Archive for category TBI

[Infographic] Changes Observed After Brain Injury

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[WEB PAGE] Smell This Way to Predict TBI Recovery – Rehab Managment

Posted by Debbie Overman | May 5, 2020 | NeurologicalTraumatic Brain Injury 

Smell This Way to Predict TBI Recovery

The ability to detect smells could predict recovery and long-term survival in patients who have experienced a severe brain injury, researchers suggest, in a new study published in Nature.

The study involved brain-injured patients showing very minimal or no signs of awareness of the external world. It found that 100% of patients who reacted to the sniff test went on to regain consciousness, and over 91% of these patients were still alive three and a half years after injury.

“The accuracy of the sniff test is remarkable — I hope it will help in the treatment of severely brain-injured patients around the world,” says Anat Arzi, a researcher in the University of Cambridge’s Department of Psychology and the Weizmann Institute of Science Israel, who led the research, together with Professor Noam Sobel from the Weizmann Institute of Science Israel and Dr Yaron Sacher from the Loewenstein Rehabilitation Hospital Israel, in a media release from University of Cambridge.

One’s sense of smell is a very basic mechanism and relies on structures deep within the brain. The brain automatically changes the way people sniff in response to different smells — for example, when presented with an unpleasant smell people automatically take shorter, shallower breaths. In healthy humans the sniff-response happens in both waking and sleeping states of consciousness.

Research was conducted on 43 severely brain-injured patients. The experimenter first explained to each patient that different smells would be presented to them in jars, and the breathing through their nose would be monitored using a small tube called a nasal cannula. There was no indication that the patients heard or understood.

Next, a jar containing either a pleasant smell of shampoo, an unpleasant smell of rotten fish, or no smell at all was presented to each patient for five seconds. Each jar was presented ten times in a random order, and a measurement was made of the volume of air sniffed by the patient.

The researchers found that minimally conscious patients inhaled significantly less in response to smells, but did not discriminate between nice and nasty smells. These patients also modified their nasal airflow in response to the jar with no smell. This implies awareness of the jar or a learned anticipation of a smell. Vegetative state patients varied — some did not change their breathing in response to either of the smells, but others did.

A follow-up investigation three and a half years later found that over 91% of the patients who had a sniff response shortly after injury were still alive, but 63% of those who had showed no response had died, the release explains.

By measuring the sniff-response in severely brain injured patients, the researchers could measure the functioning of deep-seated brain structures. Across the patient group they found that sniff-responses differed consistently between those in a vegetative state and those in a minimally conscious state — providing further evidence for an accurate diagnostic.

“We found that if patients in a vegetative state had a sniff response, they later transitioned to at least a minimally conscious state. In some cases, this was the only sign that their brain was going to recover — and we saw it days, weeks and even months before any other signs,” Arzi says.

In a vegetative state the patient may open their eyes, wake up and fall asleep regularly and have basic reflexes, but they don’t show any meaningful responses or signs of awareness. A minimally conscious state differs because the patient may have periods where they can show signs of awareness or respond to commands.

“When the sniff response is functioning normally it shows that the patient might still have some level of consciousness even when all other signs are absent,” adds Dr Tristan Bekinschtein in the University of Cambridge’s Department of Psychology, who was involved in the study, in the release. “This new and simple method to assess the likelihood of recovery should be immediately incorporated in the diagnostic tools for patients with disorders of consciousness.”

[Source(s): University of Cambridge, Science Daily]

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[TEDx Talk] Seeing the Potential in Brain Recovery | Mike Studer – YouTube

 

NOTE FROM TED: Please do not look to this talk for medical advice. This talk only represents the speaker’s personal views and understanding of recovery and lacks legitimate scientific support. We’ve flagged this talk because it falls outside the content guidelines TED gives TEDx organizers. TEDx events are independently organized by volunteers. The guidelines we give TEDx organizers are described in more detail here: http://storage.ted.com/tedx/manuals/t…

