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Life is Hard on Social Assistance

posted by SK Brain Injury    |   September 27, 2011 10:28

SBIA and SACL are both members of the Disability Income Support Coalition (DISC) which is committed to advocating for a respectful, dignified and adequate income support system for all people with disabilities in Saskatchewan.

ARTICLE

I came into work a couple of years ago for a midnight shift, and the colleague I was replacing dryly said that among our residents that night was a man who had been eviscerated and just got out of the hospital.

The resident — I’ll call him John — casually told me that someone had broken into his apartment and was looking to steal some organs. I asked him, “Do you owe someone money or drugs?”

John immediately panicked and said, “How do you know? Who told you?”

Mine was a lucky guess. I don’t know what is and what isn’t in his life story (the one about organ theft definitely wasn’t true). According to him, he had been on his own since he was 11 and started using hard drugs when he was 13.

He had significant mental health problems, which could have been a result of the drug abuse. He suffered from fetal alcohol spectrum disorder, or FASD, and schizophrenia. I don’t know if it was the FASD or the drug use that stunted his emotional or cognitive development, but I always felt John was less capable and less mature than my son, who was eight years old at the time.

There is a road to recovery available. John later took rehabilitation for the drug issues. He was on medication for the mental health problems. I am sure he could get counselling for the psychological issues, but he still will remain an eight-year-old inside, unemployable and with serious health concerns.

So what do we do with men and women who are like him? They are left to fend for themselves in some jurisdictions, but in Saskatchewan we have a safety net in terms of health care and the Ministry of Social Services.

Most of us are familiar with health care, but life on social assistance for a single person is tough. It starts with $459 a month for rent and, if you are disabled, you can qualify for the Disability Rental Housing Supplement that provides another $262 toward rent. The total $721 is not that bad — until you try to find a suite for that price.

The accommodation also has to be close to supports, so even if you find a suitable apartment, you may not qualify. Many find themselves paying a portion of their rent from the $255 they get to live on. Very quickly that living allowance becomes $150 to make it through the month.

It’s been 15 years since I lived alone, and even then $100 didn’t get me that much in groceries. Even living on a nutritionally challenged diet of Kraft Dinner, Pizza Pops, Kraft Dinner Spirals, and Three Cheese Kraft Dinner I was spending more than that on food.

The next option is the Saskatoon Food Bank. It just completed its Food Basket Challenge, which invited noted Saskatoon residents to live on a typical basket of food for a week. The participants’ comments were all interesting, but I noted how many struggled with the discipline of having to live on the amount of food that was given out.

Of course, in a oneweek challenge, a lack of discipline means that you just cheated yourself. If they were in that situation permanently, it means that they or their children go without food later in the week. For those on social assistance, it’s week after month of rationing, going hungry, walking down to the Friendship Inn, stopping by the Bridge on 20th, and heading to the Salvation Army looking for enough food to make it.

On top of that, the money you get is supposed to cover laundry, clothes and other essentials. As Sharon Brown, one of the Salvation Army’s budget management workers told me, “You can make it if you make no mistakes.”

That’s easier said than done, even in my own life. Recent studies have shown that most of us have a finite amount of self-discipline. To use most of that on just obtaining and rationing food changes the rest of one’s life.

I know that it’s hard to set social assistance rates. Too high and it provides a disincentive to work and people flood in from all over. Yet you make it too low, and even providing food and basic needs become a struggle.

Over the years I have listened to politicians talk about indexing social assistance to inflation. Not a bad idea, but here is mine. In the process of reviewing rates, have the minister of Social Services live on the money he or she judges to be appropriate. If the minister can’t do it and function, why expect others to do it?

 If it helps, I’ll do it as well. Together we’ll find out how hard it is to live on social assistance rates.

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The Invisible Scars from Bombings

posted by SK Brain Injury    |   September 25, 2011 18:31

TROOPS in Afghanistan are suffering invisible wounds from bomb blasts that can leave them with brain damage, depression and post-traumatic stress.

The injury - caused by the pressure wave from a bomb explosion that leaves no visible external wound - accounts for about 12 per cent of all wounds inflicted on Australian troops in Afghanistan.

