Posts Tagged anxiety

[WEB SITE] TBI and PTSD: Navigating the Perfect Storm – BrainLine

Marilyn Lash, MSW, Brain Injury Journey magazine
TBI and PTSD: Navigating the Perfect Storm

So often people talk about the effects of traumatic brain injury or the consequences of post-traumatic stress disorder as separate conditions — which they are. But for the person who is living with the dual diagnosis of TBI and PTSD, it can be hard to separate them.

Just as meteorologists predict “the perfect storm” when unusual and unprecedented conditions move in to create catastrophic atmospheric events, so can the combination of PTSD and TBI be overpowering and destructive for all in its path. The person with TBI and PTSD is living in a state unlike anything previously experienced. For the family, home is no longer the safe haven but an unfamiliar front with unpredictable and sometimes frightening currents and events.

While awareness of PTSD has greatly increased with recently returning service members and veterans, it is not new and nor limited to combat. Anyone — children, adolescents, adults, elderly — who is exposed to a life-threatening trauma can develop PTSD. Car crashes, shootings, floods, fires, assaults, or kidnapping can happen to anyone anywhere. But the rate of PTSD after brain injury is much higher in veterans than civilians due to their multiple and prolonged exposure to combat. According to O’Connor and Drebing, it is estimated that up to 35% of returning veterans with mild brain injury also have PTSD.

What’s unique about PTSD?

Symptoms of PTSD include:

  • Unwanted and repeated memories of the life-threatening event
  • Flashbacks where the event is relived and person temporarily loses touch with reality
  • Avoidance of people, places, sights, or sounds that are reminders
  • Feelings of detachment from people, even family, and emotional numbness
  • Shame about what happened and was done
  • Survivor guilt with loss of friends or comrades
  • Hypervigilance or constant alertness for threats.

Individuals with PTSD are at increased risk for depression, physical injuries, substance abuse, and sleep problems, which in turn can affect thoughts and actions. These risk factors also occur with brain injury.

PTSD is a mental disorder, but the associated stress can cause physical damage. TBI is a neurological disorder caused by trauma to the brain. It can cause a wide range of impairments and changes in physical abilities, thinking and learning, vision, hearing, smell, taste, social skills, behaviors, and communication. The brain is so complex, the possible effects of a traumatic injury are extensive and different for each person.

When PTSD and TBI coexist, it’s often difficult to sort out what’s going on. Changes in cognition such as memory and concentration, depression, anxiety, insomnia, and fatigue are common with both diagnoses. One basically feeds and reinforces the other, so it’s a complicated mix — it’s the perfect storm. It may help to consider and compare changes commonly seen with TBI and PTSD.

Memory

TBI: A period of amnesia for what went on just before (retrograde amnesia) or after (anterograde amnesia) the injury occurred is common. The length of time (minutes, hours, days, or weeks) of amnesia is an indicator of the severity of the brain injury. For example, the person may have no memory of what happened just before or after the car crash or IED explosion.

PTSD: In contrast, the person with PTSD is plagued and often haunted by unwanted and continuing intrusive thoughts and memories of what happened. The memories keep coming at any time of day or night in such excruciating detail that the person relives the trauma over and over again.

Sleep

TBI: Sleep disorders are very common after brain injury. Whether it is trouble falling asleep, staying asleep, or waking early, normal sleep patterns are disrupted, making it hard to get the restorative rest of sleep so badly needed.

PTSD: The mental state of hypervigilance interferes with slowing the body and mind down for sleep. Nightmares are so common with PTSD that many individuals dread going to bed and spend long nights watching TV or lying on the couch to avoid the night’s terrors. Waking up with night sweats so drenching that sheets and clothing are soaked. Flashbacks so powerful that bed partners have been struck or strangled while sleep battles waged.

Isolation

TBI: Many survivors of TBI recall the early support and visits of friends, relatives, and coworkers who gradually visited or called less often over time. Loss of friends and coworkers leads to social isolation, one of the most common long-term consequences of TBI.

PTSD: The isolation with PTSD is different as it is self-imposed. For many it is simply too hard to interact with people. The feeling of exposure outside the safe confines of the house is simply too great. The person may avoid leaving the house as a way of containing stimuli and limiting exposure to possible triggers of memories. As a result, the individual’s world becomes smaller and smaller.

Emotions

TBI: When the areas of the brain that control emotions are damaged, the survivor of a TBI may have what is called “emotional lability.” This means that emotions are unpredictable and swing from one extreme to the other. The person may unexpectedly burst into tears or laughter for no apparent reason. This can give the mistaken impression that the person is mentally ill or unstable.

PTSD: Emotional numbness and deadened feelings are a major symptom of PTSD. It’s hard for the person to feel emotions or to find any joy in life. This emotional shutdown creates distance and conflicts with spouses, partners and children. It is a major cause of loss of intimacy with spouses.

Fatigue

TBI: Cognitive fatigue is a hallmark of brain injury. Thinking and learning are simply harder. This cognitive fatigue feels “like hitting the wall,” and everything becomes more challenging. Building rest periods or naps into a daily routine helps prevent cognitive fatigue and restore alertness.

PTSD: The cascading effects of PTSD symptoms make it so difficult to get a decent night’s sleep that fatigue often becomes a constant companion spilling over into many areas. The fatigue is physical, cognitive, and emotional. Feeling wrung out, tempers shorten, frustration mounts, concentration lessens, and behaviors escalate.

Depression

TBI: Depression is the most common psychiatric diagnosis after brain injury; the rate is close to 50%. Depression can affect every aspect of life. While people with more severe brain injuries have higher rates of depression, those with mild brain injuries have higher rates of depression than persons without brain injuries.

PTSD: Depression is the second most common diagnosis after PTSD in OEF and OIF veterans. It is very treatable with mental health therapy and/or medication, but veterans in particular often avoid or delay treatment due to the stigma of mental health care.

Anxiety

TBI: Rather than appearing anxious, the person acts as if nothing matters. Passive behavior can look like laziness or “doing nothing all day,” but in fact it is an initiation problem, not an attitude. Brain injury can affect the ability to initiate or start an activity; the person needs cues, prompts, and structure to get started.

PTSD: Anxiety can rise to such levels that the person cannot contain it and becomes overwhelmed by feelings of panic and stress. It may be prompted by a specific event, such as being left alone, or it can occur for no apparent reason, but the enveloping wave of anxiety makes it difficult to think, reason or act clearly.

Talking about the Trauma

TBI: The person may retell an experience repetitively in excruciating detail to anyone who will listen. Such repetition may be symptomatic of a cognitive communication disorder, but it may also be due to a memory impairment. Events and stories are repeated endlessly to the frustration and exasperation of caregivers, friends, and families who have heard it all before.

PTSD: Avoidance and reluctance to talk about the trauma of what was seen and done is a classic symptom of PTSD, especially among combat veterans.

Anger

TBI: Damage to the frontal lobes of the brain can cause more volatile behavior. The person may be more irritable and anger more easily, especially when overloaded or frustrated. Arguments can escalate quickly, and attempts to reason or calm the person are often not effective.

PTSD: Domestic violence is a pattern of controlling abusive behavior. PTSD does not cause domestic violence, but it can increase physical aggression against partners. Weapons or guns in the home increase the risks for family members. Any spouse or partner who feels fearful or threatened should have an emergency safety plan for protection.

