Dr. Wayne Gordon at the Mt. Sinai School of Medicine and the results were evaluated by Dr. Gordon. Wyoming has a higher rate of brain injury in the general population than most states (3% vs. 2%) according to the Center for Disease Control and Injury Prevention (1999). Studies of jail and prison inmates in the United States indicate a range of brain injury from 25-87% of the inmates reporting a Traumatic Brain Injury. 82% of the individuals in the Wyoming Prison study showed a high to moderate likelihood of brain injury.The study revealed High Probability in 44% of the incarcerated men and 43% of the incarcerated women. Multiple injuries were a 71% for men and 70% for women. Loss of consciousness was noted in 67% of the men and 79% of the women. Multiple events associated with loss of consciousness were high. Motor vehicle accidents, assaults, abuse and falling during an alcohol or dug blackout were the source of injuries most frequently reported by men and women. Education was also a factor, with a higher percentage of likely brain injuries occurring among individuals with less education.

The Wyoming Prison Study is not out line with our understanding of the prevalence of brain injury in the prison population. Dorothy Lewis, M.D. in her Death Row Study found an alarmingly high rate of brain injury and neurological disease among inmates awaiting execution, substantially higher than in the general prison population. If brain injury exists at these levels in our incarcerated populations we need to consider what happens when an inmate with a brain injury is released. Prison has a highly structured and controlled environment. Upon release from prison the individual may be left without direction, structure and control and without basic tools for interacting with others, working and living. While prisons do not provide brain injury rehabilitation, we must consider how to develop effective transition plans and supports that may help the individual avoid the cycle of recidivism.

The Wyoming report makes recommendations for recognizing brain injury in the prison population and providing resources for an effective transition to the community. The incarcerated population is a group which society exiles and makes certain restorative resources scarce if not, impossible to access. We need to look at the causative factors in recidivism and take a realistic inventory of the skills and resources which are required to keep a person from entering into the cycle. The Wyoming Report sheds light on a subject that is not often discussed. Can we change how we deal with individuals with brain injury who are imprisoned?