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Brain Injury and Violence - In progress Research

posted by SK Brain Injury    |   September 12, 2012 13:00

Traumatic Brain Injury and Violence: Reducing the risks, improving the outcomes (CIHR Strategic Teams in Applied Injury Research)

STUDY OVERVIEW

Patients suffer Traumatic Brain Injury (TBI) at seven times the rate of breast cancer and 30 times the rate of HIV/AIDS each year. TBI is responsible for more trauma deaths than injury to any other region of the body, accounting for 50% or more of all trauma deaths in Canada. For severe TBI, immediate medical costs are more than $400,000 at the time of injury. Added post-treatment costs can amount to more than $60,000 each year, with indirect costs 10 times higher. In industrialized countries like Canada and the USA, it is estimated that 2% of the population live with lifelong disabilities resulting from TBI and roughly one in four adults with TBI are unable to return to work one year after injury because of physical or mental disabilities.

In addition to the substantial financial costs of TBI, adverse long-term behavioural and personality changes resulting from TBI may predispose individuals to violent behaviour. Of the more than 100,000 people in Canada admitted to hospital with mild to moderate closed head injury, 85% will have injuries to the frontal or temporal lobes. People with TBI, especially those with frontal brain dysfunction, often develop traits such as disinhibition and impulsivity, display aggressive behaviour and engage in violent acts.

While it is unknown how much violent behaviour is directly linked to TBI, it's possible that a substantial proportion may be linked and, in turn, a substantial proportion of these violent acts result in TBI among victims, thus perpetuating the cycle.

Studies have shown that individuals with disabilities are at a greater risk of violence, abuse, and neglect but very little research has focused specifically on persons with TBI.

OBJECTIVES AND HYPOTHESIS

This research program is intended to improve our understanding of traumatic brain injury (TBI) and its link to violence. It is our hypothesis that vulnerable populations carry the mutual burdens of violence and TBI for which there are shared, modifiable risk factors. The research program will examine the social causes and social, cognitive and behavioural effects of TBI and the reciprocal links between TBI and violence. 

SUBGROUPS

  1. TBI and Vulnerable People: This section aims to identify the links between TBI and violence in various vulnerable populations.
  2. Culture and TBI: The objective of this section is to examine aggression and TBI in sports and assess the influence of culture in promoting violent behaviour.
  3. TBI and Society: The series of studies that form part of this subgroup will investigate community and societal level impacts of TBI and violence in Canada.
  4. Knowledge Translation: The objective of this group of projects is to raise awareness of the risk factors for TBI and violence in vulnerable populations, as well as to develop a variety of interventions in order to influence policy and educate the public.

For more information about the research, and how you can become involved, check out the St. Michael's website.

 

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How does brain injury affect other family members?

posted by SK Brain Injury    |   August 23, 2012 10:00

Brain injured people often experience a change in personality following their injury and this can be difficult for the injured person’s family to adjust to.

On 28th June representatives from Pannone LLP attended the British Association of Brain Injury Case Managers (BABICM) Summer Conference in Bristol. The focus of the conference this year was “Relationships after head injury”, and we were lucky enough to hear from Professor Jeffrey S. Kreutzer who was visiting from Virginia Commonwealth University Medical Center. Professor Kreutzer spoke about “The Impact of Brain Injury on Family Relationships” This talk highlighted common problems experienced by the family of a brain injured person, such as feeling trapped or isolated, feeling that other family members are criticising the care that is given to the brain injured person, and feeling misunderstood. It was emphasised that role changes will inevitably take place in the family when an adult becomes dependant or less responsible, and that the care-giver must ensure they take care of themselves in order to continue giving good care to the brain injured relative.

Professor Kreutzer shared some surprising research findings on the effect that traumatic brain injury (TBI) has on family members, for example, 79% of the wives of someone with TBI identify themselves as suffering from depression, with 32% feeling that they are married to a stranger. (Mauss-Clum & Ryan) The talk highlighted the most frequent problems reported by relatives at 5 years post injury as being violence, temper, irritability, memory problems, slowness and personality change.

Professor Kreutzer went on to outline the Brain Injury Family Intervention Program that he is implementing with his patients and their families. The goals of this program include helping families to better understand how brain injury has affected each member of the family, teaching effective problem solving strategies and communication skills, and identifying progress and personal strengths. Each family member completes a family change questionnaire in order to identify how the brain injury has affected them and their role within the family. Feedback from families was very positive and it certainly seems that this program is an invaluable tool that could also be used to support the families of brain injured individuals in the UK and elsewhere.

Article from Pannone Blog

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Brain Injury Prevention this Spring/Summer

posted by SK Brain Injury    |   March 29, 2012 16:29

With Spring and Summer fast approaching, we are sharing some tips to keep you and your children safe.

PREVENTION is the only known cure for brain injury!

Brain Injury Association of Michigan President shares how to help protect children from harm by following these selected seasonal safety facts from the Brain Injury Association of America’s seasonal brochures:

Spring

  • Bicycle incidents are most likely to occur within five blocks of home. Teach by example. A bicycle helmet is a necessity not an accessory.
  • Baseball has the least amount of safety equipment required of any youth sport. Check that your child’s baseball helmet meets standards of the national Operating Committee on Standards for Athletic Equipment.
  • Falls are the most common cause of playground injuries. Check the surface under playground equipment. Avoid asphalt concrete, grass and soil surfaces. Look for surfaces with shredded mulch, pea gravel, crushed stone and other loose surfaces.
  • Two-thirds of all-terrain vehicle accidents have involved children under 16 years old. Model safe behavior by always wearing helmets with face protection and protective clothing.
  • Brain injuries occur when skaters fall and hit their heads on the pavement. Wear a helmet for protection against falls.
  • Brain injury is the leading cause of death among children hit by cars. Always stop at the curb or edge of the road; never run into the street.

