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Stem Cell Implants May Help Treat Brain Injuries

posted by SK Brain Injury    |   January 16, 2012 12:31

Implanted stem cells have substantially improved cerebral function in animals with brain trauma, but how they did it has remained a mystery. Now an important part of this puzzle has been pieced together by researchers.

In experiments with both lab rats and an apparatus that enabled them to simulate the impact of trauma on human neurons (brain and nerve cells), researchers at the University of Texas Medical Branch at Galveston identified key mechanisms by which implanted human neural stem cells (developing into neurons) help recovery from traumatic axonal injury.

A significant component of traumatic brain injury, traumatic axonal injury involves damage to axons and dendrites, the filaments that extend out from the bodies of the neurons, the Journal of Neurotrauma reports.

The damage continues after the initial trauma, since the axons and dendrites respond to injury by withdrawing back to the bodies of the neurons, according to a Texas statement.

"Axons and dendrites are the basis of neuron-to-neuron communication, and when they are lost, neuron function is lost," said Ping Wu, professor at UTMBG, who led the study.

"In this study, we found that our stem cell transplantation both prevents further axonal injury and promotes axonal regrowth, through a number of previously unknown molecular mechanisms."

Article found on Daily News and Analysis

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U.S. First Lady, Michelle Obama, Announces Brain Injury Initiative

posted by SK Brain Injury    |   January 12, 2012 10:26

First lady Michelle Obama announced Wednesday a commitment by medical schools to increase training of doctors and research of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). The agreement is in conjunction with "Joining Forces," Obama's and Dr. Jill Biden's organization that encourages society's support of military personnel and their families.

More than 100 medical schools from the American Association of Medical Colleges have committed to initiative as well as 25 schools from the American Association of Osteopathic Medicine. The announcement was made at Virginia Commonwealth University in Richmond, VA, where the medical school has been a national leader in TBI research, partnering with Hunter Holmes McGuire VA Medical Center Veterans Affairs Hospital.

"I'm inspired to see our nation's medical schools step up to address this pressing need for our veterans and military families," Obama said. "By directing some of our brightest minds, our most cutting-edge research, and our finest teaching institutions toward our military families, they're ensuring that those who have served our country receive the first-rate care that they have earned." 

"Studies show that as many as 1 in 6 veterans from Iraq and Afghanistan have reported symptoms of PTSD," Obama said. "Since the year 2000, more than 44,000 have suffered at least a moderate grade of TBI."

The Rand Corp. said in a report in 2008 that about 300,000 military service members who have returned from Iraq and Afghanistan report symptoms of post traumatic stress disorder or major depression. The report also states that only about half have sought treatment. The Department of Defense reports that 229,106 military personnel have been diagnosed with TBI since 2000.

"We all must remember in this country, the end of war marks a very long period of transition," Obama said.

Veterans and returning military personnel are asked to make sharp transitions home from combat zones, she said, and although most returning do not suffer from PTSD or TBI, the transition home is when issues and incidents bubble to the surface.

"If you are struggling, please don't be afraid to speak up. If you know someone else is struggling, encourage them to seek help. Asking for help is a sign of strength," Obama said. "It can help fight the stigma of PTSD and other mental health issues, not just for military but for all Americans."

Many military members do not seek treatment for mental and psychological illness because they worry it will harm their careers, the report from the Rand Corp. said. PTSD and depression among military personnel returning from service could cost the nation as much as $6.2 billion in the two years following deployment.

The first lady closed her remarks by encouraging the medical students, doctors, researchers in this new venture and reminding the military they will have support.

"And to all of the troops and veterans we have here, that no matter where you are, no matter what you're going through, please know that America will be there for you and your families," she said.

Article found at WNEM.com

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Gabrielle Giffords TBI Came at a Breakthrough in Brain Medicine

posted by SK Brain Injury    |   January 8, 2012 09:40

When U.S. Rep. Gabrielle Giffords was shot in the head one year ago today, many thought there was little chance she would survive, let alone open her eyes, walk or talk.

But the Arizona congresswoman, who will attend a vigil on Sunday in Tucson to remember the rampage that left six dead and wounded her and 12 others, had determination, abundant resources and, most importantly, a new era in brain medicine on her side.

"We're at an evolution today with traumatic brain injury, much like where doctors were with cancer and heart disease some 40, 50 years ago," said Dr. Geoff Manley, chief of neurotrauma at the University of California San Francisco School of Medicine. "We're just now learning that people like Giffords can not only be treated but can have meaningful recoveries."

