Traumatic brain injury, currently considered a singular event by the insurance industry and many health care provid- ers, is instead the beginning of an ongoing process that impacts multiple organ systems and may cause or accelerate other diseases and disorders that can reduce life expectancy, according to research from the University of Texas Medical Branch at Galveston. As such, traumatic brain injury should be defined and managed as a chronic disease to ensure that patients receive appropriate care and that future research is directed at discovering therapies that may interrupt the disease processes months or even years after the initiating injury, say co-authors Dr. Brent Masel, a clinical associate professor in UTMB’s department of neurology and Dr. Douglas DeWitt, director of the Moody Center for Traumatic Brain & Spinal Cord Injury Research/Mission Connect and professor in the department of anesthesiology. Masel also serves as president and director of the Transitional Learning Center in Galveston, which for more that 25 years has provided survivors of brain injury with the special rehabilitation services they need to re-enter the community. The literature review, which appears in a recent issue of The Journal of Neurotrauma, examines 25 years of research on the effects of brain injury, including its impact on the central nervous system and on cognitive and motor functions. Traumatic brain injury occurs when a sudden trauma causes damage to the brain and can be classified as mild, mod- erate or severe, de- pending on the extent of the damage. While many patients recover completely, more than 90,000 become dis- abled each year in the U.S. alone. It is esti- mated that more than 3.5 million Americans are presently disabled by brain injuries—suffering lifelong conditions as a result. “Traumatic brain injury fits the World Health Organization’s definition of a chronic disease, yet the U.S. health care system generally views it as a one-time injury that heals the way a broken bone does,” says Masel. “Only by reimbursing and managing brain injuries on par with other chronic diseases will patients get the long-term treatment and support they need and deserve.” The researchers add that re-classifying traumatic brain injury as a chronic disease may help to provide brain injury researchers with the additional funding required to investigate a potential cure. Masel and DeWitt’s review compiled extensive evidence that brain trauma initiates a disease process that severely affects cognitive function, physiological processes and quality of life. These effects can prevent patients from fully reentering society post-injury and may ultimately contribute to death months or years later. Specifically, traumatic brain injury is strongly associated with: Neurological disorders that reduces life expectancy, including epilepsy for which traumatic brain injury is the leading cause in young adults — and obstructive sleep apnea, which is associated with reduced cognition and severe cardiac arrhythmias during sleep. Neurodegenerative disorders that lead to gradual declines in cognitive function after injury, including Alzheimer’s dementia, Parkinson’s disease and chronic traumatic encephalopathy (also known as “punch drunk” and characterized by disturbed coordination, gait, slurred speech and tremors). However, research shows that those who receive more therapy in the early post-injury months, irrespective of severity of injury and level of neuropsychological impairment, were less likely to show decline over the long-term. Age is also a factor in cognitive outcome after brain injury, with older patients showing greater decline. A host of neuroendocrine disorders, possibly caused by complex hormonal responses in the hypothalamic- pituitary system that ultimately lead to acute and/or chronic post-traumatic hypopituitarism—the decreased secretion of hormones normally produced by the pituitary gland, which can result in several related conditions, including growth hormone deficiency and hypothyroidism. Continued on Page 5 RESEARCHERS URGE RECLASSIFICATION OF TRAUMATIC BRAIN INJURY AS CHRONIC DISEASE Making Headway Distributed Three Times Each Year Fall/Winter Issue2010-2011 IN THIS ISSUE Board of Directors…………………………Page 2 .TBI Ombudsman…...……………………..Page 2 BIAU Art Show…………………..…...……Page 3 Membership………………………………...Page 3 How some Cells Hook up Surprises Researchers…………………………………Page 4 Donations & Support………………….…...Page 5 Treatment of Elbow Flexion .Contractures Secondary to Head Injuries ………………Page 6 Exploring the Connection Between Brain Injury and Substance Abuse………………… …...Page 7 Cognitive Behavior Therapy…… ………...Page 8 Community Shares/Utah…………..………Page 8 Younger Brain are Easier to Rewire……. .Page 9 VISTA Volunteers in Service …… ….....Page 10 Treatment for Headache & Dizziness.......Page 12 BIAU Family Conference ………..…Page 14 - 15 Skiing & Snowboarding………...………..Page 16
Transcript
Traumatic brain injury, currently considered a singular event by the insurance industry and many health care provid-ers, is instead the beginning of an ongoing process that impacts multiple organ systems and may cause or accelerate other diseases and disorders that can reduce life expectancy, according to research from the University of Texas Medical Branch at Galveston.
