Imagine you are a parent whose child has sustained a brain injury through something as enjoyable as playing a sport or as horrific as abuse by a caretaker or as patriotic as serving our country as a member of the armed forces. Wouldn’t you want the best system of care possible to maximize the chances of recovery and quality of life for your child? There are many tragic stories about children and youth with brain injury; Congress has an opportunity to provide support and hope for them.

That’s the goal of H.R. 2600, a new bill introduced in the U.S. House of Representatives. Also known as the National Pediatric Acquired Brain Injury Plan Act (PABI Plan Act), this bill would help create a standardized, evidence-based system of universally available care for young people (ages 25 and younger), including those serving in the armed forces. The PABI Plan Act would ensure care at all stages of brain injury, beginning with prevention, and including emergency and acute treatment in medical facilities, reintegration into schools and communities, and transition into an adult system of independent living.

H.R. 2600 was introduced to Congress on July 20, 2011 by Republican Leonard Lance of New Jersey, and it has been referred to committee. But the bill has seemingly stalled, despite the fact that the bill has more than 100 co-sponsors in a rare bipartisan effort. Co-sponsors from North Carolina include:

• Rep. Walter Jones [R, NC-3]
• Rep Larry Kissell [D, NC-8]
• Rep. Mike McIntyre [D, NC-7]
• Rep. Bradley Miller [D, NC-13]

Funding for H.R. 2600 would come from discretionary money held by the Secretary of Health and Human Services, and would not add to the budget deficit.

This is an important bill that would help children and young adults recover as much as possible, and receive support as they age into adults.

“The ultimate goal of the PABI Plan Act is to maximize recovery, enhance quality of life and ensure that New Jersey — and American — youth have the best chance to live productive and meaningful lives,” said Barbara Geiger-Parker, president and CEO of the Brain Injury Association of New Jersey, a nonprofit organization whose mission it is to support and advocate for individuals affected by brain injury and raise public awareness through education and prevention.

We urge concerned individuals to contact their Representative and voice support for the PABI Plan Act. To find contact information for your Representative, click here:  GovTrack.us

To read the full article on NJ.com, click here:  More support needed

from 9News.com

Dylan Hearn probably has a great future ahead of him; he is wise beyond is meager years. The 7-year-old Colorado boy has a personal crusade to made sure that everyone takes concussion seriously.

And he knows what he is talking about:  He suffered two concussions in the past six months. The first was playing football, and the second happened when he ran into the dishwasher at his home (he was chasing his brother.) The injuries put him out of commission for about a month, including his favorite activities—no TV, no video games, no reading.

According to an article on 9News.com, Dylan says:

“It hurts,” said Dylan. “A lot of sick and dizzy. Sometimes, you have blackouts.”

Now, Dylan’s concussions are changing the way people around him view head injuries. For example, his baseball coach, Jeff Pigati, says that the determination of injury used to be totally in the hands of players. If they said they were feeling well enough to play, they played. But kids and athletes being what they are, they typically jumped back into the game sooner than they probably should have.  That’s what killed another boy, 15-year-old Jake Snakenberg:

Snakenberg died in September 2004 after sustaining a serious concussion in a football game. Doctors believe it was his second concussion in a week and he died of Second Impact Syndrome. Just before the game, he told everyone he was fine.

That’s why there is now a law in place called the Jake Snakenberg Act. It requires all coaches, like Pigati, to undergo concussion training to look for signs of possible brain injury.
Dylan and Alex Hearn [Dylan's mother] applaud the new measures.

[If you would like to see the online training program for coaches, click here:  CDC HeadsUp]

Now, coach Pigati watches kids for head injury and tell-tale symptoms, and he’s happy to do so. Like most coaches, Pigati takes the health of his players very seriously. He applauds the Colorado law requiring coaches to undergo concussion training.

And Dylan? He likes the law, too. Why?

“Because it’s safe,” said Dylan.

From the mouths of babes.