Giffords benefited from aggressive approaches to surgery and therapy born out of wars in Iraq and Afghanistan. Military doctors found that soldiers formerly dismissed as the "expectant dead" could recover with the right treatment. That approach, unheard of less than two decades ago, played a key role in Giffords' treatment and recovery.

The world also benefited from Giffords' ordeal. The spotlight on her story brought a greater awareness to a number of areas - the importance of Level 1 trauma centers, the potential of brain trauma therapy, the grueling recovery process, the need for long-term treatment to be more available to most people and the call for more research to take the field out of its infancy.

Hundreds involved

Giffords, 41, can now walk - albeit with a significant limp. She also can talk in broken speech and understand everything said to her. She still has substantial weakness on the right side of her body, a product of being shot through the left side of her brain, but she continues to improve.

Whether she has a political future hinges on her progress.

Giffords' medical journey started in Tucson and continued in Houston and North Carolina. She moved faster than expected through a series of milestones made possible by teams of surgeons, nurses, rehabilitation therapists and other specialists and support staffs.

"You're talking hundreds of people," said Dr. Brent Masel, medical director at the Transitional Learning Center in Galveston and the national spokesman for the Brain Injury Association of America. "It's an enormous project. Repairing a life is an enormous project and it takes a while."

Months of therapy

The recovery process was long and intensive, beginning with emergency responders to the shooting and a Giffords aide who kept pressure on her head wound and held her upright to prevent choking, an act her staff credits with saving her life. She underwent multiple surgical procedures at University Medical Center in Tucson and at Memorial Hermann - The Texas Medical Center. Then she engaged in months of therapy, a process that likely would've been truncated for other patients because of their insurance companies, Masel said.

The materials used to treat and rehabilitate the congresswoman included drills and scalpels used in surgery; a computer-generated synthetic implant that replaced part of her skull; plastic piping, straps and pulleys that helped to increase strength in her weakened right side; and an adapted shopping cart that helped her relearn to walk.

It wasn't cheap. The tab for her therapy alone, which was paid for by her federal employee workers' compensation insurance, has totaled about $1.26 million since she began inpatient and then outpatient work, based on daily cost estimates from the Brain Injury Association of America.

Giffords has acknowledged that most people wouldn't be able to afford such treatment, and her staff has worked with Masel and others to draw more attention to the value of extended therapy for traumatic brain injuries, said her spokesman, Mark Kimble.

A good patient

It is largely a result of her exhaustive regimen of physical, occupational, speech and music therapies, along with her and her family's positive outlook, that has allowed her to progress more quickly than expected in her recovery, said Dr. Gerard Francisco, chief medical officer at TIRR Memorial Hermann, where Giffords has been participating in therapy since Jan. 26.

While Giffords could previously only communicate in short one- or two-word bursts, she is becoming better able to talk in full sentences, said Francisco. He said she has "good days and bad days."

'She's very fortunate'

Giffords is also able to initiate questions and converse, said Dr. Nancy Helm-Estabrooks, a speech specialist who, along with another therapist, worked with the congresswoman at no cost during a two-week intensive program in Asheville, N.C. There, Giffords engaged in a range of activities designed to challenge her to express ideas by speaking, drawing, gesturing and interacting with an iPad and laptop.

The exercises have supplemented her more than 11 months of therapy through TIRR Memorial Hermann to add to her progress, Helm-Estabrooks said.

"This underscores what we've been telling people - that brain injury recovery takes place over long periods of time and have to be supported by the appropriate rehab approach," Francisco said. "She's very fortunate that she has the resources."

Other techniques she gained from were a direct result of increased exposure to brain injuries during the age of improvised explosive devices in Iraq and Afghanistan. Dr. Peter Rhee, Giffords' lead trauma surgeon in Tucson who served as a military surgeon in those countries, led the procedure to remove part of Giffords' skull in the immediate aftermath of the shooting. The procedure, pioneered in the military, relieved pressure on Giffords' swelling brain that could have been fatal. It was among a series of more aggressive approaches to surgery and treatment that have been used with wounded troops and were implemented with the congresswoman. 

Manley acknowledged that treatment of traumatic brain injury still has a long way to go. Giffords has shown that recovery is possible, he noted, but now the field needs to build on the momentum - find better ways to diagnose patients and predict outcomes, produce more data on what works best and when, and pioneer even more cutting-edge treatments.

