In an editorial in this week’s Journal of the American Medical Association (JAMA), experts report that Of the 600,000 ski- and snowboard-related injuries each year, up to 20% result in traumatic brain injury (TBI)…many times resulting in serious disability or death.

The editorial calls for a widespread change in the culture of snow sports so that helmet are not only required, but accepted and encouraged in the same way bicycle helmets have been adopted by casual and serious bikers. As a firm that sees a lot of people with TBI, we echo that call for change.

For any sport with speed or risk of falls, helmets are a smart way to protect your smarts!

University of Michigan researchers have reported that a simple test that measures reaction time can help detect and diagnose concussion in athletes.

In the study, athletes were tested once at the beginning of their sport season—they had to catch a weighted cylinder dropped by their coach. Their reaction time was measured. Then, if one of those athletes received a concussion during the season, there reaction time was measured again several days after the injury.

The researchers discovered that athletes with concussion had a 15% longer reaction time. This demonstrates that concussion carries effects that linger even after the initial headache and dizziness go away. And it dovetails with recent suggestions we reported that athletes with concussion should remain sidelined for  at least three months. Such a simple test…and yet, if it is adopted by high school and college coaches, it may help save the brains of our young athletes.

Emergency room doctors dread each new snow because they know that sledding accidents are soon to follow. This story in the Raleigh News & Observer highlights the danger of high-speed sledding–when cars tow snow-riders for that extra thrill. Too often, accidents cause severe injuries, including head injuries and even death. The white stuff is fun, especially in eastern North Carolina, where it is a relatively rare event. But please frolic responsibly! For more information about traumatic brain injury, please visit our site.

I thought we all could could use some good and hopeful news before the weekend. David Russell, a 60-year-old British man, was put into an induced coma to help save his life after a 12-foot fall. He survived, but when he didn’t come out of the coma, his doctors feared he would never awaken…and if he did, he would have serious brain damage.

But when his wife told him he had become a new grandfather, he opened his eyes and winked. A couple weeks later, he was healthy enough to meet his granddaughter, Edie. “It was just fantastic to meet Edie,” said Mr. Russell in a UPI report. “And I have got her to thank for saving my life.”

I really hope the story is true. It was the most uplifting thing I’ve read in a long time. And could there be a more heartwarming message about the power of love? Just in time for Valentine’s Day!

For more news items about brain injury, visit our site.

This year’s annual Ride for the Rock to benefit the Brain Injury Association of North Carolina will take place on March 6, 2010. Registration starts at 7:30am (rain or shine!), and roll-out begins at 9:00am from the parking lot of the Whole Foods Market in Cary, NC (please park at the back of the lot).

There are two loops–100K and 50K. The ride is fully supported, with multiple pit stops and a sag wagon. Registration is $15 in advance, $20 day-of. Tee shirts are available for $10. Join the HensonFuerst bike team–we’re 30 strong and growing! (Call us, or email ThomasHenson@lawmed.com)

For more information, or to donate to the ride, visit the sites for the Brain Injury Association of NC or the Capital Cycling Club.

2010 “Ride for the Rock” Poster

How the Ride Began

On July 31, 2005, Mark “the Rock” Ornitz sustained a life-changing brain injury during a group ride when he crashed head first into a telephone pole while trying to avoid a rider who had fallen.

The severe traumatic brain injury (TBI) stopped just short of killing him, but has left him (and his family) with a long and arduous journey of rehabilitation for his ongoing deficits, including intractable pain in his paralyzed right arm and 24-hour medical supervision.

Mark’s family is overwhelmed–physically and financially–and they have been astonished to discover that there is a lack of appropriate resources in North Carolina to help families and patients deal with this type of ordeal. His family wonders what will happen to “the Rock” when they are no longer able to take care of him.

They are not alone in this circumstance.  More than 180,000 North Carolinians suffer from brain injury—this is 5 times greater than the cases of multiple sclerosis, spinal cord injury, AIDS, and breast cancer combined! Yet in North Carolina, Medicaid does not help people with head injuries if they are older than 22. Nor are there affordable residential facilities that understand how to care for brain injured residents.