Mild traumatic brain injury - MTBI - is expected to rise as Australia suffers its share of what has been described in the US as a brain damage epidemic. While numbers are down this year, the Australian Defence Force expects they will rise as new tests, including one used on concussed AFL players, make it easier to detect.

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Two soldiers were diagnosed with the injury this month after being hit by roadside bomb blasts four times in five weeks. They sought help only after the delayed onset of symptoms, which can include memory loss, headaches, a loss of balance, an inability to think clearly, irritability, mood swings and depression.

Concerned at the long-term impact on serving soldiers and discharged veterans, Australian and US military medical experts will meet at a conference on the injury in Canberra next month. The ADF has introduced compulsory testing of all soldiers involved in bomb blasts and is considering adopting the US practice of removing soldiers from combat if they have been in three bombings.

More than 200,000 US soldiers have been diagnosed with traumatic brain injury, ranging from concussion to serious brain damage. While most recover quickly, studies show up to 15 per cent could suffer long-term effects, including symptoms similar to post-traumatic stress.

Of the 192 Australians wounded in Afghanistan, 24 have been diagnosed with MTBI. Another three suffered the injury in Iraq.

Brain injury is described as the ''signature wound'' of the Iraq and Afghanistan wars. It is caused by the insurgents' weapon of choice - homemade bombs called improvised explosive devices.

Bombs have killed 14 of the 29 Australians lost in Afghanistan, and were behind about half of the injuries.

Despite its name, experts say the effects of MTBI are not always mild.

'''Mild' means the guy is still walking around talking, but the brain might have been significantly affected by the injury,'' Melbourne neurosurgeon Jeffrey Rosenfeld, a brigadier in the Army Reserve, said.

He and the psychiatrist Nick Ford, an Army Reserve major, sounded the alarm in an army journal in 2008, when soldiers suffering MTBI were often diagnosed as having a psychiatric condition.

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Treating Brain Injuries with Poetry

posted by SK Brain Injury    |   September 25, 2011 18:28

It was the morning of Feb. 14, 2005, and Angela Hunt walked down the sidewalk heading to the staff door of the Chaska Library, where she is a librarian.

“I was due at 9:45 a.m. to open,” said Hunt, a Carver resident. “I caught my toe on a brick and tripped. The snow was falling and swirling. It was that dry kind of snow. I don’t remember hitting the ground. I do remember though that I saw a gas engine pickup truck heading down the street toward me right before I tripped. But when I got up, I saw it was an idling diesel-engine truck. I remember thinking that was odd.”

Hunt picked herself up. Her glasses were broken, and her ribs hurt. When she entered the library, she noticed that another li-brary employee had already gotten everything — the computers and equipment — up and running.

“I felt a little shook up,” Hunt said. She’d also skinned her knee badly, but attended to it, and then went on with her day.

It was one month later, when Hunt was opening the library, that she realized she didn’t know how to start up the computer.

“I didn’t recognize the people I worked with, or the patrons I know,” Hunt said. “I couldn’t read. I recognized Janet [Karius, the assistant library director] but I couldn’t say her name. Then a friend of mine came into the library, took a look at me and said, ‘She needs to go to emergency.”

OUT COLD

Doctors did X-rays and an MRI. The scans revealed that Hunt had suffered a traumatic brain injury when she tripped and fell in February. She’d been knocked unconscious.

“I have no memory of the fall,” Hunt said. “I do remember that when I picked myself up that morning, there was all this snow covering me. I had thought that was odd at the time. The doctors think I was probably knocked out for 20 minutes.

“And no one saw me lying there,” Hunt said, “because I had my white coat on and a white beret. It was snowing and I blended right in.”

Falling face first, she’d broken her nose, “crushing my sinuses like an accordion,” she said.

And being knocked unconscious explained why the gas pickup truck she’d noticed turned into a diesel truck seemingly in the next instant.

“The doctors said that I had such good coping skills and was so high functioning, it took a month before the brain injury became apparent,” Hunt said. “The brain just continues to function until it stops. I had cracked the bone by my eye, and injured my frontal lobe in a closed head injury. Right after the fall, I had noticed my nose was sore but all the pieces [of that morning] didn’t come together until they did the MRI.”

STARTING OVER

Hunt had been down this road before. In 1995, she suffered a stroke after having surgery. At that time she had to relearn speech and mobility. When doctors at HCMC looked at Hunt’s X-rays and MRI, they saw the earlier brain damage from the stroke.