Summer

  • Most children who survive drowning are found within two minutes of being under water; most who die are found after 10 minutes or longer. Always supervise your child around water.
  • Alcohol use is a leading factor in boating incidents and deaths. Stop your child from riding in a boat with anyone who has been drinking alcohol.
  • A bicyclist who is wearing a helmet is less likely to die, be seriously injured or become disabled if hit by a car. Buy a helmet that meets the safety standards of ANSI , Snell or ASTM. Tighten chin strap to keep helmets from slipping forward or backward. Only two fingers should fit under the chin strap Place the helmet directly over the forehead.
  • Screens are designed to keep out bugs, not to keep in children. Install child safety window guards

Link to article

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The Relational Impact of Brain Injury

posted by SK Brain Injury    |   March 16, 2012 09:49

Gabrielle Giffords is on a remarkable journey of recovery -- and her husband is on it with her. In January 2012, she resigned from Congress. But many Americans have been inspired with the courage and determination she has demonstrated during her recovery. Just one year ago, the Congresswoman suffered gunshot wounds to the head and a severe traumatic brain injury as the result of a shooting rampage.

Although Giffords and her husband, astronaut Mark E. Kelly, have spoken about her progress with regard to physical recovery, they have kept private regarding how her brain injury has impacted their personal relationship. With so much emphasis on survival and physical recovery after a brain injury, sometimes the aspects of emotional recovery and strains in personal relationships can be overlooked. According to a recent New York Times article, besides the physical challenges a brain injured person faces, differences in personality and mood can be significant. Sarah Wheaton writing for the Times explained, "Doctors frequently warn uninjured spouses that that the marriage may well be over, that the personality changes that can result from the brain injury may do irreparable harm to the relationship."

Marriage and Traumatic Brain Injuries

Despite these words of caution, many marriages continue after one spouse experiences a traumatic brain injury. Multiple studies have found such couples have divorce rates under the national average. Unfortunately, however, couples may still be unhappy and sticking together out of a sense of obligation or guilt rather than true love.

Psychologist Jeffrey S. Kreutzer from Virginia Commonwealth University explained, "While people may technically be married, the quality of their relationship has been seriously diminished." Dr. Kreutzer is among a group of psychologists pioneering marriage counseling techniques aimed at helping couples cope with brain injury.

Couples are taught communication strategies and encouraged to make time for one another in between doctors' appointments and physical rehabilitation. Additionally, couples need to be reminded to look forward rather than backward, because the relationship will likely never be the same as when they first met. The uninjured spouse often needs to learn how to accept that they may now be in a relationship with a very different person, and the injured spouse needs to accept the changes within himself or herself. This can be challenging for both spouses no matter how much they are focused on cultivating a healthy relationship.

One woman whose husband experienced a traumatic brain injury explained that her husband lost the sparkle she loved and "flat-lined" emotionally. Her husband told her, "I'm not the person you married," and that she was "free to leave." She felt lonely in the role of caregiver rather than wife.

Although there have been setbacks, counseling has helped the couple rebuild their relationship and set appropriate expectations. Hopefully with new attention and research focused on the issue, more couples impacted by brain injury will have similar success.

Article from Digital Journal

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Fighting in Saskatchewan Hockey

posted by SK Brain Injury    |   March 5, 2012 12:32

There were four fights in a recent game between the Saskatoon Contacts and the Beardy’s Blackhawks, midget-league hockey teams composed of 15-, 16- and 17-year-olds. The first two were spontaneous, rising out of collisions. The players struggled chaotically to tear each other’s helmets off and flailed away.

The second two were what are known as appointment fights.

The officials stood back and watched as the players dropped their gloves and approached each other. They bowed their heads, putting their foreheads together. They unfastened each other’s chin straps — removing your own chin strap is prohibited— and took off each other’s helmets. They backed away and nodded. Then, in a flash, they were together again, raining bare-fisted blows on each other, just like the fighters in North America’s professional hockey leagues.

The officials did not intercede until the players, spent, had fallen to the ice.

Josh Uhrich, 16, was the Contacts player in the second fight of the game. He later emerged from the dressing room while the game was still going on with a small nick inside his lip and talked casually with his mother and grandmother in the bleachers.

“It’s not like I want him to fight,” his mother said. “But I knew if he did, I wanted him to do well.”

A growing body of scientific studies has begun to reveal the risk of long-term cognitive damage that can be sustained in hockey. The issue gained attention last year when Derek Boogaard, an N.H.L. enforcer who died in May at 28, was found to have had chronic traumatic encephalopathy, a progressive brain disease caused by repeated blows to the head. The brains of three other former N.H.L. players have been examined posthumously, and all three were found to have the disease.

Even as some youth hockey officials advocate more stringent rules against fighting, it remains a proud tradition in places like Saskatchewan. The children who dream of playing in the N.H.L., and the parents who want to help them make those dreams come true, are convinced that fighting is an integral part of the game.

“You could get hurt falling out of bed,” said Kelly Fiske, the father of Bryce Fiske, a 14-year-old player for the North East Wolfpack, one of the province’s leading bantam teams. “It is what it is.”

‘He Was Chirping Me’

“You get one free fight,” said Ross Hnidy, 15, of the Contacts, a first-place team at the top tier of midget-level hockey. Hnidy was explaining the rules governing fighting at the midget level — one fight per season is allowed, and any fight in the last 10 minutes of a game brings an automatic suspension.

“I fought last game,” Hnidy said. “I hit this guy in the corner and he was chirping me coming out, so I turned around and we just went.”