Substance Abuse

TBI: The effects of alcohol are magnified after a brain injury. Drinking alcohol increases the risks of seizures, slows reactions, affects cognition, alters judgment, interacts with medications, and increases the risk for another brain injury. The only safe amount of alcohol after a brain injury is none.

PTSD: Using alcohol and drugs to self-medicate is dangerous. Military veterans drink more heavily and binge drink more often than civilian peers. Alcohol and drugs are being used often by veterans to cope with and dull symptoms of PTSD and depression, but in fact create further problems with memory, thinking, and behavior.

Suicide

TBI: Suicide is unusual in civilians with TBI.

PTSD: Rates of suicide have risen among veterans of OEF and OIF. Contributing factors include difficult and dangerous nature of operations; long deployments and multiple redeployments; combat exposure; and diagnoses of traumatic brain injury, chronic pain, post-traumatic stress disorder, and depression; poor continuity of mental health care; and strain on marital and family relationships. Veterans use guns to commit suicide more frequently than civilians.

Summary

There is no easy “either/or” when it comes to describing the impact of TBI and PTSD. While each diagnosis has distinguishing characteristics, there is an enormous overlap and interplay among the symptoms. Navigating this “perfect storm” is challenging for the survivors, the family, the caregivers, and the treatment team. By pursuing the quest for effective treatment by experienced clinicians, gathering accurate information, and enlisting the support of peers and family, it is possible to chart a course through the troubled waters to a safe haven.

References:

O’Connor, M. & Drebing, C. (2011). Veterans and Brain Injury. In Living Life Fully after Brain Injury: A workbook for survivors, families and caregivers, Eds. Fraser, Johnson & Bell. Youngsville, NC: Lash & Associates Publishing/Training, Inc.

Ehde, D. & Fann, J. (2011). Managing Depression, Anxiety, and Emotional Challenges. In Living Life Fully after Brain Injury: A workbook for survivors, families and caregivers, Eds. Fraser, Johnson & Bell. Youngsville, NC: Lash & Associates Publishing/Training, Inc.

Posted on BrainLine March 7, 2013. Reviewed July 26, 2018.

 

via TBI and PTSD: Navigating the Perfect Storm | BrainLine

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[WEB PAGE] 15 Incredible Natural Remedies for Anxiety and Depression

At some point in our lives we all end up going through anxiety and depression. While these feelings are normal and affect a majority of people, it’s never fun to feel blue or anxious. Many times, people dealing with depression and anxiety will turn to prescription drugs to help them with these feelings, yet natural remedies for anxiety and depression can help too.

As an advocate for mental health and wellness, as well as natural remedies, I have researched thoroughly to share the natural and safe ways to help anxiety and depression.

 

Causes

Anxiety and depression are often seen hand in hand since many individuals with anxiety often have depression too. These feelings can be caused by a wide range of environmental and/or personal triggers. For some, there is no true cause to feeling anxious or depressed, yet for others there are more clear causes and sometimes a combination of causes will lead to anxiety and depression.

Depression and anxiety can be caused by the following:

  • Genetic makeup
  • Experiencing a traumatic event
  • Stress
  • Health conditions (including but not limited to cancer, chronic pain, etc.)
  • Greif
  • Changes in your personal like (divorce, loss of a job, moving,)
  • Substance abuse

While there are many different causes to anxiety and depression, you need to remember, having these feelings is not anyone’s fault or a flaw in your own character. Sometimes there does not have to be a ‘reason’ for feeling anxious or depressed. It just happens. But the good news is, if you can recognize the signs and symptoms, you can begin to use herbal remedies to help you improve.

Signs and Symptoms

Everyone who suffers from anxiety and depression will exhibit different signs and/or symptoms. It all depends on your chemical makeup in your brain. To give you an idea of how anxiety and depression can affect individuals, here is a list of the most common signs and symptoms of depression.

  • Excessive tiredness or sleeping
  • Insomnia
  • Panic attacks
  • Sweating
  • Shallow and rapid breathing
  • Tension
  • Feeling nervous
  • Shortness of breath or trouble breathing
  • Feelings of despair or loneliness
  • Changes in your eating habits- either too much or too little
  • Inability to relax
  • Feeling cranky or moody
  • Constant feelings of worthlessness or sadness
  • Difficulty with decision making, memory, or concentration
  • Constant irrational fears or worryConstant irrational fears or worry
  • Rapid heartbeat
  • Headaches
  • Abdominal pain
  • Hot flashes
  • Loss of interests, hobbies, or social life
  • Anti-social behavior

Although these are just a few symptoms of anxiety and depression, everyone experiences anxiety and depression in different ways. Signs and symptoms of depression in women and men will vary so it is important to speak to a professional if you are feeling anxiety and depression.

Treatments​

After discussing with a professional, they will be able to diagnose your anxiety and depression. From there the signs and symptoms of depression in men and women can be improved with the help of these herbal remedies.

If you are interested to treat your depression, anxiety and panic attacks with natural remedies, these 15 home remedies for anxiety and depression can surely help you beat the blues and find your calm.

15 Incredible Natural Remedies for Anxiety and Depression

1. Drinking Chamomile Tea

Depression and anxiety will go hand in hand with sleeping problems. Yet drinking a cup of hot chamomile tea can help you relax and get to sleep when you need it. This is due to the flavonoids that are present in the tea. It is a naturally occurring chemical in the plants that induce relaxation. Richard from InsideBedroom Blog has written about the tips to get better sleep which also has mention about drinking tea.

Chamomile Tea

Required Ingredients:

  • 1 cup boiling water
  • 2 tbsp of dried chamomile or just 1 teabag
  • Dash of honey

Process:

  • Boil the water and pour it over the tea.
  • Steep for 5 minutes if loose tea. Steep for 15 minutes if using a teabag.
  • Strain the tea or remove the teabag.
  • Add the honey.
  • Drink 30 minutes before bed or when you need to relax.

2. Practice Meditation

meditation

Practicing daily meditation will help to improve the signs of depression in women and men. Taking even just 15 minutes to calm your mind and simply breathe will do wonders to help you cope, prevent, and calm your anxiety and depression.

Required Ingredients:

  • A calm, quiet space
  • Comfortable clothing
  • Time

 

Process:

  • Put on some comfortable clothing and find a calm, quiet place.
  • Turn off your phone, close your blinds, and take other measures as needed to prevent interruptions.
  • Regulate your breathing and attempt to release your thoughts.
  • Breathe deeply with a clear mind for at least 15 minutes.
  • Repeat daily.

3. Get Back to Nature

walking in countryside

Getting yourself back to nature is a great way to ground yourself and release your feelings of anxiety and depression. Spending time outside and breathing the fresh air and taking in the sunlight will certainly improve your mood and help you release your anxious feelings.

Required Ingredients:

  • Natural park, forest, or path
  • Time

 

Process:

  • Go to a place where you can experience nature.
  • Spend at least 30 minutes walking around, or just being outside in the open.
  • Repeat as often as needed.

4. Eat Your Breakfast

breakfast

Starting your day right by eating a well-balanced meal will help you through the entire day. Not only will you be giving your mind and body energy to face the day, eating a healthy breakfast will improve your mood.

Required Ingredients:

  • A variety of healthy foods

Process:

  • Set your alarm and wake up at a scheduled time each day.
  • Make yourself a breakfast of healthy and wholesome foods.
  • Eat breakfast daily.

