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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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Studies Show a Higher Risk of Brain Injury in Preemies

posted by SK Brain Injury    |   November 19, 2011 12:02

Scientists say they are beginning to understand why brain injuries are so common in very premature infants — and they are coming up with strategies to prevent or repair these injuries.

The advances could eventually help reduce the number of premature babies who develop cerebral palsy, epilepsy or behavioral disorders such as ADHD, researchers told the Society for Neuroscience meeting in Washington, D.C., this week.

Each year more than 60,000 babies are born weighing less than 3.3 pounds. And because of advances in neonatal medicine over the past several decades, most of those babies will survive. But researchers have had less success finding ways to prevent brain damage in these infants.

"That means that overall rates of cerebral palsy and other neurodevelopmental disabilities are on the rise," says David Rowitch, chief of neonatology at the University of California, San Francisco.

The most common cause of brain injury in premature infants is a lack of oxygen in the days and weeks after birth, Rowitch says. The lack of oxygen damages white matter, which provides the "communication highways" that carry messages around the brain and to distant parts of the body, he says.


And the babies at greatest risk of this sort of brain damage are those born after as little as six months of gestation, Rowitch says.

"Such a baby would weigh about a pound and would fit into the palm of your hand," he says. "As you can imagine, they're very fragile and vulnerable to stresses."

Those stresses often include periods when an infant's immature lungs are not delivering enough oxygen to the brain, even with help from a mechanical breathing device.

This lack of oxygen appears to damage the most common type of white matter, myelin, which acts like an insulator around the nerve fibers that carry messages in the brain and nervous system. Without enough myelin, short circuits can prevent these messages from getting through, Rowitch says.

He initially found evidence of white matter damage by studying brains from premature infants who died. But since then, he's been able to assess premature infants using a special incubator designed to fit in an MRI scanner.

"We've been able to now take over 250 babies who are very preterm to the MRI scanner safely to show that this is a feasible way to detect white matter injury early on," he says.

Now the question is how to prevent or repair that sort of injury.

Some studies show that it's important to act right away, says Vittorio Gallo from Children's National Medical Center in Washington, D.C.

"There is a very critical developmental time window right after birth," Gallo says. "If development is disturbed during this critical time window then the brain doesn't catch up."

Gallo is part of a team of scientists who have shown that it is possible to intervene — at least in mice. One approach involves giving the mice a drug that speeds up production of myelin, he says.

"We do this intervention right after the injury," he says. "And we found that by targeting specific targets we can recover and regenerate at least part of these cells right after the injury, during that critical developmental time window."

Any drug for people is still years off, Gallo says

But other scientists at the meeting say there are promising treatments available now. These include everything from the magnetic stimulation of certain areas of the brain to temporarily lowering the body temperature of premature infants to protect brain tissue.

And if any of the approaches work, the benefits are likely to extend far beyond infants, says Mark Goldberg of UT Southwestern Medical Center in Dallas.

"This white matter injury happens in perinatal brain injury. It happens in multiple sclerosis. It happens in traumatic brain and spinal cord injury. It happens in stroke," Goldberg says. "So we hope very much that the kind of therapeutic directions that work in one system can be applied directly to another system, another disease."


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Brain Injury Takes Toll Well After Playing is Over

posted by SK Brain Injury    |   October 18, 2011 17:02

Recently, I watched with interest as CBC’s “The National” ran an incredibly informative documentary on how physical contact in hockey is affecting the brain function of players long after they retire from the game.
Rick Martin, Bob Probert and Reggie Fleming were just some of the players in a study of brain injuries conducted by a Boston medical facility.

Following their deaths, the brains of all three men were donated to the facility, allowing doctors to study the head injuries the three had suffered during their playing days. In each case, those injuries strongly influenced their personalities and daily lives long after their days on the ice were over. In some cases, the early stages of dementia had set in.

Over the course of the past four years, the Boston facility has begun to receive more and more donations of brain material from deceased athletes and their families, all eager to know more about how concussions might have altered their personalities.

As a result, researchers have made quantum leaps in terms of understanding how brain tissue is altered by playing sports such as hockey, football and even professional wrestling.

As I watched the documentary, names flashed through my mind of men who played hockey at a physical level few of us can even imagine. Top of the list was Kevin Maguire, who surrendered to no opponent while playing with the Orillia Travelways in the 1980s, and who went on to play in the National Hockey League with Buffalo and Toronto.
His fights with Probert and others are almost legendary. Ironically, Maguire later returned to the NHL to work as a referee for approximately six seasons.

