Posts Tagged TBI

[BLOG POST] TBI AND ALCOHOL?

Canva - Assorted Wine Bottles.jpgAccording to MSKTC, “Drinking increases your chances of getting injured again, makes cognitive (thinking) problems worse, and increases your chances of having emotional problems such as depression. In addition, drinking can reduce brain injury recovery.”  Traumatic brain injury (TBI) has many side-effects including cognitive problems, depression, difficulty with balance and alcohol only intensifies these challenges. Alcohol can cause dizziness, staggering and falling, and this is not good for anybody.  In fact, many TBI injuries are alcohol related. Maria Magana recants how she got her TBI by saying, Sadly my TBI was from an alcohol/benzo issue. Yeah I was dumb as hell, but I learned through the hardest way. So I really hate talking to other TBI people about it.”  Alcohol related TBI injuries could be more common than you think. Additionally, accidental alcohol related deaths are not unheard of. Wendy Harris said, “ My uncle was a TBI survivor and he recently passed away bt drinking, falling, ang hitting his head.”  Both the coordination issues that comes with alcohol and the balance issues with TBI, together, can cause a deadly combination.  Furthermore, MSKTC continued by saying, “ says, “Traumatic brain injury puts survivors at risk for developing seizures (epilepsy). Alcohol lowers the seizure threshold and may trigger seizures.”  All of these complications are unnecessary troubles for a TBI survivor to have and we forgot to mention that the majority of TBI survivors are on medications such as muscle relaxers, blood thinners, and seizure medications that more than often counteract with alcohol.  With that said, let’s throw the anti alcohol disclaimer out the window and explore the pros and cons of alcohol consumption post TBI.

“POSITIVE” SIDE EFFECTS OF ALCOHOL

Canva - Clear Drinking Glass With Beer.jpgFor most, an alcoholic drink or two is a nice way to celebrate an occasion or to go with a nice meal. Some actually despise all alcohol – the taste, feeling, and smell.

But those who love alcohol love the sensation of being tipsy, wild, and feeling out of control. The unusual feeling is also encouraged by peers through a form of peer pressure and FOMO (fear of missing out). You’re at a party, and friends are drinking all around you, so why wouldn’t you, too? Roger Osburn, a fellow TBI survivor answred this question by saying, “Alcohol exacerbates my TBI related challenges. I do not drink anymore but sometimes will have a glass of wine, always remembering later why I don’t. It can be challenging socially.”

Canva - Shallow Focus Photography of Clear Cocktail Glass (1).jpgFor people with alcohol addictions, it’s a way to feel “numb,” separate themselves from reality, and to cope with various mental illnesses.  The problem is, individuals with TBI have higher rates of alcohol abuse than their peers, according to NCBI.  Additionally, according to MSKTC, “Up to two-thirds of people with TBI have a history of alcohol abuse or risky drinking.”  Alcohol consumption and TBI are closely related as is TBI and alcoholism.  While recreational alcohol is tolerable for the average person, for a TBI survivor, such behavior is ill-advised.  Below is a testimony given by a TBI survivor who requested to stay anonymous.  With that said, This is only anecdotal experience, and  cannot speak for everybody, and if you would like to share your experience with TBI and alcohol please do so in the comments below.

“Do you want a glass of wine?”  A friend I met in the hospital, Ben, came to visit me at my house with a bottle of wine.  Ben attempted to make a generous greeting by brandishing a bottle of wine however, I was skeptical in taking part of his offering as I am recovering from a traumatic brain injury.  I did not know how alcohol would affect my brain recovery, how alcohol would interfere with my medication, or how alcohol would make me feel. Additionally, I have to get my blood checked regularly, because I am on blood thinners, and I did not know how thin my blood would get by consuming wine. Despite my reluctance, I threw my caution to the wind and I told myself, “I was shot in the head, a glass of wine will not hurt.”  I began sipping the wine and next thing I knew it was time to take my muscle relaxers, this was not good. I took my medication and over the course of the night I took three more doses of TBI related medications which was dangerous, stupid, and made me very sick. For the next week my stomach was torn up, I was exhausted, and both my body and mind felt like it was hit by a dozen semi trucks and I still had therapy eight hours a day, everyday for the next week.  Luckily I am confined to a wheelchair because had I been walking around drunk or buzzed I would be putting myself at risk for a second brain injury.My experience with the wine I drank was so bad that I cut Ben off and told him we could not hang out again.”