At the bantam level, players wear cage face masks, and fighting is punishable by ejection and an automatic suspension, so fights are rare and swiftly broken up by officials. The next level is midget. Players still wear cages, and fights are also punished by an automatic ejection. But a player can have one fight without getting a suspension, so scraps, though still rare, do happen.

Next is junior hockey, for 16- through 20-year-olds, with 15-year-olds allowed to play in as many as five games on call-ups from their midget teams. In the second tier of junior, the Saskatchewan Junior Hockey League, a player can fight six times before earning an automatic suspension and a fine for the team, so there are plenty of altercations — about a fight every other game, on average.

But at the top level, the Western Hockey League, the rules are closer to those of the N.H.L., and a player can pretty much fight as much as he likes as long as he limits it to no more than two a game. The W.H.L., known as a haven for tough players, is where Boogaard and many other fighters made their names.

Hnidy was one of three Contacts players called up this season to the W.H.L. As under-age players, they have to wear cages and so were off-limits for fighting. But next season, at 16, the cages come off if they are in the W.H.L.

“Definitely in the W.H.L., I wouldn’t be scared to fight,” Hnidy said. “I go to the gym sometimes, do the punching bag. I do some boxing. I might as well prepare for it.”

On a recent Sunday at their rink in Saskatoon’s southern outskirts, the Contacts were playing the Blackhawks, a team from Duck Lake, 50 miles north. The Blackhawks had Ryan Pilon, a 15-year-old defenseman who is good enough to have played this season in the W.H.L. and for Canada’s youth team. He had not fought since the pee-wee level and was “definitely not” going to take boxing lessons, but he said he was looking forward to fighting in the W.H.L.

“I want to get the first one out of the way,” Pilon said. “I kind of like that side of the game. I hope they don’t cut down on it.”

Question of Respect

Fighting is on the decline, and some in the sport contend the game is changing. Players who serve no purpose other than fighting, commonly known as goons, are disappearing. This season in the N.H.L., the number of fights is down 15 percent compared with last year at this time. The W.H.L., however, still averages about one fight per game — similar to last season’s rate.

Here in Saskatoon, four players on the Blades, the city’s W.H.L. team, have been injured in fights this season. But public opinion appears to be firmly in favor of preserving fighting.

“When you eliminate the opportunity for players to quote-unquote defend themselves, there’s significantly more stickwork, significantly more bullying or verbal abuse, where a player knows if he does something he can get that other player out of the game,” said Kelly McClintock, who as general manager of the Saskatchewan Hockey Association is in charge of amateur hockey in the province.

Like most fathers of players on the Wolfpack and other teams, he played in an era when there was less protective gear.

“I’m 50,” McClintock said. “It was only in my last year of minor hockey that you had to wear a full face mask. Till that point, I was never called as many names as I was in that year. People feel pretty brave behind a face mask. The year before, if someone called you something, you’d punch him in the face. I believe there was a lot more respect in the game back then than there is today.”

McClintock said he enforces the strict antifighting rules at the bantam level. But he said he would like to remove face masks at that level.

“Put the half-visor on,” he said. “Now all of a sudden you’re not as brave, and there’s a lot more respect in the game.”

Things Are ‘Different’

The Wolfpack’s players come from throughout northern Saskatchewan, but the team is based at the Northern Lights Palace in Melfort, a city of 5,000 located 100 miles northeast of Saskatoon.

Across the street from the Palace is the city’s old arena, where Boogaard, at age 15 and playing for another Melfort team, became enraged and went into the opposing team’s bench, throwing punches. The outburst impressed scouts from the W.H.L.’s Regina Pats, who moved to add Boogaard to their roster.

“Things are a lot different now,” said Darren Seaman, the Wolfpack’s coach.

Seaman, whose son Caleb is a top prospect on the team, has had a no-fighting rule in place all season.

“When you fight in bantam hockey, it’s a glorified wrestling match,” Darren Seaman said. “In bantam, with the masks on, don’t waste my time. You’re going to get a suspension no matter what if you throw a punch, so why go? Not like in the W.H.L., where they touch their heads together and take off each other’s helmets. That’s a scrap.”

Still, Seaman considers himself old school. He played junior hockey in Saskatchewan, and an older son, Tyrel, is a center with the Brandon Wheat Kings of the W.H.L. and is expected to go in the first three rounds of the next N.H.L. entry draft.

Despite his no-fighting rule, Seaman said that for older age groups, fighting is needed to govern hockey. “If you take it right out, it’ll change the game,” he said.

Bryce Fiske, a smallish defenseman on the Wolfpack, said he had no problem with fighting.

“It doesn’t really scare me — I’ve done it a couple times this year and I did it once last year,” he said. He was suspended twice this season.

Fiske is an example of the commitment young players make to hockey. He lives in La Ronge, an isolated community a three-hour drive north of Melfort, which makes going to practice twice a week difficult. Since he was 9 months old, his family has housed players for La Ronge’s junior team. Next season he will play on a top-tier midget team in Tisdale, 25 miles east of Melfort. He will board with a family there.

“To me he’s not the average 14-year-old boy — he’s very passionate, very committed,” his mother, Tracy, said. Was she worried about him fighting if he made it to the W.H.L.?

“You don’t want him to ever get hurt, but I worry more because he’s 14 and he’s going to move from home,” she said. “But when it does happen, you hope that he can take care of himself. You hope he doesn’t get hurt, and that he doesn’t hurt anybody else.”

Seeking Character

The Wolfpack recently played in Warman, a town of subdivisions just outside Saskatoon. Scouts from nearly a dozen W.H.L. teams were at the rink to see the top prospects and interview them and their parents.

“I drove a thousand miles to get here,” said Colin Alexander, director of player personnel for the Seattle Thunderbirds, as he wrote down players’ names and numbers on a clipboard.