As such, traumatic brain injury should be defined and managed as a chronic disease to ensure that patients receive appropriate care and that future research is directed at discovering therapies that may interrupt the disease processes months or even years after the initiating injury, say co-authors Dr. Brent Masel, a clinical associate professor in UTMB’s department of neurology and Dr. Douglas DeWitt, director of the Moody Center for Traumatic Brain & Spinal Cord Injury Research/Mission Connect and professor in the department of anesthesiology. Masel also serves as president and director of the Transitional Learning Center in Galveston, which for more that 25 years has provided survivors of brain injury with the special rehabilitation services they need to re-enter the community.
The literature review, which appears in a recent issue of The Journal of Neurotrauma, examines 25 years of research
on the effects of brain injury, including its impact on the central nervous system and on cognitive and motor functions. Traumatic brain injury occurs when a sudden trauma causes damage to the brain and can be classified as mild, mod-erate or severe, de-pending on the extent of the damage. While many patients recover completely, more than 90,000 become dis-abled each year in the U.S. alone. It is esti-mated that more than 3.5 million Americans
are presently disabled by brain injuries—suffering lifelong conditions as a result.
“Traumatic brain injury fits the World Health Organization’s definition of a chronic disease, yet the U.S. health care system generally views it as a one-time injury that heals the way a broken bone does,” says Masel. “Only by reimbursing and managing brain injuries on par with other chronic diseases will patients get the long-term treatment and support they need and deserve.”
The researchers add that re-classifying traumatic brain injury as a chronic disease may help to provide brain injury researchers with the additional funding required to investigate a potential cure.
Masel and DeWitt’s review compiled extensive evidence that brain trauma initiates a disease process that severely affects cognitive function, physiological processes and quality of life. These effects can prevent patients from fully reentering society post-injury and may ultimately contribute to death months or years later. Specifically, traumatic brain injury is strongly associated with:
Neurological disorders that reduces life expectancy, including epilepsy for which traumatic brain injury is the leading cause in young adults — and obstructive sleep apnea, which is associated with reduced cognition and severe cardiac arrhythmias during sleep. Neurodegenerative disorders that lead to gradual declines in cognitive function after injury, including Alzheimer’s dementia, Parkinson’s disease and chronic traumatic encephalopathy (also known as “punch drunk” and characterized by disturbed coordination, gait, slurred speech and tremors). However, research shows that those who receive more therapy in the early post-injury months, irrespective of severity of injury and level of neuropsychological impairment, were less likely to show decline over the long-term. Age is also a factor in cognitive outcome after brain injury, with older patients showing greater decline. A host of neuroendocrine disorders, possibly caused by complex hormonal responses in the hypothalamic-pituitary system that ultimately lead to acute and/or chronic post-traumatic hypopituitarism—the decreased secretion of hormones normally produced by the pituitary gland, which can result in several related conditions, including growth hormone deficiency and hypothyroidism.
Continued on Page 5
RESEARCHERS URGE RECLASSIFICATION OF TRAUMATIC BRAIN INJURY AS CHRONIC DISEASE
Making Headway Distributed Three Times Each Year Fall/Winter Issue2010-2011
IN THIS ISSUE
Board of Directors…………………………Page 2
.TBI Ombudsman…...……………………..Page 2
BIAU Art Show…………………..…...……Page 3
Membership………………………………...Page 3
How some Cells Hook up Surprises
Researchers…………………………………Page 4
Donations & Support………………….…...Page 5
Treatment of Elbow Flexion .Contractures
Secondary to Head Injuries ………………Page 6
Exploring the Connection Between Brain Injury
and Substance Abuse………………… …...Page 7
Cognitive Behavior Therapy…… ………...Page 8
Community Shares/Utah…………..………Page 8
Younger Brain are Easier to Rewire……. .Page 9
VISTA Volunteers in Service …… ….....Page 10
Treatment for Headache & Dizziness.......Page 12
BIAU Family Conference ………..…Page 14 - 15
Skiing & Snowboarding………...………..Page 16
Board of Directors
Executive Board
President …………………..Teresa Such-Neibar, D.O. Vice-President……….………..Shared Responsibility Treasurer………………………….…...Pauline Fontaine Secretary………………………………………...LeAnn Taft
Board of Trustees
Elizabeth M. Cardell, OTR/L
Bret W. Hortin, CLU, ChFC, CASL Janet Gibbs, MED
Edward B. Havas, Esq. Laurence Hilton, Ph.D., CCC, SLP
Cheryl Hostetter , MS, SLP Julie McCauley , MSW
Miette Full Murphy MS, CCC, SLP Antonietta Anna Russo, Ph.D.
Robert B. Sykes, Esq.