To read the full story on 9News.com, click here:  7-year-old applauds new concussion rules

According to an article in The New York Times, that’s the question being investigated by Dr. Jeffrey S. Kreutzer and other psychologists at Virginia Commonwealth University (V.C.U.) in Richmond. In addition, the psychologists are working to develop marriage counseling techniques for affected couples.

According to a 2007 article published in the journal NeuroRehabilitation, when a spouse suffers a brain injury, the risk of divorce is surprisingly low—approximately 17 percent. Well below the national average for uninjured couples. But the statistic may not be an accurate reflection of the health of the marriages—the couples aren’t necessarily happy. According to Dr. Kreutzer: “While people may technically be married, the quality of their relationship has been seriously diminished.” According to The New York Times:

Dr. Kreutzer and other psychologists at V.C.U. are among the few therapists in the country trying to develop marriage counseling techniques tailored to couples dealing with brain injuries. Traditional marriage counselors often hope to restore people and their relationships to their original luster. For Dr. Kreutzer and his team, recovery often means teaching uninjured spouses to forge a relationship with a profoundly changed person — and helping injured spouses to accept that they are changed people.

“Changed” doesn’t begin to describe what some spouses experience.

Depending on the severity of the brain injury, an individual may be considerably changed by the injury…so much so that he or she may seem like an entirely different person. Injured people often have difficulties with attention, concentration, memory, reading, writing, and speaking. They may appear confused, have trouble with physical coordination, and become impulsive—buying expensive items they can’t afford, take off on trips without notification, or other potentially damaging behaviors. And then there are the possible personality changes:  aggressiveness, irritability, mood swings, depression, lack of motivation, and poor judgment. While every person experiences a different constellation of symptoms, even a small number of these symptoms can make the spouse of a brain-injured individual wonder what happened to the person they married.

The article in The New York Times talks about the experiences of Terry Curtis—who suffered brain injury from a tumor and the surgery needed to remove it—and his wife Vicky:

Mrs. Curtis, 60, was once drawn to her husband’s “sparkle,” she said. After the injury, he “flat-lined” emotionally, and he suffers from depression, anxiety and a lack of motivation. Her husband sometimes makes erratic decisions, she added, like the time he decided to take a do-it-yourself approach to the plumbing at their home in Coralville, Iowa. “Not a good picture when I got home,” Mrs. Curtis said. “And you can yell at him like a little kid, but he didn’t know any better.”

Once a software programming analyst, Mr. Curtis, 57, has “a lot fewer interests” than he did before the injury, and he estimates he has lost 90 percent of his friends.

“It’s a new you,” he said, “and they just can’t cope with that.”

It’s worse for a spouse, who lives with the changed person. According to the psychologists, the factor that seems to keep marriages from falling apart is guilt. It’s hard to be the kind of person who gets a divorce from a brain-injured person. The goal in therapy is to help the couple see that the person will not ever be exactly the same…that they will have to deal with a “new normal” in their lives…but that it may be possible to rediscover a new facet to the old relationship.

That may be the real definition of hope.

To read the full article in The New York Times, click here:  When Injuries to the Brain Tear at Hearts

To learn more about traumatic brain injuries, visit our dedicated webpage here:  HensonFuerst TBI page

U.S. Representative Gabrielle Giffords

The year did not start off well. On January 8, 2011, a man went on a shooting rampage in Tucson, Arizona. Six people were killed, 13 were injured, including U.S. Representative Gabrielle Giffords, who was shot in the head. The rapid response of the medical team saved the lives of a dozen people shot in the rampage, including Giffords’. Over the course of the year, her recovery has been better than anyone could have predicted, a tribute to the medical advances in brain injury treatment.

