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[BLOG POST] Brain Injury and Sex: What Happens After a TBI?

By Xavier Figueroa, Ph.D.

http://www.msktc.org/tbi/factsheets/Sexuality-After-Traumatic-Brain-Injury

womens-brainsWhat is the largest sex organ in the body?

The brain, of course! (Followed by the spinal cord ganglia but let’s not judge).

Intimacy, desire, physical contact and pleasure, they are very basic needs in a relationship. Marriages, partnerships and friendships rely on this most basic link. But when a brain injury occurs, changes in desire and drive (hypo- and hyper-sexuality) can become apparent. Energy and mood can also be affected, which can induce a change in libido, interest and desire. Damage to certain portions of the brain may affect your ability to move, reducing spontaneity and self-esteem. Elements of coming to terms with the trauma, such as shock and recovery may take time, as well as recovery from physical rehabilitation. If the injury is chronic, other changes may become apparent, including cognitive and behavioral changes that shift how friends and partner interact with each other.

Much of these changes can occur days, weeks or even months after the injury, even in mild to moderate traumatic brain injuries. Knowing how to identify, adapt and overcome the changes associated with an ABI/TBI is an important part of recovery.

The most important information to take away from this post is the following: you are not alone, you are not abnormal and you will get better. Millions of individuals and couples have gone through the recovery of a brain injury and difficulties with reestablishing a functional sexual relationship. Hang in there.

What the Problem Looks Like

When we talk about sex, we are talking about something that is simple in practice, but complex in execution. Prior to the brain injury, a pattern of behavior between yourself and your partner was established. How you interacted and what you expected prior to and leading to sexual intimacy were established and anticipated. I wouldn’t call it a pattern (that’s not very exciting!), but a role in which you knew which part each one would play.

A brain injury directly affects the biggest and most important sex organ in the human body. It’s no wonder that sexual issues appear in 50-60% of people that suffer a moderate to severe TBI. In a recent article in US News and World Report (Health Day, April 29, 2013; Link) that reported on the study that appeared in NeuroRehabilitation: An International Journal:

‘The study found that 50 percent to 60 percent of people with TBI have sexual difficulties, such as reduced interest in sex, erectile dysfunction, pain during sex, difficulties in vaginal lubrication, difficulties achieving orgasm or staying aroused, and a sense of diminished sex appeal, Moreno said.

The research found that partners of those with TBI experienced personality and emotional changes, and a modification of family roles that can lead to a crisis, Moreno said. “For the spouse, the survivor becomes a different person, a person they do not recognize as the one they fell in love with in the past,” he said. “The spouse becomes a caregiver and this imbalance in the relationship directly affects sexual desire.”’

Even in cases of mild TBI, there are incidences of 25-50% of people experiencing sexual difficulties [1], especially in individuals exposed to bomb-blast injuries. Brain injuries are not mild…they can take a life of their own and totally transform who you are and how you relate to your significant other (spouse, partner or lover). Many of these changes can be divided into 5 major groups:

  • Decreased Desire (Hyposexuality): inability to become interested in sex.
  • Increased Desire (Hypersexuality): inappropriate sexual behavior; constant focus on sex.
  • Decreased Arousal: Difficulty in achieving erection/lubrication.
  • Difficulty or Inability to Reach Orgasm/Climax:
  • Reproductive Changes: Low sperm count; missed periods.

But these are just the changes that occur with sexual interaction (as if that weren’t enough). These are behavioral changes that hide deeper and more profound changes that can occur throughout the body. Changes in sexual desire are like the proverbial canary in the coal mine…it warns you that something is amiss.

That Voodoo That You do…

Damage to the brain can induce a number of changes:

Fatigue/Tiredness

Hormonal Changes

Emotional Changes

Cognitive Changes

Spasticity/Movement Problems

These changes can come from very specific damage to certain areas of the brain, such as your pituitary, the frontal and temporal lobes of the brain. When you get down to it, sex is a very complicated process…neurologically speaking! A number of body systems have to work together to make the engines of desire go vroom…and when one system is not working, then it can cause the engine to misfire and stall.

The Tiny Organ

The pituitary gland is a tiny portion of the brain… but don’t let its size fool you. It is a master regulator of hormones that, when damaged, can diminish your ability to regulate your blood pressure, sleep cycle and hormones.

tiny_organThe function of the pituitary is diverse, as it can affect a number of really important functions:

Hormones secreted from the pituitary gland help control the following body processes:

  • Growth
  • Blood pressure
  • Pregnancy and stimulation of uterine contractions during childbirth
  • Breast milk production
  • Sex organ functions in both males and females
  • Thyroid gland function
  • The conversion of food into energy (metabolism)
  • Water and osmolarity regulation in the body (which affects blood pressure)
  • Water balance via the control of re-absorption of water by the kidneys
  • Temperature regulation
  • Pain relief

If that weren’t enough, this can cascade into disease states that may not seem related to a TBI. One thing that we are seeing with returning veterans is pituitary dysfunction is present and undiagnosed or under diagnosed. Even with hormone or growth factor replacement therapies, a pituitary that is not firing on all cylinders will continue to cause long-term problems. Although changes in sexual interaction are the most visible and can be due to pituitary damage, they warn that the damage is more profound. The Big Organ (the brain) has a lot of functions related to behavior…and when it comes to sex, behavior is key (good or bad).

The Tiny Brain (Hypothalamus)

This portion of the brain, the hypothalamus, is a close neighbor to the pituitary. So close, they are friends with benefits. One of the most important functions of the hypothalamus is to link the nervous system to the endocrine system via the pituitary gland (another name of the pituitary is the hypophysis).

The hypothalamus is more of a region than an actual structure. It is composed of many groups of neurons (called nuclei) that control a wide variety of hormonal secretions and behaviors. In a recent small scale study of severe TBI, it was discovered that ~21% of study subjects suffered from hypothalamic-hypophysial dysfunction. In about 40% of male TBI sufferers, there was a detectable drop in testosterone levels [2], which can affect sexual drive and desire in men. About 15% of all patients with a TBI have some degree of hypopituitarism that can go unrecognized and could be mistakenly ascribed to persistent neurologic injury and cognitive impairment [3].

The reason for the hypothalamic damage being mistaken for neurologic injury and cognitive impairment are due to the very broad effects that the hypothalamus exerts on metabolism and brain function. If the hypothalamus is misfiring, it takes a very involved physician (or physicians), with training in neurology, endocrinology and/or experience with TBI to identify the problem. A lot of systems can malfunction in a brain injury.

The Frontal Lobe

The frontal lobe (in green).