Tony Washington
Advisory Board
Erin D. Bigler, Ph.D. Elaine Clark, Ph.D.
Sam Goldstein, Ph.D. Reuel McPhie, MBA, MPH, FACHCA
Elaine Pollock, B.A. John Speed, MBBS
Calendar of Events
March 3, 2011
1st Annual Art Show Radisson Hotel—Downtown
Salt Lake City, UT
March 3-4, 2011
Medical & Legal Conference Radisson Hotel—Downtown
Salt Lake City, UT
May 21, 2011
16th Annual 5K Run, Walk & Roll Liberty Park
Salt Lake City
For additional information regarding these event, please call our office at
801-484-2240 or 800-281-8442 www.biau.org
Ombudsman Position Duties and Responsibilities:
The Brain Injury Association of Utah (BIAU) through the Traumatic Brain Injury Implementation Partnership Grant, has the responsibility to hire and provide support for an Ombudsman to help individuals and family members who have suffered a traumatic brain injury. The Ombudsman is paid through the grant by BIAU, but is independent of the organization.
An ombudsman is a person who acts as a trusted intermediary between an organization and some internal or external constituency while representing not only but mostly the broad scope of constituent interests.
The BIAU Ombudsman
Serves as a confidential and designated neutral for clients who raise concerns and request assistance to informally resolve conflicts and problems.
Develops, implements, evaluates and improves an independent, neutral problem resolution service for employees, clients, customers, etc.
Serves as a change agent for community businesses, programs and professionals by identifying systemic problems in agency policies, procedures, or regulations and submitting recommendations for change.
Promotes an effective conflict management program in affiliated organizations to facilitate effective and efficient operations.
Promotes the availability of the BIAU Ombudsman to external and internal clients.
The BIAU Ombudsman has the following primary functions:
Communications Facilitation
Problem Prevention
Dispute Resolution
Functional Description
The major functions include:
Investigates inquiries, complaints and disputes to determine patterns and systemic issues that may need to be addressed/modified.
Analyzes policies, operating programs and procedures to determine if existing or proposed programs accomplish organizational goals and objectives.
Effectively engages respondents in evaluating the “fairness” of action or policies.
Assists in negotiating care plans, educational plans, and various independent living plans to improve clients’ quality of life.
Educates employees about the services of the Ombudsman.
Publicizes and practices proactive strategies to market ombudsman services to organizations, community groups and the public.
Holds presentations, briefings, training sessions, and conferences as needed
for all clients to provide information about ombudsman programs and to
Kimberly Kirkham Michelle Law Reuel & Katherine McPhie
Yvonne Mellinger Mary Parker Karma Prescott John Speed
M. Shane Wamsley
Corporate Members
Phoenix Services Corp.
Utah State University, Center for Persons with Disabilities
Why Become A Member?
The Brain Injury Association of Utah’s (BIAU) primary purpose is to provide support for individuals with brain injuries and their families. The BIAU serves professional interest through efforts that include advocacy, educational programs and the promotion of research and training. Throughout our years of service, the BIAU has embarked on an aggressive agenda to improve the quality of life for those suffering from a brain injury, along with the needs of their families.
As a member you will receive and/or support the following:
Brain Injury Association of Utah, Inc. newsletter three - issues
Brain Injury Association of America newsletter four - issues of The Challenge
Requested educational material
Announcements of upcoming educational conferences and/or events
Emotional support through our Helpline and/or support groups
Legislative efforts
Promote prevention
Voting privileges at BIAU annual meeting
To become a member contact us at:
801-484-2240 or 800-281-8442
or on the website: www .biau.org
http://www.biau.org/whatdo/whatdo_membershiphtml
presents
The First Annual
Showcasing
The Artwork of Individuals with Brain Injuries, Family
All Proceeds will be donated to the BIAU for Brain Injury Advocacy and Prevention Programs.
PAGE 4 HEADWAY
How some brain cells hook up surprises researchers
Immune cells known as microglia, long thought to be activated in the brain only when fighting infection or in-jury, are constantly active and likely play a central role in one of the most basic, central phenomena in the brain – the creation and elimination of synapses. The findings, publishing next week in the online, open access journal PLoS Biology, catapult the humble microglia cell from its well-recognized duty of protecting the brain to direct involvement in creating the cellular networks at the core of brain behavior. Its apparent role as an architect of synapses – junctions between brain cells called neurons – comes as a surprise to researchers long accustomed to thinking of microglia as cells focused exclusively on keep-ing the brain safe from threats.
The research helps move microglia up into the pantheon of brain cells known to affect brain signaling. Years ago, brain signaling was thought to be the exclusive domain of neurons. During the last two decades, scientists have found that astrocytes also have vast signaling networks. Now, microglia also seem to be an important player in the brain's ability to adapt immediately and constantly to the environment and to shift its resources accordingly.