Dale McMullin, director of scouting for the Regina Pats, was asked about Fiske.

“You’re talking about a character player,” McMullin said. “He’s got battle. He’s a hard-nosed kid.”

If another young player emerged with Boogaard’s skill set — a fighter with little scoring ability — would he be snapped up?

“Society has changed in the last 20 years,” Alexander said.

Another Regina scout, Graham Newton, said W.H.L. scouts were no longer looking for pure enforcers.

“You look for the compete level, and you look for the player who is fearless, too,” Newton said. “The terminology is throwing snow — if someone is coming to hit you, you stop short and throw snow. I’m looking for the player who can accept the body check, who has a little pushback, who shows he’ll stand up for his teammate. Not necessarily someone who’ll drop the mitts, but you look for the toughness, the fearless play — that’s what you want in a real hockey player.”

The Wolfpack lost, 4-0, to the Sask Valley Vipers. Before the players got back into their shirts and ties and headed to their chartered bus for the ride to their Saskatoon motel, McMullin, Alexander and other scouts talked to them and their parents. Would their sons be willing to go to Seattle, Victoria, Kelowna and other far-flung locales to play in the W.H.L.?

The answer was always yes.

Few players were thinking about American collegiate hockey, where there is no fighting.

Part of the Game

Tristan Elder, a tall and thin 14-year-old, is one of Fiske’s teammates and a top player for the Wolfpack. He lives near Kinistino, a town of 700 with little more than a grain elevator and a gas station, just like many other towns spread far apart along the two-lane prairie highway. Visitors often miss the gravel turnoff that leads to Elder’s house, so his father drives to the road in his pickup with the flashers on to show the way.

Elder has been playing hockey since he was 3. If he continues to progress, in about a year and a half he will probably join a club in the W.H.L.

“This is what we worked for our whole life,” said his father, Derek. “We’ve always been trying to get to the next level, playing summer hockey, driving to tournaments in Edmonton, Calgary, Fargo.”

If Tristan Elder must fight when he reaches the W.H.L., he will be ready.

“Definitely we’ve been talking about fighting,” Derek Elder said. “Tristan’s a left-hander. It’s an advantage because if you grab the guy’s right arm with your right arm, you’re swinging with your left and you’ve got his dominant arm.”

Derek Elder played junior B in Saskatchewan in the late 1970s. Unlike his son, a wing who grinds in the corners and scores a fair number of goals, Derek was a defenseman.

“I was the mean one,” he said. “I used to fight lots as a kid, whether it was on the ice or off the ice.”

Now he says he will help his son prepare for what is inevitable if he makes the W.H.L.

“I’ve got a good buddy that I played a little bit of rec hockey with — he was drafted into the W.H.L. for fighting, basically, and he told me that he would help out with Tristan a little bit with the fighting part of it — balance, some pointers,” Derek said.

“I’ve been thinking that in the summer it wouldn’t hurt to put him into boxing, how to block, where to strike, know those striking spots ...,” Derek added.

His son finished his sentence: “So you can take the guy down.”

Article from the New York Times

 

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NASCAR and Head Injuries

posted by SK Brain Injury    |   February 22, 2012 17:26

If Michael Waltrip were to count up all the concussions he has sustained over a NASCAR career that stretches back nearly 30 years, he'd certainly hit 10 — and probably keep going.

Safety measures since Dale Earnhardt's death in 2001 have gone a long way toward preventing head injuries, and NASCAR officials have taken steps to improve the way they identify and treat concussions. But Waltrip knows that won't undo all those hits he took in the 1980s and '90s.

"I whacked my head — a lot," Waltrip said. "If you think about this, I showed up in '85, when it was relatively 'safe.' We thought we had it figured out. I raced all the way through 2001 when people were getting killed. And all through that time, I was hitting my head and knocking myself out and getting concussions and going to the hospital. And I don't know what that means to me in 10 years. But I know it's a concern."


The 48-year-old Waltrip gets uneasy when he hears stories about NFL players and other athletes who are having serious neurological problems after they retire, issues that a growing amount of research indicates may have been caused by repetitive brain injuries they sustained during their playing days.

Could that happen to him, too?

"I would be the perfect case study to see what's going to happen," Waltrip said. "Because I can go back and look at the races and count up times I was knocked unconscious that I can't count on both hands."

Five-time NASCAR champion Jimmie Johnson says he has had two concussions racing stock cars, and probably many more racing dirt bikes when he was younger.

"We're not immune to concussions," Johnson said. "And certainly after severe concussions or being concussed several times, the numbers change. We know that. The dynamic is there. I think we've reduced the opportunity for it to happen, but ultimately, it can happen. I just think the odds are a lot better today than they've ever been."

Earnhardt's death in the 2001 Daytona 500 — which came after drivers Kenny Irwin, Adam Petty and Tony Roper all were killed from similar head injuries — forced NASCAR to get serious about safety.

Today, drivers must wear a head and neck restraint, while impact-absorbing SAFER barriers have been installed on racetrack walls and NASCAR completely redesigned race cars to reduce the risk of injury. Racing seats used to look a lot like passenger car seats; now they look more like something out of a spaceship, with foam-padded supports on each side of the helmet that barely allows a driver's head to move during a crash.

It's working. Going into Sunday's Daytona 500, there hasn't been a death in NASCAR's top three national series since Earnhardt's.

"If I'm Kasey Kahne or Kyle Busch, I don't have those concerns any more," Waltrip said. "We've got the cars and the tracks, we've got it all fixed. You can still get hurt. You're running 200 miles an hour. But the chances of getting hurt are slimmer. The chances of hitting your head and hurting it are really slim."