Mark’s teammates at The Capital Cycling Club (www.capcycling.org) honor him by keeping his name on their team roster. In addition, they have partnered with the Brain Injury Association of North Carolina (www.bianc.net) to conduct the Ride for the Rock to raise awareness of TBI, promote safety among cyclists, and raise funds. Their mission is to offer help, hope, and a voice to people with brain injury and their families.

A study published in the Proceedings of the National Academy of Sciences found that people who have damage to a part of the brain called the amygdala seem to lose the natural fear of losing money. They understand the value of money, and they have a normal, excited response to money as a reward…they just don’t worry about loss.

This research looked at only two people, but the examination was intensive. One interpretation is fascinating: that some people with brain injury that includes damage to the amygdala may be more inclined to gamble, and do so with abandon. One of the people in the study even sought out high-risk opportunities. (The BBC provides a clear analysis of the study.)

We know that people with brain injury can have dramatically different behavior from before the trauma–excess gambling and risk-taking among them. This study is another reminder of how brain injury devastates lives.

People in a vegetative state pose a diagnostic problem for physicians. They are wakeful, but unconscious. They open their eyes, but they are unresponsive. They don’t talk or communicate, and they can’t follow the simplest commands to lift a finger or blink. They fall low in the Glasgow coma scale—one step above brain death.  Vegetative states that last longer than a year are called “persistent.”  Those patients rarely recover and are typically given up for lost forever.

But a new study–published last week (February 3, 2010)  in an online version of the prestigious New England Journal of Medicine–gives hope that some consciousness may remain…although buried deep in the brain, accessible only by sophisticated functional MRI.

How fMRI Works

A regular MRI uses magnetic imaging to see the inside the physical brain, the actual structures. The report will be a series of pictures that look similar to an x-ray.

A functional MRI (fMRI), on the other hand, allows us to see the way the brain works. The person whose brain is being scanned is asked to perform a mental task. The process of thinking creates metabolic changes in very specific parts of the brain, and the fMRI can pick up on these changes. The report will show the brain’s pattern of activity before, during, and after doing the mental tasks. (For more information about the fMRI, click here.)

Research Specifics

In this study, 54 patients considered to have minimal or vegetative consciousness were asked to perform 2 mental imagery tasks—to imagine playing tennis (swinging a racquet), and then to imaging walking through their home. That let the scientists see the parts of the brain that responded to those images. Of the 54 original patients, five—all of whom had suffered traumatic brain injury—showed the ability to follow the instructions to imagine the scenes

For one vegetative patient, testing went an additional step. That patient was asked simple “yes” or “no” questions (such as “Do you have any brothers?”)… and told to use the images to answer. For example, imaging swinging a tennis racquet if the answer is “yes”…or imaging walking through your home if the answer is “no.”

Since the scan had already shown where those images appeared in the brain, scientists could read the “yes” or “no” answer by where brain activity appeared. That patient was able to answer correctly simply by imaging the scenes.

Where Hope Lies

The lessons of this study can be used to improve diagnosis of people with minimal consciousness. Without motor ability, it is impossible for doctors to know whether conscious brain activity exists. By using fMRI technology, diagnosis and labeling can become more accurate. Some people in vegetative states may be underestimated.

Even more importantly, this study give hope that traumatic brain injury patients may be able to communicate enough to address quality of life issues. For example, may be they could tell us whether they experience pain… if they are comfortable… or any other issues that could help guide treatment. They may be able to make their wishes known. And in the long-run, the medical community will learn more about the depth and scope of consciousness.

This might seem like meager reward for such an extensive study, but for family members, it is the very definition of hope. Think of it this way:  If you had the opportunity to ask one “yes” or “no” question of a loved one you thought was lost forever–someone you believed you could never talk to again–what would you ask?  I guarantee:  The answer would be precious.