"When scientists talk about microglia, the talk is almost always about disease. Our work suggests that microglia may actively contribute to learning and memory in the healthy brain, which is something that no one expected," said Ania Majewska, Ph.D., the neuroscientist at the Uni-versity of Rochester Medical Center who led the work.
The group's paper is a detailed look at how brain cells interact with each other and react to their environment swiftly, reaching out constantly to form new links or abolish connections. First author Marie-Ève Tremblay, Ph.D., a post-doctoral associate in Majewska's lab, used two sophisticated imaging techniques to get an unprece-dented look at microglia in the brain. She used immu-noelectron microscopy and two-photon microscopy to look at how microglia interact with synapses in the brains of healthy mice as their environment changed. In the experiments, the scientists looked into the brain while the mice were 1) on a normal cycle of light and dark, 2) while the mice were in the dark for several days, and 3) when the mice went back to a normal light/dark cycle. Their study reveals a high level of activity among micro-glia in response to changes in visual experience. This shows that even under nonpathological conditions microglia are actively participating in neuronal functions.
Specifically, Majewska's group found that microglia showed a great deal of structural and morphological plasticity. When the lights were off, microglia con-tacted more synapses, were more likely to reach toward a particular type of synapse, and tended to be larger. When the lights came back on, most of those changes reversed. In time-lapse video of their experiments, microglia seemed to dance across the screen, extending their processes dynamically across their local environment. Tremblay and Majewska showed that microglia touch and wrap around synapses constantly and may have some say in decid-ing which synapses will survive. Microglia also appear key to creating or changing the extracellular space around synapses, a factor that would profoundly affect synapse function. The team even found indications that microglia may be involved in destroying synapses. Eliminating dendritic spines is one way to destroy synapses, and in their study, Majewska's group found that dendritic spines that were touched by microglial processes were more than three times as likely to be eliminated within the next two days compared to spines that were not.
The findings are timely for scientists who are increasingly studying links between the nervous and immune systems, Tremblay said. The role of microglial cells are now being studied in the context of a number of diseases, including Parkinson's, Alzheimer's, schizophrenia, and even autism.
Taken from the Children’s Neurobiological Solutions Newsletter
November 2, 2010 Source: Public Library of Science
In Appreciation To Those Who Support The BIAU August 1, 2010 — October 31, 2010
Gold Bar
$2,500 & Over
Phoenix Services Corp.
Gold Nugget $1,000 & Over
Community Shares of Utah
HealthSouth Rehabilitation Hospital of Utah
Teresa Such-Neibar
Utah Charities Foundation
Gold Ring $500 & Over
Gold Chip
$250 & Over
Robert Gilchrist Edward Havas
Colin King
Alan Mortensen Erik Ward
Gold Coin
$100 - $249
Elizabeth Cardell
Joyce Dolcourt
Pauline Fountaine
Cheryl Hostetter
Miette Murphy
Friends of BIAU
David & Sue Dewey Julie McCauley
G. Barrie Nielson
Karma Prescott Antonietta Russo
Richard & Carolyn Scheid
Volunteers
We would like to thank the many volunteers who give of their time
and energy to support the mission of the BIAU, without them this
organization would not exist.
Only with your help can we continue to expand public awareness,
enact legislative change, and serve the people whose lives are
forever changed by the physical, cognitive, social and financial
consequences of this devastating injury.
Please make your tax-deductable contribution to the
Brain Injury Association of Utah
Psychiatric and psychological diseases, which are among the most disabling consequences of traumatic brain injury. Many individuals with mild brain trauma and the majority of those who survive moderate-to-severe brain injury are left with significant long-term neurobehavioral conditions. These range from aggression, confusion and agitation to obsessive-compulsive disorders, anxiety/mood/psychotic disorders, ma-jor depression and substance abuse. It is also associated with high rates of suicide.
Non-neurologic disorders, including sexual dysfunction, which affect 40-60 percent of patients; incontinence; musculoskeletal dysfunction, or spasticity that results in abnormal motor patterns that may limit mobility and independence; and metabolic dysfunction, as brain injury appears to impact the way the body absorbs, utilizes and converts amino acids, which play a critical in brain function.
According to Masel and DeWitt, research suggests that the progression of symptoms seen in chronic traumatic brain injury patients may be due, in part, to defective apoptotic cell death — a natural process in which cells die because they are genetically pro-grammed to do so or because of injury or disease. It is possible that the abnormal apoptotic cell death is triggered by brain trauma, leading to an accelerated decline in cognitive function and development of disease.