Tissue regeneration

Memorial Hermann doctors are conducting such cutting-edge research, specifically using stem cells. The research, a Department of Defense - funded trial about to enroll people who have suffered brain injuries, involves the injection of stem cells from the patients' bone marrow. Doctors hope those stem cells can regrow healthy tissue.

"Seeing patients like Gabby is really inspiring us to come up with new treatments - treatments that will return patients to normal, not just recover to a certain extent," said Dr. Dong Kim, Giffords' neurosurgeon at Memorial Hermann. "In the next 10 to 20 years, thanks to therapy that regenerates brain tissue, I think you'll see that."

Article found at chron.com

 

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Hormonal Dysfunction and Brain Injury

posted by SK Brain Injury    |   January 6, 2012 09:38

Over 7 years ago, Dr. Mark L. Gordon began his crusade promoting the relationship between head trauma and the progressive loss of life-promoting hormones. Dr. Gordon began lecturing to physicians at national and international medical conferences, presenting thousands of compelling studies about the causes and effects of traumatic brain injury on quality-of-life issues.       

Dr. Gordon, working with professional boxers, mixed martial artists, retired football players, motocross racers, and now veterans suffering with "Post-Traumatic Stress Disorder," has found the majority are suffering with one or more hormonal insufficiency or deficiencies noting that each had experienced at least a minimal traumatic brain injury (mTBI).

In 2006, after giving a lecture on mTBI, Dr. Gordon was approached by ESPN: Outside the Lines to provide the framework for a program looking at Sports and TBI. On January 21, 2007, Dr. Dan Kelly, a neurosurgeon and expert on TBI, and Dr. Mark Gordon provided the science and clinical aspects of hormonal dysfunction arising out of TBI.

A number of well-known sports celebrities, each with documented TBI and under Dr. Gordon's care, shared their experiences before and after hormone replenishment. 

Whether the trauma was mild, moderate, or severe it still altered the brain's ability to regulate the patient's hormones leading to increased risk of heart attack, stroke, emotional instability, drug and alcohol abuse, depression, anxiety, mood swings, memory loss, fatigue, confusion, amnesia, poor cognition, learning disabilities, decreased communication skills, poor healing, frequent infections, poor fracture healing, poor skin quality, increased body fat, decreased muscle strength and size, infertility, and loss of sex drive.

Also in 2007, Dr. Gordon's book The Clinical Application of Interventional Endocrinology was published, offering medical documentation to support the causes, clinical findings, laboratory testing, specific hormone replacement strategies, and the outcomes for Traumatic Brain Injury associated with hormonal dysfunction.

Recently, Dr. Gordon was featured on the cover of Life Extension Magazine (Jan. 2012) with an interview article on "Using Hormones to Heal Traumatic Brain Injury." In this piece, Dr. Gordon shares his views on how the medical community is presently addressing patients with TBI and presents one of many cases where a young man was being treated with three anti-depressants that did not control his depression. When he was found to be significantly deficient in one of the major hormones, replacement allowed him to be weaned off his traditional medication by his psychiatrist (within 6 months). Two years after the fact, he is living a quality of life that was previously unobtainable.   

This paradigm shift from treating hormonally deficient individuals experiencing both cognitive and behavioral problems with medications that mask the symptoms to a treatment protocol that focuses on replenishing the missing hormone(s) is starting to catch on. The relationship between behavior and hormones is indelibly connected, answering why many of the traditional medications fail.

As indicated in the Life Extension article, Dr. Mark L. Gordon has a grant from Access Medical Laboratories of Jupiter, Florida to provide free hormonal testing to veterans of the Gulf War and Law Enforcement. Again, the consultation and laboratory fees are at no cost to you or anyone for that matter.

Article found at sacbee.com


Read more here: http://www.sacbee.com/2012/01/03/4159326/traumatic-brain-injury-hormonal.html#storylink=cpy

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Helping Soldiers with Brain Injuries

posted by SK Brain Injury    |   December 30, 2011 19:00

Three NATO troops were killed by a roadside bomb in Afghanistan Wednesday. That kind of attack has caused nearly 40 percent of fatalities in Afghanistan and Iraq. It often causes the what's considered the "signature wound" of these wars: brain injuries. CBS News correspondent Clarissa Ward in Afghanistan says the military is taking a new approach.

Getting treated by Capt. Amy Gray can entail playing with dogs, watching movies, even getting massages.

An occupational therapist, Gray heads the concussion care center at Forward Operating Base Fenty where a simple technique is making the world of difference in treating soldiers with mild traumatic brain injury, known as brain sprain.