The frontal lobe (in green) • tumblr

In head injuries, damage to the frontal lobe is thought to occur frequently. Car crashes (especially front end collisions, are thought to cause frontal and occipital lobe damage. Damage to the frontal lobe has been reported to cause individuals to behave inappropriately in response to normal social situations. Loud or overly-boisterous exchanges, inappropriate genital touching (in public) or fixation on one subject or person have been reported outcomes after a TBI. Changes in emotional affect (expression of emotions) that are felt may not be expressed in the face or voice. For example, someone who is feeling happy would not smile, and his or her voice would be devoid of emotion. This can be very disconcerting to a partner and can be experienced a loss of affection or interest. How a partner or loved one that is a caretaker of a TBI victim experiences the injury will have a direct effect on their own sexual desire and interest.

Along the same lines, though, the person may also exhibit excessive, unwarranted displays of emotion or poor control of anger. Poor anger management is associated with some forms of frontal lobe damage. Depression is not an uncommon outcome from a head injury, especially if there is frontal lobe damage. Also common along with depression is a loss of or decrease in motivation. Someone might not want to carry out normal daily activities and would not feel “up to it”. Sex might not seem as interesting or motivating.

Those who are close to the person who has experienced the damage may notice that the person no longer behaves like him or herself. The frontal lobe is the same part of the brain that is responsible for executive functions such as planning for the future, judgment, decision-making skills, attention span, and inhibition. These functions can decrease drastically in someone whose frontal lobe is damaged. A short list of behavioral changes associated with frontal lobe damage is given below:

  • Agitation
  • Explosive anger and irritability
  • Lack of awareness and insight
  • Impulsivity and disinhibition
  • Emotional lability
  • Self-centeredness
  • Apathy and poor motivation
  • Depression
  • Anxiety
  • Inflexibility and obsessionality
  • Sexual problems

Frontal lobe damage is only one part of cerebral cortex, but is the most common type of cortical damage due to a TBI. Other parts may be damaged as well. Frontal lobe damage is common and better associated with impulse and emotional control, making sufferers act completely out of character and unable to control or edit themselves or their responses.

Putting it Together

So, after reading all of this, what does it do for you? How does this help you re-establish the emotional, sexual and intimate relationship you wish with your partner? As a caretaker, or as a sufferer, the TBI is a big elephant in the room. It exists; it takes up space in your life, even though it can’t be seen. The person you knew is not present…they have not come back from their injury and they might not come back. Some do recover, others do not. But you can still create a new bond, a new relationship and a new life. And you can fight to repair the damage to the brain.

There are limited options for therapy in current medical practice. Mostly, it is focused on developing new skills, relearning old ones, developing coping skills or taking medications. That’s just for the TBI sufferer, not the caretaker(s). The complexity and variety of problems that pop-up when dealing with a brain injury are truly staggering and expensive. Fortunately, the majority of mild-to-moderate TBI’s do recover. Patience and persistence in therapy are required in order to make a recovery.

Unfortunately, for a portion of all TBI sufferers, recovery may take years. That is a long-time to wait. Therapies that help to re-build the brain connections (neuroplasticity) or restore blood flow to the brain hold promise for restoring function again. Hyperbaric oxygen therapy (HBOT) is one such therapy that has a good number of clinical studies to support its use for chronic TBI and PCS [4-9]. Near infra-red and infra-red technologies show promise for a TBI therapy, as well [10-13].

Nutritional support, such as Omega-3 fatty acids (DHA and EPA), has shown the ability to reduce the long-term neuroinflammation associated with a TBI [14-16] and help with white matter repair. Other nutritional therapies may exist to help mediate repair in a TBI.

The take home message is that there are potential therapies that are being developed to help treat the neurological damage of a TBI. Take heart that the “new normal” for yourself or your loved one may not need to be permanent.

  1. Wilkinson, C.W., et al., High prevalence of chronic pituitary and target-organ hormone abnormalities after blast-related mild traumatic brain injury. Front Neurol, 2012. 3: p. 11.
  2. Kopczak, A., et al., Screening for hypopituitarism in 509 patients with traumatic brain injury or subarachnoid hemorrhage. J Neurotrauma, 2014. 31(1): p. 99-107.
  3. Pekic, S. and V. Popovic, Chapter 18 – Alternative causes of hypopituitarism: traumatic brain injury, cranial irradiation, and infections, in Handbook of Clinical Neurology, M.K. Eric Fliers and A.R. Johannes, Editors. 2014, Elsevier. p. 271-290.
  4. Boussi-Gross, R., et al., Hyperbaric Oxygen Therapy Can Improve Post Concussion Syndrome Years after Mild Traumatic Brain Injury – Randomized Prospective Trial. PLoS One, 2013. 8(11): p. e79995.
  5. Wolf, G., et al., The effect of hyperbaric oxygen on symptoms after mild traumatic brain injury. J Neurotrauma, 2012. 29(17): p. 2606-12.
  6. Harch, P.G., et al., A phase I study of low-pressure hyperbaric oxygen therapy for blast-induced post-concussion syndrome and post-traumatic stress disorder. J Neurotrauma, 2012. 29(1): p. 168-85.
  7. Lin, J.W., et al., Effect of hyperbaric oxygen on patients with traumatic brain injury. Acta Neurochir Suppl, 2008. 101: p. 145-9.
  8. Shi, X.Y., et al., Evaluation of hyperbaric oxygen treatment of neuropsychiatric disorders following traumatic brain injury. Chin Med J (Engl), 2006. 119(23): p. 1978-82.
  9. Wright, J.K., et al., Case report: Treatment of mild traumatic brain injury with hyperbaric oxygen. Undersea Hyperb Med, 2009. 36(6): p. 391-9.
  10. Grillo, S.L., et al., Non-invasive infra-red therapy (1072 nm) reduces beta-amyloid protein levels in the brain of an Alzheimer’s disease mouse model, TASTPM. J Photochem Photobiol B, 2013. 123: p. 13-22.
  11. Gkotsi, D., et al., Recharging mitochondrial batteries in old eyes. Near infra-red increases ATP. Exp Eye Res, 2014. 122: p. 50-3.
  12. Quirk, B.J., et al., Near-Infrared Photobiomodulation in an Animal Model of Traumatic Brain Injury: Improvements at the Behavioral and Biochemical Levels. Photomedicine and Laser Surgery, 2012. 30(9): p. 7.
  13. Naeser, M.A., et al., Significant Improvements in Cognitive Performance Post-Transcranial, Red/Near-Infrared Light-Emitting Diode Treatments in Chronic, Mild Traumatic Brain Injury: Open-Protocol Study. JOURNAL OF NEUROTRAUMA, 2014. 31: p. 10.
  14. Pu, H., et al., Omega-3 polyunsaturated fatty acid supplementation improves neurologic recovery and attenuates white matter injury after experimental traumatic brain injury. J Cereb Blood Flow Metab, 2013. 33(9): p. 1474-84.
  15. Lewis, M., P. Ghassemi, and J. Hibbeln, Therapeutic use of omega-3 fatty acids in severe head trauma. Am J Emerg Med, 2013. 31(1): p. 273 e5-8.
  16. Hasadsri, L., et al., Omega-3 fatty acids as a putative treatment for traumatic brain injury. J Neurotrauma, 2013. 30(11): p. 897-906.