5. Inhaling Lavender

lavender-products

Lavender is well-known for its calming and soothing effects. The aroma of lavender is actually considered an emotional ant-inflammatory. Inhaling fresh lavender or lavender oil will give you a sense of calm and relaxation which will help improve anxiety and panic attacks.

Required Ingredients:

  • Essential oil of lavender or fresh lavender

Process:

  • Place a few drops of essential oil of lavender on your wrists and behind your ears and inhale deeply.
  • If you are using fresh lavender, fill your home with a few bouquets so you can continuously breathe in their calming scent.
  • Breathe in fresh lavender whenever you begin to feel anxiety and depression.

6. Avoid Coffee

a cup of cofee

While coffee is a great kick start to your day, it is not so great for those with anxiety and depression. The stimulation from coffee can enhance your feelings of anxiety and depression and even trigger them.

Required Ingredients:

Process:

  • Avoid drinking coffee (and other caffeinated drinks) for a couple of days.
  • If you truly need a coffee, switch to decaf.
  • Avoid coffee and caffeine for as long as you need to prevent triggers of anxiety and depression.

7. Supplement St. John’s Wart

Credit: WebMD

A very popular home remedy for anxiety and depression is the herb St. John’s Wart. This is because of the hypercin that is one of its main components. The hypercin will affect the various neurotransmitters in a similar manner to prescription drugs for depression and anxiety.

Required Ingredients:

  • A high quality capsule of St. John’s Wart

Process:

  • Take 300 milligrams of the St. John’s Wart 3 times each day.
  • Repeat for at least one week.

Notes:

The hypercin in the St. John’s Wart can sometimes interact with other drugs. Be sure to speak to your doctor before you start this home remedy for anxiety and depression.


8. Increase Your B Vitamin Intake

Vitamin B

Increasing your B Vitamins will help your brain produce more serotonin, epinephrine, and dopamine, thus resulting in an improved mood.

Required Ingredients:

  • Vitamin B capsules
  • Foods that contain high amounts of Vitamin B (fish, shellfish, cheese, spinach, turkey, and bell peppers to name a few)

Process:

  • Eat more foods that contain Vitamin B naturally.
  • Take 300 milligrams of vitamin B capsules each day if you do not eat the foods that naturally contain Vitamin B.
  • Make this a part of your regular diet.

9. Increase Your Magnesium Intake

Magnesium

Magnesium is a very important part of a balanced diet. Without a proper level of magnesium, we cannot keep the chemicals within our brain stable, regulate our heartbeats, or synthesize our RNA and DNA.

Required Ingredients:

  • Incorporate foods such as spinach, bananas, dry almonds, and/or soy milk.
  • If you do not enjoy these foods, magnesium capsules will suffice.

Process:

  • Intake magnesium rich foods or a magnesium capsule each day for a highly functioning body and mind.
  • Make magnesium a part of your daily diet.

10. Get Some Exercise

Exercise

Exercise is a fundamental part of maintaining a good mood and a relaxed mind. Exercise will release endorphins which will make you feel good and feel happy.

Required Ingredients:

Process:

  • Take a minimum of 15 minutes each day to exercise.
  • Repeat daily and make it a part of your regular schedule. Not only will you feel better mentally, you will feel better physically.

 


11. Utilize Light Therapy

light therapy

Light therapy is great to do if you happen to have seasonal affective disorder. Your mood drops in the winter months due to the limited sunlight, but light therapy can also help with depression. This is because the light will help activate the circadian pacemaker in the brain which will help to regulate your sleep cycles.

Required Ingredients:

  • Bright light made for SAD and depression
  • timer

Process:

  • Turn on the light and shine it on you (not directly in your face though)
  • Set a timer for 10 minutes.
  • Repeat a few times per day after the sun has set.

 


12. Intake Pumpkin Seeds

pumpkin seeds

Pumpkin seeds will contain healthy fats as well as magnesium- both will help to lighten your mood. In addition, pumpkin seeds contain L-tryptophan which is an amino acid that helps your brain produce serotonin.

Required Ingredients:

  • One cup of cooked or raw pumpkin seeds

 

Process:

  • Eat one cup of the raw or cooked pumpkin seeds once per day.
  • Repeat daily while you are struggling with depression.

 


13. Face the Fear

face the fear

If something is making you feel afraid, face the fear. This can help you understand your anxiety since most anxiety stems from the uncertain. Exposure therapy or facing your fears will help you learn how to live your life with uncertainty and risk.

Required Ingredients:

  • Time
  • Exposure to your fears and uncertainties

Process:

  • Take it slow and set aside some time to face the fears or what is causing your anxiety.
  • Repeat as often as needed until the fears or causes of anxiety are no longer there.

Notes:

Speaking to a therapist or friends and family for support will help you through this process.


14. Partake in Laughter

laughter

They always say, laughter is the best medicine. And it’s true! Cultivating a good sense of humor, even if you do a fake laugh, will boost your mood and your dopamine production.

Required Ingredients:

  • Humorous movie
  • Funny jokes or people

 

Process:

  • Spend time indulging in something humorous and laugh.
  • Take time each week to find laughter.

 


15. Administer Lemon Balm

lemonpalm

Lemon balm is an herbal remedy that can help reduce your stress and anxiety, as well as help you with your sleep. Lemon balm extract can be found in a tincture, capsule, or tea form. No matter which form you choose to use, start with the smallest dosing schedule and be sure to follow the directions and soon you will be feeling less anxious and more calm.

Required Ingredients:

  • Lemon balm extract

 

Process:

  • Take the smallest dose of lemon balm extract and follow the directions closely.
  • Repeat daily as needed.

 

Notes:

It is important to follow the directions accordingly because taking too much can actually make you feel much more anxious.


How to Prevent Anxiety and Depression

Battling anxiety and depression is not easy. However, if you make effort to take certain measures in your day to day life, you will certainly notice an improvement in these conditions. Along with the help of natural remedies for anxiety and depression, the following methods can be used to help you manage and cope with these issues.

  • Exercise daily, for at least 20-30 minutes.
  • Keep a journal and write in it each day.
  • Make sure you get plenty of sleep. ​SleepAdvisor.org got some advice for ​​reducing anxiety before bed.
  • The Quality of sleep matters as much as the quantity.” Check out this article on how to get a higher quality of sleep.
  • Limit alcohol and caffeine.
  • Learn and understand what triggers your anxiety and depression.
  • Get support from friends and family.
  • Keep a positive attitude.
  • Get involved with a volunteer organization.
  • Accept and understand that you cannot control everything.
  • Get your daily dose of sunshine.
  • Learn more about anxiety and depression by reading articles.
  • Do things that will make you feel good- even if you don’t feel like doing them.

As an advocate for mental health and wellness, I hope you have enjoyed this article. If you found something in this article useful for signs of depression in men and women, or anxiety and panic attacks, please comment to let me know! Or if you would like to share the 15 incredible home remedies for anxiety and depression, please do!

 

via 15 Incredible Natural Remedies for Anxiety and Depression – eHome Remedies

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[BLOG POST] Benefits Of Magnesium For Traumatic Brain Injury treatment

magnesium tabletMagnesium is a vital nutrient that the human body requires in order to function healthily. It’s important for a range of bodily processes, including regulating nerve functions, blood sugar levels, blood pressure, and making protein, bone, and DNA. It’s one of the 24 essential vitamins and minerals critical for a healthy body.