The processes by which the brain can learn new information, or recover after injury, are known as neuroplasticity. In this presentation, we reveal actual applications using our latest understandings of exactly how to maximize neuroplasticity for people recovering from stroke, Parkinson’s Disease, concussion, and more! Mike Studer, PT, MHS, NCS, CEEAA, CWT, CSST is a physical therapist certified as a neurological clinical specialist. He has been a PT for nearly 30 years, conducting research, writing papers and book chapters on topics ranging from stroke rehabilitation, cognition, Parkinson’s Disease, dual tasking, and much more. He has presented by invitation to 48 states, 4 provinces in Canada, 9 countries, and 3 continents. His full-time clinical practice is located in Salem, Oregon at Northwest Rehabilitation Associates. As an avid marathoner, and health nut/longevity nerd, Mike can be easily engaged on his thoughts about exercise, nutrition, sleep, and learning! http://www.mikestuder.com This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

via Seeing the Potential in Brain Recovery | Mike Studer | TEDxSalem – YouTube

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[VIDEO] Seeing the Potential in Brain Recovery – YouTube, TEDx

The processes by which the brain can learn new information, or recover after injury, are known as neuroplasticity. In this presentation, we reveal actual applications using our latest understandings of exactly how to maximize neuroplasticity for people recovering from stroke, Parkinson’s Disease, concussion, and more! Mike Studer, PT, MHS, NCS, CEEAA, CWT, CSST is a physical therapist certified as a neurological clinical specialist. He has been a PT for nearly 30 years, conducting research, writing papers and book chapters on topics ranging from stroke rehabilitation, cognition, Parkinson’s Disease, dual tasking, and much more. He has presented by invitation to 48 states, 4 provinces in Canada, 9 countries, and 3 continents. His full-time clinical practice is located in Salem, Oregon at Northwest Rehabilitation Associates. As an avid marathoner, and health nut/longevity nerd, Mike can be easily engaged on his thoughts about exercise, nutrition, sleep, and learning! http://www.mikestuder.com This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

via Seeing the Potential in Brain Recovery | Mike Studer | TEDxSalem – YouTube

 

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[BLOG POST] Symptoms of Post -Traumatic Stress

After experiencing a traumatic event, a person can be inflicted with stressful reminders of that event, which can be crippling and debilitating, and seriously interrupt a person’s life. The onset of Post-Traumatic Stress (PTS) doesn’t have a specific time frame, it can take hold weeks, months, or even years after the occurrence of a traumatic event. While there aren’t yet any concrete ways to determine who will and will not experience PTS, a recent study has identified some genetic links. It’s important to understand the symptoms and warning signs of PTS because they can begin to appear at any time, even without warning.

The four hallmark symptoms of PTS involve re-experiencing, avoidance, arousal and reactivity, and mood and cognition. In some cases, a patient needs to express a symptom of at least one of each for at least a month to be diagnosed with Post-Traumatic Stress.

Re-Experiencing 
The phenomenon of re-experiencing can occur at any time of the day, and frequently disrupts a person’s daily routine. At night, bad dreams and nightmares can upend a full night’s sleep, and depending on the severity of nightmares or night terrors, cause insomnia. These flashbacks can make it feel like a person is experiencing the traumatic event for the first time. The triggers for re-experiencing are typically rooted in reminders of the event in the form of words, objects, or situations.

Avoidance
Reminders of a traumatic event can trigger avoidance symptoms in a person suffering with PTS. Those reminders can be places, things or people. A change in a close relationship with a person they experienced the traumatic event with could be a hint of avoidance. However, avoidance can also manifest in avoiding other people entirely, which can then lead to feeling isolated and alone.

Arousal and Reactivity
While many of the symptoms of PTS can be triggered by something, arousal symptoms tend to be constant. The arousal symptoms typically cause feelings of stress and anger, and can result in angry outbursts. They can also lead to feeling on edge, and being easily startled. Daily tasks such as eating, focusing, and sleeping can all be affected by these symptoms.

Mood and Cognition
While re-experiencing is a well-known symptom of PTS, it isn’t required to diagnose it. Mood swings and changes in mood, such as feelings of hopelessness, numbness, as well as guilt and shame, or even suicidal thoughts, can be an indicator of the onset of PTS. Loss of interest in activities that were previously enjoyable is also common, and these feelings can also cause a person to feel isolated and detached from family, friends, and their life.