Disclaimer: I am not a medical doctor. I am not giving medical advice, diagnosis or treatment recommendations. The posts on this blog are my opinion. If you are thinking of following or using any of this information for any health related conditions, I would recommend you talk to your physician and seek guidance and help. I try to be as meticulous as possible in the information I use for these posts. I look for potential therapies that are low-risk/high impact. There are no guarantees, but knowledge is power and self-direction can lead you to uncover and do incredible things.

Source: Brain Injury and Sex: What Happens After a TBI? | Brain Health & Healing Foundation

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[WEB SITE] 9 1/2 Need-to-Know Facts About Traumatic Brain Injury

9 1/2 Need-to-Know Things About Traumatic Brian InjuryAn estimated 5.3 million Americans — about 2 percent of the U.S. population — currently have a long-term or lifelong need for help with everyday activities due to traumatic brain injury (TBI). (1) Many believe this number to be low as it only takes into account the number of reported injuries to hospital emergency rooms and by health care professionals. We’ve compiled the top 9 1/2 things to know about traumatic brain injury, it would have been 10 but the last 1/2 was left off because memory is often affected by traumatic brain injury.

Multimedia

  1. A traumatic brain injury is a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. You do not need to lose consciousness to sustain a concussion.
  2. 1.7 million people sustain a TBI each year in the United States. By the numbers, every American has more than a 1:300 chance of sustaining a traumatic brain injury each year. (2)

  3. The three groups at highest risk for traumatic brain injury are children (0-4 year olds), teenagers (15-19 year olds), and adults (65 and older). (2)

  4. Estimates peg the number of sports-related traumatic brain injuries as high as 3.8 million per year. (2)

  5. Using a seatbelt and wearing a helmet are the best ways to prevent a TBI.

  6. Males are almost twice as likely as females to sustain a TBI.

  7. A concussion is a mild brain injury. The consequences of multiple concussions can be far more dangerous than those of a first TBI. (3)

  8. The area most often injured are the frontal lobes that control thinking and emotional regulation.

  9. A blow to one part of the brain can cause damage throughout.

9 1/2. Most people do make a good recovery from TBI.

If you found this useful, please share with family and friends or leave a comment below if you think we’ve left something off.

References:

  1. Centers for Disease Control. http://www.cdc.gov/traumaticbraininjury/pdf/BlueBook_factsheet-a.pdf
  2. Langlois JA, Rutland-Brown W, Thomas KE. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2006.
  3. Cifu, David, MD. eMedicine.com. www.emedicine.com/sports/TOPIC113.HTM.

Source: 9 1/2 Need-to-Know Facts About Traumatic Brain Injury

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[BLOG POST] Recognizing the Signs of PTSD After Stroke

Post-Traumatic Stress Disorder (PTSD) is a condition that runs its victims down emotionally and physically. Though most frequently linked to combat veterans and sexual-assault survivors, PTSD can present itself following any traumatic experience, and that includes medical emergencies. Following a stroke and its resulting medical treatment, it is common for patients to feel overwhelmed.

 

According to a study published in the journal PLoS ONE in June of 2013, almost one quarter of patients who survive a stroke will suffer from PTSD. Unfortunately, it is common for the symptoms of PTSD following a stroke to go unnoticed; due to the intense nature of physical recovery, the psychological hardship associated with it can lead to increased risk for heart disease or another stroke.

 

What is PTSD?

After experiencing or witnessing a traumatic event, such as a medical emergency, natural disaster, or an assault, it is difficult to adjust to everyday life again. Some people may struggle with relaxing or sleeping, have flashbacks or unsettling memories, or feel constant anxiety.

This psychological reaction is common and very frustrating. The good news is that it typically diminishes, and life returns to normal over the course of weeks or months, depending on the severity of the event. If a patient is experiencing these mental health symptoms for longer than a few weeks or months, whether constant or in waves, it is possible that they may have PTSD.

 

Symptoms of PTSD After Stroke

It is important to know the signs and symptoms of PTSD so that you can recognize them in a patient or loved one you are caring for after a stroke. Common symptoms of PTSD include experiencing a traumatic event over and over again, having nightmares, or being unable to stop thinking about it. To add to these extremely uncomfortable experiences, victims can also feel  general, unyielding anxiety and try to avoid reminders of the event that started their suffering. They can also be tortured with feelings of self-doubt or misplaced guilt after a stroke or other traumatic event, a state of hyperarousal, or feeling overly alert.

If you are worried that a patient or family member is suffering from PTSD, ask them questions such as:

  • Are you having nightmares?
  • How are you coping?
  • How does this make you feel?

These questions can help the patient discuss their symptoms and improve the likelihood of psychological recovery.

 

TIA and PTSD

Transient Ischemic Attack (TIA), also known as a mini stroke, can increase the likelihood of developing PTSD because the fear of having a stroke may become overwhelming. According to a study published in the American Heart Association journal Stroke, about one third of TIA patients develop signs of PTSD. Approximately 14 percent of TIA patients also experience a drop in physical quality of life, with 6.5 percent of patients experiencing a drop in mental quality of life.

 

Treating PTSD

There are ways to relieve the strain of PTSD. Treatment for PTSD may include medication, psychotherapy, or both. Patients experiencing signs of PTSD should see a trained and qualified mental health professional as treatments may vary from patient to patient.

Medications

A mental health provider or psychiatrist may prescribe antidepressants to patients struggling with PTSD. Antidepressants have been shown to relieve the symptoms of anger, sadness, and overwhelming worry better than other available medications.

Psychotherapy

Sometimes referred to as “talk therapy,” psychotherapy can take place in a one-on-one capacity or in a group setting. Talk therapy is the process of speaking with a mental health professional and can encompass the discussion of PTSD symptoms alone or the effect such symptoms may be having on a patient’s life.

PTSD can sometimes wreak havoc on a person’s social, family, or professional life. To help heal the damage, a mental health professional may combine multiple forms of psychotherapy to address any and all issues a patient may be having with the aftermath of a stroke or TIA. Most often, psychotherapy lasts six to twelve weeks, but it is not unusual for it to take longer to address each patient’s symptoms and struggles. Patients are encouraged to involve family and friends in their recovery because having the extra support can improve the speed and efficiency of mental recovery from a stroke.

 

Finding Relief

PTSD can plague individuals who experience or witness a traumatic event. Medical emergencies are often traumatic, so it is common for survivors of stroke to suffer from PTSD; survivors of TIA can develop PTSD because they may be scared of suffering another mini stroke or of having a full-fledged stroke.