“Media coverage of traumatic brain injury among soldiers and athletes, especially football players, has highlighted the serious health problems resulting from brain injury that are experienced later in life and helped raise awareness among the general public,” says DeWitt.
“But until traumatic brain injury is recognizes as a chronic dis-ease, research funding won’t be adequate for the work that is needed to help patients minimize or avoid these outcomes.”
Taken from the Centre For Neuro Skills Inside View Issue 19.4 Fall 2010
For all of your Self Administered
Service needs.
We offer the experience of a large company and the
Joint contractures are a common complication following head injuries. One study reported an 84% incidence of contractures in a population of patients with head trauma requiring inpatient rehabilitation. The joints most commonly affected were the hips *81%), shoulders (76%), ankles (76%), and elbows (44%).
One of the factors contributing to contracture formation is an imbalance in activity of antagonistic muscle groups acting across the joint. In patients with upper motoneuron lesions such as head trauma, this imbalance may be due to a combination of spasticity and paretic muscle weakness. Prolonged contraction of the spastic muscles (usually flexor muscles in the upper extremity and extensor muscles in the lower extremity) can result in fixed, abnormal posturing and subsequent joint contracture. Akeson and colleagues investigated the mechanism of contracture formation using immobilized rabbit knee joints. They found the main structural change to be increased collagen cross-linking in the periarticular connective tissue.
Prevention of joint contracture is the ultimate therapeutic goal. It is well known that motion, either active or passive, acts in some way to prevent contracture formation, although
PAGE 6 HEADWAY
The lawyers at Dewsnup, King & Olsen in Salt Lake City, Utah, represent victims in complex, major litigation involving
brain injuries, paralysis, amputation and other serious personal injuries, wrongful death, medical malpractice, product
liability, pharmaceutical liability, insurance bad faith and other significant cases. Dewsnup, King & Olsen is frequently asked
by other lawyers and law firms to join forces for the client’s benefit. For more information call * 801-533-0400 *.
Low-load, Prolonged Stretch in Treatment of Elbow Flexion Contractures Secondary to Head Trauma
the specific mechanism remains unclear. Akeson et al postulated that motion stimulates the production of proteoglycans, which in turn lubricate the collagen fiber interface, thus preventing cross-linking and allowing joints to move freely. Daily range-of-motion exercises have become a standard prophylactic measure in the management of patients with head trauma. Despite this intervention, however, contracture formation remains a major sequelae of head injuries. Furthermore, manual passive stretching, the principal physical therapy method of treating contractures, is of limited effectiveness. Kottke et al reported that connective tissue has a high tensile resistance to tension applied for a short duration. Prolonged, mild tension, however, does result in elongation, which has been attributed to the separation of the collagen cross-links. A comparison of stretching methods using rat tail tendon as the tissue model revealed that the low-force, long-duration procedure was more effective than short-term vigorous stretching at producing residual elongation of the connective tissue.
Continued on Page 10
November 2006r of the PAGE 7 HEADWAY
Exploring the Connection Between Brain Injury and Substance Abuse
By: Duane Reynolds, LSW, LADC, BCCR Associate Director, Vinland National Center
www.VinlandCenter.org
One out of two people living with a brain injury suffers from some form of substance abuse issue, according to the Office on Disability. This is in striking contrast to the substance abuse rate among the general population, which is one out of ten. Several factors contribute to this increased risk, including medicine and health problems, enabling by family and friends, an inability to identify potential problems, and a lack of appropriate prevention and treatment services.
People recovering from a brain injury often face many obstacles. Depression, isolation and boredom are fairly common feelings after a brain injury. In an effort to cope with these feelings, some brain injury survivors turn to alcohol or drugs, but even a casual use of these substances can have negative consequences for people recovering from and living with brain injuries.
Drinking After Brain Injury The adverse effects alcohol and drugs have on a healing
mind can be devastating to the quality of life for a person in recovery. After an injury, the brain has to re-learn skills by discovering new ways to transmit information. The brain does this by making new connections between neurons to compensate for the part of the brain that was damaged. Using alcohol and drugs after a brain injury slows recovery by interfering with the new connections between neurons. Inhibiting the brain’s ability to heal and adapt to life after an injury prolongs and frustrates the healing process.
People who have sustained one brain injury are three times more likely to suffer a second injury. Some brain injuries cause problems with balance, coordination, vision and judgment. These problems will be compounded with alcohol and drug use. It is important to remember that no matter how much alcohol or other drugs a person was able to use before, it is always less after an injury. This is because the brain is more sensitive to alcohol and other drugs after an injury.