She worked with physical and occupational therapists for 14 months to help her relearn spatial relationships, manipulating objects, and dealing with her loss of peripheral vision.

“I was spilling and dropping things and poking myself,” Hunt said. “And the sad thing is, if I’d been a housewife, someone who didn’t work outside the home, they would have sent me on my way after a few weeks. If you can read at a fifth-grade level, they con-sider you recovered.

“But I’m a librarian,” Hunt told her doctors. “A librarian has to know and access all this information. It’s what I do. This is the expectation of this profession.”

Hunt had to learn to speak and read all over again. Comprehending what she read took longer.

“I wouldn’t know what I had just read,” Hunt said. “When I’d had my stroke I’d started getting up in the middle of the night to do devotions. I would open my Bible, and I would look at two words and concentrate on them. And then I worked up to three words. And I just kept at it, adding words. So I did that again.

“My doctor encouraged me to go back to work after a month,” Hunt said. “But I didn’t know how I could. It turned out they let me work in the library’s back room, where I scanned bar codes on materials. It helped with my hand and eye coordination, and with my thinking process.

“’When was the last time this material had been checked out?’ ‘Should it go to another branch?’ It helped me so much to learn the collection again.”

POET EMERGES

Not being able to find the words to speak and describe her feelings felt lonely, Hunt said. It was a struggle to search for the right word. For all the thoughts and emotions she had swirling inside, “I only had nickel-and-dime words,” Hunt said. “I could write things down but my vocabulary was small.”

“The core of humanity is emotion,” Hunt said. “If you don’t have that palette of words, it’s a black and white world.”

Hunt began writing poems to express the thoughts she couldn’t vocalize.

“It began with the speech therapist,” Hunt said. “She’d ask, ‘How are you?’ I would hand her the poem I wrote.

“Speech, physical, and occupational therapy can be like school,” Hunt said. “A person tends to get out of it what they put into it. But after TBI (Traumatic Brain Injury) or stroke, the effort to get to ‘normal’ can be a lot more excruciating than a formal education because the struggle is continual. A brain-injured person can’t just close a book and take a break from it. I quite literally studied every night in preparation for the next day’s speech therapy in order to gain back a lifetime of skills in 14 months. I affectionately call that time in my life my MBA-N: My Best Angela Now Degree.

“I didn‘t know how to make dinner,” Hunt described her life as she recovered. “I would go to the closet and not being able to fig-ure out what to wear. I’d ask myself, ‘what am I going to do today? What is the weather like? Do I need different shoes? It was a big puzzle. When I had my cognition test at HCMC, I asked, ‘Am I dressed all right?’

Hunt found that the physical act of writing helped her brain make connections with language. Writing poetry helped her recover language skills. It was also an outlet for expression and integral to regaining her emotional equilibrium.

Since her injury, Hunt has published is “Am I Still Me? A Group of Words with Fundamental Questions for Those Struggling to Recover Themselves.” The poems express Hunt’s emotional journey as she regains her cognitive skills, her language skills and vocabulary.

“Evidently people haven’t done a lot of writing during recovery,” Hunt said. “Not many [people with brain trauma] have done a journal and published it. I wrote a book two months out of hopper about what it was like to have a brain injury and then start to recover.”

She had definite ideas about how the book would look and feel, drawing on her own difficulties and experience.

“I wanted it to have stiff pages to make it easy to turn, to let it lay flat,” Hunt said, drawing on the challenges she faced as she re-covered. “I didn’t want it to be too heavy. I wanted lots of white space and to have a photograph on each page so the reader would have visual cues to what the words meant. I put exercises in the back of the book, for each poem, for the patient to regain verbal and comprehension skills.”

At Christmas, Hunt will publish her second book entitled, “I Am Still Me,” a book of free verse, directed in part to caregivers who are learning how brain injury can manifest, as well as for those recovering from TBI.

ONGOING RECOVERY

Though it’s been six years, Hunt’s brain injury keeps providing surprises.

Like reading her poems from her book after a length of time.

“It was a surprise to read them, that I had written them,” Hunt said. “It was the same when I had my stroke. I had to look at photo albums and I had kept journals of the funny things my kids had said and done. But I don’t have many memories. I don’t have memo-ries between the pictures.