Symptoms can be very taxing on survivors and heartbreaking for their families to see. Fortunately, there are effective treatments for PTSD, including antidepressants and talk therapy with a mental health professional. If you are experiencing PTSD, it is important that you communicate how you feel with your doctor, family, and friends, as a strong support system can help you find the relief from psychological pain that you deserve.

Source: Recognizing the Signs of PTSD After Stroke | Saebo

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[WEB PAGE] What Is PTSD? – PTSD: National Center for PTSD

What Is PTSD?

PTSD (posttraumatic stress disorder) is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault.

It’s normal to have upsetting memories, feel on edge, or have trouble sleeping after this type of event. At first, it may be hard to do normal daily activities, like go to work, go to school, or spend time with people you care about. But most people start to feel better after a few weeks or months.

If it’s been longer than a few months and you’re still having symptoms, you may have PTSD. For some people, PTSD symptoms may start later on, or they may come and go over time.

What factors affect who develops PTSD?

PTSD can happen to anyone. It is not a sign of weakness. A number of factors can increase the chance that someone will have PTSD, many of which are not under that person’s control. For example, having a very intense or long-lasting traumatic event or getting injured during the event can make it more likely that a person will develop PTSD. PTSD is also more common after certain types of trauma, like combat and sexual assault.

Personal factors, like previous traumatic exposure, age, and gender, can affect whether or not a person will develop PTSD. What happens after the traumatic event is also important. Stress can make PTSD more likely, while social support can make it less likely.

What are the symptoms of PTSD?

PTSD symptoms usually start soon after the traumatic event, but they may not appear until months or years later. They also may come and go over many years. If the symptoms last longer than four weeks, cause you great distress, or interfere with your work or home life, you might have PTSD.

There are four types of symptoms of PTSD (en Español), but they may not be exactly the same for everyone. Each person experiences symptoms in their own way.

  1. Reliving the event (also called re-experiencing symptoms). You may have bad memories or nightmares. You even may feel like you’re going through the event again. This is called a flashback.
  2. Avoiding situations that remind you of the event. You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.
  3. Having more negative beliefs and feelings. The way you think about yourself and others may change because of the trauma. You may feel guilt or shame. Or, you may not be interested in activities you used to enjoy. You may feel that the world is dangerous and you can’t trust anyone. You might be numb, or find it hard to feel happy.
  4. Feeling keyed up (also called hyperarousal). You may be jittery, or always alert and on the lookout for danger. Or, you may have trouble concentrating or sleeping. You might suddenly get angry or irritable, startle easily, or act in unhealthy ways (like smoking, using drugs and alcohol, or driving recklessly.

Can children have PTSD?

Children can have PTSD too. They may have symptoms described above or other symptoms depending on how old they are. As children get older, their symptoms are more like those of adults. Here are some examples of PTSD symptoms in children:

  • Children under 6 may get upset if their parents are not close by, have trouble sleeping, or act out the trauma through play.
  • Children age 7 to 11 may also act out the trauma through play, drawings, or stories. Some have nightmares or become more irritable or aggressive. They may also want to avoid school or have trouble with schoolwork or friends.
  • Children age 12 to 18 have symptoms more similar to adults: depression, anxiety, withdrawal, or reckless behavior like substance abuse or running away.

What other problems do people with PTSD experience?

People with PTSD may also have other problems. These include:

  • Feelings of hopelessness, shame, or despair
  • Depression or anxiety
  • Drinking or drug problems
  • Physical symptoms or chronic pain
  • Employment problems
  • Relationship problems, including divorce

In many cases, treatments for PTSD will also help these other problems, because they are often related. The coping skills you learn in treatment can work for PTSD and these related problems.

Will people with PTSD get better?

“Getting better” means different things for different people. There are many different treatment options for PTSD. For many people, these treatments can get rid of symptoms altogether. Others find they have fewer symptoms or feel that their symptoms are less intense. Your symptoms don’t have to interfere with your everyday activities, work, and relationships.

What treatments are available?

There are two main types of treatment, psychotherapy (sometimes called counseling or talk therapy) and medication. Sometimes people combine psychotherapy and medication.

Psychotherapy for PTSD

Psychotherapy, or counseling, involves meeting with a therapist. There are different types of psychotherapy:

  • Cognitive behavioral therapy (CBT) is the most effective treatment for PTSD. There are different types of CBT, such as cognitive therapy and exposure therapy.
    • One type is Cognitive Processing Therapy (CPT) where you learn skills to understand how trauma changed your thoughts and feelings. Changing how you think about the trauma can change how you feel.
    • Another type is Prolonged Exposure (PE) where you talk about your trauma repeatedly until memories are no longer upsetting. This will help you get more control over your thoughts and feelings about the trauma. You also go to places or do things that are safe, but that you have been staying away from because they remind you of the trauma.
  • A similar kind of therapy is called Eye Movement Desensitization and Reprocessing (EMDR), which involves focusing on sounds or hand movements while you talk about the trauma. This helps your brain work through the traumatic memories.

Medications for PTSD

Medications can be effective too. SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors), which are also used for depression, are effective for PTSD. Another medication called Prazosin has been found to be helpful in decreasing nightmares related to the trauma.

IMPORTANT: Benzodiazepines and atypical antipsychotics should generally be avoided for PTSD treatment because they do not treat the core PTSD symptoms and can be addictive.

Visit Site —> What Is PTSD? – PTSD: National Center for PTSD

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[VIDEO] The Effects of Brain Injury on Memory – YouTube

How does brain injury affect memory? Learn about memory impairment following brain injury in this video featuring NeuroRestorative’s Tori Harding. Following a brain injury, the deeply embedded and long-term memories usually remain intact while short-term memory may significantly be affected. Learn about the three memory system areas and strategies that can help a survivor improve their memory.

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[BLOG POST] Menses and Sexual Changes in Women After Trauma – H.O.P.E TBI

Menses and Sexual Changes in Women After Trauma

Blood cells

What is the endocrine system?

Your endocrine system includes glands and organs that make and release hormones, which are chemicals that help your body work properly. They control growth, sexual development, how your body uses and stores energy (metabolism), how it deals with illness, and more. You need proper types and amounts of hormones to feel well.

How can TBI affect the endocrine system?

Two important parts of the endocrine system—the pituitary gland and the hypothalamus—are located in or near the brain. The hypothalamus and the pituitary gland are like orchestra conductors. Their job is to tell other endocrine glands throughout the body to make the hormones that affect and protect every aspect of your health. TBI can injure them, causing hormone problems. A person with TBI may have hormone problems right away or months or even years after the injury.