Seeking Treatment It is important for a person with a brain injury who is
seeking help for substance abuse to locate a program that has experience in treating people with brain injuries. Too often, substance abuse treatment is not accessible to people living with a brain injury because of learning barriers caused by the injury. Treatment centers that are not familiar with brain injuries may interpret certain behaviors as intentionally disruptive or as resistance to treatment. Working with a counselor who understand the common behaviors associate with brain injury is essential for a person trying to recover from addiction
If you or someone you know is living with a brain injury or other cognitive disabilities and struggling with substance abuse, treatment may help. Since 1990, Vinland National Center has been helping people with cognitive disabilities address their chemical health issues.
PAGE 8 HEADWAY
Community Shares/Utah brings hope, comfort and help to
those in need. Our mission consists of human, animal, and
environmental services.
We unite a remarkable and varied group of nonprofits. These
agencies receive training, education, and financial resources
that enable them to reach their goals and programs each year.
Community Shares/Utah recommends and encourages
Utahn’s to “designate.” This is accomplished by selecting the
agency and the amount of their contribution on the pledge
form. The member agency always receives the designated
contribution. All money collected remains in Utah. For more
information contact our website,
http://www.communitysharesutah.org
Cognitive Behavioral Therapy (CBT) is a type of psychotherapy that helps people change how they think, feel, or act in order to improve their mood, reduce stress, or achieve other important health and life goals. Some goals may be specific, such as reducing worrying or procrastination, whereas others can be more general, such as figuring out why one's life seems to lack meaning, passion or direction, and figuring out what to do about it. There are three parts to CBT:
1. How you think (cognitive) can and does change your behavior.
2. The way you think may be monitored and altered.
3. The desired behavior change may be affected through changes in the way you think.
This type of therapy is very effective in trauma, chronic
illness, pain management, sports and performing arts.
“Cognitive Behavior Therapy is focused on the present rather than the past," said Deanna Barch, Ph.D., an associate professor of psychology in Arts & Sciences at Washington University and supervisor of the social anxieties group therapy project.
"It's focused on the kinds of thoughts, beliefs, ideas that people have currently and how that influences their emotions and behaviors. It also focuses on what behaviors you are actually engaging in and not engaging in at the moment, in the here-and-now." Taken from the website of Dr. Diane
The Brain Injury Association of Utah is a member of
Community Shares Utah
Cognitive Behavioral Therapy (CBT)
PAGE 9 HEADWAY
A new paper from MIT neuroscientists, in collaboration with Alvaro Pascual-Leone at Beth Israel Deaconess Medical Center, offers evidence that it is easier to rewire the brain early in life. The researchers found that a small part of the brain's visual cor-tex that processes motion became reorganized only in the brains of subjects who had been born blind, not those who became blind later in life.
The new findings, described in the Oct. 14 issue of the journal Current Biology, shed light on how the brain wires itself during the first few years of life, and could help scientists understand how to optimize the brain's ability to be rewired later in life. That could become increasingly important as medical advances make it possible for congenitally blind people to have their sight restored, said MIT postdoctoral associate Marina Bedny, lead author of the paper.
In the 1950s and '60s, scientists began to think that certain brain functions develop normally only if an individual is exposed to relevant information, such as language or visual information, within a specific time period early in life. After that, they theo-rized, the brain loses the ability to change in response to new input.
Animal studies supported this theory. For example, cats blind-folded during the first months of life are unable to see normally
Younger Brains are Easier to rewire Study shows a period early in a person’s development when brain regions can switch functions
after the blindfolds are removed. Similar periods of blind-folding in adulthood have no effect on vision.
However, there have been indications in recent years that there is more wiggle room than previously thought, said Bedny, who works in the laboratory of MIT assistant professor Rebecca Saxe, also an author of the Current Biology paper. Many neuroscientists now support the idea of a period early in life after which it is difficult, but not impossible, to rewire the brain.
Bedny, Saxe and their colleagues wanted to determine if a part of the brain known as the middle temporal complex (MT/MST) can be rewired at any time or only early in life. They chose to study MT/MST in part because it is one of the most studied visual areas. In sighted people, the MT region is specialized for motion vision.
In the few rare cases where patients have lost MT function in both hemispheres of the brain, they were un-able to sense motion in a visual scene. For example, if someone poured water into a glass, they would see only a standing, frozen stream of water.