"I tell them, 'Your mission when you are with me is to sleep, relax and get better,'" she said.

Specialist Nick McKee was inside his base when an insurgent rocket exploded less than 20 feet away from him. He escaped without a scratch but quickly knew something was not right.

"I felt nauseous all that day and pretty much had headaches ever since," he said. "Trouble sleeping mainly. Trying to go on like it didn't happen -- that was probably the hardest part."

Despite incredible developments with blast-resistant vehicles, traumatic brain injury is still the most common injury on the battlefield. In the last 10 years, more than 320,000 servicemen and women have been diagnosed.

Up until recently, mild concussions often went untreated. If soldiers weren't visibly wounded, they kept on fighting, sometimes resulting in serious long-term health issues.

Now the military is rethinking its approach.

"What we found is that if we get them in the first 24 hours, get them down, get them a good night's sleep, their symptoms go away," said Gray.

More than 200 soldiers have passed through here since Gray arrived in May. Almost all have returned to duty within a week.

"I'm sleeping and eating and pretty much just anxious to get out to my guys," said McKee.

Gray: "I go from becoming Capt.Gray to mom and they will literally call me 'mom.'"

Part officer, part mother: Capt. Gray is wholly committed to treating her soldiers.

Article and related video found at cbsnews.com

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Advanced Imaging Assists in Brain Injury Treatment

posted by SK Brain Injury    |   December 12, 2011 16:00

Improvements in the imaging of a human brain during maturation may allow for more effective understanding and treatment of brain injuries incurred during youth and adolescence.
 
Research published in Neuron has examined the structural changes that occur in the brain during development and is the first comprehensive study of coordinated anatomical maturation.
 
The study has highlighted a number of sex specific differences in brain development and found that functionally-connected brain regions often mature together, which could inform treatment strategies in the cause of traumatic injury.
 
Dr Armin Raznahan, from the National Institutes of Mental Health in Bethesda, Maryland, said that developments in this area of imaging have progressed "rather slowly" to date.
 
He said: "We drew from the largest and longest-running longitudinal neuroimaging study of human brain maturation … to analyse patterns of correlated anatomical change across the sensitive developmental window of late childhood, adolescence and early adulthood."
 
Earlier this week, researchers at the Max Planck Florida Institute announced that they had successfully conducted the first realistic 3D reconstruction of a brain circuit, bringing scientists closer to understanding how the brain can be damaged.

News brought to you by Serious Law specialists in brain injury.

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Probiotics Help in Treatment of Brain Injuries

posted by SK Brain Injury    |   December 6, 2011 18:00

Probiotics, added to nutrients supplied through a feeding tube to a patient with a traumatic brain injury, may improve outcomes, Chinese researchers suggest.

Professor Jing-Ci Zhu -- study leader from the Third Military Medical University School of Nursing and colleagues at the North Sichuan Medical College and Hospital in China -- said traumatic brain injury is associated with a profound suppression of a patient's ability to fight infection. Probiotics, found in yogurt and supplements, are live microorganisms thought to be beneficial to the host organism.

Patients often suffer hyper-inflammation due to the brain releasing glucocorticoids in response to the injury, the researchers said.

Suppression of the immune system can be measured by an alteration of helper T-cells (Th) from Th1 -- which stimulate action of macrophages to fight infection -- to Th2. Th2 cells recruit B-cells, which in turn are involved in antibody production.

The switch from Th1 to Th2 leaves patients vulnerable to infections including ventilator-associated pneumonia and sepsis, the researchers said.

In a small scale trial, 52 patients who had suffered traumatic brain injuries and who were being treated in the intensive care unit were either treated as usual or had their nutrition supplemented with probiotics.

The study, published in the journal Critical Care, found those who received the probiotics had increased interferon levels and a reduced number of infections, and spent less time in intensive care.

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Stroke Damage can be Prevented Using Anti-Inflammatory Chemical

posted by SK Brain Injury    |   December 5, 2011 22:51

Drugs that block inflammation in the brain could help patients who have a stroke or a brain haemorrhage, Manchester scientists said today (5 December) at the British Society for Immunology Congress in Liverpool.

Inflammation occurs when a person has a stroke, haemorrhage or trauma. Whilst it is a necessary part of the process to repair the damage to the brain, excessive inflammation causes further damage. Inflammation can be sustained for long periods of time and can contribute to brain degeneration, for example in Alzheimer's, Parkinson's and multiple sclerosis.