• Arizona Shooting Spree Aftermath
• Gabrielle Giffords’ Recovery Called Ideal

Long-Term Effect of Concussion

The biggest brain injury story by far is about the long-term effects of concussion, especially in athletes. This year, scientists linked multiple concussions to chronic traumatic encephalopathy (CTE), a kind of central nervous system damage that happens when people suffer repeated head injuries, typically soldiers or athletes in high impact sports, such as football or ice hockey. Early symptoms of CTE include memory problems, difficulty concentrating, and disorientation. As the disease progresses, people with CTE show behavioral problems—poor judgment, aggression, sexual compulsiveness, erratic behavior, and drug and alcohol abuse—as well as increasing nervous system symptoms, including tremors, staggering gait, deafness, and dementia. Unfortunately, the only way to definitely diagnose CTE is to examine the brain of the affected individual during an autopsy. From kids to football players to hockey teams, concussion has been the biggest TBI story of the year.

• Concussion Has Long-Term Effects for Teen Athletes
• Football Player Dave Duerson Donates Brain to Research
• NFL to Diagnose Player Concussions on the Sidelines
• Will NHL Take Action Against Concussion?
• Athletes’ Dementia: New Name for an Old Disease
• What You Need to Know About Youth Sports Concussion
• Football Players Sue League Over Concussion Risks
• Football Players Demand Better Health Monitoring
• Repeated Head Trauma Can Lead to CTE
• Kids Suffer Long-Term Effects from Head Trauma

Cheer Safety

What do you call an activity requires strength, stamina, flexibility, agility, planning, and coordination with team members?  What if the participants were required to train with weight-training and aerobic exercises?  And what if that activity was performed in gymnasiums, in stadiums, and on outdoor fields?  And what if teams competed regionally and nationally? Sounds like a sport, right? Well, not to sports authorities. Cheer (what used to be called “cheerleading”) injures participants like a sport, including some devastating head injuries. That’s why we wrote a 3-part series on cheer as a sport.

• Cheerleaders Are Athletes, Part One
• Cheerleaders Are Athletes, Part Two
• Cheerleaders Are Athletes, Part Three

How to Hire an Experienced Brain Injury Lawyer

TBI is a difficult, complex injury for doctors to treat…and for lawyers to pursue. If you are considering pursuing a legal case, it’s important to choose an attorney who knows the complicated ins and outs of brain injury. That’s why we’ve provided this guide:

• How to Hire an Experienced Brain Injury Lawyer

VIDEOS

In addition to blogs, we also create videos about important health, medical, and legal topics. To see all of our available videos, please visit our YouTube channel here:  HensonFuerst YouTube Channel

Here are links to some of our brain injury videos:

Symptoms of Concussion

Epidemic of Concussion in Youth Sports

Hiring an Experienced Brain Injury Lawyer

The study examined 729 children treated for TBI. Researchers tested the children 3, 12, and 24 months after their injury for their health-related quality of life, their participation in social and community activities, and their communication skills and ability to care for themselves.

The findings were surprising:  Quality of life was lower at all follow-up times. Social activities were significantly affected even after 3 months, but were improved (although not back to pre-injury levels) after a year or two. Communication and self-care abilities were lower at 3 months, and did not improve by 24 months.

The lesson:  A bump on the head can have effects that last much longer than the tears. Prevention of head trauma is key. But if injury occurs, get prompt medical attention to ensure that a serious injury doesn’t become a devastating problem.

RESOURCES

To read an abstract of the Pediatrics article, click here:  Pediatrics

To learn more about TBI, visit our dedicated web page here:  HensonFuerst Brain Injury Page

“There’s no way to know how much was damage caused by fighting as opposed to hits to the head sustained in the normal course of playing the game. Personally, though, I suspect it’s caused more by fighting,” Cantu said. “In my practice, when I’ve studied ‘enforcer-type’ guys and we discuss fights, they say roughly one in four times they get concussed. But they never bring it to the trainer’s attention. They just go to the box and try to recover enough to make it back to the bench when the penalty’s over. It’s the code. They’re afraid if they admit it, they’ll be out of a job.”

The results are in. According to an article in The New York Times, Boogaard had Chronic Traumatic Encephalopathy (CTE), a neurological disorder thought to be caused by repeated blows to the head. It can only be diagnosed after death, via autopsy and examination of the brain, but symptoms often reveal the disorder. Memory loss, mood swings, impulsiveness, addictions, and in the late stages, a person with CTE can develop symptoms that look very similar to dementia and amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease).