Closer to home, Ryan Crowther found his career in the Ontario Hockey League cut short by concussions following what seemed like a promising start with the Belleville Bulls.

Any number of players with professional connections have moved in and out of the region, some leaving with more battle scars than others. Andre Benoit, Chris Kontos, Dave Latta, Jason Lafreniere, Tony Hrkac, Guy Jacobs, Ernie Hall, Doug Kirton, Rick Ley, John French, Brett Parnham, Daryl Bat, Dave Wrigley, Claire Alexander and so many more. Thankfully, most of them escaped serious injury on the ice and still lead normal lives today.

But the world of sports often takes a toll, both emotionally and physically. And, as the Boston research lab has shown, the side effects linger long after the equipment comes off.

Part of the reason we are having a discussion about brain injuries and concussions now is because of the lengthy absence of Sidney Crosby from the Pittsburgh Penguins lineup.

His concussion has made him the poster boy for the issue, leading to ramped-up commentary on whether the NHL has become too violent.

I’ve said it before, but it is worth repeating. Barring a change of mindset by the NHL brass, I predict a player will die on the ice in the middle of a live broadcast sometime in the next two seasons. And then everyone will be in the midst of soul searching.

It’s not like we haven’t been warned about this before. It has now been determined Bill Masterson was dealing with a head injury leading up to the 1968 incident in which he died after striking his head on the ice while playing with the Minnesota North Stars.

Almost overnight, players began wearing helmets, but the Oakland Seals-North Stars contest was not a game broadcast live across North America.

Had it been a Toronto-Montreal contest in today’s hockey environment, the outcry would have been heard coast to coast.

I pray we never hear it, but, from where I stand, it’s only a matter of time before tragedy strikes.
Then watch the finger pointing begin.


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NHL Great, Rick Martin, Diagnosed with Degenerative Disease

posted by SK Brain Injury    |   October 10, 2011 21:05

Boston University researchers have found a degenerative disease linked to head trauma in the brain tissue of the late NHL great Rick Martin, the first 50-goal scorer for the Buffalo Sabres and a member of their famed French Connection line.

Martin, who died in March of hypertensive heart disease at age 59, becomes the third former NHL player found by researchers to have had chronic traumatic encephalopathy (CTE) — a disease that causes cognitive decline, behavioural abnormalities and ultimately dementia.

After his death, Martin's family donated his brain to the Centre for the Study of Traumatic Encephalopathy, a collaboration between Boston University Medical School and the Sports Legacy Institute.

All three former NHL players who agreed to have their brains studied post-mortem at the centre — Martin, Bob Probert and Reggie Fleming — have now been shown to have had CTE, but Martin is the first who did not play an enforcer role and regularly participate in on-ice fights, the centre says.

Neurosurgeon Robert Cantu, who co-founded the institute and is co-director of the CTE centre, told CBC News the findings in Martin's case are alarming because he only suffered perhaps one concussion in his career, unrelated to fighting.

"What I can tell you bothers me: The first two cases in the National Hockey League, Reggie Fleming and Bob Probert [were] renowned fighters, 400 recognized fights during their ice hockey career, God knows how many in bars," Cantu told CBC's Stephanie Jenzer in an documentary airing Wednesday on The National, in which CBC News was granted rare access to the brain centre's lab.

"And so the amount of brain trauma they took from fighting was horrendous. And it could be thought logically that their CTE is related to their fighting. And indeed it possibly is.

"But when we look at this most recent case of Mr. Martin, that's a problem because he wasn't a fighter, he'd only had perhaps one concussion. And so we've got to be concerned that the jostling of the brain just from the skills of the sport of playing in the National Hockey League led to him having chronic traumatic encephalopathy when he died."

Star's head struck ice

Born in Verdun, Que., Martin was an NHL star in the 1970s with 384 goals and 317 assists for 701 points in 685 games, all but a handful with the Sabres.

During his time in Buffalo, Martin combined with fellow French Canadians Gilbert Perreault and René Robert to give Buffalo the top line in the league for a time, and they helped lead the Sabres to the 1975 Stanley Cup final in just the franchise's fifth year of existence.  

Martin was remembered as much for his goal-scoring abilities as a frightening incident in 1978, when he was hooked from behind and his helmet-less head struck the ice. He was knocked unconscious and went into convulsions on the ice before being carried off on a stretcher.

Martin was back the next season with a helmet, as were many other players on his team.

Over the years, Martin adopted Buffalo as his home, and died there in March when his heart failed while he was driving.

Chris Nowinski, a co-founder and president of the Sports Legacy Institute, tracked down Martin's widow after his death, not long after the brain lab made the results of former NHLer Bob Probert's CTE case public.

"Mrs. Martin said Rick would have wanted people to learn from him," Nowinski, the only Harvard graduate to wrestle at the WWE, is widely credited with putting the concussion issue on the map, told CBC News. "If other hockey players could be safer by studying his brain then he would have been all for it."

The centre's researchers said Martin's disease was relatively mild and suggested he was resilient to the disorder and less susceptible to its severity than some of the other athletes whose brains they've studied.

'No question' Martin would have developed dementia

Martin only had stage 2 disease at 59 years old, and by that age most cases in the centre's brain bank have advanced to stage 3 or 4.

But Nowinski said had Martin lived longer, the disease would have progressed.

"Who knows how quickly and who knows how badly, but he would have eventually developed dementia had he lived long enough," Nowinski said. "No question."

 Dr. Ann McKee, the brain centre's co-director who diagnosed the two previous former NHLers Probert and Fleming with CTE after their deaths, said it is unlikely that Martin's disease was triggered by just the 1978 on-ice incident.

"I'm going to imagine that there were many other more trivial blows to the head," she told CBC News chief correspondent Peter Mansbridge in an interview.

"He didn’t play with a helmet for most of his years. So any blow to the head may have been a contributing factor."

Ex-players hope brain study gives answers

There is growing concern about players suffering head trauma and struggling with physical and mental health issues later, especially amid this summer's tragic off-season for the NHL, which saw the deaths of three NHL enforcers: Derek Boogaard, Rick Rypien and Wade Belak.

Cantu and his team have examined Boogaard's brain but the results are not yet public.

Keith Primeau and Ryan VandenBussche, two former players forced out of the game because of traumatic brain injury, have agreed to have their brains donated to the centre for study after their deaths.

Both skilled and physical on the ice, Primeau never shied from aggressive play, even as the concussion tally mounted.

Six years on from his last concussion, Primeau still only counts the number of days he doesn't suffer from the effects of the brain injury — dizziness, headaches and torment that can come with depression — in days and weeks.

 "I have periods where I feel much better and I enjoy them while they last, but I have the ability to regress and show symptoms again," Primeau said at a hockey tournament, where he was coaching one of his kids.

"You become very emotionally volatile. People around you take the brunt of it, so that is sad. So it is almost a domino effect of emotions, and nothing you can really do or are capable of stemming it other than ride it out."

Looking back on his career, Primeau said it was one of his four documented concussions — he believes he suffered "north of 10" in his career — which should have been the wakeup call. On May 2000, a devastating hit at centre ice sent him to the hospital. But 48 hours later, Primeau was back for another game.

"For me, probably, I would reflect that as being the beginning of the demise," he said. "I grew up with the mentality that you get out there at all costs. You play through injury and you play through pain, and I was no different."

VandenBussche told CBC News he first brought up the idea of donating his brain to the centre with Probert, his former roommate.

"I remember chatting to him that I was going to donate my brain and we both agreed that's what we were going to do," he said. "Why wouldn't you?"

A fellow tough guy of the league who famously ended the career of Nick Kypreos with a knockout punch, VandenBussche said he tried to conceal several of the more than a dozen concussions he suffered during his playing days, first to avoid being considered concussion-prone, then later just to stay in the NHL.

"I hid every one of them that I possibly could hide," he said.

Concussions and other injuries ended his career in 2007. His body battered, today he's almost constantly in pain. But VandenBussche never imagined that a few years later, his friend would be dead and his brain might be used to help solve the concussion riddle.

"I believe I don't know the facts," he said. "I wanna be able to see it. I mean I hear a lot of stuff but whether or not you believe it, you have to go figure it out yourself. I am sure it has got some sort of correlation to that. There is no doubt about it if you take repeated blows to the head, there is going to be some sort of effects later on down the road. So I just don't know to what degree."



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