Menses and Sexual Changes in Women After Brain Trauma

Repeated mild Traumatic Brain Injuries (TBI) occurring over an extended period of time can result in cumulative neurological and cognitive deficits. Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal.

After TBI, there may be some changes to the pituitary. The Pituitary is a pea-sized gland in your brain that makes hormones that help to keep your periods regular every month. When the pituitary makes low levels of certain hormones, this can mean having skipped or missed periods. Stress can cause your hormone levels to change. This can also change your periods. Certain medications can also cause changes to your periods. Ask your doctor about the side effects of the medications you are taking.endocrine3

Recent research indicates there is a higher incidence of hormone abnormalities in people who have sustained a brain injury.  This is directly related to injury of the hypothalamus, and pituitary gland and all the hormones they produce or stimulate to produce, including thyroid hormone, growth hormone, cortisol, and the sex hormones (FSH, LH, Prolactin, estrogen, and testosterone).  It is more common to see these abnormalities early on after a brain injury but they can come on as a long term consequence.  The hypothalamus and/or pituitary gland, are small structures at the base of the brain responsible for regulating the body’s hormones. Damage to these areas can lead to insufficient or increased release of one or more hormones, which causes disruption of the body’s ability to maintain a stable internal environment (homeostasis).  Damage to the pituitary gland leads to a reduction in hormone production resulting in a condition known as hypopituitarism. Medication and other medical illnesses should be ruled out as the cause of any hormone
abnormalities as well.

Chart

Women experience greater cognitive decline, poorer reaction times, more headaches, extended periods of depression, longer hospital stays and delayed return-to-work compared to men following head injury. Such results are particularly pronounced in women of childbearing age; girls who have not started their period and post-menopausal women have outcomes similar to men.

At one year after injury, negative outcomes (persistent physical symptoms, requiring assistance with cognitive difficulties, social and occupational difficulties, reduced quality of life) were repeated more frequently by those who were female, older, and had received more severe injuries.  However, among patient with mTBI injuries it has been identified that 24% of patients who suffered with persistent symptoms and significant life disruption at 3 months post injury were more likely to be young and female, had a prior head injury, neuro/psychiatric symptoms, or a TBI as a result of a motor vehicle accident.

Menstrual troubles such as amenorrhea, or the absence of a period, and irregular cycles are more common in women with TBI. The mean duration of amenorrhea was 6.5 months with a range of 1 – 60 months.  There was one participant whose menses stopped at time of injury and had not returned by time of interview.

After a TBI you may have skipped or missed periods. You may also have more pain or notice more headaches during your periods. You may notice changes to your periods while in the hospital, rehabilitation or at home. These changes can happen in mild to more serious injuries. Still, absence of a menses is more likely to happen when the brain injury is serious. Skipping or missing your period can last from 1 month to many years. For many women, the changes to their periods get better with time, but not always.

Of 104 women with TBI (W-TBI), 46% experienced amenorrhea with duration of up to 60 months. Cycles became irregular for 68% of W-TBI after the injury. These findings were significantly different from those of controls. Among W-TBI, menstrual disturbances were associated with injury severity. No differences were shown between W-TBI and controls with respect to fertility, although significantly fewer W-TBI had one or more live births, and they reported more difficulties in the postpartum period than controls. W-TBI were less likely to have regular Pap smears and reported lower mental health, self-rated health, and function.

Significantly fewer (49%) reported changes in menstrual flow after injury compared with the control counterparts (64%).  Matched case-control conditional regression analyses showed that W-TBI were 21 times more likely than controls to report amenorrhea after injury; for those with regular cycles, W-TBI were 6 times more likely to experience irregular cycles.  Among W-TBI, amenorrhea was associated with lower GCS Scores, Higher ISS, and longer length of acute hospital stays.  Irregular periods emerging after the injured were significantly associated with higher ISS only.

Pregnancy/Fertility – 28% of W-TBI indicated that they tried to conceive or became pregnant after their TBI vs. 35% of controls during a comparable time period.  Hence, the subgroups for these analyses are smaller in size.

Changes in sexual functioning are common after TBI as well. Brain Injury can change the way a person expresses or experiences their sexuality. There are many reasons sexual problems happen after TBI. Some are directly related to damage to the brain. Others are related to physical problems or changes in thinking or relationships.

No significant group differences were found in terms of difficulty conceiving or difficulties during pregnancy after injury.  Those who became pregnant however, significantly fewer W-TBI had one or more live births compared with controls.  W-TBI were also more likely to report post pregnancy difficulties in the pregnancies that occurred after the brain injury compared with controls in the equivalent time period.  The 12 women reported the following: Increased fatigue, pain, depression, mobility problems, inability to concentrate and lower extremity edema. Three women who did not report depression reported “feeling the blues” and 1 woman reported hip pain/headaches.

These findings inform prognosis after TBI for women and provide evidence for long-term monitoring of health outcomes and increased support after childbirth. More research is needed in this area, particularly with respect to the neuroendocrine system.

“I don’t think doctors consider menstrual history when evaluating a patient after a concussion, but maybe we should,” noted Bazarian, associate professor of Emergency Medicine at the University of Rochester School of Medicine and Dentistry who treats patients and conducts research on traumatic brain injury and long-term outcomes among athletes. “By taking into account the stage of their cycle at the time of injury we could better identify patients who might need more aggressive monitoring or treatment. It would also allow us to counsel women that they’re more – or less – likely to feel poorly because of their menstrual phase.”

Although media coverage tends to focus on concussions in male professional athletes, studies suggest that women have a higher incidence of head injuries than men playing sports with similar rules, such as ice hockey, soccer and basketball. Bazarian estimates that 70 percent of the patients he treats in the URMC Sport Concussion Clinic are young women. He believes the number is so high because they often need more follow-up care. In his experience, soccer is the most common sport leading to head injuries in women, but lacrosse, field hockey, cheerleading, volleyball and basketball can lead to injuries as well.

sex and tbi

Sex hormone levels often change after a head injury, as women who have suffered a concussion and subsequently missed one or more periods can attest. According to Kathleen M. Hoeger, M.D., M.P.H.,study co-author and professor of Obstetrics and Gynecology at the University of Rochester School of Medicine and Dentistry, any stressful event, like a hit to the head, can shut down the pituitary gland in the brain, which is the body’s hormone generator. If the pituitary doesn’t work, the level of estrogen and progesterone would drop quickly.

According to Bazarian, progesterone is known to have a calming effect on the brain and on mood. Knowing this, his team came up with the “withdrawal hypothesis”: If a woman suffers a concussion in the premenstrual phase when progesterone levels are naturally high, an abrupt drop in progesterone after injury produces a kind of withdrawal which either contributes to or worsens post concussive symptoms like headache, nausea, dizziness and trouble concentrating. This may be why women recover differently than men, who have low pre-injury levels of the hormone.