NASCAR officials say they've identified 29 concussions in their top three series since 2004 — and only 11 of those happened in the past five seasons.

"Not huge numbers, when you see it," said Steve O'Donnell, NASCAR's senior vice president of racing operations. "But with each of those, each one's different, we've had to assess each one differently. Knock on wood, we haven't had as many to have to deal with."

And while there have been some drivers who experienced long-term effects from traumatic head injuries over the years — including Bobby Allison, Ernie Irvan, Jerry Nadeau and Steve Park — O'Donnell says NASCAR doesn't see any evidence of widespread health issues related to multiple head injuries, as the NFL and other sports are.

"There's always concerns for any driver that's been in the sport," O'Donnell said. "But in terms of drivers formally approaching us and saying, 'Hey, I want to talk about this or look at it,' we haven't seen that occur, in terms of what you're seeing in other sports right now. We'd certainly be open to working with anyone, if we see that, in helping to stop any trend that we saw."

In response to reports of football players, hockey players and other athletes having serious neurological issues in retirement, researchers at the Boston-based Sports Legacy Institute have studied brain tissue of deceased former athletes. They've found evidence of a degenerative brain disease known as Chronic Traumatic Encephalopathy that has been linked to repetitive brain injuries.

O'Donnell said NASCAR officials have noticed.

"Absolutely," O'Donnell said. "It's something we pay attention to on any aspect of other sports, what they're doing. Can we learn from it? Can we implement some of these things? We're open to working with any other sport as well."

For now, veteran driver Jeff Burton is trying to gather as much information as he can about the long-term effects of concussions. Burton's father-in-law is a physician and has attended sports medicine conferences on his behalf.

"I think anybody that has any sense at all has to understand that it doesn't matter if you're playing football or hockey or racing a car, head injuries can have bad ramifications later in life," Burton said. "It appears to be the case. I think we are exposed to less of it. But at the same time, when we do have them, they can be big hits."

The 44-year-old Burton started racing in NASCAR's top division in 1993, well before the post-Earnhardt safety advances.

"I can tell you that in retrospect, there's been many times that I've had concussions," Burton said. "And the definition of concussion is a very widely used term, and how you actually define a concussion has changed over the years. But there's no question that with hitting concrete, not having (today's safety equipment), there's no question people had concussions. No question."

Waltrip said he blacked out after an accident in practice at Las Vegas in 1998, but kept it to himself.

"Hit the wall, got in the backup car, made a couple laps, went to the hotel, woke up the next morning, didn't even know how I got there," Waltrip said. "You could just fake people out back then. 'Yeah, I'm fine, I'm fine.' They didn't care. 'OK, you're fine.'"

Today, any driver involved in a significant accident must visit the infield medical center, where checking for signs of a concussion is standard procedure. If there's reason to suspect a concussion, the driver will be sent to a local hospital. From there, the driver will need to be cleared by a neurosurgeon with at least five years' experience in sports-related head injuries before he or she can race again.

"They always ask you," Burton said. "The key to that, though, is honesty. Unless it's obvious. Sometimes you can tell. But a lot of times, in football and in every sport, people say, 'I'm fine.' It's hard if you don't tell them the truth to help you."

Burton acknowledged that drivers, along with athletes in other sports, have an incentive to hide symptoms.

"There's fear in not being able to do what you want to do," Burton said. "NASCAR's always been really good saying, 'Look, we don't want to keep you from racing unless it's in your best interests.' They've been pretty good about that. People are always nervous, I think, in any sport to stand up and say I'm having these issues, because they want to race or they want to play. But if NASCAR doesn't want you to race, then you probably shouldn't be racing."

Article found at the Tahlequan Daily Press

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Link Between Brain Injury and Addiction Studied

posted by SK Brain Injury    |   February 16, 2012 11:10

When Dr. Gabor Mate began to investigate the medical literature about brain injury and addictions, he was expecting to find addictions could develop after acquiring a brain injury, but he discovered the opposite was true.

The reality is many people who end up with a brain injury have substance abuse issues already, he said.

"Brain injuries happen mostly to young men and they tend to have a history of substance abuse. When you look at the literature you'll find drug use tends to predate the injury," he said.

Mate will be presenting his research findings today at the 22nd Pacific Brain Injury Conference, which continues Friday at the Sheraton Vancouver Wall Centre.

"It means [some] people ending up with traumatic brain injuries tend to have pre-existing addictions. With that understanding we need to look at the childhood risk factors in a preventive sense. There's a lot more we can do to prevent brain injuries by looking at the kids who are at risk because of family circumstances, learning disabilities, behavioural manifestations, emotional dysfunction. This can be intervened in a positive way if we had a preventive system in place," he said.

But Mate said the kids who are most likely to engage in risky behaviour are either not identified early enough or simply being told drinking or drug use is bad, which isn't an effective deterrent.

Mate added there have also been studies showing a high percentage of incarcerated individuals have suffered a brain injury. He pointed out an American expert on trauma once reported "people with childhood trauma, abuse and neglect make up almost the entire justice population in the U.S." An Australian study in 2006 found 82 per cent of prisoners inter-viewed had suffered a traumatic brain injury, he added.

Given the evidence, Mate said the federal government's plan to increase penalties for drug possession as part of its tough-on-crime legislation is the wrong approach to dealing with sub-stance abuse.

"The government's drive is to build more prisons. We're jailing people who were traumatized as children instead of providing rehabilitation," said Mate.

Other US studies have shown incarceration rates of brain injured people vary from 78 per cent in Ohio to 86 per cent in Tacoma, Wash., said John Simpson, of the Fraser Valley Brain Injury Association.

Simpson has been visiting prisons in B.C. since 1991 offering support to inmates and providing in-service training for staff on how to recognize signs of brain injury.