A naturally-occurring chemical known as IL-1Ra is used to treat inflammatory conditions such as rheumatism, but until recently scientists thought it could not cross from the blood stream into the brain. However, Professor Nancy Rothwell, a neuroscientist at The University of Manchester, and her colleagues have shown in humans as well as in mice and rats that blocking interleukin 1, the chemical that regulates inflammation, can enter the brain.

“In a series of pharmacokinetic studies, we have looked at what happens to IL-1Ra when it is injected in humans and animals,” said Professor Rothwell. “IL-1Ra is a safe and effective treatment and we now know that it can cross into the brain. Once in the brain, it blocks the interleukin and helps to prevent the long-term damage caused by too much inflammation.”     

IL-1Ra also markedly improves traumatic brain injury in rodents and has shown promise in a Phase II clinical trial in stroke patients.

“The ability of the inflammatory processes to repair, yet cause further damage, is a delicate balance of a cascade of reactions to trauma which we don’t fully understand,” said Professor Rothwell. “However, the results are encouraging, and we are now embarking on trials of IL-Ra in patients who have had a stroke or a brain haemorrhage.”

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Study Suggests, Pine Tree Extract Helpful in Treating Brain Injury Survivors

posted by SK Brain Injury    |   November 22, 2011 15:26

A new study has suggested that using pine tree extract can help facilitate healing in traumatic brain injury (TBI) patients.
Researchers at Auckland University of Technology (AUT) are examining the use of supplements developed from New Zealand pine tree bark. The belief is this extract can possibly aid in improving the cognitive difficulties that often emerge after an individual sustains a TBI.Professor Valery Feigin, Director of AUT’s National Institute for Stroke and Applied Neuroscience, is leading the team of researchers looking at the effects of Enzogenol, which is a Pinus Radiata bark extract, on a group of individuals who sustained a mild traumatic brain injury (mTBI). Enzogenol is the brand name given to the supplements.According to a press release issued today, Fagin said,
“Every day, 90 New Zealanders sustain a brain injury, ranging from mild to severe. Acquired brain injury - including stroke and traumatic brain injury - is the leading cause of disability and death in this country costing our health system an estimated $100 million per year.“Many supplements claim health benefits, however this research is one of very few evidence-based treatments. Until now, there has been a lack of effective medication for mild TBI. Other than brain exercises, there are limited treatments available to improve damage as a result of TBI.”
According to the U.S. Centers for Disease Control and Prevention (CDC), cognitive issues can emerge in the form of concentration problems, attention difficulties, memory problems and/or orientation problems.Cognitive difficulties are not uncommon after suffering a TBI, whether it be a mild, moderate or severe injury. TBI patients often go through cognitive therapy, sometimes for years, after sustaining a brain injury.For the pilot study, researchers tracked 60 individuals who were experiencing cognitive difficulties, for either a six or 12 week period of time. The goal was to investigate the effectiveness of Enzogenol to see if it made any difference in cognitive deficiencies three to 12 months post-injury.Preliminary results suggest an improvement in daily cognitive functioning.Senior Research Fellow Dr Alice Theadom said in the press release,
“The pilot trial has revealed some promising findings for use of the Enzogenol supplement to improve everyday cognitive failures. We’ll now be looking at conducting a full scale clinical trial to determine the effectiveness.”
In New Zealand "brain injuries caused by stroke, motor vehicle crashes, sports injuries, assaults and falls are the leading cause of disability and death." Brain injuries costs about $NZ100 million ($76.07 million) a year, according to the Herald Sun. In the U.S. an estimated 1.7 million people sustain a TBI annually, of which 52,000 die, 275,000 are hospitalized and 80 percent are treated and released from hospital emergency rooms. These figures do not include those who have not sought treatment, or are unaware they have suffered a TBI, as is often the case with concussions and mild head injuries.The results of this pilot study were given at New Zealand's first national conference on stroke and applied neuroscience. The primary researchers hope to conduct a full scale study to determine the effectiveness of using pine tree bark in connection with TBI treatments.


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Behind Sidney Crosby's Comeback

posted by SK Brain Injury    |   November 4, 2011 10:42

 

Ted Carrick is listening to Sidney Crosby’s heart. The NHL superstar is strapped into a computerized rotating chair that has just spun him like a merry-go-round.

It is, as Carrick likes to tell people who visit his lab at Life University near Atlanta, one of only three “whole-body gyroscopes” in the world, and it’s integral to his work as the founding father of “chiropractic neurology.” He uses it to stimulate certain injured and diseased brains.