Symptoms of PTS can vary in intensity, but they don’t operate on a standard progression from mild to intense over time. Instead, they depend on the scenario in which they are triggered. For example, if a person is dealing with a stressful situation and they are triggered, their symptoms could be more intense. For military service members, it is imperative that they have the opportunity to be diagnosed and treated if they experience or display symptoms of PTS. The Intrepid Spirit Centers that the Intrepid Fallen Heroes Fund is constructing are helping thousands of military service members address and heal from their symptoms of Post-Traumatic Stress. To learn more about these centers click here or, donate today.

via Symptoms of Post-Traumatic Stress | Intrepid Fallen Heroes Fund

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[WEB SITE] Brain Injury News – CNS

RESEARCH UPDATES, INDUSTRY NEWS, SURVIVOR STORIES

The world of advancements in brain injury knowledge and treatment is a rich composite of the progress being made by scores of dedicated people. The articles and reports below reflect current research, industry analysis, and stories of recovery. Innovations in patient care and the evolution of best practices in rehabilitation are among the subjects addressed by thought leaders, universities, and institutes noted here.

Categories:  Survivor  Stories  Traumatic Brain Injury  Concussion  Stroke  Aneurysm  Coma

NEWS & EVENTS ARCHIVES

via Brain Injury News

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[BLOG POST] Brain Imaging: What Are the Different Types? – BrainLine

Positron Emission Topography
Positron Emission Topography (PET) measures brain metabolism. Different applications of PET allow one to “see” pathology associated with Alzheimer’s disease, for instance, that cannot be visualized any other way. Used in a different way, PET also allows doctors to see how different areas of the brain use oxygen or glucose – both very important to understanding not just what the damage might look like but also how the brain provides energy to itself.
T1-Weighted MRI
The T1-Weighted MRI is the standard imaging test and part of every general MRI exam. It provides doctors with a very clear view of brain anatomy and structure. It can also show damage in brain injury but generally only when the damage is very significant.
T2-Weighted MRI
The T2-Weighted MRI is also a standard part of every MRI exam. But unlike T1-weighted imaging, the T2 allows visualization of severe diffuse axonal injury such as what is expected following severe TBI.
Diffusion Weighted Magnetic Resonance Imaging
Diffusion Weighted MRI (DWI) shows alterations in tissue integrity. In ischemic injury — such as many types of stroke or when blood is not able to get to all parts of the brain — there is a chemical reaction in the cells. As the cells die because of lack of blood flow (with oxygen), there is an increase in sodium and this changes (increases) the amount of water in the tissue. DWI is very sensitive to this change. In fact, using DWI, doctors can identify a stroke or ischemic injury within seconds of occurrance.
Fluid-Attenuated Inversion Recovery MRI
Fluid-Attenuated Inversion Recovery (FLAIR) MRI is also sensitive to water content in brain tissue. This is very useful in patients who have reductions in brain tissue following an injury. Most commonly, however, FLAIR is used to visualize alterations in tissue in diseases such as multiple sclerosis.
Diffusion Tensor Imaging
Diffusion Tensor Imaging (DTI) shows white matter tracts in brain tissue. These tracts allow different parts of the brain to talk to each other. Think of the brain as if it were a computer. With DTI doctors can see and measure the “cables” connecting parts of the brain. DTI can provide information about damage to parts of the nervous system as well as about connections among brain regions.
Gradient Record MRI
Gradient Record MRI (GRE) shows blood or hemorrhaging in the brain tissue. This is very important in acute head injury. CT scans are also very useful in this stage but sometimes miss very small bleeds ― or so called microbleeds ― in the brain. MRI and types of MRI more sensitive to blood can identify these and allow doctors to monitor the patient.
Functional MRI
Functional MRI (fMRI) is a newer type of MRI that takes advantage of the iron in blood and the fact that when neurons fire there is ― eventually ― an increase in local iron in the areas where the neurons fired. For this imaging test, doctors ask patients to do something while in the MRI machine like opening and closing their right hand for 30 seconds and then opening and closing their left hand for 30 seconds. Then, the doctors model the change in signal associated with an increase in blood related to that task. So, areas involved in opening the right hand will show increased signal. This allows images to be created that reveal how the brain does tasks. This is potentially useful in TBI when the brain structures all appear normal but the brain is functioning in a different way. It is important to know that fMRI is not approved for clinical use for diagnosis of TBI.

via Brain Imaging: What Are the Different Types? | BrainLine

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[BLOG POST] What Is the Glasgow Coma Scale? – BrainLine

What Is the Glasgow Coma Scale?The Glasgow Coma Scale (GCS) is the most common scoring system used to describe the level of consciousness in a person following a traumatic brain injury. Basically, it is used to help gauge the severity of an acute brain injury. The test is simple, reliable, and correlates well with outcome following severe brain injury.