Magnesium cannot be produced by the body itself – in other words, it needs to be sourced elsewhere, such as from food or supplements. The levels of magnesium needed for each person varies on gender, age and size. However, when a Traumatic Brain Injury occurs, magnesium becomes a nutrient you should strive for with its many mental and physical health benefits.

Many ordinary people today use Magnesium supplements to help with their energy, flexibility, muscle strength, and even sleep or stress management. In particular, people who have a love for fitness or sports take regular Magnesium tablets to assist with recovery and performance.

 

So, what could it do for TBI?

Magnesium For TBI
Following a traumatic brain injury, the side effects of anxiety, stress, brain swelling, cramping and tightening of muscles, stiff muscles, and insomnia are quite possible.

That’s where magnesium comes in to save the day.

Increase Flexibility, Decrease Tone, Reduce
Considering magnesium can assist with flexibility and loosening tight muscles, increasing your magnesium intake after a traumatic brain injury can likely help alleviate your stiff, cramped muscles.

Low magnesium levels can also cause a large build-up of lactic acid, which results in workout pain and tightness.

Taking magnesium for this particular problem allows your muscles to relax correctly before and after exercise.

 

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Stress & Anxiety
Magnesium can also help to control stress hormones. Serotonin, in particular, depends on magnesium for production.

This is responsible for relaxing your nervous system and encouraging positive moods, thus stabilizing you mentally.

Low magnesium levels are linked with anxiety behaviours and heightened stress – all the more reason to ensure you are taking in adequate amounts after your injury.

Brain Swelling
Magnesium is an anti-inflammatory, and as such, it can help to reduce brain swelling from a traumatic brain injury.

It increases cardiac output and cerebral blood flow. When the body has appropriate levels of it circulating throughout the body, people can experience improved neurological and cognitive outcomes.

It has also shown to possibly reduce pain intensity and headache severity.

Insomnia
Serotonin also helps encourage a good night sleep. Low magnesium levels can affect the sleep-regulating hormone melatonin, too.

Insomnia is indeed a common symptom of magnesium deficiency seen in many people today. They experience restless sleep and constant waking during the night, which leads to unhealthy sleep.

By maintaining the correct magnesium levels, people can enjoy deep, undisturbed sleep. Along with the melatonin, magnesium plays a role in maintaining healthy levels of “GABA” which is a neurotransmitter that promotes optimal sleep quality.

How To Take Magnesium

Magnesium can be taken in the form of a tablet supplement, but there are many magnesium-rich foods that can be incorporated into your daily diet, as well.

Try this list of power foods to hit your daily magnesium intake.

Dark leafy green vegetables
Flax seeds and pumpkin seeds
Almonds
Seaweed
Brown rice
Avocado’s
Walnuts, cashews, pecans

 

Other Sources of Magnesium

Magnesium Cream: Magnesium cream delivers the nutrients full spectrum of benefits, soothes muscle tension and increases flexibility in the applied area.

Magnesium Oil: Magnesium oil is  a no mess, easy-to-absorb, form of magnesium that may be able to raise levels of this nutrient within the body when applied topically to the skin.

 

In Conclusion

Ensuring that you have optimal levels of magnesium is the first step towards a healthy recovery following TBI.

It will help your muscles improve in flexibility, reduce pain, balance hormone levels, encourage positive moods, and sleep more soundly.

via Benefits Of Magnesium For Traumatic Brain Injury – treatment

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[WEB PAGE] Chemical imbalance in the brain: Myths and facts

Everything you need to know about chemical imbalances in the brain

Last reviewed 

A chemical imbalance in the brain occurs when a person has either too little or too much of certain neurotransmitters.

Neurotransmitters are the chemical messengers that pass information between nerve cells. Examples of neurotransmitters include serotonin, dopamine, and norepinephrine.

People sometimes call serotonin and dopamine the “happy hormones” because of the roles that they play in regulating mood and emotions.

A popular hypothesis is that mental health disorders, such as depression and anxiety, develop as a result of chemical imbalances in the brain.

While this theory may hold some truth, it runs the risk of oversimplifying mental illnesses. In reality, mood disorders and mental health illnesses are highly complex conditions that affect 46.6 million adults living in the United States alone.

In this article, we discuss conditions with links to chemical imbalances in the brain, myths surrounding this theory, possible treatment options, and when to see a doctor.

Myths

a man looking sad because he is experiencing a Chemical imbalance in the brain

Many factors may contribute to a person’s risk of mental illness.

Although chemical imbalances in the brain seem to have an association with mood disorders and mental health conditions, researchers have not proven that chemical imbalances are the initial cause of these conditions.

Other factors that contribute to mental health conditions include:

  • genetics and family history
  • life experiences, such as a history of physical, psychological, or emotional abuse
  • having a history of alcohol or illicit drug use
  • taking certain medications
  • psychosocial factors, such as external circumstances that lead to feelings of isolation and loneliness

While some studies have identified links between distinct chemical imbalances and specific mental health conditions, researchers do not know how people develop chemical imbalances in the first place.

Current biological testing also cannot reliably verify a mental health condition. Doctors do not, therefore, diagnose mental health conditions by testing for chemical imbalances in the brain. Instead, they make a diagnosis based on a person’s symptoms and the findings of a physical examination.

What conditions are linked to chemical imbalances?

Research has linked chemical imbalances to some mental health conditions, including:

Depression

Depression, also called clinical depression, is a mood disorder that affects many aspects of a person’s life, from their thoughts and feelings to their sleeping and eating habits.

Although some research links chemical imbalances in the brain to depression symptoms, scientists argue that this is not the whole picture.

For example, researchers point out that if depression were solely due to chemical imbalances, treatments that target neurotransmitters, such as selective serotonin reuptake inhibitors (SSRIs), should work faster.

The symptoms of depression vary widely among individuals, but they can include:

  • persistent feelings of sadness, hopelessness, anxiety, or apathy
  • persistent feelings of guilt, worthlessness, or pessimism
  • loss of interest in formerly enjoyable activities or hobbies
  • difficulty concentrating, making decisions, or remembering things
  • irritability
  • restlessness or hyperactivity
  • insomnia or sleeping too much
  • changes in appetite and weight
  • physical aches, cramps, or digestive problems
  • thoughts of suicide

It is possible to develop depression at any age, but symptoms usually begin when a person is in their teenage years or early 20s and 30s. Women are more likely than men to experience depression.

Many different types of depression exist. These include:

The dramatic hormonal changes that take place after giving birth are among the factors that can increase a woman’s risk of developing postpartum depression. According to the National Institute of Mental Health, 10–15% of women experience postpartum depression.

Bipolar disorder

Bipolar disorder is a mood disorder that causes alternating periods of mania and depression. These periods can last anywhere from a few days to a few years.

Mania refers to a state of having abnormally high energy. A person experiencing a manic episode may exhibit the following characteristics:

  • feeling elated or euphoric
  • having unusually high levels of energy
  • participating in several activities at once
  • leaving tasks unfinished
  • talking extremely fast
  • being agitated or irritable
  • frequently coming into conflict with others
  • engaging in risky behavior, such as gambling or drinking excessive quantities of alcohol
  • a tendency to experience physical injuries

Severe episodes of mania or depression can cause psychotic symptoms, such as delusions and hallucinations.

