February 2015 archive

How to Live With Brain Injury

Every year in the United States, about one million people seek emergency room care due to a traumatic brain injury (TBI), and an estimated 230,000 people are hospitalized. Traumatic brain injuries range significantly in severity, from a mild concussion that has no long-term impact on health, to a severe injury that directly impacts every facet of life. For those in the latter category, establishing a new normal is especially difficult, but with motivation and hard work, it is possible to enjoy a sustained quality of life.

The areas of life that are impacted by a TBI will depend on which parts of the brain were injured, as well as the severity of the TBI diagnosis. While it’s nearly impossible to accurately gauge exactly how much impact a TBI will have on a person’s life in the long term, there are general steps a person can take to help them overcome many of the challenges associated with a TBI.

Attention and Concentration

A traumatic brain injury can render you unable to focus or concentrate on multiple tasks. As a result, you may suffer from restlessness and may become easily distracted. To combat those hurdles, remove any potential distractions prior to starting a task. Do it no matter how seemingly simple a task is (answering a phone call) or how difficult (writing a letter). As you gain confidence, you will notice a slow progression in your ability to complete increasingly complex tasks, and eventually the distractions will no longer be a hurdle to completing them.

Communication

Communication can also be problematic for TBI victims. You may find yourself having a hard time coming up with the right word, following conversations, using facial expressions, and reading the emotions of others. To help regain abilities in this area, maintain conversations with only one person at a time, speak slowly and deliberately, and create a signal that others can use to let you know when you have gone off topic. The more you practice these steps, the easier communicating will become.

Organization, Planning and Retaining

Scheduling appointments, making plans, and performing multi-step tasks can be a challenge for people who have a TBI. So, start making and keeping lists of things you need to do and create step-by-step instructions for tasks that you find difficult. If a task is simply too complex, break it down into smaller steps. When faced with a task that you cannot figure out, focus on the desired end result and work backward.

Another common problem for victims of TBI is the inability to recollect events and retain information. You might recall memories from long ago, but short term memory and the ability to grasp new information are generally affected. Write down a list of daily routines and activities and keep a copy by your bed, on your refrigerator, in your car, or wherever else you may need it. Use notebooks, wall calendars and smartphone apps to help you along the way, too.

Also, the more relaxed you are and the more rest your brain gets, the better it will function. So, get plenty of sleep and reduce anxiety triggers. One way to lower anxiety is to review your notes and practice new tasks regularly. That way, you will become more familiar with them, and that will lead to reduced stress.

A traumatic brain injury can be a setback, but there are countless ways you can help yourself along the path to recovery. Even if you don’t regain full capacity, with patience and practice you can still function at a high level. The quality of life you enjoy will be directly impacted by your level of motivation and long term commitment to recovery.

Progesterone and TBI

Traumatic brain injury (TBI) results from a blow or jolt to the head or a penetrating head injury that disrupts brain function. As reported on Brainline, of the 1.7 million people in the U.S. who suffer TBI every year, 52,000 die, 275,000 are hospitalized, and 1.365 million are treated in emergency rooms and released. Severe TBI can cause unconsciousness or amnesia and may result in long-term independent function problems for victims.

Hopes for Progesterone and TBI in the Scientific Community

Progesterone is a female hormone involved in menstrual cycles and reproduction that can also be found in the brains of both males and females. According to a Life Extension Magazine article, neuroscientist Donald G. Stein, PhD, and some of his colleagues noted that some females recover more completely and quickly from brain injury than males do, and began investigating the neuroprotective effects of progesterone more than 30 years ago.

Studies with animals have indicated that progesterone may reduce damage to the brain and improve recovery from TBI. As reported in the Life Extension article, Dr. Stein’s successful experiments using progesterone to alleviate the effects of brain injury to rats eventually led to clinical trials using progesterone to treat humans suffering from TBI.