Canva - Margarita Glass in Shallow Photo

via TBI AND ALCOHOL? – treatment

, , , , ,

Leave a comment

[QUOTATION] Surviving Head Trauma

Η εικόνα ίσως περιέχει: κείμενο

,

Leave a comment

[VIDEO] Woman with Traumatic Brain Injury (TBI) Improves with Neurofeedback — Even Over 9 Years Later – YouTube

http://www.CenterforBrain.com

April has suffered debilitating symptoms for over nine years since an illness left her with a severe traumatic brain injury (TBI). After just six weeks of neurofeedback, she has experienced significant improvement. This interview with April, her daughter, and Mike Cohen of the Center for Brain Training explores the power neurofeedback can have in people’s lives, even many years after a brain injury occurs.

Neurofeedback, or brain training, can help people suffering repercussions of traumatic brain injury, post-concussive syndrome, and stroke.

A transcript of the video is available below:

A: She is a walking miracle for sure.

Ap: Yes.

A: I mean, even now if you look at her actual MRI or anything, there is so much damage that people thought that she should be a vegetable or something like that by now. So after she got out of the hospital she couldn’t read, she couldn’t write, she had no depth perception. She was very out of it. She didn’t remember our names or anything like that.

M: What are you both seeing change since you’ve been training your brain with the neurofeedback?

Ap: My communication is lot better. My finding direction is a lot better.

A: I think she’s becoming more of herself again. She’s getting some of her personality back. She has always been pretty feisty. She keeps going no matter what happens. She seems to be getting a lot better. She can tell her right from left, which is a big deal. She is becoming a lot more sharp, I guess, mentally. She definitely has a ways to go, but this is improving her for sure. I think that a lot of things are possible with her because, before she got sick, she had so much drive and she was very inventive and creative and never let anything in life stop her. She’s still like that now, but she is really having a hard time putting her thoughts together and being organized, and the sharper her brain gets, I think that she could take that a long way.

M: When I met you, one of the things I noticed, April, was that you were almost like in a fog.

Ap: Yes. I’m much more alert.

M: So you are better able to communicate with other people now?

Ap: Yes, much better. Sometimes I have to hear what they said, and I can hear what they said but I couldn’t process it all. This is very encouraging. It’s amazing how I am seeing the brain come back around.

M: Did any of your doctors ever mention anything like this?

Ap: No.

A: No.

M: Did any of the other therapies ever help your brain like this?

Ap: No.

M: I am just excited for you that your brain seems to be waking up.

Ap: Yes.

M: Is that what it seems like?

Ap: Yes, in so many ways. I mean, I had other things; it’s very interesting, like the taste and the smell. You know, that didn’t really work.

A: Yes she had no taste, no smell for the most part. Even her vision changes all the time. Like when she goes to the doctor, everything is different all the time, so they can never give her glasses or contacts that actually work the whole time, which is really interesting, but it seems like since she has been doing the brain therapy, some of that has been coming back.

M: And you are interested in medical and going to a med school, is that right?

A: Yes, definitely. So the brain is definitely something that I am really interested in now, especially after seeing this, because doctors don’t seem to use this, like you had said, so I would definitely be interested in learning more and seeing how far you can go with it.

, , ,

Leave a comment

[VIDEO] Stages of Brain Injury – YouTube

, , ,

Leave a comment

[BLOG POST] TBI Grief Is A Thief…and Post-TBI Grief Is Rarely Brief

Having something personal stolen from you isn’t just upsetting…it’s offensive, and well…it’s just not fair. That’s how TBI feels to many. Leaving a TBI survivor to start over, the thief (TBI) often leaves no trace. Still, other times there is more than enough evidence.

Talking about grief, versus experiencing grief…or living with grief daily are totally different things. Grief can be an overwhelming sense of loss, a heavy mental weight pressing down on your very soul. After a traumatic brain injury, grief is an understatement. But it’s a place to start a discussion of what grief is, and how it’s different to people that may have been through similar situations.

Finding your way through the grieving process is like navigating without a map (or a GPS) – because there’s no set arrival time, and no itinerary – you just go along at your own pace, feel what you feel, and hope for the best. Nobody wants to hear that! With that being said, here’s an excerpt from a “tip card” by Lash & Associates Publishing titled “Loss, Grief, and Mourning.”

Tips for persons with brain injury to grieve and mourn…

✓ Be gentle with yourself – grieving can be physically, spiritually, and emotionally draining.