People who have bipolar disorder can experience distinct changes in their mood and energy levels. They may have an increased risk of substance abuse and a higher incidence of certain medical conditions, such as:

The exact cause of bipolar disorder remains unknown. Researchers believe that changes in the dopamine receptors — resulting in altered dopamine levels in the brain — may contribute to the symptoms of bipolar disorder.

Anxiety

pensive woman

A person with an anxiety disorder may experience excessive worry.

However, people who have an anxiety disorder often experience persistent anxiety or excessive worry that worsens in response to stressful situations.

According to the authors of a 2015 review article, evidence from neuroscience research suggests that the gamma aminobutyric acid (GABA) neurotransmitter may play a crucial role in anxiety disorders.

The GABA neurotransmitter reduces neuronal activity in the amygdala, which is the part of the brain that stores and processes emotional information.

GABA is not the only neurotransmitter that anxiety disorders involve. Other neurotransmitters that may contribute to these disorders include:

  • serotonin
  • endocannabinoids
  • oxytocin
  • corticotropin-releasing hormone
  • opioid peptides
  • neuropeptide Y

Treatment

Doctors can prescribe a class of medications called psychotropics to rebalance the concentration of particular neurochemicals in the brain.

Doctors use these medications to treat a range of mental health conditions, including depression, anxiety, and bipolar disorder.

Examples of psychotropics include:

  • Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft).
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs), including venlafaxine (Effexor XR), duloxetine (Cymbalta), and desvenlafaxine (Pristiq).
  • Tricyclic antidepressants (TCAs), such as amitriptyline (Elavil), desipramine (Norpramin), and nortriptyline (Pamelor).
  • Benzodiazepines, including clonazepam (Klonopin) and lorazepam (Ativan).

According to 2017 researchantidepressants improved symptoms in an estimated 40–60% of individuals with moderate-to-severe depression within 6–8 weeks.

While some people experience reduced symptoms within a few weeks, it can sometimes take months for others to feel the effects.

Different psychotropics have varying side effects. People can discuss the benefits and risks of these medications with their doctor.

The side effects of psychotropic medications can include:

Suicide prevention

  • If you know someone at immediate risk of self-harm, suicide, or hurting another person:
  • Call 911 or the local emergency number.
  • Stay with the person until professional help arrives.
  • Remove any weapons, medications, or other potentially harmful objects.
  • Listen to the person without judgment.
  • If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.

When to see a doctor

man talking to doctor in her office both smiling

If a person experiences anxiety and mood changes every day for longer than 2 weeks, they should consider speaking to their doctor.

These symptoms should not cause alarm if they are mild and resolve within a few days.

However, people may wish to consider speaking with a doctor or trained mental health professional if they experience emotional, cognitive, or physical symptoms every day for more than 2 weeks.

Summary

Mental health is complex and multifaceted, and numerous factors can affect a person’s mental well-being.

Although chemical imbalances in the brain may not directly cause mental health disorders, medications that influence the concentration of neurotransmitters can sometimes provide symptom relief.

People who experience signs and symptoms of a mental health problem for more than 2 weeks may wish to speak to a doctor.

 

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[WEB SITE] Brains Tend to Work in Sync During Music Therapy, Study Suggests

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The brains of a patient and therapist become synchronized during a music therapy session, a breakthrough that could improve future interactions between patients and therapists, researchers suggest.

The research, published in the journal Frontiers in Psychology, was carried out by Professor Jorg Fachner and Dr Clemens Maidhof of Anglia Ruskin University (ARU).

In the study, they used a procedure called hyperscanning, which is designed to record activity in two brains at the same time, allowing them to better understand how people interact.

During the session documented in the study, classical music was played as the patient discussed a serious illness in her family. Both patient and therapist wore EEG (electroencephalogram) caps containing sensors, which capture electrical signals in the brain, and the session was recorded in sync with the EEG using video cameras, a media release from Anglia Ruskin University explains.

Music therapists work towards “moments of change,” where they make a meaningful connection with their patient. At one point during this study, the patient’s brain activity shifted suddenly from displaying deep negative feelings to a positive peak. Moments later, as the therapist realized the session was working, her scan displayed similar results. In subsequent interviews, both identified that as a moment when they felt the therapy was really working.

The researchers examined activity in the brain’s right and left frontal lobes where negative and positive emotions are processed, respectively. By analyzing hyperscanning data alongside video footage and a transcript of the session, the researchers were able to demonstrate that brain synchronization occurs, and also show what a patient-therapist “moment of change” looks like inside the brain.

“This study is a milestone in music therapy research,” says lead author Jorg Fachner, Professor of Music, Health and the Brain at Anglia Ruskin University (ARU), in the release.

“Music therapists report experiencing emotional changes and connections during therapy, and we’ve been able to confirm this using data from the brain.

“Music, used therapeutically, can improve well-being, and treat conditions including anxiety, depression, autism and dementia. Music therapists have had to rely on the patient’s response to judge whether this is working, but by using hyperscanning we can see exactly what is happening in the patient’s brain,” he continues.

“Hyperscanning can show the tiny, otherwise imperceptible, changes that take place during therapy. By highlighting the precise points where sessions have worked best, it could be particularly useful when treating patients for whom verbal communication is challenging. Our findings could also help to better understand emotional processing in other therapeutic interactions,” he concludes.

[Source(s): Anglia Ruskin University, Science Daily]

 

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[WEB PAGE] Music Therapy Improves Symptoms and Behaviors of Palliative Care Patients

—Music therapy interventions have led to improved outcomes for patients with a number of common conditions. The effects of patient characteristics, goals, and interventions on outcomes aren’t fully understood, however. A recent study was designed to get some answers.

Does music truly have the power to heal? A recent study, published in American Journal of Hospice and Palliative Medicine, suggests that it does. According to the authors, music therapy improves a host of symptoms, including pain, anxiety, depression, and shortness of breath, among others.1

image

Music therapy, an evidence-based practice, involves addressing patients’ individualized goals through a therapeutic relationship with a board-certified music therapist (MT-BC),2 who can help patients address their physical, social, emotional, psychological, and spiritual needs.3Interventions include playing instruments, listening to music, choosing songs, singing, songwriting, music-assisted relaxation/imagery, and improvisation.

Previous studies have reported improved outcomes with music therapy; however, the effects of patient goals, patient characteristics, and music therapist interventions haven’t been investigated in-depth.

Research that strikes a chord

“Our study looks more in-depth at music therapy interventions and their effects on symptoms,” explains Lisa M. Gallagher, MT-BC, of the Cleveland Clinic Arts & Medicine Institute, in Lyndhurst, Ohio. “We also had the opportunity to utilize a database of over 1500 patient records and were able to obtain statistically significant results with the largest number of patients researched to date—293 who met all study inclusion criteria.”

The objectives of the study included the following:

  • To describe patient characteristics, patient goals, and interventions used by the music therapist
  • To assess the impact of music therapy sessions on outcomes
  • To identify which patient characteristics, goals, and interventions had an effect on outcomes

This retrospective study included data obtained from music therapy sessions held between September 2000 and May 2012. “Sessions were conducted with patients and any family members present,” Gallagher says. “These included addressing any symptoms such as pain, anxiety, depression, shortness of breath, and mood, while also working on other goals, such as coping and relaxation. We had patients rate the level of their symptoms before and after the sessions, and we were able to investigate the level of change that occurred.” Moreover, therapists examined changes in vocalization, facial expression, and body movement.