Continued on Page 13
PAGE 10 HEADWAY
Continued from Page 6
One method of providing low intensity, prolonged-duration force across a contracted joint is through the application of a dynamic splint known as the Dynasplint. This device consists of two adjustable cuffs with medial and lateral struts hinged at the joint axis. By varying the tension of the springs housed in each of the distal struts, the amount of force applied across the joint can be altered. Effective use of this splint has been reported in the treatment of elbow flexion contracture subsequent to a supracondylar fracture and in the case of an elbow flexion burn contracture. A recent article reviewed the sue of the Dynasplint in a single case of a contracture secondary to a cerebrovascular accident and in 12 cases of contractures resulting from orthopedic conditions such as knee and elbow fractures. Although the manufacturer’s information refers to the use of the Dynasplint for joint contractures following head trauma, previous studies on such application have not been reported. The purpose of this case report is to describe the application of the Dynasplint in the treatment of a patient with elbow flexion contracture secondary to head trauma.
Article submitted by Dynasplint Systems, Inc. of Utah Reprinted from Physical Therapy with the permission of the
American Physical Therapy Association
PAGE 11
HEADWAY
Martin Luther King Jr. Day of Service BIAU AmeriCorps *VISTA’s Volunteers
Our BIAU AmeriCorps VISTA Volunteers Jason Molesky and
Olivia Niitsuma volunteered at the Utah Food Bank services
warehouse for Martin Luther King Jr. Day. We are proud
of Jason & Olivia’s commitment of service not only to our
organization but on this special day of service to our
community.
A recent retrospective study by four Michigan physicians shows strong evidence that symptoms of headache, dizzi-ness and anxiety in some patients with traumatic brain in-jury potentially could be alleviated or even eliminated with specialized eyeglass lenses containing prisms.
The paper was published in a recent issue of Physical Medicine and Rehabilitation. The investigators included doctors from three southeast Michigan hospitals and one in private practice, and involved 43 patients with TBI. “This represents a new approach to the treatment of post-concussive symptoms,” says Mark S. Rosner, M.D., adjunct clinical instructor in the Department of Emergency Medicine at the University of Michigan Medical School and Emergency Department staff physician at St. Joseph Mercy Hospital in Ann Arbor. “Vision was known to be affected by TBI, but now it appears that the vision abnormalities caused by the TBI are causing the other post-concussive symptom.” The study suggests that TBI appears to be causing visual image misalignment—or vertical heterophoria. To correct this misalignment and prevent double vision, the eye muscles are utilized to force the eyes back into proper alignment. This causes the eye muscles to become over worked , strained and fatigued, which accounts for many post-concussive symptoms, including headaches, dizziness, anxiety and neck pain. The use of prismatic eyeglass lenses to realign the images and reduce or eliminate eye muscle overwork let to a 71.8 percent reduction of patient’s symp-toms. TBI affects 15 to 20 percent of our servicemen and women returning from Iraq and Afghanistan—caused mostly by ex-plosions—and approximately 2 million people per year in the U.S.—caused mostly by falls, auto accidents and sports injuries. Approximately 10 to 25 percent of patients with TBI still have significant post-concussive symptoms one year after their injury. “Treatment involves a multifaceted approach, including physical therapy, occupational therapy and multiple medica-tions, and can take years to complete,” says Jennifer E. Doble, M.D., a physiatrist at St Joseph Mercy Hospital, Ann Arbor. “Prismatic lens treatment seems to allow the other therapies to be effective more quickly. And as a result,
patients get better quicker, reducing the time and cost of caring for this patient population.” The first patient with TBI was recognized as having vertical heterophoria in 2005 by two of the study co-authors—Doble, a TBI rehabilitation specialist—and Debby L. Feinberg, O.D, and optometrist at Vision Specialists of Birmingham, Bir-mingham, Michigan. The overlap of TBI and vertical heter-ophoria symptoms was significant: headaches, neck ache, upper back pain, dizziness, nausea, anxiety and reading diffi-culties. To date, no single unifying cause of TBI symptoms had been identified. Doble initially say patients with TBI. When vertical heter-ophoria was suspected, they were then referred to Feinberg for further evaluation. “A retrospective analysis of the data from these patients was performed, and 43 patients were diagnosed with vertical het-erophoria and included in the study.” says Feinberg. “These patients had persistent post-concussive symptoms despite receiving standard treatments and medications for an aver-age of 3.5 years.” A diagnostic and therapeutic process developed by Feinberg was used to identify and treat vertical heterophoria. Prism lenses were added to the patient’s baseline prescription, which resulted in a 71.8 percent reduction of symptoms in an average of 3.5 months. “Our study concluded that in this group of patients who de-veloped post-concussive symptoms and vertical heterophoria symptoms because of their TBI, malfunctioning of the binocu-lar visual system was found to be a single common factor shared by all patients,” says Arthur J. Rosner, M.D., an oto-laryngologist at the Department of Otolaryngology, William Beaumont Hospital, Troy, Michigan. “Treatment of the vertical heterophoria with prismatic eyeglass lenses was found to be effective in reducing symp-toms associated with both TBI and vertical heterophoria.”