"It's the same here in Canada. The men I've met and interviewed are truly the walking wounded. The vast majority have no visible signs of a brain injury. They look perfectly normal on the outside but only when you begin talking to them you see some have speech difficulties, behavioural or cognitive problems," said Simpson.

Unfortunately, many go unidentified in prison and are seen as having behavioural problems when the root cause is a brain injury and no rehabilitation is offered, he said.

Simpson also agreed more prisons are not the answer.

"You don't need bigger and better prisons. You need bigger and better programs in the community."

The Fraser Valley Brain Injury Association is beginning a new support group for inmates with a brain injury at Mission Institution in the coming weeks. Simpson said it used to have a very active program there but two of the inmates who were key members of the group moved to a minimum security prison. He added both of those men had suffered brain injuries as youths when they were both severely beaten by step-fathers. One also had been involved in a car crash and another suffered a concussion in sports.

Article from The Vancouver Sun


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Brain Injury in US Prisoners

posted by SK Brain Injury    |   February 8, 2012 10:17

A car accident, a rough tackle, an unexpected tumble. The number of ways to bang up the brain are almost as numerous as the people who sustain these injuries. And only recently has it become clear just how damaging a seemingly minor knock can be. Traumatic brain injury (TBI) is no longer just a condition acknowledged in military personnel or football players and other professional athletes. Each year some 1.7 million civilians will suffer an injury that disrupts the function of their brains, qualifying it as a TBI.

About 8.5 percent of U.S. non-incarcerated adults have a history of TBI, and about 2 percent of the greater population is currently suffering from some sort of disability because of their injury.

In prisons, however, approximately 60 percent of adults have had at least one TBI—and even higher prevalence has been reported in some systems. These injuries, which can alter behavior, emotion and impulse control, can keep prisoners behind bars longer and increases the odds they will end up there again. Although the majority of people who suffer a TBI will not end up in the criminal justice system, each one who does costs states an average of $29,000 a year.

With more than two million people in the U.S. currently locked up—and millions more lingering in the justice system on probation or supervision—the widespread issue of TBI in prison populations is starting to gain wider attention.

A few pioneering programs offering rehabilitation to prisoners—and education to families and correctional staff about TBI—are underway around the country. And several studies aim to ascertain the best ways to handle this huge population. "It's not as cut-and-dry as a lot of people think," says Elisabeth Pickelsimer, an associate professor at the Medical University of South Carolina. Some of the best options so far include cognitive therapy for prisoners and education for the people around them.

The kicker seems clear to many researchers: "If we don't help individuals specifically who have significant brain injuries that have impacted their criminal behavior, then we're missing an opportunity to short-circuit a cycle," says Peter Klinkhammer, associate director of services at the Brain Injury Association of Minnesota.

One hard knock 

Concussions are the most common type of brain injury, and about 85 percent of people who suffer one will more or less fully recover within a year. But for those who do not, lingering symptoms, such as headaches or increased irritability, can get in the way of everyday functioning.

Many of the behavioral issues that result from a TBI are due to the nature of the impact itself. In an accident or altercation, the brunt of the blow is often borne by the front or top of the head—right around the frontal lobes where behavior is regulated.

 

Interactive by Ryan Reid 

This sort of injury can be loosely compared with a computer glitch: "If something went wrong with the central processing unit, it might be slower—you couldn't save documents as easily—but it might chug along," says Wayne Gordon, a professor of rehabilitation medicine at Mount Sinai School of Medicine. Traumatic brain injury can lead to attentional and memory deficits as well as increased anger, impulsivity and irritability—which make for a poor match with the corrections world.

One of the big challenges in addressing TBI in prison populations, and beyond, is that it is not as easy to diagnose as a broken bone or a blood-borne illness. Symptoms are by no means unique to the injury and can be co-occurring with other mental health conditions. To make things even tougher for those hoping to track the disability, no two brain injuries are alike. "Two people can have the same injury and have a totally different set of impairments," Gordon says. "One can be fine, and one can be not so fine—but we don't know why that is yet." He suggests that differential responses could be due to a combination of physical, genetic, contextual and social factors, such as skull thickness, the magnitude of g-forces involved in the impact or past history of more minor, sub-concussive injuries.

Due in part to these variables, not all TBIs result in a medical paper trail. Doctors treating people with serious wounds might miss diagnosing a brain injury, and hospitals do not always code for every presenting condition. Also, many people who suffer a head injury, especially a milder one, such as a concussion, might not seek medical attention at all.

Researchers have started using detailed interviews with prisoners to get a better sense of how many have suffered from a brain injury. In a recent South Carolina survey of 636 prisoners, some 65 percent of males and 73 percent of females reported having sustained TBIs at some point in their lives. Injury counts are likely underestimated. Many people, for example, are unaware of injuries that they might have sustained when they were babies or young children. And even adulthood injuries were not entirely clear to prisoners. "They were told they had their bell rung—they got knocked out," says Rebecca Desrocher, assistant program director at the U.S. Department of Health and Human Services's Federal Traumatic Brain Injury Program.

The very nature of brain injuries can also make tracking them—and figuring out how many an individual might have suffered—especially difficult. As Pickelsimer points out, "after you've had some, you don't remember them as clearly." These injuries are additive, with each assault to the brain compounding damage from the previous ones. The average reported number of TBIs for an individual prisoner was about four, Pickelsimer says. And some reported up to a dozen.

Through these interviews, Pickelsimer says, another thing became clear: prisoners were often not aware that a single event—or a series of them—could be making it harder for them to earn a ticket out of jail, or avoid being sent back in the future.

Bad behavior 

As much as TBI seems to increase the likelihood that a person will wind up in prison, it also seems to make the corrections environment that much more difficult to navigate. In prison, "there's so much that goes on a day-to-day basis: 'Line up over here; do this; do that,'" says David Maltman, a policy analyst at the Washington State Developmental Disabilities Council. When a prisoner with TBI is misremembering rules or is slow in responding to instruction, many prison staff are likely to see a prisoner as noncompliant or intentionally defiant, provoking situations that can lead to further injury—or at least poorer chances at an early release.

Brian injury also increases the likelihood that people will have other mental health troubles, including substance abuse, and can also make it more difficult to overcome additional conditions. In a survey of adults enrolled in a New York State substance abuse program, about half had a record of TBI, Gordon says. The screening that Pickelsimer and her colleagues have done in South Carolina found that for both men and women, alcohol and crack cocaine were among the most common substances to which TBI prisoners were addicted. And these habits can cloud a person's memory of brain injuries they might have suffered in accidents, altercations or other incidents, which makes accurate diagnosis even more challenging. For those getting substance abuse treatment, a TBI can also make traditional rehab programs less effective. With the "reduced processing speed and their memory challenges," Gordon says, lessons might need to be altered or even repeated for enrolled prisoners with a history of TBI.

The behavioral and other cognitive changes that TBI can bring, "if left unaddressed, are apt to provide challenges to the offender post-release as they attempt to reintegrate into their respective communities," notes Adam Piccolino, a neuropsychologist for the Minnesota Department of Corrections.

Bridge to the outside

Treating TBI in the broad adult population is not a perfect science. The goal is to "supply them with skills they need to better regulate their behavior and process information," Gordon explains. It often involves cognitive retraining and rehabilitation—and has imperfect results. And as he points out, these therapies have yet to be thoroughly tested on incarcerated populations.

Others argue that tools that seem to work in the broader population should be used in prisons as well. Cognitive rehabilitation therapy is one such tool that seems to be gaining traction in the TBI field. It aims to help those TBI sufferers make better-informed choices and to improve memory. And with such minimal knowledge about TBI and its symptoms, simply educating inmates about their—and others'—condition might go a long way in helping them cope with related challenges, Desrocher says.

Even with proper education and therapy, though, people with TBI will often experience behavioral issues. So many groups have put an emphasis on training staff—and even arresting officers—to handle these sorts of prisoners better in hopes that they "can recognize a behavior for what it is—and not defiance of an infraction of the rules," Maltman says. Resulting altercations can put law and corrections staff—and fellow prisoners—at risk for injury.

But knowing which prisoners might benefit from alternative approaches requires thorough screening processes that are either highly variable across institutions or entirely absent. "Additionally," Piccolino notes, "once an offender is identified with having incurred a TBI, the process of knowing whether they also experience ongoing complications related to their TBI is challenging."

Some organizations, such as the Brain Injury Association of Minnesota, have gone a step further and are also working with prisoners' family members, probation officers and outside support services to ready ex-convicts for release. Klinkhammer notes that for prisoners with TBI, returning to the outside world can be an extremely difficult transition. Once predictable prison routines disappear, he explains, it's almost like Dorothy going from her black-and-white reality in Kansas to the colorized world in Oz. Although that shift might sound like a blessing, for those with a brain injury who have difficulty managing their reactions or processing a lot of incoming information quickly, the new environment can be too much. "It can be very overwhelming, and it could result in one or more reason for a person to 'recidivize'"— do something that will land them back in jail, even if they had no intention of breaking the law— Klinkhammer says.

Much of his group's efforts come down to education and helping family and other community members learn how to support a prisoner with TBI returning to the outside world. And oftentimes just explaining to them that an old injury might be contributing to unpredictable behavior is a big help. "People know that their loved one's been knocked out" or were in a car accident years before, Klinkhammer says. "But the thought that the outcome of that may result in disinhibition or that it could be an aggravating factor to a person's criminal behavior gets lost."

The group does not yet have formal data on the success of the program, but from his observations, Klinkhammer says, "individuals are doing better when they are able to dovetail back into society in a way that they're supported." The key is "making sure that when people step out into the community they're not falling into an abyss," he says. And "in doing that, we're also helping society at large stay safer."

Earlier intervention

Once a person with TBI is behind bars, arguing for a chunk of shrinking budgets to help them out is not always an easy sell. In South Carolina, for example, once a person is identified as having TBI, the department of corrections is obligated to provide extra resources for them. "It's cheaper for them to just lock them up," Pickelsimer says.

In her estimation, "the intervention has to be when they are much younger"—before they commit a crime, by encouraging teenagers to stay in school and not have children until they are prepared to provide and care for them. By doing that, she says, the next generation will be less likely to fall into a cycle of injury and crime.

Gordon would extend this early intervention to screening, too. In his research on TBI in substance abusers, participants who had multiple brain injuries tended to be in their 30s. But, he says, "the average age when they had their first injury was 14." If their injury had been identified—and they had received any necessary assistance—earlier, future substance abuse and behavioral issues might have been avoided altogether. This, he says, is an example of "using screening and identification as prevention—and what you're preventing is social failure." That social failure due to TBI is not limited to the corrections world, he notes: "In any group of folks who are failing—substance abuse, the hardcore unemployed—I would say, the prevalence of TBI is very high." Early diagnosis does not necessarily require expensive intervention, he says.

Treatment for those already in trouble can also start younger. An experimental program in El Paso, Texas, adapted a TBI cognitive treatment program for juvenile offenders. The goal was "to try to teach them how to be in touch with their own sensations and activities so they can learn to stop and think before they act—and then consciously choose a choice and evaluate whether that was the right choice," Gordon explains. When administered to kids—both those who had a history of TBI and those who did not—there was a fivefold reduction in recidivism, he reports.