✓ Do not diminish how you feel about what has happened and don’t allow others to underrate your loss either. Your loss is real.

✓ Take time to work through your feelings about what has happened and how it affects you.

✓ Recognize that you may have secondary losses (e.g., loss of income, loss of friends, and loss of lifestyle).

 

✓ Recognize that your family is also experiencing grief. They need time to work through their emotions and may do it differently than you do.

✓ Find appropriate and safe ways to express your grief. It is essential to your well-being.

✓ Take time to reflect on who you were before your injury, who you are now, and who you want to be in the future.

✓ Ask for help – you do not need to do this alone.

✓ Keep life in perspective so that grieving and mourning do not totally overwhelm you.

Bereavement, Grieving, and Mourning

They are not the same. These words are used inter­changeably; however, they have different meanings. Dr. Alan Wolfelt, of the Center for Loss and Life Transition in Fort Collins, CO, defines bereavement, grieving, and mourning as follows.

Bereavement is the “call”.

It is the event that causes a loss (death, injury, ending of a relationship, etc.).

Grieving is the “internal response” to loss.

It is how one feels on the inside (sad, angry, confused, afraid, alone, etc.).

Mourning is the “external response” to the loss.

It is how one expresses feelings about the loss (funerals, ceremonies, rituals, talking, writing, etc.).

Primary and secondary losses are also a part of the process, in a “domino effect” of sorts. The initial injury of the TBI survivor is considered the primary loss…the other losses that follow affect the survivor, their family, friends, co-workers, and more. Everyone’s lives are changed.

Also, a whole range of emotions come with these losses, and mourning due to the situation can range from complicated, to extraordinary.

The journey of grief is complex, and acceptance is a big part of getting to the point with your life that you can go forward and find some happiness and reward. Embracing the new isn’t replacing the old…it’s acknowledging the old but moving ahead without it! It would be too easy to say “don’t let it get you down” …and survivors hear that more than they’d like. Although it’s meant as encouragement, many folks just don’t know how to put it into words in a more empathetic way. The point is that they didn’t experience what the TBI survivor did, but they deal with a lot of the aftermath on a daily basis – and they are just trying to build up and encourage the survivor.

In closing, grief is different in every single instance because every injury is different, every survivor is different…and every family is different. The difference is inevitable, but embracing each other’s differences after TBI is the best way to help each other feel included, and a part of the survivor community. Work to accept your differences as well, and you’ll be better prepared to have empathy for what other survivors have overcome too.

If you’d like to purchase the Lash tip card “Loss, Grief and Mourning After Brain Injury, by Janelle Breese Biagioni, you can click this link (price is $1.00 each, and is great to share with others).  https://www.lapublishing.com/loss-grief-mourning-tbi/

 

via TBI Grief Is A Thief…and Post-TBI Grief Is Rarely Brief

, , , , , ,

Leave a comment

[ARTICLE] Follow-up after 5.5 years of treatment with methylphenidate for mental fatigue and cognitive function after a mild traumatic brain injury – Full Text

Objective: Prolonged mental fatigue and cognitive impairments are common after a mild traumatic brain injury (TBI). This sets limits for rehabilitation and for regaining the capacity for work and participation in social life.

Method: This follow-up study, over a period of approximately 5.5 years was designed to evaluate the effect and safety of methylphenidate treatment for mental fatigue after a mild TBI. A comparison was made between those who had continued, and those who had discontinued the treatment. The effect was also evaluated after a four-week treatment break.

Results: Significant improvement in mental fatigue, depression, and anxiety for the group treated with methylphenidate (p < .001) was found, while no significant change was found for the group without methylphenidate. The methylphenidate treatment group also improved their processing speed (p = .008). Withdrawal produced a pronounced and significant deterioration in mental fatigue, depression, and anxiety and a slower processing speed. This indicates that the methylphenidate effect is reversible if discontinued and that continued methylphenidate treatment can be a prerequisite for long-term improvement. The effect was found to be stable and safe over the years.

Conclusion: We suggest methylphenidate to be a possible treatment option for patients with post-TBI symptoms including mental fatigue and cognitive symptoms.

