A large TRACK-TBI cohort study published in JAMA Network Open finds incomplete recovery at 5 years in 53% of mild traumatic brain injury (mTBI) patients, dictating need for longer term rehabilitation.
A multi-center transforming research and clinical knowledge in TBI (TRACK-TBI) cohort study published March 20, 2023 in JAMA Network Open followed 1196 patients at 18 level 1.0 trauma care centers in the US over five years, including patient with mTBI, patients with moderate-severe brain injury (msTBI) and orthopedic controls. It found persistently elevated rates of incomplete functional outcomes in 53% of mild traumatic brain injury patients and 83% of msTBI patients compared to controls, supporting a need for longer term monitoring and rehabilitation.
A recent study published in JAMA Network Open finds that patients with a history of traumatic brain injury (TBI), including mild TBI (mTBI), are at significantly greater risk of developing chronic cardiovascular, endocrine, neurological and psychiatric disorders. This proved to be true in all age groups, including younger adults (18-40).
This study is important because, as the authors note, “the risks of incident comorbidities in previously healthy patients who sustained mTBI and msTBI (moderate-severe TBI) has not previously been reported.” The most important takeaway of the study is that “patients with TBI in all age groups may benefit from a proactive targeted screening program for chronic multisystem diseases, particularly cardiometabolic diseases.” Read More
As highlighted in prior posts in this blog, TBI research increasingly highlights the importance of providing follow-up care to patients discharged from the ER with a diagnosis of TBI. Put simply, patients with follow up care have better outcomes.
One of the most frequent questions I get from TBI clients in my Vermont law practice is: “Are there alternative therapies I can explore to help support my recovery from a traumatic brain injury without risking further harm?” Physicians practicing “integrative oncology” offer a multi-disciplinary approach to patient care for cancer that implements complementary therapies in collaboration with conventional treatment. Although TBI medicine is not as well organized, the peer reviewed TBI literature does support similar evidence-based complementary therapies for the treatment of TBI. Several have been featured in prior posts in this blog, including yoga and other mindfulness based therapies, exercise therapies, dietary therapies (especially foods rich in ‘polyphenols” found in many fruits and vegetables) and promising supplements including melatonin and curcumin (found in tumeric, curcumin reduces the levels of two enzymes in the body that cause inflammation.)
Another supplement receiving increasing attention in the literature is resveratrol, a “phytoalexin” produced by plants such as the red grape in response to various stresses, which promotes disease resistance. Read More
Victims of mild traumatic brain injury (“mTBI”) commonly report psychological distress, which is not surprising given the impact the injury can have on every aspect of everyday life including but not limited to balance, vision, sleeping, physical discomfort including headaches, and perhaps most significantly thinking clearly. Patients often report that they are not the same person and fear that person will never return.
Israeli study finds that one in four children with mild traumatic brain injury (mTBI) suffer from persistent post-concussive symptoms
In a large multi-center retrospective matched cohort study, Israeli scientists recently found that one in four children (25.3%) who have been discharged from the emergency room after a mild head injury suffered from persistent post- concussive symptoms.
Among the chronic symptoms seen in these children were forgetfulness, memory problems, sensitivity to light and noise, ADHD and even psychological problems. Sadly, many of these children had been misdiagnosed as suffering from unrelated ADHD, sleep disorders, depression, etc. This misdiagnosis, the researchers noted, leads to treatment that is not suited to the problem, thus causing the children prolonged suffering. Read More
A new study published February 16, 2022 by the American Academy of Neurology in the Journal “Neurology” finds that the frequency of clinically meaningful poor cognitive outcomes one year after a concussion are more common than previously thought. The results, says study author Raquel Gardner, MD, of the University of California San Francisco, “highlight the need to better understand the mechanisms underlying poor cognitive outcome, even after relatively mild brain injuries, to improve therapy for recovery.” Read More
A small region of the brain called the anterior thalamus could hold the key for restoring memory function after a traumatic brain injury. Researchers in New Zealand and the University of Oxford in the UK have shown that targeted electrical stimulation of the anterior thalamus could help with memory restoration in patients with brain injury.
Given how complex the brain is, scientists do not fully understand the extent to which memory impairments following TBI or stroke are caused by irreversible tissue loss and are therefore not treatable or by treatable dysfunctions in the wider brain networks. The hypothesis tested in this study is that lost memory function may be in part due to network dysfunction that can be improved with targeted stimulation. The results of this study support this thesis and could ultimately revolutionize therapies for memory defects. Read More
Earlier this year the Brain Injury Association of America (BIAA) issued an open letter encouraging all individuals with brain injury to get a COVID vaccine. The letter cites evidence from the American Academy of Neurology that anyone with a neurologic disorder such a brain injury is particularly vulnerable to diseases like influenza and COVID:
“When one is infected with COVID-19, the virus attacks the “weakest link” it finds in the body, which is why individuals with longstanding chronic medical conditions are at the greatest risk for infection, complications and even death,” explained BIAA National Medical Director Brent E. Masel, M.D. “Studies have shown that traumatic brain injury triggers an inflammatory process in the brain that causes an individual to experience chronic issues. This process places those individuals at far greater risk of developing complications from COVID-19, which itself is well known to cause chronic neuroinflammatory issues.”
Most personal injury lawyers have represented clients suffering from the chronic consequences of concussion and musculoskeletal injuries following a rear end collision that caused minimal damage to the vehicles involved. This blog has reported on countless scientific studies showing that in some patients concussions can have long-term, chronic consequences. The standard defense employed by insurers in minimal damage rear end collisions (which they call “MIST” cases) is to argue that any injury is improbable in these accidents because the forces involved are similar to the forces involved in many activities of daily living (ADLs) where injuries rarely occur (like sitting down in a chair or sneezing.
The insurers and their defense counsel typically have an “accident reconstruction” expert they routinely use (often retired police officers) who calculate the speed change in the crash (the “delta V”) and then compare it to the delta V involved in everyday activities. (The delta V calculations by these so-called experts is often inaccurate, but that is a different issue.) Experience shows that this testimony can be very compelling to a jury, faced with judging the credibility of an injury victim whose injury is not immediately apparent. Read More