The GCS is a reliable and objective way of recording the initial and subsequent level of consciousness in a person after a brain injury. It is used by trained staff at the site of an injury like a car crash or sports injury, for example, and in the emergency department and intensive care units.

The GCS measures the following functions:

Eye Opening (E)

  • 4 = spontaneous
  • 3 = to sound
  • 2 = to pressure
  • 1 = none
  • NT = not testable

Verbal Response (V)

  • 5 = orientated
  • 4 = confused
  • 3 = words, but not coherent
  • 2 = sounds, but no words
  • 1 = none
  • NT = not testable

Motor Response (M)

  • 6 = obeys command
  • 5 = localizing
  • 4 = normal flexion
  • 3 = abnormal flexion
  • 2 = extension
  • 1 = none
  • NT = not testable

Clinicians use this scale to rate the best eye opening response, the best verbal response, and the best motor response an individual makes. The final GCS score or grade is the sum of these numbers.

Using the Glasgow Coma Scale

A patient’s Glasgow Coma Score (GCS) should be documented on a coma scale chart. This allows for improvement or deterioration in a patient’s condition to be quickly and clearly communicated.

Individual elements, as well as the sum of the score, are important. The individual elements of a patient’s GCS can be documented numerically (e.g. E2V4M6) as well as added together to give a total Coma Score (e.g E2V4M6 = 12). For example, a score may be expressed as GCS 12 = E2 V4 M6 at 4:32.

Every brain injury is different, but generally, brain injury is classified as:

  • Severe: GCS 8 or less
  • Moderate: GCS 9-12
  • Mild: GCS 13-15

Mild brain injuries can result in temporary or permanent neurological symptoms and neuroimaging tests such as CT scan or MRI may or may not show evidence of any damage.

Moderate and severe brain injuries often result in long-term impairments in cognition (thinking skills), physical skills, and/or emotional/behavioral functioning.

Limitations of the Glasgow Coma Scale

Factors like drug use, alcohol intoxication, shock, or low blood oxygen can alter a patient’s level of consciousness. These factors could lead to an inaccurate score on the GCS.

Children and the Glasgow Coma Scale

The GCS is usually not used with children, especially those too young to have reliable language skills. The Pediatric Glasgow Coma Scale, or PGCS, a modification of the scale used on adults, is used instead. The PGCS still uses the three tests — eye, verbal, and motor responses — and the three values are considered separately as well as together.

Here is the slightly altered grading scale for the PGCS:

Eye Opening (E)

  • 4 = spontaneous
  • 3 = to voice
  • 2 = to pressure
  • 1 = none
  • NT = not testable

Verbal Response (V)

  • 5 = smiles, oriented to sounds, follows objects, interacts
  • 4 = cries but consolable, inappropriate interactions
  • 3 = inconsistently inconsolable, moaning
  • 2 = inconsolable, agitated
  • 1 = none
  • NT = not testable

Motor Response (M)

  • 6 = moves spontaneously or purposefully
  • 5 = localizing (withdraws from touch)
  • 4 = normal flexion (withdraws to pain)
  • 3 = abnormal flexion (decorticate response)
  • 2 = extension (decerebrate response)
  • 1 = none
  • NT = not testable

Pediatric brain injuries are classified by severity using the same scoring levels as adults, i.e. 8 or lower reflecting the most severe, 9-12 being a moderate injury and 13-15 indicating a mild TBI. As in adults, moderate and severe injuries often result in significant long-term impairments.

Posted on BrainLine February 13, 2018. Reviewed July 25, 2018.

References

Teasdale G, Allen D, Brennan P, McElhinney E, Mackinnon L. The Glasgow Coma Scale: an update after 40 years. Nursing Times 2014; 110: 12-16

Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974,2:81-84. PMID 4136544.

The Glasgow Structured Approach to Assessment of the Glasgow Coma Scale. (n.d.). Retrieved February 13, 2018, from www.glasgowcomascale.org.

via What Is the Glasgow Coma Scale? | BrainLine

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[Infographic] DO I HAVE PTSD?

PTSD.jpg

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[BLOG POST] Top tips for dating after receiving a traumatic brain injury – Jumbledbrain

Dating after receiving a traumatic brain injury

Guest Post: Top Tips For Dating After Receiving A Traumatic Brain Injury

Brandon Leuangpaseuth is a freelance copywriter from San Diego, CA. Brandon is an avid traveler, book enthusiast and loves animals. He loves exploring new places and going on long walks on the beach. You can connect with him on LinkedIn @ bleuangpaseuth.

Today he wants to share with you his personal experience of dating after receiving a traumatic brain injury, including his top tips for how to successfully settle down with the right person.

 


In 2015, I was hit by a car and I received a severe traumatic brain injury. A brain injury that left me without the ability to remember what I had done the day prior, constant fatigue, and the need to sleep more than usual. I have openly written and shared my journey to recovery since the incident on Jumbled Brain’s blog… From my struggles to graduating from college while dealing with the detrimental effects of my brain injury to struggling to work a full-time job (but finding a great career that worked with my TBI!) to coping with the everyday changes, my brain injury has had on my life.

Now, the next strenuous chapter I face while living with a brain injury is…dating (honestly, dating without a brain injury was already hard enough!) Dating with a brain injury opens up a slew of other obstacles that make it even more arduous. In this article, I want to spread how I learned to cope with the new obstacles my brain injury has had on my dating life.

The Importance of Communication

My doctor once told me a brain injury is only invisible to the outside world if I did not tell people about my head injury. What he meant by that other people will not know I suffer some negative effects from an unseen disability, unless I inform them of it.  It can definitely be a tough conversation to have. At first, I struggled with telling people about my brain injury because I was ashamed and I wanted nothing more than to be normal. As time passed, I’ve come to terms with my head injury.

I made it a point to tell everyone who I dated after the car accident about my brain injury. I want to let my partner know what they were getting into before they started to date me. That I do have a lingering invisible disability that would impact the relationship. I’ve had some partners that said it was not a big deal until they had to deal with some of the issues I faced when dealing with a brain injury.

I have to let them know that I can be quite forgetful and I get horrific TBI exhaustions that make me take an enormous amount of naps throughout a day. Sometimes I can’t drive for long hours or stay out too late because my body would get too fatigued and I would need to sleep.

After I communicated with my partner, they would understand that I needed a nap whenever I got brain fog.

Being honest with my partner about some of the hurdles I face and that the effects it would have on the relationship have been extremely helpful. Telling my partner ahead of time some situations where the effects of my brain injury would come into play has helped my partner understand me better.

Dealing With the Dreaded Fatigue and Brain Fog

Fatigue is the absolute biggest issue I face. Hands down it is the worst part of my brain injury. My partner would get mad at me when I would fall asleep watching a movie in every theater date we had or when I would say I could not stay out any longer because I was getting some serious brain fog. Of course, I want to spend time or being out late nights with my partner…but it is just harder with a brain injury. I would get pretty sad when I had to tell my partner that I can’t stay out late on some date nights because I was too tired.

The best solution for me was to plan ahead of time. I’m a freelance writer so I would write in the mornings and take my naps throughout the day if I had a big date that night or an outing. I would also pack some bottles of black teas to keep with me in case I needed to stay awake.

I would also make sure to use ride-sharing applications on some night outs because I know I’d be too exhausted to drive later.

I can’t stress it enough that preparation is key when you are dating with a brain injury.

Being Confident in Myself

Right after I received the brain injury, I had a lot of confidence issues. I used to pride myself on being a pretty academic and intelligent guy, but when I could not even remember what I did the day prior and I had difficulty forming cogent thoughts…I started to second guess that belief.

Thoughts of “who would date somebody with a TBI” started to pop into my head…

I felt like damaged goods.

–and my own thoughts and how I felt about myself flowed out into my dating life. People around me can sense my lack of confidence whenever I interacted with them.

If I didn’t even want to date myself, who would want to date me…

So, the first step was rebuilding some confidence in myself. I started to routinely hit the gym, cleaned up my diet and really worked on reframing how I thought about my brain injury. I realized that if someone didn’t completely accept me for who I was, a guy with a brain injury, why would I want to date that person? I had to learn how to be loved for who I was and accept all parts of me. If a girl was not interested in dating me because of my disability, then it was her loss! With this mindset, I started to be more confident with myself in my dating life.

Here’s to Dating With A Brain Injury

If you have a brain injury and you are struggling with dating, hang in there. Hopefully, my tips can make it a little bit easier to dating someone when you have a brain injury. Being honest with your partner, being prepared for dates and reframing how you think about your brain injury can go a long way.

I wish you the best of luck on your dating journey and I hope you stay safe!

via Guest post: Top tips for dating after receiving a traumatic brain injury | Jumbledbrain

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