As discussed in prior posts on this blog, sleep alterations are commonly found after a concussion or other traumatic brain injury, both short term and in some cases long term. One of the most well documented impacts of concussion, also discussed in prior posts, is an increased risk of mood disturbances, including depression, increased anxiety and increased risk of suicide. In recent years researchers have turned to sleep studies to explore the connection between these symptoms.
There is substantial evidence in the literature of the role healthy sleep plays in the “consolidation” of emotional memories. At first blush, this research is counter-intuitive. If sleep “consolidates” emotional memories, doesn’t this have the potential to increase rather than decrease mood disturbance? The answer appears to be that, although sleep preserves memory of events associated with emotional experience, at the same time it weakens the emotional “charge” coating the experience (referred to in the literature as “valence”) in a process called “habituation.” As one researcher hypothesized, “we sleep to forget the emotional tone, yet sleep to remember the tagged information.”Read More
Several of my traumatic brain injury (TBI) clients have been treated for gut issues – issues that were not present prior to their TBI. Insurers, of course, insist that this treatment cannot be related to the brain injury. The scientific literature indicates otherwise. Researchers at the University of Maryland School of Medicine recently found a two-way link between TBI and intestinal changes.
The findings indicate that this two way interaction may contribute to increased infections in TBI patients and may also worsen chronic brain damage. Read More
A treatment protocol combining Ritalin, a stimulant commonly used for ADHD, and a form of Cognitive Behavioral Rehabilitation known as “Memory and Attention Adaptation Training” (MAAT) shows great promise for improving persistent traumatic brain injury (TBI) symptoms, including attention, episodic and working memory and executive function. The research supporting this finding, led by Thomas McAllister and Brenna McDonald at the Indiana School of Medicine, was published in 2017 in the journal of the American College of Neuropsychopharmacology. Read More
Although the primary focus of this blog is on “traumatic” brain injury, the literature increasingly demonstrates that the physiological causes of cognitive impairment overlap between a range of conditions having neurodegenerative consequences, including TBI, PTSD, Alzheimer’s disease and “Chemobrain”. (Chronic inflammation appears to be one of the common variables, as discussed in prior posts.) Read More
A review published in the September 2017 issue of Frontiers in Neurology proposes use of “systems science” to better understand concussion diagnosis and prognosis. This is a discipline that analyzes complex problems as whole systems and integrates research findings from different disciplines. In explaining the need for a systems approach, the reviewers note one description of concussion that is uniformly recognized – that it is a highly heterogeneous phenomenon, with numerous factors interacting dynamically to influence an individual’s recovery trajectory. (This concept is highlighted in the title of one of the Concussion WebCasts made available by the American Association of Family Physicians : “If you have seen one concussion, you have seen one concussion.”) Read More
One of the most common symptoms following TBI is photophobia, an intense intolerance to light that can cause significant discomfort, interfere with activities of daily living, and contribute to post traumatic headaches. It can impact the ability to work at computer screens and in well-lit offices and can cause a great deal of fatigue for patients who try to return to usual activities. Avoiding light can be very limiting. Read More
In a study published in the Journal of the American Medical Association (JAMA) on December 20, 2016, Canadian researchers found that children and adolescents who returned to exercise within seven days of experiencing a concussion had nearly half the rate of persistent post-concussive symptoms a month later. This finding challenges the current cornerstone of pediatric concussion management, which is physical and cognitive rest until acute symptoms have resolved. Read More
Department of Defense researchers endorse use of eye tests as an effective screening tool for acute mild traumatic brain injury (concussion)
In prior posts we have discussed the growing recognition that one of the signature symptoms of concussion is a subtle change in visual processing. Army researchers funded by the US Department of Defense have just published findings further supporting this understanding in the November 15, 2016 issue of the Journal of the Neurological Sciences.
In the published findings, the authors note that “mild” traumatic brain injury (mTBI) is sometimes difficult to diagnose because of the overlap of symptoms with other disorders such as PTSD. This has led to a quest for biomarkers or diagnostic tests (e.g. protein, imaging, cognitive, neurosensory.) This quest is especially significant for warfighters at risk for more severe “second-impact” concussions and whose lives and safety may be endangered by visual or cognitive compromises. Read More
There’s new evidence supporting immediate removal of athletes from play following concussion.
A new study published in the September, 2016 issue of Pediatrics provides evidence that returning to play immediately following a sports related concussion, even without a “second impact” nearly doubles, on average, the length of time required to recover and exposes athletes to a greater risk of protracted symptoms. As the authors point out in their report, the Institute of Medicine and National Research Council stated in 2013 that
“the culture of sports negatively influences SRC [sports related concussion] reporting and that athletes, coaches, and parents do not fully acknowledge the risks of playing while injured.”