Boogaard’s brain was the fourth hockey player brain examined, and all four were found to have CTE. According to The New York Times:

But this was different. The others were not in their 20s, not in the prime of their careers. The scientists….told the Boogaard family that they were shocked to see so much damage in someone so young. It appeared to be spreading through his brain….

“To see this amount? That’s a ‘wow’ moment,” [Dr. Ann] McKee said as she pointed to magnified images of Boogaard’s brain tissue. “This is all going bad.”

What’s particularly scary is that other current, young hockey players could have the disease…and how many will sustain blows to the head tomorrow that will start the disease process. And yet, the NHL isn’t convinced that here is a link between hockey and CTE.  Hmmm…guess that means that they won’t be changing the rules about fighting on the ice. In fact, NHL Commissioner Gary Bettman told The New York Times:

“If you polled our fans, probably more would say they think it’s a part of the game and should be retained.”

There you go—the fans want the fights, so I guess we can tolerate a little brain damage. As Chris Nowinski, another co-director of the Boston University center, said:  ”They are trading money for brain cells.”

That says it all.

RESOURCES

To read our September blog about the call to ban fights in hockey, click here:  A Call to Ban Hockey Fights

To read the full article in The New York Times, click here:  Derek Boogaard–A Brain ‘Going Bad’

Chloe is a 17-pound mutt (best guess is that she is a mix of Bichon Frise, Poodle, and Shih Tzu) that was living in an animal shelter, scheduled to be killed. Instead, she found a second life as a service dog for Marine Dan Sauer. The big Marine and the teensy dog make an unlikely pair. But they help each other.

According to an article in the Daily Herald, Sauer was in the service for eight years, including nearly 10 months in Kuwait during Desert Storm. He was diagnosed with post-traumatic stress disorder 13 years ago.

During the war, Sauer suffered a traumatic brain injury from a mortar round that also tore the retina in his left eye, damaged a fingernail on his left hand and affected his memory. Sauer’s experience overseas and PTSD made him bunker down at home and avoid people. For years, he didn’t seek treatment for PTSD.

“I’m a Marine,” Sauer said, describing his mentality before he finally got help. “Just deal with it; that’s all.”

Chloe helps by sensing when Sauer is aggravated, angry or stressed, and then to distract him from those feelings. She also senses when he is having nightmares and wakes him up at night…cuddles close to help de-stress him…and protects Sauer’s personal space by standing between him and other people. It sounds simple, but the effects are dramatic. In the time that he has had Chloe, Sauer is able to leave the house and live a relatively normal life.

He’ll run errands, go for walks and participate in and attend school functions, all with the dog in tow. He’s also a lot more social and cracking more jokes.

But one problem keeps popping up:  Many people don’t understand Chloe’s job as a service dog. Shop owners will tell him that he is not allowed to bring his pet in the shop, and restaurants try to refuse to seat him. But service dogs are allowed by law to accompany their disabled owner nearly everywhere. Sauer takes every opportunity to educate people about the valuable role service dogs can play in rehabilitating brain-injured war vets.

It’s a great relationship for everyone—for Sauer, for Chloe, for Sauer’s family, for Sauer’s community. And it’s a great lesson for the rest of us that sometimes disabilities are invisible…and sometimes even the smallest creatures can help change the course of a life.

To read the full story in the Daily Herald, click here:  Tiny service dog heals Hampshire Marine

The study, which was discussed at the annual meeting of the Radiological Society of North America, found that regularly heading a soccer ball (bouncing the ball off the head) can lead to concussion-like brain injuries. According to MSN Fox Sports, the researchers scanned the brains of 38 amateur soccer players, and compared the images to the number of times they deeded the ball during the past year. Players who exceeded 1000 headers per year had “significant injury” to the brain. The damage was done to five specific areas of the brain, areas responsible for attention, memory, and vision. Functionally, players who frequently headed the ball performed worse on tests of verbal memory and hand-eye coordination.