“If you get hit when progesterone is high and you experience a steep drop in the hormone, this is what makes you feel lousy and causes symptoms to linger,” said Bazarian. “But, if you are injured when progesterone is already low, a hit to the head can’t lower it any further, so there is less change in the way you feel.”

The team suspected that women taking birth control pills, which contain synthetic hormones that mimic the action of progesterone, would have similar outcomes to women injured in the low progesterone phase of their cycle. As expected, there was no clear difference between these groups, as women taking birth control pills have a constant stream of sex hormones and don’t experience a drop following a head hit, so long as they continue to take the pill.

“Women who are very athletic get several benefits from the pill; it protects their bones and keeps their periods predictable,” noted Hoeger. “If larger studies confirm our data, this could be one more way in which the pill is helpful in athletic women, especially women who participate in sports like soccer that present lots of opportunities for head injuries.”

In addition to determining menstrual cycle phase at the time of injury, Bazarian plans to scrutinize a woman’s cycles after injury to make sure they are not disrupted. If they are, the woman should make an appointment with her gynecologist to discuss the change.

sexandtbi

How does a traumatic brain injury affect sexual functioning?

The following changes in sexual functioning can happen after TBI:

  • Decreased Desire: Many people may have less desire or interest in sex.
  • Increased Desire: Some people have increased interest in sex after TBI and may want to have sex more often than usual. Others may have difficulty controlling their sexual behavior. They may make sexual advances in inappropriate situations or make inappropriate sexual comments.
  • Decreased Arousal: Many people have difficulty becoming sexually aroused. This means that they may be interested in sex, but their bodies do not respond. Men may have difficulty getting or keeping an erection. Women may have decreased vaginal lubrication (moisture in the vagina).
  • Difficulty or Inability to Reach Orgasm/Climax: Both men and women may have difficulty reaching orgasm or climax. They may not feel physically satisfied after sexual activity.
  • Reproductive Changes: Women may experience irregular menstrual cycles or periods. Sometimes, periods may not occur for weeks or months after injury. They may also have trouble getting pregnant. Men may have decreased sperm production and may have difficulty getting a woman pregnant.

Possible causes of changes in sexual functioning after TBI include:

  • Damage to the Brain: Changes in sexual functioning may be caused by damage to the parts of the brain that control sexual functioning.
  • Hormonal Changes: Damage to the brain can affect the production of hormones, like testosterone, progesterone, and estrogen. These changes in hormones affect sexual functioning.
  • Medication Side Effects: Many medications commonly used after TBI have negative side effects on sexual functioning.
  • Fatigue/Tiredness: Many people with TBI tire very easily. Feeling tired, physically or mentally, can affect your interest in sex and your sexual activity.
  • Problems with Movement: Spasticity (tightness of muscles), physical pain, weakness, slowed or uncoordinated movements, and balance problems may make it difficult to have sex.
  • Self-Esteem Problems: Some people feel less confident about their attractiveness after TBI. This can affect their comfort with sexual activity.
  • Changes in Thinking Abilities: Difficulty with attention, memory, communication, planning ahead, reasoning, and imagining can also affect sexual functioning.
  • Emotional Changes: Individuals with TBI often feel sad, nervous, or irritable. These feelings may have a negative effect on their sexual functioning, especially their desire for sex.
  • Changes in Relationships and Social Activities: Some people lose relationships after TBI or may have trouble meeting new people. This makes it difficult to find a sexual partner.

Problems Reported by Females with TBI regarding sexual activity include:

  • Inadequate energy for sex
  • Problems with initiation and arousal
  • Dificulty reaching orgasm
  • Inability to masterbate
  • Low sex drive or  no sex drive
  • Painful sex
  • Problems with orgasm and lubrication
  • Decreased sensation
  • Discomfort in positioning
  • Depression
  • Endocrine/hormonal problems
  • Urogenital problems

Less Reported Symptoms:

  • Safety concerns (impulsivity, judgement,promiscuity, sexual agressiveness)
  • Disinhibition and surging hormones (hypersexuality)

 

 

References:

Womens Reproductive Health and Traumatic Brain Injury (pdf)
Menstrual Phase as Predictor of Outcome After Mild Traumatic Brain Injury in Women (pdf)
Brain Injury and Sexual Issues
Sexuality After Traumatic Brain Injury
Women’s health outcomes after traumatic brain injury
Effects of Brain Injury and Hormonal Changes
Menstrual cycle influences concussion outcomes
Traumatic Brain Injury
Women face additional challenges after traumatic brain injury
Headaches are common in year following traumatic brain injury, especially among females
Does brain injury cause early onset menopause
Women At War
Traumatic brain injury outcomes
Womens Health Outcomes After Traumatic Brain Injury

Source: Menses and Sexual Changes in Women After Trauma | H.O.P.E TBI

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[TED Talk] David Casarett: A doctor’s case for medical marijuana

Subtitles and Transcript

0:12 I would like to tell you about the most embarrassing thing that has ever happened to me in my years of working as a palliative care physician. This happened a couple of years ago. I was asked as a consultant to see a woman in her 70s — retired English professor who had pancreatic cancer. I was asked to see her because she had pain, nausea, vomiting … When I went to see her, we talked about those symptoms and in the course of that consultation, she asked me whether I thought that medical marijuana might help her. I thought back to everything that I had learned in medical school about medical marijuana, which didn’t take very long because I had learned absolutely nothing. And so I told her that as far as I knew, medical marijuana had no benefits whatsoever. And she smiled and nodded and reached into the handbag next to the bed, and pulled out a stack of about a dozen randomized controlled trials showing that medical marijuana has benefits for symptoms like nausea and pain and anxiety. She handed me those articles and said, “Maybe you should read these before offering an opinion … doctor.”

1:29 (Laughter)

1:30 So I did. That night I read all of those articles and found a bunch more. When I came to see her the next morning, I had to admit that it looks like there is some evidence that marijuana can offer medical benefits and I suggested that if she really was interested, she should try it. You know what she said? This 73-year-old, retired English professor? She said, “I did try it about six months ago. It was amazing. I’ve been using it every day since. It’s the best drug I’ve discovered. I don’t know why it took me 73 years to discover this stuff. It’s amazing.”

2:10 (Laughter)

2:11 That was the moment at which I realized I needed to learn something about medical marijuana because what I was prepared for in medical school bore no relationship to reality.

2:22 So I started reading more articles, I started talking to researchers, I started talking to doctors, and most importantly, I started listening to patients. I ended up writing a book based on those conversations, and that book really revolved around three surprises — surprises to me, anyway. One I already alluded to — that there really are some benefits to medical marijuana. Those benefits may not be as huge or as stunning as some of the most avid proponents of medical marijuana would have us believe, but they are real. Surprise number two: medical marijuana does have some risks. Those risks may not be as huge and as scary as some of the opponents of medical marijuana would have us believe, but they are real risks, nonetheless. But it was the third surprise that was most … surprising. And that is that a lot of the patients I talked with who’ve turned to medical marijuana for help, weren’t turning to medical marijuana because of its benefits or the balance of risks and benefits, or because they thought it was a wonder drug, but because it gave them control over their illness. It let them manage their health in a way that was productive and efficient and effective and comfortable for them.