Interventions were classified according to 6 main categories, including music-assisted relaxation, music listening, verbal/emotional participation (verbal processing, lyric analysis, etc.), verbal/cognitive participation (music discussion, songwriting, etc.), vocal participation (singing and humming), and physical participation (clapping, foot-tapping, playing instruments). In the majority of the sessions, the MT-BC used more than 1 intervention.

The database included 5970 music therapy sessions spread among 1570 patients who were at least 18 years old and reported a minimum of 1 incidence of depression, anxiety, mood, pain, or shortness of breath before and after their session. For patients who participated in more than 1 session, only data from the first session was included.

What the study revealed

The final analysis included 293 patients with complete data on all primary outcome measures. Of these patients, most (67%) were women, with a median age of 61 years and a cancer diagnosis (93%). Lung cancer, hematologic cancers, breast cancer, and gastrointestinal cancer were the most common. The most frequent reasons for referral to music therapy were enjoyment (23%); relief of anxiety (16%), pain (13%), or depression (12%); and support (7%).

Significant improvements in the mean scores from pre- to post-session were reported for pain, depression, anxiety, shortness of breath, mood, facial expression, and vocalization. No significant improvement was reported for body movement. Positive verbal responses were recorded for 96% of patients; 4% had ambivalent responses or no response. (Demographics and cancer diagnosis did not impact outcomes.)

“We found that vocal and emotional interventions were the two most effective interventions for improving symptoms,” Gallagher says. “Perhaps the only surprise was the level of response—for instance, that 96% had a positive response to their experience and that both clinical and statistical significance were demonstrated.”

Ending on a high note

In this study, the greatest percentage of patients achieved clinically relevant improvements in mood, vocalization, and facial expression. These results also demonstrate that, going forward, no intervention changes are required based on age, gender, or diagnosis.

Limitations of the study included the use of observational behavioral data and the potential for reporting bias. Furthermore, data were missing for patients who experienced severe pain or high anxiety, had fallen asleep, were actively dying, or participated in sessions that were interrupted.

“There are a few other questions that we would like to investigate,” says Gallagher. “These include the cost-effectiveness and duration of music therapy; the validation of scales for mood, anxiety, and depression; and a more in-depth look at specific interventions used to address goals with patients and families.”

“I knew at a gut level that music therapy was effective,” Gallagher continues, adding that the current study helped to demonstrate that. Music therapy is an evidence-based profession that provides value-based healthcare to a wide variety of patients, including palliative medicine patients.”

Published: March 01, 2018

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[WEB SITE] How does music therapy work? Brain study sheds light

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Music therapy works, but no one is really sure how. Now, a novel type of brain scan may provide key insight.

man listening to music

Music is a powerful thing. In fact, it forms the basis of a type of therapy, the aptly named “music therapy.”

During sessions, a music therapist attempts to form a bond with their client in order to enhance well-being and improve confidence, communication skills, awareness, and attention.

There are several types of music therapy. Some involve simply listening to relaxing music while talking. Others involve making music with instruments, which can be particularly effective for those who struggle to communicate verbally.

One type, known as the Bonny Method of Guided Imagery and Music (GIM) aims to facilitate discussion. The therapist plays music and asks the client to describe the images that come to mind.

Trials have found benefits to music therapy, but how it works remains unclear.

Using GIM as their focus, a team led by two experts from Anglia Ruskin University, in the United Kingdom — Prof. Jörg Fachner and Clemens Maidhof, Ph.D. — set out to find the answer. Their findings appear in the journal Frontiers in Psychology.

Discovering important moments

The goal of a music therapist is to reach a “moment of change” in which they can strengthen their connection with their client. Therapists and clients often describe feeling in sync, and now there is evidence to prove it.

In the current study, the researchers used hyperscanning — a procedure that can simultaneously record two people’s brain activities — to study a music therapist’s session with a client.

The method, says lead author Prof. Fachner, “can show the tiny, otherwise imperceptible, changes that take place during therapy.”

The therapist and client wore EEG caps to record the electrical signaling in their brains, and the session was filmed. Ultimately, the researchers hoped to learn more about how the individuals interacted.

“Music, used therapeutically, can improve well-being and treat conditions including anxietydepressionautism, and dementia. Music therapists have had to rely on the patient’s response to judge whether this is working, but by using hyperscanning we can see exactly what is happening in the patient’s brain,” says Prof. Fachner.

Once the recordings were complete, the researchers asked the therapist, client, and two other GIM therapy experts to watch the video and each note down three moments of change, as well as one unimportant moment.

A clear connection

The team examined their answers for overlap to see whether any points were of interest to all four participants. A couple of moments fell into this category.

With that knowledge, Prof. Fachner and Maidhof examined the EEG readings from those moments. They paid particular attention to the areas of the brain that process positive and negative emotions.

Surprisingly, they came up with an image that illustrates a moment of change inside the brain.

When the client’s brain switched from negative emotions to positive ones, their EEG recording clearly showcased this. A few moments later, the therapist’s brain showed the exact same pattern.

Both the therapist and client later identified this moment as a point when they felt that the session was working. Not only were their thoughts in sync, but their brain activity, too.

The researchers also noted increased activity in both participants’ visual cortexes during these moments of change.

More effective therapy

It is unlikely that other case studies will provide the exact same results, due to the personalized nature of therapy. But more research will need to go into therapist-client relationships before the synchronicity can be confirmed.

Still, Prof. Fachner described the study as “a milestone in music therapy research.”

Music therapists report experiencing emotional changes and connections during therapy, and we’ve been able to confirm this using data from the brain.”

Prof. Jörg Fachner

He adds that the study has further implications than just proving a point. He explains, “By highlighting the precise points where sessions have worked best, it could be particularly useful when treating patients for whom verbal communication is challenging.”

The findings could also make music therapy more effective by exposing when and how a therapist should intervene for maximum efficacy.

And, as Prof. Fachner notes, studies such as this may “help [researchers] better understand emotional processing in other therapeutic interactions.”

 

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[WEB SITE] Head MRI: Uses, results, and what to expect – Educational

What to know about head and brain MRI scans

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Doctors use MRI scans to diagnose and monitor head injuries and to check for abnormalities in the head or brain.

Magnetic resonance imaging (MRI) scans provide 3-D images of specific body parts. The scan produces highly detailed images from every angle. Depending on the purpose of the scan, a doctor may recommend contrast, which is a substance that a person takes beforehand. It helps the images to be more clearly defined.

An MRI scan is painless and noninvasive. The length of the procedure varies, depending on the situation.

In this article, we take a close look at head MRI scans in adults and children. We discuss their uses, what to expect during a scan, and how a person receives the results.

Purpose and uses of head MRI scans

Man having head and brain MRI

An MRI scan can provide detailed imagery of soft tissue.

MRI scans allow doctors to see what is happening inside the body. These scans do not produce radiation, unlike CT scans and X-rays.

MRI scans use strong magnetic forces and radio waves to create images. They can scan bone, organs, and tissue, which makes them ideal for a complex body part like the head.

MRI scans show a higher level of detail than other imaging techniques, especially in soft tissue. This is important when examining the brain or brain stem for damage or disease.