Crosby, who plays for the Pittsburgh Penguins and has been famously sidelined with a concussion since January, is Carrick’s newest patient, and this day in August is the first time they’ve met. Carrick leans in close, his balding, tanned head looming inches from Crosby’s face, and rests the stethoscope on his chest. “Let’s make sure you’re not dead.”

Carrick then signals to restart the gyroscope—with one difference. This time Crosby will be turned upside-down while he is also spun around. He hasn’t experienced this dual action yet. The door clangs shut. Above it, a stack of red, yellow and green lights shines while 10 high-pitched beeps signal the gyroscope is about to start. Ding! Ding! Ding! Ding! Ding! Ding! Ding! Ding! Ding! Ding!

A low hum floods the room as the gyroscope begins its 20-second “montage” of rotations. With each flip, Crosby grips the black handles flanking his thighs, his face reddens and his jaw clenches. Before long, the gyroscope, called GyroStim, winds down. “Perfect,” Carrick concludes.
—-
Since January, when the hockey world was dealt a blow unlike any other it had ever experienced, fans have made Google searches of “Crosby” and “concussion” move in tandem as they try to make sense of what has happened to their favourite player. The best player since Wayne Gretzky was suddenly knocked out of the game indefinitely because of an invisible injury: no blood on the ice, no cracks on any X-rays and no way to know how bad was the damage done.

Scientists, doctors and equipment makers have used Crosby as a talking point to raise awareness and as a case study in the complexity of concussion. The NHL is embroiled in a polarizing debate over fighting in hockey—how to keep it in, but make it safe? And nervous hockey parents everywhere are reconsidering whether their children should keep playing. How Crosby recovers will help them decide.

Maclean’s obtained exclusive access to the lab where Crosby saw Carrick, and learned about his unique methods of treating brain injuries. While the details of Crosby’s personal health data remain private, over the course of two days, the magazine was granted access to a range of information about the treatments used on patients, including him. During that time in late September and early October, anastonishing assortment of patients came through the clinic. A wealthy businessman and his son. A prominent NFL player. An aging biology teacher who’d had a stroke. A boy with brain damage sustained after a van ran him over. A middle-aged physician who’d lost his ability to talk or walk after a tick bite. In every case, Carrick ran through a version of the same evaluation, exercises and equipment he used on Crosby. “We saw something like nine MDs, neurologists, cardiologists,” says one patient’s relative. “I’ve seen nothing that compares to this.”

The wait list to see Carrick can be as long as three years, though in some cases, such as with Crosby, patients can be expedited. By the time they met in Georgia, the reality of what Crosby could lose if he didn’t get better soon was abundantly and uncomfortably clear: his career, his endorsements, the adoration of an entire nation.

However strange that first day of treatment in the gyroscope was for Crosby, it proved encouraging enough that he continued seeingCarrick for the whole next week. They’d meet as early as seven in the morning, and they’d go as late as six at night, says Carrick, running through a circuit of high-tech equipment and low-tech exercises in the lab and at the local hockey rink. By the time Crosby travelled back to Pittsburgh, Carrick says, “he was better than, you know, super-normal.” The Penguins’ medical team, who have been overseeing Crosby’s recovery, also saw an improvement: they ran computerized tests called IMPACT to compare his current neurocognitive abilities with what they were before the concussion. The results: not quite “super-normal,” but “the best we’ve seen” since Crosby got hurt, as MichaelCollins, a neuropsychologist who has been treating him for months said at the Sept. 7 press conference to update Crosby’s health.

“Carrick had a very prominent role in Sidney’s current recovery status,” Brisson, Crosby’s agent, told Maclean’s. “He progressed extremely well under Carrick.” Just 10 days after the press conference, Crosby joined his teammates on the ice for the first day of training camp. Three-and-a-half weeks after that, Crosby was cleared for contact—the final step before returning to play. Now, after nearly a year of nagging symptoms that have included fogginess, light-headedness and nausea so paralyzing Crosby couldn’t drive or watch TV, and after a slew of setbacks each time he pushed too hard while exercising or skating, the greatest hockey player of this generation is verging on a comeback—perhaps because of a relatively unknown therapy he received at a relatively unknown university from a relatively unknown man who isn’t even a medical doctor.

Come what may, Carrick has set out to do what no amount of time or rest or other expert has managed to accomplish so far: rebuild Sid’s brain.

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