“About eight months after the fall, I woke up in the middle of the night. I felt words actually downloading into my head. I could see the words. It was as if the ligands and receptors had turned back on, the synapses in my brain. I was laughing. This went on for about four hours.”

Another result of the brain injury for Hunt was seeing only in black and white for about 10 days.

“One day, I was just staring off, looking at the wallpaper, and suddenly it went from black and white to color. I thought ’Wow. Those cones and rods have started firing again.’”

“Six years later and strange things still happen,” Hunt said. “Things are still coming back. Anyone with a brain injury can re-late. I was medium to mild brain injured,” Hunt said. “But it’s nothing compared to what some people experience.”

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Returning to Play after a Brain Injury

posted by SK Brain Injury    |   September 25, 2011 18:27

High school athletes, kindergartners playing at recess and even junior high students practicing for a play or dance performance can get a concussion or other type of head injury.

Davis School Board members recently discussed a proposal that changes the way the district deals with head injuries.

Students who are injured will be pulled out of games or other activities and will not be allowed to return until they have medical clearance from their doctor. The injured student will also need clearance from school personnel, who will monitor that student's progress. Parents of all students participating in athletic activities will be required to read and sign the district's new policy.

Scott Zigich, risk manager for the school district, said reports of concussions always increase during the football and soccer seasons.

But it's not just athletes getting hurt.

Last year, five head injuries were reported during theater productions, he said.

"Four of them were due to props that were not properly balanced, then fell and hit a student," Zigich said.

The fifth one occurred when two students practicing for a dance performance ran into each other.

Every district is required by law and by the State Board of Education to have a head injury policy in place for students who participate in sports, physical education classes, recess, field days, elementary school activities or secondary school extra-curricular activities.

The rule approved in September by the State Office of Education encompasses more than what legislators required in a bill they passed in March.

The bill's sponsor, Rep. Paul Ray, R-Clinton, said, "The law doesn't require them to be that encompassing, but if they feel they need it, OK."

Before action by the legislature and the state office, districts were not required to have a head-injury policy in place.

Ray, who is also a boys basketball coach at Sunset Junior High School, said he sponsored the bill because "concussions are a major issue in sports."

Concussions or head injuries have become such an issue that the National Football League has instituted a strict policy governing when a player can return to the field after receiving a blow to the head, Ray said.

Dr. Garrett Emery, emergency physician at Davis Hospital and Medical Center, said weekends are busy in the emergency room during the football and soccer seasons.

But emergency personnel also see at least two children every day who have fallen from playground equipment, a bicycle, or in their homes and have some type of brain injury, including a concussion.

A concussion is a mild traumatic brain injury, caused by a bump, blow or jolt to the head or body that causes the brain to move rapidly inside the skull.

Emery said too often parents and caretakers think a child's eyes will show signs of concussion.

"That's a myth," Emery said. "If they're conscious, don't look at their pupils."

Emery said it is also normal for someone who has a concussion to be sleepy.

The time to get worried is when the person won't wake up, he said. That is why medical personnel tell parents to wake their child every two hours if a head injury is suspected.

Dr. Joyce Soprano, with the University of Utah Medical Center and Primary Children's Medical Center, said the headaches and other symptoms that accompany a concussion clear up within seven to 10 days. The only cure for a concussion is rest, which includes physical rest and cognitive, or no thinking, rest.

A CAT scan will not show any injury to the brain from a concussion because the injury is a "functional problem," Soprano said.

But if a child doesn't get the proper rest and receives a second concussion within a short period of time after the first, severe complications, like brain swelling or death, could occur.

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Connections - Fall 2011

posted by SK Brain Injury    |   September 20, 2011 23:37

Check Out the Newest Edition of Connections. Inside you'll find pictures from the 9th Annual Positive STEPS Walk-a-Thon, and information regarding the upcoming Fall Retreat. To register for the Retreat please click on our Events Tab to download the form.

fall2011-final.pdf (1.24 mb)

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Mental Illness: A likely byproduct of concussion

posted by SK Brain Injury    |   September 20, 2011 00:55

A concussion from an impact while an athlete is playing hockey can result in life-threatening psychological and psychiatric damage, a Toronto psychiatrist says.