In 2012, the National Institutes of Health (NIH) published the findings of a study conducted to assess the safety and effectiveness of progesterone for treating patients with acute TBI. Data for the study was obtained from 3 randomized controlled trials of progesterone versus placebo for treatment of a total of 315 acute TBI patients. This study concluded that progesterone may improve neurologic outcome for TBI victims, but that evidence was insufficient and further controlled trials would be required.

Disappointing Results of Further Clinical Trials

On December 25, 2014, the New England Journal of Medicine published the results of a double-blind clinical trial in which 882 patients with moderate, moderate-to-severe, or severe acute brain injury were randomly given either progesterone or a placebo within 4 hours after injury, with treatments continuing for 96 hours. Most of the patients received their injuries through motor vehicle accidents.

The results of the trial were disappointing, to say the least. There was no significant difference in favorable outcomes for patients treated with progesterone as compared to those treated with a placebo. The conclusion of the study was that progesterone has no clinical benefit for acute TBI patients.

According to a February 10, 2015 Health News article, the study, which was funded by NIH and known as Pro TECT-III, began in April 2009 and continued to October 2013. The University of Cincinnati Medical Center was among the 49 trauma centers that participated in the study and enrolled 85 of the 882 patients involved. Patients were followed closely by researchers for 6 months after treatment.

As reported in the Health News article, Jordon Bonomo, M.D., lead investigator for the trial in Cincinnati, said that the research team was disappointed to learn that progesterone was not as helpful as had been hoped. Dr. Bonomo also commented on the importance of developing new therapies to treat TBI.

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Despite New Study’s Findings, Parents Should Take Potential Child TBI Seriously

Let’s say your child is playing on a swing at school, falls off and hits his or her head on the ground, causing a bruise or bump to form. As a parent, should you be concerned that a serious child brain injury has occurred?

According to a recently published study, if your child’s only sign or symptom after the accident is a headache, there is actually a fairly low risk that the child has suffered a “clinically important” traumatic brain injury (ciTBI), or a brain injury that is likely to require hospitalization or surgery.

However, out of an abundance of caution, you should still have your child examined by a doctor after one of these “bumps on the head.” You should also keep a close watch for signs and symptoms of TBI in the weeks that follow.

Study Finds Low Risk of TBI in Children with Isolated Headaches

Researchers from New York’s Presbyterian Morgan Stanley Children’s Hospital conducted the study, which was reported February 2 in the online edition of the journal, Pediatrics.

The study analyzed data from a prospective observational study of children between ages 2 and 18 with “minor blunt head trauma,” or head trauma registering a score of 14 or 15 on the 15-point Glasgow Coma Scale.

As Reuters Health describes, the children were placed into two groups: Those with isolated headaches and those with signs and symptoms in addition to a headache.

Out of 2,462 children who suffered only isolated headaches, none were found to have ciTBI. In contrast, out of 10,105 children with more than an isolated headache, 162 had ciTBI (1.6 percent).

In other words, the risk of serious brain injury is 1.6 percent higher when a child presents signs and symptoms that go beyond an isolated headache.

Additionally, commuted tomography (CT) scans identified ciTBI in only three out of 456 children with isolated headaches (0.7 percent). Out of a group of 6,089 children with additional signs and symptoms, CT scans revealed ciTBI in 271 (4.5 percent). In other words, the risk of ciTBI was 3.8 percent higher.

This research follows a study published online in September 2014 by JAMA Pediatrics that analyzed children with isolated loss of consciousness after suffering mild blunt head trauma. The researchers in that study found there was a “very low risk for ciTBI” among children with that lone symptom and concluded that they “do not routinely require” CT scan evaluations.

How Should Parents React to Head Injuries?

While the these studies, taken together, may suggest that parents have little to worry about if a child merely bumps his or her head and suffers only an isolated headache or loss of consciousness, it is still important to take these injuries seriously.

As the Brain Injury Association of America notes, “62,000 children sustain brain injuries [each year] requiring hospitalization as a result of motor vehicle crashes, falls, sports injuries, physical abuse and other causes.”