Introduction

Long-term mental fatigue and cognitive impairment are common after a mild, moderate or severe traumatic brain injury (TBI) and these can have a significant impact on work, well-being and quality of life (1). Fatigue and concentration deficits are acknowledged as being one of the most distressing and long-lasting symptoms following mild TBI (1). There is currently no approved treatment (2), although the most widely used research drug for cognitive impairments after TBI is methylphenidate (3). A few studies have used methylphenidate for mental fatigue after TBI with promising results including our own (4,5). Other clinical trials of drugs have reported improvements in mental fatigue ((−)-osu6162 (6)) or none ((−)-osu616, modafinil (79)).

In our feasibility study of methylphenidate (not placebo controlled) we reported decreased mental fatigue, improved processing speed and enhanced well-being with a “normal” dose of methylphenidate compared to no methylphenidate for people suffering from post-traumatic brain injury symptoms (4). We tested methylphenidate in two different dosages and found that the higher dose (20 mg three times/day) had the better effect compared to the lower dose. We also found methylphenidate to be well tolerated by 80% of the participants. Adverse events were reported as mild and the most commonly reported side-effects included restlessness, anxiety, headache, and increased heart rate; no dependence or misuse were detected (10). However, a careful monitoring for adverse effects is needed, as many patients with TBI are sensitive to psychotropic medications (11).

Participants who experienced a positive effect with methylphenidate were allowed to continue the treatment. We have reported the long-term positive effects on mental fatigue and processing speed after 6 months (12) and 2 years (13). No serious adverse events were reported (13)(Figure 1). In a 30-week double-blind-randomized placebo-controlled trial, Zhang et al. reported that methylphenidate decreased mental fatigue and improved cognitive function in the participants who had suffered a TBI. Moreover, social and rehabilitation capacity and well-being were improved (5). Other studies evaluating methylphenidate treatment after TBI have focused only on cognitive function reporting improved cognitive function with faster information processing speed and enhanced working memory and attention span (1421). A single dose of methylphenidate improved cognitive function and brain functionality compared to placebo in participants suffering from post-TBI symptoms (22,23). Most of these have been short-term studies covering a period between 1 day and 6 weeks and included participants suffering from mild or more severe brain injuries.

This clinical follow-up study was designed to evaluate the long-term effect and safety of methylphenidate treatment. We also evaluated the effect after a four-week treatment break and compared the subjective and objective effects with and without methylphenidate. Patients who had discontinued methylphenidate during this long-term study were also included in this follow-up, as it was our intention to compare the long-term effects on mental fatigue in patients with and without methylphenidate treatment.

[…]

 

Continue —->  Follow-up after 5.5 years of treatment with methylphenidate for mental fatigue and cognitive function after a mild traumatic brain injury: Brain Injury: Vol 0, No 0

, , , , ,

Leave a comment

[Infographic] Traumatic Brain Injury

0001

, ,

Leave a comment

[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

, , , , , , , , , , , ,

Leave a comment

[ARTICLE] Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE): A pilot clinical trial for chronic traumatic brain injury – Full Text

Abstract

BACKGROUND:

Virtual reality (VR) technology may provide an effective means to integrate cognitive and functional approaches to TBI rehabilitation. However, little is known about the effectiveness of VR rehabilitation for TBI-related cognitive deficits. In response to these clinical and research gaps, we developed Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE), an intervention designed to improve cognitive performance, driving safety, and neurobehavioral symptoms.

OBJECTIVE:

This pilot clinical trial was conducted to examine feasibility and preliminary efficacy of NeuroDRIVE for rehabilitation of chronic TBI.

METHODS:

Eleven participants who received the intervention were compared to six wait-listed participants on driving abilities, cognitive performance, and neurobehavioral symptoms.

RESULTS:

The NeuroDRIVE intervention was associated with significant improvements in working memory and visual search/selective attention— two cognitive skills that represented a primary focus of the intervention. By comparison, no significant changes were observed in untrained cognitive areas, neurobehavioral symptoms, or driving skills.

CONCLUSIONS:

Results suggest that immersive virtual environments can provide a valuable and engaging means to achieve some cognitive rehabilitation goals, particularly when these goals are closely matched to the VR training exercises. However, additional research is needed to augment our understanding of rehabilitation for driving skills, cognitive performance, and neurobehavioral symptoms in chronic TBI.

1. Introduction

Each year, emergency departments treat approximately 2.5 million traumatic brain injuries (TBIs) (). TBI can affect a wide range of brain systems, resulting in sensorimotor deficits (e.g., coordination, visual perception), cognitive deficits (e.g., memory, attention), emotional dysregulation (e.g., irritability, depression), and somatic symptoms (e.g., headache, fatigue) (). These TBI-related impairments can have significant life consequences. Studies conducted across a wide range of neurological and psychiatric conditions show that neuropsychological abilities are strongly associated with functional skills and employment outcomes (). For example, challenges in attention and concentration could result in distractibility and errors in work settings, and deficits in executive functions could lead to poor organization and problems with setting and achieving occupational goals. As many as 3.2–5.3 million people in the US are living with TBI-related disability ().