Article taken from the Centre for Neuro Skills,
Inside View 19.4 2010
PAGE 12 HEADWAY
Treatment for Headaches and Dizziness Caused by Traumatic Brain Injury Appears Promising
Prismatic eyeglass lenses resulted in 71.8 percent
reduction of symptoms
PAGE 13 HEADWAY
Continued from Page 9
Previous studies have shown that in blind people, MT is taken over by sound processing, but those stud-ies didn't distinguish between people who became blind early and late in life. In the new MIT study, the researchers studied three groups of subjects – sighted, congenitally blind, and those who became blind later in life (age nine or older). Using functional magnetic resonance imaging (fMRI), they tested whether MT in these subjects responded to moving sounds — for example, approaching footsteps.
The results were clear, said Bedny. MT reacted to moving sounds in congenitally blind people, but not in sighted people or people who became blind at a later age.
This suggests that in late-blind individuals, the visual input they received in early years allowed the MT complex to develop its typical visual function, and it couldn't be remade to process sound after the person lost sight. Congenitally blind people never received any visual input, so the region was taken over by auditory input after birth.
"We need to think of early life as a window of opportunity to shape how the brain works," said Bedny. "That's not to say that later experience can't alter things, but it's easier to get organized early on." Bedny believes that by better understanding how the
brain is wired early in life, scientists may be able to learn how to rewire it later in life. There are now very few cases of sight restoration, but if it becomes more common, scientists will need to figure out how to retrain the patient's brain so it can process the new visual input.
"The unresolved question is whether the brain can relearn, and how that learning differs in an adult brain versus a child's brain," said Bedny.
Bedny hopes to study the behavioral consequences of the MT switch in future studies. Those would include whether blind people have an advantage over sighted people in auditory motion processing, and if they have a disadvantage if sight is restored.
Taken from the Children’s Neurobiological Solutions Newsletter
Article posted October 21, 2010 Source: Massachusetts Institute of Technology
21st Annual Family & Professionals Conference 2010
The Brain Injury Association of Utah would like to thank our sponsors, exhibitors, silent auction donors, and attendees for another successful conference. The conference attracted 288 attendees with representatives from Arizona, Colorado, and Idaho. We would also like to thank our Conference Committee for their hard work and dedication to bring the very best speakers and topics to this event each year. Without their direction this conference would not be possible.
CO-SPONSORS
Utah Department of Health-Violence & Injury Prevention Program Utah State Office of Education
Utah State Office of Rehabilitation
MAJOR SPONSORS Dewsnup King & Olsen, Attorneys at Law HealthSouth Rehabilitation Hospital of Utah Intermountain Healthcare Disability Law Office of Brian D. Kelm
Phoenix Services Corporation Law Office of Robert J. DeBry & Associates
University Health Care Rehabilitation Center
CONTRIBUTING SPONSORS
Defense & Veterans Brain Injury Center Dyna Vox Mayer-Johnson Homewatch Care Givers Learning Services Corporation Morning Star Financial Services, LLC
SILENT AUCTION DONORS
Southwest Airlines
Ski n See
Ballet West
Resorts at Wendover
Alta Ski Resort/Ski n See
Do Do Restaurant
Utah Symphony Porcupine Pub & Grill
Orson Gygi
Le Bus
University of Utah Guest House
Marriott Ogden
Firehouse Car Wash
Nuchi’s Pizza
Rodizio Grill Lamb’s Grill & Café
Wasatch Gift Baskets
Uinta Brewing
Greenery Restaurant
Starbucks
Utah Jazz
Great Harvest Bread
Heber Valley Railroad
Stein Mart
Grand Theater Stampin Up
Tony Caputo’s Market
Tuscany Restaurant
Fat Cats
University of Utah Athletic Dept.
Wingers
PAGE 15
HEADWAY
Lifetime Achievement Award Judith Holt
Rachelle White Memorial Award
Rolf Halbfell
Educator’s Award Laurie Fue
Individual with Brain Injury Community Service Award
Jared Willis
Family Award
David & Ellen Haddock
FACT: Most skiers are hurt at the beginning and end of the day FACT: Many injuries occur when the skier or snow-boarder is tired FACT: Most children who are injured when snowboarding are beginners
HEADWAY
Skiing & Snowboarding
1800 So. West Temple, Suite 203
Salt Lake City, UT 84115
RETURN SERVICE REQUESTED
Due to the cost of mailing this newsletter to you, it is
extremely important for you to notify our office at