Depression, a form of mental illness, frequently occurs beyond the common hockey injuries of stitches and bruises, Shree Bhalerao said. "But no one's talking about it because there's a stigma attached to it."

Because of the stigma associated with mental illness, depression can drive a problematic injury even deeper, the doctor said. Players in a macho game don't want to be seen as "damaged goods" in the lineup, he said.

Often called an "invisible injury," depression and concussion are cited as conditions afflicting fist-fighting NHL enforcers in their careers. Sometimes they have been connected to untimely deaths and suicides of NHL players.

"I've spent 12 years doing this stuff in an acute setting, but what I haven't seen is articles from the psychiatric point of view," Bhalerao told a conference on Outcomes in Concussion cases, organized by neurosurgeon Michael Cusimano.

Cusimano of St. Michael's hospital here is a pioneer in brain injury management. He said there will be between 15,000 and 20,000 concussive brain injuries across Canada this year.

The conference heard more concussions happen in the first period, when players are charged up aggressively with adrenalin and by coaching pep talks about "owning" the rink. (This is contrary to the belief that injuries occur late in games when athletes are tired and let down their guard down.)

The psychiatrist said he sees depression frequently in concussion patients - 30 per cent of patients exhibit it. They suffer from diminished motivation, impaired sleep, are withdrawn, have anxiety and have unfounded fears.

"They don't want to return to the ice. They have a feeling of panic ... the elements of an acute stress disorder," Bhalerao said. Concussion patients often exhibit personality changes. They are irritable, they have increased impulsivity and can lapse into substance abuse.

"Eighty-seven per cent have cognitive changes in short-term memory and problems in executive functions, encapsulated in the acronym SOAP: sequencing a series of events, organization, attention and planning."

"There's still an attitude out there that brain injury is like a broken arm," Cusimano said. "You can't take your brain for granted."

In the seminar, Michael Hutchison, the assistant coach of the men's University of Toronto Blues and a postdoctoral fellow in injury prevention at St. Mikes, said a videotape study of almost 200 concussions in the NHL from 2007 to 2010 showed most concussions are caused by head shots initiated by the shoulder, elbow or gloves. Only about one in 10 were the result of fights, he said.

The seminar also heard from Karolina Urban, captain of the University of Toronto women's Varsity Blues hockey team, who has had three concussions while playing - the first one from a direct hit to the head (although women's hockey is supposed to have no body checking) and two more which have not been direct head hits. In none of the cases was a penalty called, she said. Toronto's women's team had 11 concussions last winter.

Repeat concussions can happen if a player comes back when not fully healed from an initial concussion, Toronto neurosurgeon Charles Tator said. Kids who suffer concussions may be willing to take their time healing before coming back to play, but there's pressure from parents who are paying money for equipment, coaching, fees and ice time. Second impact syndrome can occur, Tator said, although it is rare. That rarity isn't a good thing: Sometimes players die because of second concussions or are severely disabled by them.

Education of coaches and trainers of what to look for in possible cases of concussion are the key, he said. About half the states in the United States have legislated more education of concussion symptoms for coaches and trainers. "For some reason, we're still thinking this through in Canada," he said. He said coaches and trainers, because they are on the spot at hockey games, should be trained as the first line of defence against serious brain injury.

Cusimano said that part of the problem has been the macho culture of hockey. A few years ago, he said, researchers tried to take the message to hockey coaches "and some of them wouldn't be part of it," he said. The reluctant coaches were fearful they might be urged to take a softer approach to a physical game.

Rob Zamuner, who played 13 years in the NHL and is now a divisional representative for the National Hockey League Players' Association, said NHL hockey was still making spots for enforcers, "who have five years to do it, make the money that is supposed to support the family for their whole lives." Some decide to make a difficult bargain with themselves: They take a high-paying job, but they risk a serious injury and have a short career. "It's what they've grown up to do [play the enforcer role] and they do it well." But he said it's wrong to chastise players who take a lucrative role pro hockey makes open to them as long as it's there.

Cusimano said about one in 4,000 hockey players has a pro career "but about 70 per cent of young mothers are thinking they don't want their young athletes playing hockey. There's an urgency to do something now, not 10 years from now."

The incidence of concussion is serious, he said, noting research that shows that the occurrence of concussion is seven times as common as breast cancer and 30 times as common as HIV.

"What's happening is, it's now possible to talk about TBI [traumatic brain injury] and it becomes more possible to talk about mental illness from injury in the brain," Bhalerao said. Some may have grown up being rewarded for tough behaviour, but some may have learned it.

"It would be interesting to talk to players and see their developmental histories and to see... are their certain enforcers or certain types of players who have a certain background? Do they have aggressive role models or have they had multiple head injuries that have made them that way even before they got to the NHL? Did the NHL create more of that problem?"

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Panel Discusses Concussion

posted by SK Brain Injury    |   September 18, 2011 12:43

Contrary to how it's depicted in cartoons, a blow to the head is a serious occurrence with possibly long-lasting effects. Concussions can cause damage to the soft tissue of the brain. And children's brains are even more susceptible to traumatic brain injuries because their heads are disproportionally large compared with the rest of their bodies.

Concussions and traumatic brain injuries (TBI) caused by blows to the head or body are common among young athletes, especially those playing contact sports. About 1 million children each year suffer concussions, according to the National Dissemination Center for Children with Disabilities, and more than 30,000 incur long-term disabilities as a result of traumatic brain injuries.

With football season in full swing — both professionally and scholastically throughout the country — TBI is taking center stage. Prevention is key, says Dr. Chris Rackley, a pediatric neuropsychologist at Blythedale Children's Hospital. Prompt recognition of a concussion or brain injury by parents, teammates, coaches, school nurses, and/or physicians is essential in preventing a more serious brain injury, he says. Under Connecticut law, a coach should not send a player back into a game after a player shows symptoms of a concussion or is determined to have suffered a concussion. But how can one determine exactly what those symptoms are?

Blythedale Children's Hospital in Valhalla, N.Y., will host its first-ever Concussion & Traumatic Brain Injury Town Hall, bringing together student athletes, coaches, parents and members of its Traumatic Brain Injury Team. The town hall will take place Tuesday, Sept. 20, from 7 to 8:30 p.m. at Blythedale Children's Hospital, 95 Bradhurst Ave., Valhalla.

Dorsey Levens will also be a part of the discussion. Levens is a former Green Bay Packer football player and producer of the upcoming documentary "Bell Rung: An Alarming Portrait of Professional Football," which looks at concussions among NFL players.

"Concussions are often not recognized for a variety of reasons, especially in children and adolescents. As our understanding of the causes and consequences of concussions increases, we can better manage and treat these injuries," says Rackley. "The Concussion Town Hall Meeting at Blythedale Children's Hospital aims to provide education regarding what a concussion is and what parents, coaches, school personnel and the youths themselves can do to identify and manage this condition."

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Could suffering a brain injury lead to violence later in life?

posted by SK Brain Injury    |   September 18, 2011 12:41

It seems like head injury awareness is everywhere these days. From veteran hospitals and construction sites to cheer practice and Pee-Wee hockey games, it appears that people are beginning to understand just how serious a head injury can be. One of the more important aspects of that awareness is the realization that with these types of injuries, many of the associated risks may not become apparent until long after the swelling has subsided and bruises have healed, or there may be no bruises at all. Memory loss, brain damage and difficulties with school have all been seen in children who suffered a blow to the head, and sometimes these conditions don’t manifest for months or years after the accident. Now, according to a new study published in the journal Pediatrics, there could be yet another risky, long-term side effect for children with brain injury: An increased risk for violent behavior. 

The study, which followed 850 high school students for five years, showed that of the 88 study participants who had suffered head injury, 43 percent of them were involved in some form of violence in the year following their injury. That’s almost a 10 percent increase in violent activity when compared to study participants who had never suffered a head injury. These numbers may seem staggering to some, but come as no real surprise to the medical community.

“Given what we know about brain injuries’ ability to affect behavior, these results are far from shocking. Depending on the nature of the injury, it’s not unusual for a patient’s judgment of what is and what isn’t acceptable behavior to change after significant brain trauma,” says Mark Proctor, MD, of Children’s Hospital Boston’s department of Neurosurgery.  “It’s a little bit like what happens when some people drink. Their inhibitions and normal judgment change, sometimes fairly significantly.”

A change in a patient’s mood or judgment following a head injury is known as disinhibition, where the person suddenly displays a lack of restraint, or regard for social norms not previously shown in their behavior. It’s not fully understood how blows to the skull result in disinhibition, but it is a fairly regular occurrence after serious brain injury, and can be seen in less severe cases as well.

“There are many cases where a child has suffered a head injury and then acted differently afterwards,” Proctor says. “Often the parents believe their child’s brain trauma was the trigger.”

To treat potential cases of disinhinbition, as well as other affects of head injury, patients at Children’s Hospital Boston’s Brian Injury Center are cared for by experts from many services, including Neurology, Neurosurgery, Trauma Program, Sports Medicine and Neuropsychology. Once admitted to the program, the multifaceted care team screens the patient for potential future concerns like academic difficulties or problems reintegrating to their normal life. By establishing concerns early and keeping up with the long term-care of each patient, the team at the Brain Injury Center is often able to offer treatment options before problems occur, instead of addressing them after the fact.

“Depending on the nature of the injury, it’s not unusual for a patient’s judgment of what is and what isn’t acceptable behavior to change after significant brain trauma.”

It’s a preemptive strategy, which is one of the cornerstones of Children’s Brain Injury Center’s mission. In addition to furthering the treatment of children with brain injury, the Brain Injury Center is dedicated to educating the next generation of health care practitioners and increasing awareness in the community through continued training and outreach programs.  “People are finally beginning to recognize that kids with brain injury are more likely to have future problems in school, and possible social problems, as they recover,” Proctor says. “The more aware of that fact people are, the more likely they will be help identify these problems before they become too much of an issue.”

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Visual Test is Effective in Diagnosing Concussions, Study Suggests

posted by SK Brain Injury    |   September 18, 2011 12:14

A sideline visual test effectively detected concussions in collegiate athletes, according to a team of researchers from the Perelman School of Medicine at the University of Pennsylvania. Concussed athletes scored an average of 5.9 seconds slower (worse) than the best baseline scores in healthy controls on the timed test, in which athletes read a series of numbers on cards and are scored on time and accuracy. This quick visual test, easily administered on the playing field, holds promise as a complement to other diagnostic tools for sports-related concussion.

Up to 3.8 million Americans sustain sports-related concussions each year, yet current methods fall short from objectively and quickly measuring the presence and severity of a concussion. Evidence-based protocols are needed, both on sidelines to prevent injured players from returning to play too soon, and off the field, for physicians to more accurately and effectively diagnose, treat and rehabilitate patients suffering from concussions.

"This test has demonstrated its ability to provide objective evidence to aid medical professionals and trainers in determining which athletes need to come out of games after a blow to the head," said Laura Balcer, MD, MSCE, professor of Neurology and senior author on the paper. "We'll continue to measure the test's effectiveness in different groups -- players who play the same position who have and have not suffered concussions, for instance. It is our hope that the new test, once validated, can be folded into the current sideline battery of tests for concussion, as no single test at this time can be used to diagnose or manage concussion."

The King-Devick test, originally used as a dyslexia test, detects impaired eye movements and rapid eye movements called saccades, indicating diminished brain function. A previous study, published in Neurology, of this visual screening test for concussion found that boxers and mixed martial arts (MMA) fighters who had head trauma during their matches had significantly higher (worse) post-fight time test scores. Fighters who lost consciousness were on average 18 seconds slower on the test after their bouts.

In this follow-up study, published online in the Journal of the Neurological Sciences, 219 collegiate athletes were given the 2 minute test as a baseline at the start of the sports season. Athletes who sustained concussions -- an impulse blow to the head or body that results in transient neurologic signs or symptoms -- in games or practices during the season were given the test immediately on the sidelines.

Athletes who suffered concussions had significantly higher (worse) time scores compared to baselines. In the injured group, there were occasional accuracy errors while reading the cards, with one athlete making four errors and two others making one mistake each following a blow to the head. Two of these three did not have significantly slower test-taking times, suggesting that there may be a tradeoff of accuracy for increased time to complete the test in some concussed athletes. Researchers proposed adding a defined amount of time to the cumulative score for every error on the test, to account for the tradeoff of accuracy for time.