A doctor may recommend an MRI head scan if they suspect that a person has:

Procedure and what to expect during a head MRI

A head MRI is noninvasive. When a person arrives at the clinic, a doctor or technician will talk them through the process and tell them what to expect.

Preparation

First, a healthcare professional will ask a series of questions about a person’s medical history.

Radiographers also need to know if a woman is pregnant. Doctors tend not to recommend MRI scans during pregnancy, because it is unclear whether the magnetic force can affect fetal development.

They will also ask if a person has any metallic objects, such as piercings, metal plates, watches, or jewelry. These can interfere with the scan, and a person must remove them before entering the scanner.

Other metallic objects that can interfere with a scan include:

  • brain aneurysm clips
  • cochlear implants
  • dental fillings and bridges
  • eye implants
  • metallic fragments in the eyes or blood vessels
  • metal plates, wires, screws, or rods
  • surgical clips or staples

A healthcare team member will usually ask a person to put on a hospital gown. They will store a person’s clothes and any jewelry in a safe locker until the scan is finished.

During the scan

The technician will bring the person into the room that contains the MRI scanner. The person will lie on a sliding trolley, and the technician may cover them with a sheet.

The technician will then position the trolley so that the person’s head and neck are inside the MRI scanner. They will leave the room and speak to the person through a radio.

People should be aware of the following:

  • Pillows or foam blocks on the trolley will keep the head in the right position.
  • MRI machines make a lot of noise, so expect to hear loud hums, knocking sounds, and general electronic noise. Technicians will usually provide headphones or earplugs.
  • People must stay very still inside the scanner to ensure clear, accurate images. If a person moves, they may have to repeat the scan. If someone, such as a person with Parkinson’s, has trouble lying still, a technician may offer restraints to help.
  • Every MRI machine has a call button. If a person feels anxious or wants to stop the procedure, they can press the call button and talk to the medical staff.
  • Most tattoos are safe in an MRI. However, some inks contain traces of metal, which can cause heat or discomfort during a scan. If a person feels any discomfort, they should tell the radiographer.

The medical team may offer anesthetics or sedatives to people who have extreme claustrophobia.

If a person has taken a sedative, they should avoid driving themselves home. Also, a person needs time to recover from an anesthetic at the medical center. In the event of an allergic reaction, the healthcare team will keep the person under observation.

Types of MRI scanner

MRI scanner machine

MRI machines come in a range of sizes.

Several types of scanners can provide a head MRI. The size of the machine will depend on the purpose of the scan and whether the person has claustrophobia.

Types of scanner include:

  • Closed bore. These look like enormous tubes, which a person enters by lying on a sliding bench.
  • Short bore. In this type of machine, the tubular part is shorter, making it less likely to trigger claustrophobia.
  • Wide bore. The opening of the tubular area can be around 70 centimeters in these machines.
  • Open MRI. These come in a variety of shapes. They can have an open side or top.

The narrower the bore, the more detailed the image will be.

Head MRI scans with contrast vs. no contrast

Contrast is a magnetic substance. If a person drinks or receives an injection of contrast before a scan, it can help to improve the image. The majority of MRI scans do not require contrast.

The doctor and radiologist will decide if contrast is necessary, and a person takes it orally or by injection.

Contrast travels to organs and tissue through the bloodstream. The MRI procedure is the same, whether or not it requires contrast.

Contrast makes tissues and organs stand out on the MRI image. This can illuminate early abnormal tissue growth, including tumors. Receiving an early diagnosis can help improve a person’s outlook.

Scans related to the following issues can require contrast:

There is a small chance that a person may have an allergic reaction to contrast materials. Before administering the contrast, a doctor will ask about:

  • allergies
  • current medications
  • medical history
  • recent illnesses or operations

After taking the contrast, a person should check for any side effects. Report any adverse effects to a healthcare provider.

Results

The radiographer will review and interpret the scans. They will then contact the doctor with the results. This can take several days unless it was an emergency scan.

A person can request to see their scans by asking their doctor. The doctor may need a follow-up scan, and they will explain why.

Costs

The costs of an MRI procedure, and how much insurance will cover, varies.

There may also be associated costs, for contrast, anesthesia, and additional procedures.

Speak to the healthcare provider for an accurate estimate.

Head MRI scans in children

Doctor showing child MRI results

A doctor can explain the MRI process to children before undergoing the procedure.

Medical procedures can be scary. It is important for a caregiver to find out the details and explain them to the child beforehand, to reduce any anxiety. Some hospitals have leaflets that help to explain certain procedures.

Head MRI scans for children are almost identical to those for adults. The main difference is the use of a coil.

An MRI coil fits around the child’s head as they lie or sit in the machine because their heads are smaller.

Young children and babies find it hard to stay still for long, and the healthcare provider may recommend an intravenous sedative. The medical team will monitor them throughout the procedure.

Usually, a caregiver stays with the child during the scan. If this is not possible, the caregiver can often wait in the radiographer’s station.

Summary

Head MRI scans are an important tool for diagnosing and monitoring. They can indicate changes in tissue, which is vital in assessing many conditions, particularly those affecting the brain.

Unlike X-rays and CT scans, MRI scans do not involve radiation. They present no risk, apart from triggering certain anxieties or claustrophobia. There are ways to prevent this from happening.

MRI scanners are being improved all the time. With the new generation of scanners, the aim is to cut down scan times and enhance accuracy.

 

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[ARTICLE] Psychological Resilience Is Associated With Participation Outcomes Following Mild to Severe Traumatic Brain Injury – Full Text

Traumatic brain injury (TBI) causes physical and cognitive-behavioral impairments that reduce participation in employment, leisure, and social relationships. Demographic and injury-related factors account for a small proportion of variance in participation post-injury. Personal factors such as resilience may also impact outcomes. This study aimed to examine the association of resilience alongside demographic, injury-related, cognitive, emotional, and family factors with participation following TBI. It was hypothesized that resilience would make an independent contribution to participation outcomes after TBI. Participants included 245 individuals with mild-severe TBI [Mage = 44.41, SDage = 16.09; post traumatic amnesia (PTA) duration M 24.95 days, SD 45.99] who completed the Participation Assessment with Recombined Tools-Objective (PART-O), TBI Quality of Life Resilience scale, Family Assessment Device General Functioning Scale, Rey Auditory Verbal Learning Test, National Adult Reading Test, and Hospital Anxiety and Depression Scale an average 4.63 years post-injury (SD3.02, R 0.5–13). Multiple regression analyses were used to examine predictors of PART-O scores as the participation measure. Variables in the model accounted for a significant 38% of the variability in participation outcomes, F(13, 211) = 9.93, p < 0.05, R2 = 0.38, adjusted R2 = 0.34. Resilience was a significant predictor of higher participation, along with shorter PTA duration, more years since injury, higher education and IQ, and younger age. Mediation analyses revealed depression mediated the relationship between resilience and participation. As greater resilience may protect against depression and enhance participation this may be a focus of intervention.

Introduction

Following traumatic brain injury (TBI), participation in employment, education, leisure, and relationships is often significantly reduced, leaving individuals substantially less integrated in their communities (14). As a result, many individuals spend increased time at home, straining family and other relationships (5). Given that TBI occurs commonly during young adulthood (6), participation deficits coincide with a critical period of development in which individuals are completing education, establishing a vocation, leaving home, and forming important lifelong relationships. Failure to attain these goals may profoundly impact their sense of self, mental health and general well-being. Reduced participation often extends beyond the acute recovery period and continues to be associated with poorer quality of life up to two decades after injury (7). Arguably participation in these life roles, including employment, education, leisure and relationships, represents one of the most important and objective indicators of injury outcomes.

