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
Scientists announce dramatic research where epidural stimulation offers potential for recovery from paralysis following spinal cord injury
Nearly six million Americans are living with paralysis, including 1.275 million spinal cord injuries. Most have been told that no recovery is possible and that complete paralysis is permanent. This belief was fundamentally challenged with the announcement on April 8, 2014 by international team of scientists at the University of Louisville, UCLA and the Pavlov Institute of Physiology, that four young men who had been paralyzed for years were able to voluntarily move their hips, ankles and toes following the implantation of an epidural electrical stimulator. These results were published in journal Brain. Read More
Recent literature has highlighted the prevalence of dysfunctions in vision following traumatic brain injuries of all levels of severity (including concussion.) Research published by the Veterans Administration (VA) in 2012 indicates that the percentage of TBI victims with vision problems could be as high as 60%. They explain that this prevalence is not surprising, since over 50% of the brain is involved in visual processing. Alvarez et. al. explain how visual and other symptoms occur when the brain is subjected to “acceleration/deceleration” forces: Read More
I travel between two worlds that may appear far apart – by day I am a trial lawyer with a focus on traumatic brain injury; nights and weekends I am a yoga teacher. I increasingly find that these worlds are very close together.
As a brain injury lawyer I work with people struggling to recover from the loss of sense of self so often caused by brain injury as well as associated depression and chronic pain. Many of my clients have reported meaningful increases in the quality of their lives following injury through “mindfulness” practices such as yoga and meditation. Practices such as yoga are designed to increase awareness of the present moment, to increase awareness of our thoughts, emotions and physical sensations without filtering them through past experience or fears of the future – to recapture our sense of ourselves. Read More
On January 23, 2014 the Defense and Veterans Brain Injury Center released new clinical recommendations with a standardized approach for concussion recovery. Included in the recommendations for managing concussion symptoms is a first of its kind five-stage approach for return to activity following a concussion. Detailed “do”s and “do not”s are specified for each stage. Movement from stage to stage is determined by scores on a simple twenty-two item “neurobehavioral symptom inventory” included in the recommendations. Read More
The American Academy of Sleep Medicine has announced the results of a recent study showing that bright light therapy following Mild TBI (concussion) may improve sleep, cognitive and brain function. The study results were presented at the June 3, 2013 meeting of the Associated Professional Sleep Societies LLC and published in an online supplement to the journal Sleep. Read More
The topic of sexual dysfunction after a traumatic brain injury shouldn’t be taboo. Millions of people in the United States live with the physical, cognitive and emotional consequences traumatic brain injury (TBI). Sexuality is often impacted, but not often discussed or addressed. Failure to address this issue can compound the adverse effect of TBI symptoms on important relationships and self-esteem. NeuroRehabilitation: An International Journal recently published a critical review of fourteen studies on this topic. Read More