Rehabilitation has been shown to improve outcomes for those experiencing chronic effects of TBI (). Previously-validated rehabilitation approaches for TBI include both ‘cognitive’ and ‘functional’ approaches. ‘Cognitive’ methods of rehabilitation are focused on improving performance on individual cognitive tasks, with the hope that these gains will generalize to functional activities (). Restorative cognitive training approaches have been shown to improve cognitive functioning across multiple conditions such as schizophrenia, traumatic brain injury, and normal aging (). Some of the most promising results to date have been demonstrated for training of attention and working memory, which have been shown to correspond to changes in functional brain activity (). Evidence suggests that the format of therapist-guided rehabilitation is able to harness some of the well-established benefits of the therapeutic relationship, and may be preferable to computer-guided training (). While there is some evidence indicating that benefits of cognitive remediation extend to untrained tasks, a number of studies have shown that improvements in performance on individual cognitive tasks tend to generalize very weakly, if at all, to other cognitive tasks and functional abilities (). This weak transfer of training might be attributable to low levels of correspondence between the cognitive and sensorimotor demands of rehabilitation tasks and those encountered during challenging real-world situations.

In contrast to methods of rehabilitation that rely upon generalization of cognitive benefits to functional outcomes, ‘functional’ methods of rehabilitation focus on improving performance on real-life activities through direct practice of those activities (). This approach requires effective targeting of specific functional tasks that are relevant to each patient and may be limited by the physical environments available within the treatment setting (e.g., a simulated home environment used to practice activities of daily living). However, the basic functional tasks that are often emphasized in functional rehabilitation (e.g., self-care, food preparation) may not be sufficiently challenging to address more subtle or ‘higher order’ cognitive and functional deficits that many mild to moderate TBI patients experience in the long-term phase of recovery ().

Virtual reality (VR) technology may provide an effective means to integrate cognitive and functional approaches to TBI rehabilitation (). The guiding concept for VR rehabilitation is to provide an immersive, engaging, and realistic environment in which to practice cognitive, sensorimotor, and functional skills. VR scenarios can simulate a wide range of real or imagined tasks and environments. While VR may not be necessary for tasks that are easily recreated in existing therapy environments, it is particularly well-suited for tasks that are challenging or dangerous to recreate within real-world treatment environments, such as driving an automobile ().

Driving is one of the most universal, cognitively challenging, and potentially-dangerous activities of everyday life. Safe driving requires continuous synchronization of processes like reaction time, visuo-spatial skills, attention, executive function, and planning (). Whereas it would be obviously unsafe to place an impaired patient into many real-world driving situations, VR allows for safe assessment and rehabilitation of driving-relevant skills at the true limits of the individual’s current capabilities. Individuals with TBI are at elevated risk for motor vehicle accidents and other driving difficulties (). Many individuals with severe TBI never return to driving (), and an estimated 63% of those with severe TBI who do return to driving are involved in motor vehicle accidents (). Available evidence suggests that deficits in attention and visual search may underlie these driving impairments. While most of this research has been conducted with moderate-to-severe TBI populations, these issues are not exclusive to severe forms of TBI. Individuals recovering from mild TBI have also been found to exhibit slower detection of driving hazards in simulated driving experiments () and to be at increased risk for real-world motor vehicle accidents ().

Previous results suggest that VR driving rehabilitation can be effective for improving driving skills among those with moderate-to-severe TBI (). However, these findings have not been replicated or validated for those with symptomatic mild TBI. Additionally, little is known about the effectiveness of VR rehabilitation programs for TBI-related cognitive deficits (). In response to these clinical and research gaps, we developed an intervention known as Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE), which was designed to improve cognitive performance and overall driving safety by providing integrated training in these skills. In contrast to intervention approaches that are geared toward more severely impaired individuals, NeuroDRIVE was designed for use with a wide range of TBI patients (i.e., mild, moderate, or severe TBI) who are seeking treatment in these areas and have the capability to engage in the driving process. This pilot clinical trial examined feasibility and preliminary efficacy of NeuroDRIVE for improving VR driving performance, cognitive performance, and symptom outcomes among those with chronic TBI. Given the focus of the intervention, effects on attention and working memory were of particular interest. Additionally, we have provided the NeuroDRIVE treatment manual as a supplementary document to facilitate continued development of VR rehabilitation for those with TBI.