The Traumatic Brain Injury Act of 1996 carried provisions to help reduce the incidence of TBI and improve psychological treatment, and in 2000 it was expanded to include education about prevention—especially to parents. A 2008 reauthorization of the act added a mandate to study TBI prevalence among institutionalized populations, which includes prisons but also nursing homes and other institutions where people reside. But studies have been slow to materialize. Minnesota is currently assessing data from their prison population to determine how much TBI affects substance abuse treatment completion, use of medical and mental health resources, and rates of recidivism.

One of the first steps to better understanding TBI in these populations, however, is to boost screening—as well as ensure that such monitoring is scientifically sound and widespread. And just demonstrating the value of screening might take years, Desrocher says. Her hope is that down the road, the data show that it is "not only [of] clinical value for the individual—but also a value for society."

Article from the Huffington Post

 

 

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A School in Cleveland will be Studying Brain Injury

posted by SK Brain Injury    |   February 6, 2012 10:48

Two competitive Ohio medical research institutions are teaming up at a new lab to study head and spinal injuries that occur in sports and combat.

The Cleveland Clinic and Case Western Reserve University will jointly run the Cleveland Traumatic Neuromechanics Consortium, working to learn more about the causes of head and neck injuries and to create better protection and treatment, The Plain Dealer reported Saturday.

“There are many more questions than answers” about brain injuries, said mechanical engineer Adam Bartsch, who leads the Clinic’s Head, Neck and Spine Research Laboratory. One of those questions is what level of force or number of repeated impacts causes temporary or permanent brain damage. There’s concern that injuries like concussions can cause lasting damage.

The lab will search for answers with specialized equipment, including an air-powered ram that will be used to test football helmets on replica human heads by mimicking certain impacts, such as a straight-line hit or an oblique, head-spinning blow from an aggressive NFL linebacker barreling into a quarterback, which some researchers suspect may be even more damaging.

Developing sensors for the test heads and simulations of how a brain reacts might help the researchers better understand what causes concussions, and that could pave the way for better rules or safety standards and improved helmets and other protective gear.

“There are things that can be done to the helmet that would be helpful in basically absorbing energy and protecting the head,” said Case Western mechanical and aerospace engineering professor Vikas Prakash, who has worked on creating better protective gear for military personnel and vehicles. “Engineering-wise, it’s very rich.”

Prakash and Bartsch, who are co-directing the joint research effort, unpacked the air-powered ram – known as a linear impacter – this week. Later they plan to add high-speed cameras and a ballistic air gun. That would allow them to study the type of brain injuries caused by roadside bombs through simulations of the shock-wave effects.

The number of concussions from sports and battlefield service has drawn attention to brain injury care in recent years. The Centers for Disease Control and Prevention reports athletic activities lead to nearly 4 million concussions a year. A study by the nonprofit Rand Corp. determined at least 320,000 U.S. troops that served in Iraq and Afghanistan during the past decade suffered probable concussions, the newspaper said.

Bartsch and Prakash said they will pursue funding for their research from government grants, private donors and organizations such as the National Football League and the Department of Defense.

Article from the Claims Journal

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Brain Injury Effects on Children: Larger than Experts First Thought

posted by SK Brain Injury    |   January 24, 2012 11:15

Young children who suffer a severe head blow may not overcome the traumatic brain injury (TBI) as well as previously believed, and interventions may be needed even years after, according to two new studies out of Australia.

For the first study, Australian researchers looked at 56 children, 40 of whom were injured between ages 2 and 7 and the other 16 who served as a control group. They found that a decade after each of the 40 suffered a TBI, evidence persisted of intellectual deficits. The study is published this week in the journal Pediatrics online and will be included in February's issue.

They looked at the intellectual, adaptive and executive abilities of the children, as well as their social/behavioral skills. Those with severe TBI tested lowest on IQ exams compared to a control group — as much as 18 to 26 points lower. They also found that regardless of how serious the injury was, recovery "seemed to plateau in the five- to 10-year range," the researchers said.

A release announcing the findings noted that "this is important because it counters the theory that children 'grow into the deficits' and suggests that even many years post-TBI, intervention may be necessary and helpful."

Most of the children in this study were injured by car accidents or a serious fall. They were tested at the time of their injury, then tested again three, six and 18 months after the injury, as well as again at five years and 10 years.

The findings apply to major brain trauma, not to cases of mild concussion or bumps on the head.

"Most of the deficits occurred in higher learning skills such as organization, planning and reasoning, because these are centered in the frontal regions of the brain, which are most often affected in head injuries," wrote Alice Park on a blog for Time magazine.

"These regions are also the ones that develop fastest early in life, so any injury that disrupts the normal trajectory of nerve growth can have long-lasting effects," said lead author Vicki Anderson, director of critical care and neuroscience research at Murdoch Children's Research Institute in Melbourne, Australia. Scientists have long talked about the brain's plasticity and its remarkable ability to reroute signals when something injures the brain. Some researchers believe that injuries to very young children are more apt to be overcome for that very reason than brain injuries in older children and adults. But Anderson noted that young children's brains are not fully developed and, after injury, development lags and may not catch up. "If you look at the trajectory of improvement over time, normal kids have one trajectory, while those with brain injuries have the same trajectory but start out at a much lower point," Anderson told Time.

The study did note a positive: Brain development after a traumatic brain injury does not appear to grind to a halt, as some had theorized.

The other study, also published in Pediatrics this week, found that socioeconomic status might be an even stronger predictor of intellectual development than simply having suffered a traumatic injury to the brain. They told CNN that lower socioeconomic status, high parental stress and low parental involvement affect a child's recovery after TBI and that might account for it.

Article from Deseret News

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