“Heading a soccer ball is not an impact of a magnitude that will lacerate nerve fibers in the brain,” [lead author Michael Lipton] added. “But repetitive heading may set off a cascade of responses that can lead to degeneration of brain cells.”

The damage caused by soccer balls is insidious—it sneaks up on players after months or even years of normal play. This is different from the more slam-bam kinds of immediate concussion damage done in the more hard-hitting sports. But in some ways, that may make soccer more hazardous because you can’t prevent the damage without totally changing the rules of the game. This was just a small study, so it is too early make specific recommendation. Experts suggest that players try to minimize heading, especially during practice.

According to Canadian television station CTV, brain injury specialists with the non-profit group ThinkFirst identified heading as a possible safety issue three years ago, and drew up guidelines on how to headhit the ball safely. Their number one rule was not to teach the skill too early to children.

“So anybody out there who’s listening to this who has a child less than 10, do not teach that child to head the ball. Then if they are of the appropriate age, which is 10 to 12, then they can start learning how to head the ball with the appropriate sized ball,” ThinkFirst founder Dr. Charles Tator tells CTV News.

So the general advice seems to be to delay teaching heading until a child is at least age 10, and to minimize the amount of heading done in practices. For individual soccer players, I’d recommend just using your noggin, but that would just be a horrible pun, so I’ll just say to protect your brain and minimize the use of heading.

RESOURCES

To read the full story on MSN Fox Sports, click here:  Heading soccer ball may lead to brain damage

To read the full article on CTV, click here: ‘Heading’ a soccer ball could cause brain injury

The device, which costs about $200, is endorsed by former hockey star Keith Primeau. It is currently being worn by more than a thousand youth football players in the United States, and it can also be used by hockey and lacrosse players.

Primeau, now age 39, played in the NHL for 16 years before his fourth documented concussion forced him to retire from the Philadelphia Flyers. He still feels crippling effects of his head injuries: headaches, head pressure, dizziness and fatigue.

According to an article in The Globe and Mail:

Primeau said the Impact Indicator doesn’t prevent concussions but indicates when someone should come out of a game. Information is a weapon in the fight against concussions, he said. People can have an objective measurement rather than just subjective judgment of coaches, teachers, administrators and even physicians on the sidelines.

Once the LED turns red, there is a 50% probability of a concussion. At that point, a player shouldn’t take anymore head hits. It takes the guesswork out the equation:  When the light turns red, the player should be removed from play and see a doctor.

Whether players, coaches, and team owners will ever fully adopt the new technology remains to be seen, but it seems like a no-brainer. We support measures that help preserve health and prevent brain injury. Paralympian Paul Rosen won a gold medal with Canada’s sledge hockey team. He believes that losing his leg in 1999 was easy compared with post-concussion symptoms. As he told TSN:

“Losing my leg was an absolute joke in the way I dealt with it compared to what I’m dealing with on a day to day basis,” said Rosen, who suffered a concussion after a sled hit him in the head. “Thing was, they told me to suck it up. We have to get out of this mentality, whether kids are 10 years old or playing professional hockey, is get out of that mentality of suck it up.

“One hit to the head is one hit too many.”

To read the full article in The Globe and Mail, click here:  New chin strap flashes red

To read the full article on TSN, click here:  Primeau believes helmet can cut down on concussions

According to an article on Digital Journal, the researchers reviewed the past medical records of about 200 patients, looking to see if those who had experienced head trauma at some time in their lives later developed Parkinson’s disease. Why might this be true? The answer comes from another research study:

The UCLA team found that brain trauma causes an immediate 15% loss in brain cells called nigrostriatal dopaminergic neurons. The loss of these cells continued so that after about 6 months, up to 30% of those neurons were lost. It is the loss of these dopaminergic neurons that make a person more susceptible to Parkinson’s disease.

Although there is still no cure for Parkinson’s disease, this research may provide another piece of the puzzle that could eventually lead to prevention or more effective treatments. But in the meantime, the sad news is that people who suffer TBI need to be watchful for signs of Parkinson’s disease as they grow older.