(New England Journal of Medicine article:  http://content.nejm.org/cgi/content/full/NEJMoa0905370)

The herbal medication Ginko biloba (sometimes called G. biloba, or even just “Ginkgo”) is commonly sold as a memory-boosting supplement. Now, a study published in the Journal of Natural Products reports that using Ginkgo may increase the risk of seizures in people with epilepsy, and Ginkgo could reduce the effectiveness of anti-seizure drugs. (see full story here: ScienceDaily)

Why am I writing about this here? Well… many people with traumatic brain injury (TBI) suffer from memory problems…and some of them will also need to take anti-seizure medications for an extended time. This study shows that it is potentially dangerous to use Ginkgo herbal treatments while taking the medications.

About TBI and seizures:

Between 5% and 10% of people with traumatic brain injury (TBI) have seizures as a result of their head injury. The risk is greatest among those with more severe head trauma. The seizures can start immediately, or may not become apparent for days, weeks, or even months. According to the Brain Injury Resource Foundation, seizures are so common that the drug Dilantin (phenytoin) is often given to head trauma patients for 7 days after the incident as a preventive measure.

If a patient has a seizure within the first week, they are advised to stay on the anti-seizure medication for at least one year. Some people with TBI end up with persistent seizures, and may therefore be on medication indefinitely. (for more information, click here)

As always, check with your doctor before taking any additional over-the-counter drug, supplement, or herbal remedy. Some chemicals have powerful interactions–even those you can buy without a a prescription!

[side note: Randomized studies, such as these published in the Journal of the American Medical Association, or JAMA, have shown that the belief that Ginkgo improves memory is pretty much false---it doesn't improve memory, nor does it prevent cognitive decline as we age. FYI.]

One of the world’s leading brain injury researchers recommends that children under age 18 should sit out of sports participation for three months after suffering a concussion. This statement was made by Dr. Bennet Omalu, co-founder of the Brain Injury Research Institute at West Virginia University, on February 1, 2010, while testifying at a House Judiciary Committee hearing on the impact of injuries in collegiate and youth football. (See AP story here.)

Dr. Omalu was the expert who discovered the condition called chronic traumatic encephalaopathy (CTE), a form of degenerative, permanent brain damage which can be caused by repeated concussions.

In an earlier committee meeting (January 2009), Dr. Omalu explained that concussions cause damage to brain structures at the cellular and sub-cellular levels. After concussion, some genes get “turned on” and cause a type of protein (APP, or amyloid precursor protein) to accumulate in brain cells and nerve fibers. APP is strongly associated with Alzheimers disease and other degenerative brain disorders.

So concussion increases APP. And APP is related to brain degeneration.

Here’s the kicker:  After a concussion, it take 3 months for all the extra APP to disappear. That’s why Dr. Omalu recommends that children stay out of sports (and other vigorous activities that could reinjure the brain) for 3 months. Adults should probably also be sidelined for that long, but it would be next to impossible to regulate when a 250-pound star football player can run back out onto the field.

Logical, right?

Except that the sports most likely to result in concussion are the same ones that value toughness and a certain degree of violence. According a report in the New York TImes (12/10/2009),

“…one day after the N.F.L. decided that no player showing any significant sign of concussion could return to a game, several players at Tustin High School in California admitted they still wouldn’t tell a trainer if they got hurt.”

And, from the DailyMe…

In the immortal words of U.S. Representative Ted Poe, R-Texas, “I mean if Congress gets involved, it would be the end of football as we know it…. We would all be playing touch football out there.”

It’s one thing to voluntarily damage your brain if you’re an adult, but we need to protect kids from activities that could cause them a lifetime of misery…or even a premature death. A single concussion can have devastating consequences. A Bellevue, Washington boy, Zachery Lystedt, is still learning to walk again after a severe concussion he got playing football when he was 13.

It is imperative that doctors, schools, coaches, and parents all cooperate for the health of our children. Concussions need to be diagnosed properly–as mild traumatic brain damage–and treated with the same care, respect, and time we give to other serious injuries. A broken collarbone means 3 months of down-time from sports. A child’s brain deserves at least the same amount of time to heal.

(For more info on APP and neurodegeneration, click here.)