Numerous variables have been associated with participation outcomes post-TBI, including injury-related and demographic variables as well as post-injury environmental and personal factors. Injury severity, cognitive difficulties, and limb injuries with related pain and impact on mood, affect an individual’s ability to engage socially and often present significant barriers to education and employment (816). Injury severity is a particularly well-researched predictor of participation outcomes, with duration of post traumatic amnesia (PTA) having the most robust association (1721). With respect to demographic factors, younger age, higher premorbid education level, higher premorbid IQ, and being employed prior to injury have all been associated with better participation outcomes (102229). Notably, older age at injury has been found to predict both worse participation overall as well as progressively worsening participation over time (10). Although gender does not appear to be directly associated with participation (30), it may have an indirect association, for example through mood and pre-injury education (14). Post-injury psychological functioning, particularly depression and anxiety, are also important predictors of participation outcomes (10123133). The impact of family functioning on participation is thought to be both direct, and through association with emotional well-being (3435).

Due to this broad range of factors influencing outcome, research has moved toward a multivariate approach to prediction of participation outcomes following TBI (24363738). These models contribute to a more comprehensive understanding of participation outcomes; however, the average amount of variance accounted for by predictive models is around 30% (21). This suggests there are additional predictive factors yet to be identified. One such factor that has increasingly gained scholarly recognition, due its positive association with quality of life and well-being outcomes among different clinical populations, is resilience.

Resilience has been conceptualized as a process of adaptation to adversity or the ability to bounce back after trauma or adversity. Resilience arguably influences the extent to which a person is able to resume important life roles after an injury. Resilience may impact participation outcomes directly through facilitating or promoting return to normal life or the development and achievement of new life goals (39), and indirectly through its effects on improved well-being, quality of life and psychological adjustment. Participating in employment, education, leisure, and relationships represent fundamental areas of participation. Resilience has been positively associated with physical and emotional well-being in individuals with cancer (40), Parkinson’s disease (41), diabetes (42), chronic spinal cord injury (43), multiple sclerosis, spina bifida, stroke, and posttraumatic stress disorder (4445). There has been less resilience research in TBI, with only one study to date examining the association between resilience and participation. Notably, it has been suggested that the study of resilience after TBI poses a distinct challenge, in that the skills characteristically associated with resilience are typically impaired after TBI (4547). For example, resilience requires emotional stability, a positive outlook, good problem-solving skills and social perception (47); however, TBI is commonly associated with impaired executive functioning (4849), irritability and aggression (5051), depression (3345), and difficulties with social perception (52).

The little research that has focused on resilience after TBI has been largely limited to patients with mild TBI, in whom no studies have examined impact on participation. In this group, greater resilience has been associated with less reporting of post-concussional and post-traumatic stress symptoms (5355), reduced fatigue, insomnia, stress, and depressive symptoms, as well as better quality of life (56). One study found that greater pre-injury resilience was significantly associated with greater post-concussion symptom severity 1 month post-injury (57), perhaps reflecting insufficient time for participants to “bounce back” (44), or overrating of pre-injury resilience levels, a phenomenon known as the “Good Old Days”(58).

Only three studies have examined resilience in individuals with moderate to severe TBI, of which one examined an association with participation. Marwitz et al. (39), conducted a large (n = 195) longitudinal study and found that resilience was significantly associated with participation over the first 12 months post-injury (39). Other studies have associated higher resilience in individuals with moderate to severe TBI with fewer depressive and anxiety symptoms, better emotional adjustment, use of task oriented coping and greater social support (4445). However, one of these studies used a sample of individuals who were actively seeking help with adjusting to changes post-injury, possibly biasing the sample toward those experiencing greater adjustment problems (45).

The aim of the present study was to examine the relative association of resilience, as well as demographic, injury-related, cognitive, emotional, and family factors with participation (productivity, social relations and leisure) following mild to severe TBI. To the best of our knowledge, this is the first study to examine the association between resilience and participation outcomes more than 12 months after mild to severe TBI. This critically extends previous research by examining the impact of resilience across the spectrum of TBI severity, from mild to severe, and how this association influences outcomes beyond the acute post-injury period. It was hypothesized that resilience would make an independent contribution to participation after TBI, in a model that would include demographic variables (gender, age, pre-morbid IQ, education, pre-injury employment), injury variables (injury severity, cognitive functioning, limb injury, time since injury) and post-injury personal and environmental factors (depression, anxiety, family support).[…]

 

Continue —> Frontiers | Psychological Resilience Is Associated With Participation Outcomes Following Mild to Severe Traumatic Brain Injury | Neurology

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[WEB SITE] Christiana Care Health System opens first Epilepsy Monitoring Unit in Delaware

 

To increase access to advanced neurological care, Christiana Care Health System has opened the first Epilepsy Monitoring Unit (EMU) in the First State.

Specially outfitted private hospital rooms in the Transition Neuro Unit at Christiana Hospital provide state-of-the-art equipment for video and audio monitoring. In the rooms, brain waves are tracked with electroencephalography (EEG) and electrical activity in the heart is recorded with electrocardiography (EKG), helping clinicians understand what is happening during a seizure. To further enhance safety, nurses assist patients whenever they are out of their bed. And patients wear mobility vests that connect to a stationary lift, a system that allows patients to move around a room – and prevents them from falling if they have a seizure. This is one of the few EMUs in the U.S. that uses a patient lift to prevent falls.

Epilepsy is a central nervous system disorder, in which brain activity becomes abnormal, leading to seizures or periods of unusual behavior, sensations or loss of awareness. The U.S. Centers for Disease Control and Prevention report that there are 3.4 million Americans with epilepsy and there is a growing incidence of the disease among the adult population in Delaware, especially among people 60 and older.

“Our community deserves the very best in neurological care,” said Valerie Dechant, M.D., physician leader, Neuroscience Service Line, and medical director, Neurocritical Care and Acute Neurologic Services. “Our new Epilepsy Monitoring Unit will enable us to serve the complex neurologic needs of our adult patients.”

Christiana Care’s EMU is part of a larger effort to establish an epilepsy center of excellence, so adults of any age can receive the highest quality routine and specialty care for seizure disorders.

“We want to help patients who believe they have been over-diagnosed or under-diagnosed so they can see improvement in their lives,” said Neurologist John R. Pollard, M.D., medical director of the new EMU.

While most patients with epilepsy are successfully treated by a general neurologist or epileptologist, a significant number of patients have persistent fainting or seizure episodes – or they have unwanted side effects from medications. This new facility enables physicians to work more closely with these patients to understand their seizures and determine appropriate treatment.

“Typically, these patients visit an EMU where they may stay for several days so they can be safely taken off medications, inducing seizures that are recorded and studied so a proper diagnosis and treatment can be planned,” said Christy L. Poole, RN, BSN CRNI CCRC, a neurosciences program manager. Visiting an EMU to induce a seizure could be a source of anxiety for patients and their families.

“Our staff works with patients and families to reduce any fear by providing information on what to expect, stressing procedures that enhance patient safety and making the stay as pleasant as possible,” said Susan Craig, MSN, RNIII-BC, epilepsy clinical nurse practice coordinator.

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