Pay attention to signs and symptoms of TBI that a child may develop in addition to headaches or loss of consciousness, which the Children’s Health Center of Atlanta describes as:

  • Fluid draining from the ears or nose
  • Confused or dazed looks
  • Inability to see or speak clearly
  • Repeated vomiting
  • Seizures
  • Severe neck pain
  • Progressive drowsiness
  • Weakness in the arms or legs
  • Inability to remember people or places.

If your child has suffered an apparent head injury, don’t do the evaluation yourself. Instead, take your child to see a doctor as soon as possible. Allow the doctor to do an examination and to consult with you on whether to order additional testing such as a CT scan or X-ray.

Brain Injuries Caused by Medical Malpractice

A 26-year-old woman who had recently graduated from medical school and planned to become a pediatrician died after going to a Pennsylvania hospital complaining of days of headaches. The team of doctors who treated her did some tests and gave her medication, but did not order a head -imaging scan that would have detected her life threatening condition, a blood clot.

The patient was at the hospital more than 40 hours before a neurologist examined her and she was within hours of death before she was given clot-busting medications, according to a newspaper account. She eventually suffered massive cerebral hemorrhaging, a stroke, brain damage, and died. The young woman’s parents filed a medical malpractice lawsuit claiming the doctors failed to diagnose a blood clot that should have been obvious.

Approximately 30 percent of all injury related deaths can be attributed to some type of brain trauma, according to the Centers for Disease Control and Prevention. While the majority of brain injuries happen as a result of falls, traffic accidents, or being struck by an object, medical malpractice by health care providers also can cause serious and fatal brain injuries.

Examples of Doctor Negligence Causing Brain Injuries

Doctors and hospitals have a legal responsibility to deliver medical treatment according the recognized standard of care. When doctors fail to deliver the appropriate care, the impact to the patient receiving treatment can often be devastating.

Examples of doctor negligence that can lead to these types of brain injuries include:

  • Failure to order appropriate tests and diagnose
  • Improper diagnosis and treatment of any sort of concussion or head trauma
  • Anesthesia errors
  • Mistakes in medication dosage, including a failure to properly monitor pain pumps
  • Lack of proper ventilation or failure to follow safety procedures before, during, and after surgery, leading to infection
  • Surgical errors
  • Errors or delays made during labor and delivery that deprive the baby’s brain of oxygen
  • Inadequate monitoring during the birthing process and failure to respond quickly to signs of distress during the birth.
  • Improper treatment of pre-eclampsia, resulting in a seizure cutting off oxygen to the baby in utero
  • Failure to render treatment or aid to a patient having breathing difficulties or showing signs indicating respiratory distress
  • Failure to diagnose and treat signs of an aneurysm, arrhythmia, stroke, or heart attack in a timely fashion

Delays in Diagnosis and Treatment can Cause Long Lasting Effects

Even a seemingly insignificant delay in diagnosis or medical treatment can end up causing an individual to become deprived of adequate oxygen supply or experience abnormally low levels of oxygen in the body’s organs and tissue. Should this happen, hypoxic or anoxic brain injuries are likely to result. This is due to the fact that brain cells cannot survive without oxygen. It only takes about four or five minutes for brain cells to begin to die once deprived of oxygen. If hypoxia is allowed to continue for longer than a few minutes, it could lead to seizures, coma, and possibly brain death.

Once the brain has been deprived of oxygen, damage can be permanent. Recovery will depend on the extent of the damage caused, as well as the length of time the brain was either deprived of oxygen or was subjected to exceedingly low levels of oxygen. In many cases, recovering from a brain injury will be a long, grueling process. Others may not ever be able to return to the standard of living they once enjoyed.

Neither the doctor nor the hospital is likely to admit to a patient that they have made an error leading to a brain injury. According to Sansone & Lauber, if you have a loved one who you suspect suffered a brain injury caused by medical malpractice, you may not know what actually happened unless you consult a qualified medical malpractice attorney and have the patient’s medical records examined, to determine if doctors followed the appropriate standard of care.

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Guest post by Sansone & Lauber