[…]

 

Continue —-> Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE): A pilot clinical trial for chronic traumatic brain injury

An external file that holds a picture, illustration, etc.Object name is nre-44-nre192718-g002.jpg

Fig.2
T3 VR Driving Simulator.

, , , , , , , , , , ,

Leave a comment

[WEB PAGE] Complementary and Alternative Therapies for TBI: Key Points for Clinicians

Long-term treatment protocol for traumatic brain injury patients

Figure. Long-term treatment protocol for traumatic brain injury patients

THE CASE

JM is a 22-year-old student-athlete who reports increased anxiety, difficulty focusing on his studies, trouble falling asleep, and intermittent headache following his second concussion during a recent football game at his college. He saw the team physician immediately after the concussion and was treated appropriately in the acute setting.

For the past week, he has avoided playing football and has been jogging and trying to eat healthily. His primary concern is prevention of chronic traumatic encephalopathy. He has read some frightening reports in the news and is concerned that he may be developing early symptoms.

Long-term management of TBI

Recent data have shown that targeting secondary injury cascades may be an important component in preventing neurotrauma-related neurodegeneration.1 Unfortunately, limited emphasis has been placed on targeting these pathways to prevent disease progression. The primary guidelines deal with acute management of concussion and vastly neglect how to treat patients over the long term. This report focuses on complementary and alternative treatment options for the long-term management of traumatic brain injury (TBI).

Supplements

TBI has been shown to activate endoplasmic reticulum stress, oxidative stress, and neuroinflammation within the brain.2 Endoplasmic and oxidative stress are primary contributors to long-term neuroinflammation, which is an initiator for the development of tauopathy.3

Oral supplements can help mitigate these secondary cascades. Endoplasmic reticulum stress is one of the early contributors immediately after injury. Docosahexaenoic acid (DHA), an omega-3 fatty acid, has been shown to significantly reduce endoplasmic reticulum stress.4 For patients with mild to moderate TBI, daily supplementation with DHA is recommended for 1 year after the initial injury and indefinitely for those with repetitive injury.

Oxidative stress occurs in the subacute period after injury. Lipoic acid has been shown to inhibit oxidative stress and prevent neuronal injury.5 Daily supplementation with lipoic acid is recommended from day 3 post-injury to 6 months after injury. For prevention of neuroinflammation, it is advisable to take vitamin D, vitamin E, and magnesium supplements daily from 2 weeks post-injury to 6 months after injury (Figure). Enzogenol is an emerging agent that may be added in the future to aid in cognitive recovery, but the data are still forthcoming.6

Alternative therapies

Depression and anxiety are common following TBI. Mind-body practices have been shown to be effective for patients with TBI and should be encouraged.7 It is important for patients to keep a daily log of their symptoms and physical functioning. Mind-body practices focus on controlling emotions and thoughts to enhance mental well-being. In addition, these practices can be combined with music therapy, massage, and exercise to improve outcomes.

Exercise should be in the form of sustained cerebrovascular-promoting activity such as running, biking, or swimming. These activities enhance cerebrovascular mechanics, improve clearance of toxic proteins throughout the brain’s glymphatic system, and decrease responsiveness to pain. Sustained cerebrovascular-promoting exercise is the single most important factor to aid in recovery and has been shown to greatly reduce the need for opiates in patients with TBI.8 A cerebrovascular-promoting exercise regimen should be started as soon as patients are clinically stable.

Complementary approaches

Eastern medicine can provide some beneficial options for the long-term management of TBI. Acupressure and acupuncture are helpful for stress management and pain reduction.Yoga has been shown to improve mental functioning.10 The data for tai chi and qi gong are less convincing but warrant further investigation. Mindfulness cognitive-based therapy is the best studied intervention and has a positive effect on self-esteem and mental clarity.11

These complementary approaches should be used as adjuncts to the supplements, not as stand-alone therapies. They should also not replace consistent and sustained cerebrovascular-promoting exercise.

More on TBI complications and the outcome of the case >>

via Complementary and Alternative Therapies for TBI: Key Points for Clinicians | Neurology Times

, , , , ,

Leave a comment

%d bloggers like this: