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Brain Injury 101 (video)
 

Brain Injury Handbook: An Introductory Guide to Understanding Brain Injury for Vocational Rehabilitation Professionals

 

 

Scanner helps find traumatic brain injuries

SAN DIEGO — An advanced, high-tech scanner is providing a team of Navy, Veterans Affairs Department and university researchers with detailed pictures of brain activity that will better identify traumatic brain injury, the signature but often-invisible war wound.

 

Moreover, said a lead researcher, an initial study involving 55 military members and veterans with mild or moderate TBI shows that the advanced imaging scanner — using a technique called magnetoencephalography, or MEG — also can reveal and identify post-traumatic stress disorder.

“We have some exciting data ... that the MEG potentially diagnoses PTSD,” said Mingxiong Huang, professor and associate director of the University of California, San Diego’s MEG Radiology Imaging Laboratory, in a June 1 interview.

 

The initial study involved 55 military and civilian patients, ages 18 to 45, with mild to moderate TBIs. The group includes 23 patients, mostly Marines, who endured blasts from improvised explosive devices, which are among the common injuries reported by Iraq and Afghanistan war veterans.

 

Huang said VA recently approved extending the study, which began in 2007, for another four years, and the research team, which includes UCSD professor Roland R. Lee and Dewleen Baker, a VA and Navy researcher, hopes to broaden the study with additional patients and expand its research toward better understanding what causes PTSD. The team plans to publish its initial study next month in a professional, peer-reviewed journal.

 

“Can we make the ‘invisible’ injury visible?” Huang said. “Being able to see the injury is really a key start to help understand how the brain recovers from TBI. The treatment and diagnosis of TBI and PTSD may be very different.”

 

Although the study is preliminary, researchers hope to help diagnose brain injuries in countless wounded military veterans, including those with less-obvious injuries from blasts, falls and concussions.

 

“Six to nine months after the injury, the majority of people with mild TBIs become symptom-free,” Huang said. “The brain, as a system, can recover.”

 

“But 20 percent of people with TBI have long-term symptoms,” he said, noting those patients will require additional therapy or medications, and some may need treatment and therapy for PTSD. “Part of the problem is we cannot see the injury,” he added.

 

Meet the machine

 

The MEG system, a large machine that resembles a Transformers-size hair dryer, was originally designed for research into epilepsy, stroke and other brain disorders.

 

Unlike an X-ray, the MEG system is a noninvasive machine and passively records electrical activity in brain tissue.

 

The scanner can locate abnormal areas of low-frequency waves, which are telltale signs of injured brain tissue.

 

“The brain is like a huge network [that] has to communicate with each other,” Huang said.

Mild and moderate TBIs, like concussions and “closed brain” wounds from blasts, often go undetected by more conventional imaging machines — including MRI and computerized tomography, or CT, scanners. An MRI can show bleeding, but in most cases, it doesn’t see damaged “axonal injuries” such as torn or shredded brain tissue that often mark mild TBIs, Huang wrote in an article he co-authored in the August 2009 issue of the Journal of Neurotrauma.

 

Although TBIs are considered neurological wounds, PTSD is a psychological disorder. But patients diagnosed with either share related symptoms tied to damaged tissue in specific parts of the brain. Huang said MEG scans of PTSD sufferers show injuries in the four main parts of the brain, including the amygdala and hippocampus, which control emotions, sensory responses and memory.

 

“With the MEG, you can visualize these areas that are injured,” he said.

 

In one case, a 17-year-old football player who suffered three concussions complained of headaches, dizziness, fatigue, poor memory and changes in speech and language — but several MRI and CT scans came up negative for TBI. The MEG scanner revealed injuries in two areas of his brain.

Another case of negative clinical MRI and CT scans involved a 27-year-old Marine who was knocked unconscious when his Humvee hit an IED. He later suffered from anxiety, irritability, poor memory and sleep, fatigue, dizziness and depression.

 

The Marine wasn’t diagnosed with PTSD, but a MEG scan showed brain injuries consistent with TBI, and possibly PTSD.

 

Finding answers

After now-retired Col. Gary Wilson survived an IED blast in Iraq, MRI and CT brain scans came up negative and showed normal functions despite the Marine officer’s symptoms, which included headaches, poor recollection and inattentiveness. In MEG scans, three parts of his brain “lit up” to reveal three injured areas that also reflected his symptoms, “so that explained very well the problems he was having,” Huang said.

For months after he returned from Iraq, Wilson struggled with short-term memory, migraines and poor sleep; he said he knew he had a concussion and was frustrated when MRI and CT scans came up negative for TBI. The MEG scans, which Huang conducted, revealed TBI and showed him what was happening in his brain, which explained the problems he was having.

 

Wilson said those results helped him begin the healing process.

 

“For me, it was important to know what was PTSD and what was TBI,” he said.

 

He credits therapies with improving his functions and even easing his PTSD.

 

“It made everything else less severe, because it didn’t add to the anxiety and to the frustration,” he said. “I’ve become less hypervigilant, and I started sleeping better.”

 

Although the MEG scanners provide more detailed information than conventional MRI machines, there are far fewer of them available around the country. UCSD’s lab has the only working MEG scanner in California. Each MEG machine costs about $2.5 million, but there are higher operating costs, Huang said.

 

Although Wilson wasn’t part of Huang’s initial study, he said he hopes VA and the military expand the research and enable broader use of MEG scanners to help diagnose other wounded warriors, especially vets who are still struggling through problems and symptoms that remain undiagnosed.

 

“You have to sort it out, but it’s so hard to do that until you know what it is,” Wilson said.

 

Knowing What to Look for Can Aid in Proper Diagnosis & Treatment of Mild Traumatic Brain Injuries

According to the Centers for Disease Control and Prevention (2006), approximately 1.5 million Americans sustain traumatic brain injuries every year, 75 percent of which are considered mild. There has been a recent surge in interest concerning mild traumatic brain injuries (MTBI's) in the U.S., due in large part to the ongoing involvement of American troops in the Middle East. As many as 18% of the 1.5 million American soldiers who have served in Iraq and Afghanistan during the past eight years have suffered from a mild traumatic brain injury, reports the New England Journal of Medicine.

"The trauma that our military personnel continue to endure has propelled our need to better appreciate and adequately treat the dynamics of traumatic brain injury," says Douglas J. Mason, Psy.D, a neuropsychologist who specializes in the diagnosis and rehabilitation of people with brain injuries. In his book, The Mild Traumatic Brain Injury Workbook (New Harbinger Publications, 2004), Mason explains that often the biggest hurdle to treating mild traumatic brain injuries is getting the diagnoses. MTBI's are frequently hard to diagnose because of the individualized nature of the injury, and the fact that symptoms vary from impairments in fine motor speed and coordination to changes in abilities to engage in hobbies and leisure activities.

 

Symptoms include. . .

§  Emotional: depression, anxiety, hopelessness, apathy, irritability and emotional numbness

§  Behavioral: impatience, anger, frustration, impulsivity, and withdrawal

§  Physical: headaches, fatigue, numbness, sensory changes (touch, taste, smell, vision, hearing), vertigo, nausea, and impairments in fine motor speed and coordination

§  Cognitive: confusion, disorientation, alterations in judgment, and increased distractibility

§  Social: changes in abilities to engage in hobbies and leisure activities, isolation, and increased alienation from others

Diagnosis and treatment are vital for those suffering from the effects of a mild traumatic brain injury. According to Mason, "The effects of head trauma are treatable and the brain can heal when given the appropriate treatment."

Source: The Mild Traumatic Brain Injury Workbook: Your Program for Regaining Cognitive Function and Overcoming Emotional Pain (New Harbinger Publications)

TBI ONLINE TRAINING

The Michigan Department of Community Health (MDCH) and its partners offer a FREE online training. This course offers professionals in case management, education, nursing, and social work the opportunity to earn continuing education credits toward their respective Michigan licenses. Caregivers will also benefit from the course.

The curriculum consists of four modules, each requiring 30-45 minutes to complete.

Introduction to TBI

Impairments and interaction strategies

Screening for a history of TBI

Public services

Many other educational materials are available from the MDCH TBI project at www.michigan.gov/tbi including:

Michigan Resource Guide for Persons with Traumatic Brain Injury and Their Families

Traumatic Brain Injury Provider Training Manual

 

Can you find quality medical information when you need it? Use the Web for research - there's a lot of valuable information on the Internet. Here are some Web sites you may find useful in your search for information.

AHCPR Guidelines
http://www.ahcpr.gov
Clinical practice guidelines from the American Agency for Health Care Policy and Research

American Academy of Physical Medicine and Rehabilitation
http://www.aapmr.org
PM&R news, Academy updates and programs.

American Association of Electrodiagnostic Medicine (AAEM)
http://www.aaem.net
Links to the AAEM journal and newsletter, membership directory, information on current practice issues, training and education news and a calendar of events.

American Board of Physical Medicine and Rehabilitation
http://www.abpmr.org
A certifying body of the American Board of Medical Specialties.

American Congress of Rehabilitation Medicine
http://www.acrm.org/home.htm
Contacts and links to rehabilitation research

American Spinal Injury Association (ASIA)
http://www.asia-spinalinjury.org
Includes bulletin board, publications, upcoming meetings, links and membership information.

Australian Association of Musculoskeletal Medicine (AAMM)
http://www.musmed.com
Source of information for doctors and the public about Musculoskeletal Medicine.

Brain Injury Recovery Kit 
http://www.biaoregon.org/store.htm
The Brain Injury Recovery Kit is a step-by-step approach to recovery that can be tailored to each individual’s needs and can be used at an individual’s own pace.
Brought to you by Day-Timers, the Brain Injury Recovery Kit is a unique, patented system invented by Lisa Keller – a creative individual who sustained a brain injury – and her case manager, Sandra Knutson, CRC, CCM, CDMS, a professional specializing in the needs of individuals and their families after brain injury.

Case Management Society of America
http://www.cmsa.org/
Information, events, support and development for case management professionals.

Disability Law Handbook

This Disability Law Handbook is a 50-page guide to the basics of the Americans with Disabilities Act and other disability related laws. Written in an FAQ format, The Disability Law Handbook answers questions about the Americans with Disabilities Act, the ADA Amendments Act, the Rehabilitation Act, Social Security, the Air Carrier Access Act, the Individuals with Disabilities Education Act, the Civil Rights of Institutionalized Persons Act, and the Fair Housing Act Amendments.

Listen to the Disability Law Lowdown Podcast at http://dll.ada-podcast.com
 

GUIDE FOR EMPLOYERS
Facts About Concussion and Brain Injury Brochure (.pdf)

 

Understanding Brain Injury: Guide for Employers (.pdf)


Returning to work is a goal that drives most survivors of brain injury through the long and difficult rehabilitation process. Yet when this goal is finally achieved, there is often difficulty adjusting to expectations of the workplace.

Employers are required by the Americans With Disabilities Act to provide reasonable accommodations to help an employee with a disability achieve vocational success.

The Mayo Clinic has prepared a 28-page booklet to assist employers in this process: Understanding Brain Injury: Guide for Employers and Understanding Brain Injury: Guide for Employers in Spanish.

 This booklet contains information on the following topics:

·  The structure and function of the brain

·  The cause of brain injury

·  The recovery process

·  Behavior, communication, fatigue and other changes after brain injury

·  Examples of simple workplace accommodations

 

International Association for the Study of Pain (IASP)
http://www.iasp-pain.org
Website for a professional organization dedicated to furthering research on pain and improving the care of patients with pain. Contains news, publications, resources and job opportunities, and information about membership, continuing education, grants and awards, SIGs and meetings.

International Brain Injury Association (IBIA)
http://www.internationalbrain.org
Information for members and the media concerning brain injury. Also has links to resources and publications, and details concerning membership and upcoming conferences.

International Society of Physical and Rehabilitation Medicine (ISPRM, formerly IFPM&R & IRMA)
http://www.isprm.org
History, membership, affiliations and by-laws. Also has information about upcoming world congresses.

International Spinal Cord Society (ISCOS, formerly IMSOP)
http://www.iscos.org.uk
Includes information about upcoming meetings and conferences, membership and contacts.

Medical/Health Sciences Libraries on the Web
http://www.arcade.uiowa.edu/hardin-www/hslibs.html
Medical and health sciences libraries grouped by state.

Medical Matrix
http://www.medmatrix.org
One of the Internet's largest medical indexing sites.

Merck Sharp & Dohme
http://www.msd-australia.com.au
A research driven pharmaceutical company that produces more than 60 medicines and provides quality information to consumers.

Movement Disorders Society
http://www.movementdisorders.org
Contains information about upcoming meetings and congresses, membership, and grants available for movement disorder related research. Training videotapes are also available for purchase online.

National Library of Medicine
http://www.nlm.nih.gov
Every library program, from medical history to biotechnology.

National Stroke Foundation
http://www.strokefoundation.com.au
Contains information about stroke and rehabilitation, child stroke, stories, links, conferences and events.

Network of Care
http://oregon.networkofcare.org/
State-wide community-based, resources and tools for seniors and peope with disabilities; mental health; and children ages 0-5.

Oregon TBI/ABI Provider Training Manual
Oregon TBI/ABI
Provider Training Manual

Servier (Pharmaceutical Company)
http://www.servier.com
Information on cardiovascular disease, diabetes and venous disease, research and development

Visual Human Project
http://www.nlm.nih.gov/research/visible/visible_human.html
The National Library of Medicine's complete, anatomically detailed, 3-D representations of the male and female human body.

World Institute of Pain (WIP)
http://www.wipain.org
Website concerning pain medicine. Newsletter, lectures, education documents and directory are available online. Also contains information on membership and future meetings.

WWW Virtual Library
http://www.ohsu.edu/cliniweb/wwwvl/all.html
A gateway to medical sites worldwide

Access Sites For Online Searches

Healthy Net
http://www.healthy.net/Library/search/medline.htm
Free access to MEDLINE® searches. MEDLINE® contains over 6.5 million bibliographic records covering medicine and related fields

Physicians' Online
http://www.po.com
Offers physician members free access to the World Wide Web and the ability to search abstracts online in thousands of medical journals in National Library of Medicine databases, including MEDLINE&reg.

National Safety Council
http://www.nsc.org
The National Safety Council offers information on first aid, CPR, environmental health, and safety.

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