The New England Journal of Medicine has published the most exhaustive analysis to date of brain injury in children and adolescents. The results reinforce the critical importance of safety helmets for children under 12 and the importance of safety helmets and seatbelts for adolescents.
The data analyzed in the study was from over 40,000 pediatric brain injuries. The most common cause of trauma in children under 12 was falls, often from bicycles. Motor vehicle accidents, sports injuries and assaults were the most frequent mechanisms of injury among adolescents. Read More
The weight of scientific evidence demonstrates that “diffusion tensor imaging” is an effective tool for demonstrating damage to the white matter of the brain associated with mild traumatic brain injury.
The damage typically associated with mild traumatic brain injury (mTBI) is in the axons, the microscopic fiber tracts in the white matter of the brain too small to be seen by conventional tools such as MRI and CT. In fact an individual with a perfectly normal MRI and CT could even be in a coma due to a brain injury. Treatment providers have been left to infer injury from clinical symptoms. However, even the most commonly used clinical tools, such as neuropsychological assessment, are generally seen as insensitive to the subtle, but sometimes life altering, effects of mTBIs. Read More
Findings released on November 25, 2014 in the Journal of Neurotrauma indicate that the presence of a blood protein known as SNTF shortly after a sports-related concussion can predict the severity of post-concussion symptoms in professional athletes.
The authors of the study – Robert Simon, PhD, and Douglas H. Smith, MD, professor of neurosurgery and director of the Center for Brain Injury and Repair at the University of Pennsylvania – noted upon release of this study of SNTF in concussion patients that
“these observations lend further support to the growing awareness that concussion is not trivial, since it can induce permanent brain damage in some individuals.”Read More
On the evening of November 13, 2014 the U.S. House of Representatives passed S. 2539, the Traumatic Brain Injury Reauthorization Act of 2014, (TBIRA) sponsored by Senator Orrin Hatch (R-UT) and co-sponsored by Senator Bob Casey (D-PA). The next step is for the bill to be signed by President Obama.
With Republicans and Democrats bitterly divided on most public policy issues, it is encouraging to see them come together on how to approach what is now being recognized as a serious public health issue – traumatic brain injury. Read More
Researchers at the Henry Ford Neuroscience Institute, a leading neuroscience research facility, recently announced the results of research showing that the only drug currently approved to treat the crippling effects of stroke shows promise, when administered as a nasal spray, to help heal the effects of less severe forms of traumatic brain injury. This is exciting news, since researchers have been struggling unsuccessfully for years to find an effective drug treatment for TBI. The research results are based on animal studies, so further work will be needed to determine the best dose and window for administration in humans. Read More
Good News for Future Players, Bad News for Past and Current Players Left to Seek Compensation on an Individual Basis
On July 29, 2014, the NCAA and representatives of college athletes announced an agreement to settle a concussion class action lawsuit that came on the heels of a similar lawsuit against the NFL. The settlement will need to be approved by the Court, a process that could take several months. It is anticipated that several former athletes experiencing the long-term effects of concussions suffered in college sports will object to the settlement, since it does not provide any direct compensation – unlike the proposed settlement in the NFL case. Players with concussion claims are left to pursue those claims on an individual basis. Read More
Several recent developments demonstrate increasing recognition of the serious potential consequences of concussion, and commitment to minimize those consequences through appropriate treatment of concussion:
Physicians have an ethical obligation to become knowledgeable about concussion.
On June 9, 2014 the American Academy of Neurology, the largest professional association of neurologists, released a position paper stating that doctors have an ethical obligationto educate and protect athletes from sports concussion and clear them to play only when the athlete is medically ready, standing firm against objections from players, athletes and coaches. The statement declares that sports concussion “is a major issue in the world of health care” and requires more attention from physicians. Read More
Different symptom patterns of concussion depend on the precise nature of the damage to the brain
Medical research is increasingly identifying the various ways a concussion can impact the brain and is providing explanations for why different symptoms persist in a subset of people diagnosed with concussion, based on the anatomy and physiology of the brain.
Much of this recent research has benefited from new techniques to “image” the brain, including various MRI techniques such as “diffusion tensor imaging” (“DTI”). In a prior post, I discussed research concerning the subset of concussed patients who experience persistent ocular (vision) and vestibular (balance) problems. A paper published online on April 15, 2014 in the journal Radiology reported that DTI imaging of patients with these symptoms revealed damage in the parts of the brain know to be associated with vision and balance. Read More
Recent research has shown that traumatic brain injury, (TBI) including mild traumatic brain injury (mTBI), can damage and cause dysfunction in the pituitary gland, a pea-sized gland located in the center of the skull that releases several essential hormones affecting such functions as growth and metabolism (part of the neuroendocrine system). Researchers have found that a surprisingly high percentage of patients with persistent symptoms following a TBI show evidence of neuroendocrine dysfunction.
It turns out that the anatomy of this gland makes it particularly susceptible to the sheering injuries seen in TBI. The most common dysfunction found after TBI is deficiency in the Growth Hormone (GH), one of the key hormones released by the pituitary gland. The symptoms of GH deficiency overlap with many persistent TBI symptoms including fatigue, poor memory, depression, emotional lability, lack of concentration and attention difficulties. Read More
Most current guidelines recommend “cognitive rest” during the initial stages of recovery from concussion. “Cognitive rest” involves limiting activities that require attention and concentration such as reading, doing homework, text messaging, playing video games, working online, watching movies and television and listening to music. Cognitive rest has been recommended in the past based on somewhat limited evidence suggesting that failing to minimize these activities in the early stages following a concussion could delay recovery. Read More