3:37 To show you what I mean, let me tell you about another patient. Robin was in her early 40s when I met her. She looked though like she was in her late 60s. She had suffered from rheumatoid arthritis for the last 20 years, her hands were gnarled by arthritis, her spine was crooked, she had to rely on a wheelchair to get around. She looked weak and frail, and I guess physically she probably was, but emotionally, cognitively, psychologically, she was among the toughest people I’ve ever met. And when I sat down next to her in a medical marijuana dispensary in Northern California to ask her about why she turned to medical marijuana, what it did for her and how it helped her, she started out by telling me things that I had heard from many patients before. It helped with her anxiety; it helped with her pain; when her pain was better, she slept better. And I’d heard all that before. But then she said something that I’d never heard before, and that is that it gave her control over her life and over her health. She could use it when she wanted, in the way that she wanted, at the dose and frequency that worked for her. And if it didn’t work for her, then she could make changes. Everything was up to her. The most important thing she said was she didn’t need anybody else’s permission — not a clinic appointment, not a doctor’s prescription, not a pharmacist’s order. It was all up to her. She was in control.

5:00 And if that seems like a little thing for somebody with chronic illness, it’s not — not at all. When we face a chronic serious illness, whether it’s rheumatoid arthritis or lupus or cancer or diabetes, or cirrhosis, we lose control. And note what I said: “when,” not “if.” All of us at some point in our lives will face a chronic serious illness that causes us to lose control. We’ll see our function decline, some of us will see our cognition decline, we’ll be no longer able to care for ourselves, to do the things that we want to do. Our bodies will betray us, and in that process, we’ll lose control. And that’s scary. Not just scary — that’s frightening, it’s terrifying. When I talk to my patients, my palliative care patients, many of whom are facing illnesses that will end their lives, they have a lot of be frightened of — pain, nausea, vomiting, constipation, fatigue, their impending mortality. But what scares them more than anything else is this possibility that at some point, tomorrow or a month from now, they’re going to lose control of their health, of their lives, of their healthcare, and they’re going to become dependent on others, and that’s terrifying.

6:17 So it’s no wonder really that patients like Robin, who I just told you about, who I met in that clinic, turn to medical marijuana to try to claw back some semblance of control. How do they do it though? How do these medical marijuana dispensaries — like the one where I met Robin — how do they give patients like Robin back the sort of control that they need? And how do they do it in a way that mainstream medical hospitals and clinics, at least for Robin, weren’t able to? What’s their secret? So I decided to find out.

6:54 I went to a seedy clinic in Venice Beach in California and got a recommendation that would allow me to be a medical marijuana patient. I got a letter of recommendation that would let me buy medical marijuana. I got that recommendation illegally, because I’m not a resident of California — I should note that. I should also note, for the record, that I never used that letter of recommendation to make a purchase, and to all of you DEA agents out there —

7:21 (Laughter)

7:22 love the work that you’re doing, keep it up.

7:25 (Laughter)

7:26 Even though it didn’t let me make a purchase though, that letter was priceless because it let me be a patient. It let me experience what patients like Robin experience when they go to a medical marijuana dispensary. And what I experienced — what they experience every day, hundreds of thousands of people like Robin — was really amazing. I walked into the clinic, and from the moment that I entered many of these clinics and dispensaries, I felt like that dispensary, that clinic, was there for me. There were questions at the outset about who I am, what kind of work I do, what my goals are in looking for a medical marijuana prescription, or product, what my goals are, what my preferences are, what my hopes are, how do I think, how do I hope this might help me, what am I afraid of. These are the sorts of questions that patients like Robin get asked all the time. These are the sorts of questions that make me confident that the person I’m talking with really has my best interests at heart and wants to get to know me.

8:33 The second thing I learned in those clinics is the availability of education. Education from the folks behind the counter, but also education from folks in the waiting room. People I met were more than happy, as I was sitting next to them — people like Robin — to tell me about who they are, why they use medical marijuana, what helps them, how it helps them, and to give me advice and suggestions. Those waiting rooms really are a hive of interaction, advice and support.

9:03 And third, the folks behind the counter. I was amazed at how willing those people were to spend sometimes an hour or more talking me through the nuances of this strain versus that strain, smoking versus vaporizing, edibles versus tinctures — all, remember, without me making any purchase whatsoever. Think about the last time you went to any hospital or clinic and the last time anybody spent an hour explaining those sorts of things to you. The fact that patients like Robin are going to these clinics, are going to these dispensaries and getting that sort of personalized attention and education and service, really should be a wake-up call to the healthcare system. People like Robin are turning away from mainstream medicine, turning to medical marijuana dispensaries because those dispensaries are giving them what they need.

9:57 If that’s a wake-up call to the medical establishment, it’s a wake-up call that many of my colleagues are either not hearing or not wanting to hear. When I talk to my colleagues, physicians in particular, about medical marijuana, they say, “Oh, we need more evidence. We need more research into benefits, we need more evidence about risks.” And you know what? They’re right. They’re absolutely right. We do need much more evidence about the benefits of medical marijuana. We also need to ask the federal government to reschedule marijuana to Schedule II, or to deschedule it entirely to make that research possible. We also need more research into medical marijuana’s risks. Medical marijuana’s risks — we know a lot about the risks of recreational use, we know next to nothing about the risks of medical marijuana. So we absolutely do need research, but to say that we need research and not that we need to make any changes now is to miss the point entirely. People like Robin aren’t seeking out medical marijuana because they think it’s a wonder drug, or because they think it’s entirely risk-free. They seek it out because the context in which it’s delivered and administered and used, gives them the sort of control they need over their lives. And that’s a wake-up call we really need to pay attention to.

11:16 The good news though is that there are lessons we can learn today from those medical marijuana dispensaries. And those are lessons we really should learn. These are often small, mom-and-pop operations run by people with no medical training. And while it’s embarrassing to think that many of these clinics and dispensaries are providing services and support and meeting patients’ needs in ways that billion-dollar healthcare systems aren’t — we should be embarrassed by that — but we can also learn from that. And there are probably three lessons at least that we can learn from those small dispensaries.