Researchers also looked at test improvement over time and post-game fatigue. A group tested following an intense scrimmage showed no signs of fatigue and actually improved their test scores compared to baseline. Another group tested before and after the season showed modest improvements, likely a result of learning effects common in many performance measures.

This rapid sideline visual screening tool can complement other diagnostic assessments for sports-related concussion.

The study was funded in part by a National Eye Institute grant and done in conjunction with the University of Pennsylvania's Athletic Department and researchers from the Departments of Neurology, Orthopaedics, Epidemiology, and Ophthalmology in the Perelman School of Medicine, along with researchers from the Illinois College of Optometry and the King-Devick Test, LLC.

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Technology Helps Concussion Monitoring

posted by SK Brain Injury    |   September 6, 2011 22:22

With concussions becoming a growing concern among athletes at both pro and Joe levels, new products are on the way to help coaches and parents better determine when a player might have suffered one.

Over the next few weeks, a U.S. company called Battle Sports Science is making its Impact Indicator available throughout Canada and the United States. It is a sensor that is fastened to a helmet chin strap and detects when the user’s head undergoes an impact likely to cause a concussion.

Football versions of this device should be on the way to Canada in two weeks, said Battle Sports CEO Chris Circo, and one for hockey is expected to be available in late September or early October.

When attached and operating, a green light will be illuminated at the player’s chin. If the light turns red, it’s indicating that the player has been hit hard and should be evaluated before returning to play.

“Most leagues and organizations have some protocol that they typically follow (for assessing possible concussions) but (a red light is) saying this kid has had an impact . . . They need to be looked at before they’re allowed to be hit again,” Circo said.

The Impact Indicator is programmed to turn red if it senses an impact of 240 HICs (head injury criteria), noting that research shows there’s about a 50 per cent chance of a concussion being suffered at this level of impact.

Circo explained that HICs take into consideration gravitational force (G-force) and how long the impact was felt. The 240-HIC threshold, he explained, is essentially a G-force of 75 sustained for five milliseconds.

With a personal history of concussions himself, Circo had a motive for moving forward with such a product. Circo, now 42, had three concussions as a child. When he was an adult, he started having seizures. After a battery of tests, it turned out the condition was the result of those childhood concussions.

“There are long-term effects on people who sustain concussions,” he said “We have to do something about this.”

In recent years, the dangers of concussion and their longer-term effects have gained more attention. Parents have become increasingly concerned about the safety of their children in sports after seeing some high-profile athletes, such as Pittsburgh Penguins star Sidney Crosby, being seriously affected by concussion. Crosby, perhaps hockey’s biggest star, missed half of last season because of concussion, and his status remains uncertain as the NHL season approaches.

Because concussions are difficult to detect and young athletes, just like the pros, often want to avoid sitting out, the Impact Indicator is meant to act as an “extra pair of eyes” for coaches, trainers or parents, Circo said.

A handful of National Football League players, including Detroit Lions defensive tackle Ndamukong Suh and Denver Broncos receiver Eddie Royal, wear the Impact Indicator, Circo said, even though the device is geared more toward younger athletes.

Circo said the Impact Indicator will cost about $200 in Canada and be good for two seasons of play.

Ottawa-based Impakt Protective Inc., also has developed a helmet device, called the Shockbox, that detects and records impact to an athlete’s head.

It’s a sensor that gets placed inside an athlete’s helmet. When the Shockbox detects a significant amount of impact — a G-force of 60 or more — it sends an alert wirelessly to a smartphone or laptop computer within a range of about 100 metres.

It will send an orange signal for hits creating a G-force of between 60 and 90, and red for anything greater than 90.

“A number of clinical studies have pointed 90 G or more as being where 65 per cent of concussions occur,” said Impakt Protective CEO Danny Crossman.

It comes with software that will prompt the recipient of the alert to perform standardized tests on the player affected to determine whether the athlete has been concussed. It also will maintain history on players’ occasions in which they sustained a significant hit, and whether it resulted in an actual concussion.

Crossman said, for the next year or so, the Shockbox will be in trials with unnamed National Hockey League and junior hockey teams. About a year from now, it’s expected to be available as a feature embedded in hockey helmets, and some time after sold separately and as a feature in helmets for other sports. As a stand-alone item, he said it will sell for about $90.

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