11:51 One: we need to find ways to give patients more control in small but important ways. How to interact with healthcare providers, when to interact with healthcare providers, how to use medications in ways that work for them. In my own practice, I’ve gotten much more creative and flexible in supporting my patients in using drugs safely to manage their symptoms — with the emphasis on safely. Many of the drugs I prescribe are drugs like opioids or benzodiazepines which can be dangerous if overused. But here’s the point. They can be dangerous if they’re overused, but they can also be ineffective if they’re not used in a way that’s consistent with what patients want and need. So that flexibility, if it’s delivered safely, can be extraordinarily valuable for patients and their families. That’s number one.

12:39 Number two: education. Huge opportunities to learn from some of the tricks of those medical marijuana dispensaries to provide more education that doesn’t require a lot of physician time necessarily, or any physician time, but opportunities to learn about what medications we’re using and why, prognoses, trajectories of illness, and most importantly, opportunities for patients to learn from each other. How can we replicate what goes on in those clinic and medical dispensary waiting rooms? How patients learn from each other, how people share with each other.

13:13 And last but not least, putting patients first the way those medical marijuana dispensaries do, making patients feel legitimately like what they want, what they need, is why, as healthcare providers, we’re here. Asking patients about their hopes, their fears, their goals and preferences. As a palliative care provider, I ask all my patients what they’re hoping for and what they’re afraid of. But here’s the thing. Patients shouldn’t have to wait until they’re chronically seriously ill, often near the end of life, they shouldn’t have to wait until they’re seeing a physician like me before somebody asks them, “What are you hoping for?” “What are you afraid of?” That should be baked into the way that healthcare is delivered.

13:58 We can do this — we really can. Medical marijuana dispensaries and clinics all across the country are figuring this out. They’re figuring this out in ways that larger, more mainstream health systems are years behind. But we can learn from them, and we have to learn from them. All we have to do is swallow our pride — put aside the thought for a minute that because we have lots of letters after our name, because we’re experts, because we’re chief medical officers of a large healthcare system, we know all there is to know about how to meet patients’ needs.

14:31 We need to swallow our pride. We need to go visit a few medical marijuana dispensaries. We need to figure out what they’re doing. We need to figure out why so many patients like Robin are leaving our mainstream medical clinics and going to these medical marijuana dispensaries instead. We need to figure out what their tricks are, what their tools are, and we need to learn from them. If we do, and I think we can, and I absolutely think we have to, we can guarantee all of our patients will have a much better experience.

15:00 Thank you.

15:01 (Applause)

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[WEB SITE] Traumatic Brain Injury Resource Guide – Neuroplasticity

Neuroplasticity

by Lisa Kreber, Ph.D. CBIS
Senior Neuroscientist, Centre for Neuro Skills

What is Neuroplasticity?
Neuronal Firing
How Neuroplasticity Works
Mechanisms of Plasticity
Synaptogenesis
Stem Cells
Modulation of Neurotransmission
Unmasking
Forms of Neuronal Plasticity
Neuronal Remodeling
Depression and Hippocampal Plasticity
Appreciating Plasticity
Ten Principles of Neuroplasticity
Learning, Injury and Recovery

Source: Traumatic Brain Injury Resource Guide – Neuroplasticity

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[OPINION ARTICLE] Enhancing Our Lives with Immersive Virtual Reality – Full Text

Summary

Virtual reality (VR) started about 50 years ago in a form we would recognize today [stereo head-mounted display (HMD), head tracking, computer graphics generated images] – although the hardware was completely different. In the 1980s and 1990s, VR emerged again based on a different generation of hardware (e.g., CRT displays rather than vector refresh, electromagnetic tracking instead of mechanical). This reached the attention of the public, and VR was hailed by many engineers, scientists, celebrities, and business people as the beginning of a new era, when VR would soon change the world for the better. Then, VR disappeared from public view and was rumored to be “dead.” In the intervening 25 years a huge amount of research has nevertheless been carried out across a vast range of applications – from medicine to business, from psychotherapy to industry, from sports to travel. Scientists, engineers, and people working in industry carried on with their research and applications using and exploring different forms of VR, not knowing that actually the topic had already passed away.

The purpose of this article is to survey a range of VR applications where there is some evidence for, or at least debate about, its utility, mainly based on publications in peer-reviewed journals. Of course not every type of application has been covered, nor every scientific paper (about 186,000 papers in Google Scholar): in particular, in this review we have not covered applications in psychological or medical rehabilitation. The objective is that the reader becomes aware of what has been accomplished in VR, where the evidence is weaker or stronger, and what can be done. We start in Section 1 with an outline of what VR is and the major conceptual framework used to understand what happens when people experience it – the concept of “presence.” In Section 2, we review some areas where VR has been used in science – mostly psychology and neuroscience, the area of scientific visualization, and some remarks about its use in education and surgical training. In Section 3, we discuss how VR has been used in sports and exercise. In Section 4, we survey applications in social psychology and related areas – how VR has been used to throw light on some social phenomena, and how it can be used to tackle experimentally areas that cannot be studied experimentally in real life. We conclude with how it has been used in the preservation of and access to cultural heritage. In Section 5, we present the domain of moral behavior, including an example of how it might be used to train professionals such as medical doctors when confronting serious dilemmas with patients. In Section 6, we consider how VR has been and might be used in various aspects of travel, collaboration, and industry. In Section 7, we consider mainly the use of VR in news presentation and also discuss different types of VR. In the concluding Section 8, we briefly consider new ideas that have recently emerged – an impossible task since during the short time we have written this page even newer ideas have emerged! And, we conclude with some general considerations and speculations.

Throughout and wherever possible we have stressed novel applications and approaches and how the real power of VR is not necessarily to produce a faithful reproduction of “reality” but rather that it offers the possibility to step outside of the normal bounds of reality and realize goals in a totally new and unexpected way. We hope that our article will provoke readers to think as paradigm changers, and advance VR to realize different worlds that might have a positive impact on the lives of millions of people worldwide, and maybe even help a little in saving the planet.

Continue —> Frontiers | Enhancing Our Lives with Immersive Virtual Reality | Virtual Environments

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[WEB SITE] EBRSR – Evidence-Based Review of Stroke Rehabilitation

Introduction

Welcome to the 17th edition of the EBRSR. The EBRSR now includes in-depth reviews of well over 4,500 studies including 1,699 randomized controlled trials. Parts of the EBRSR have been translated into a number of languages.

We extend sincere gratitude to the Canadian Partnership for Stroke Recovery (CPSR), a joint initiative of the Heart and Stroke Foundation and Canada’s leading stroke research centres, for funding the EBRSR.

Many readers have e-mailed us with their comments and we encourage you do so as well. We also encourage you to e-mail us if you have any concerns regarding our analyses. This helps us to ensure our data and conclusions are the best possible.

Robert Teasell MD FRCPC
Norhayati Hussein MBBS
Norine Foley MSc
Andreea Cotoi MSc

Source: Introduction | EBRSR – Evidence-Based Review of Stroke Rehabilitation

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