I have discussed research on the important role of sleep in TBI recovery in prior posts. Accordingly, I have encouraged clients to get help with sleep issues as soon as they become apparent after an injury. Studies have shown that approximately 50% of patients diagnosed with mTBI (“mild traumatic brain injury”) experience chronic sleep disruption. There is evidence that the brain repairs itself during sleep, which is one of the reasons why poor sleep can delay recovery. Poor sleep following a brain injury has been associated with disturbance in the normal rhythm of melatonin production.
In a recent review the literature, researchers at the Walter Reed Army Institute of Research identified the establishment of a protective gut microbiota as a “compelling therapeutic avenue” for the treatment of traumatic brain injury (TBI).
Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) have been often been viewed as two distinct conditions, one with an “emotional” cause and the other with a “physical” cause. It has been recognized for some time that these conditions can produce similar symptoms, such as problems with sleep, concentration, memory and mood. As noted by the authors of a literature review published in Current Neurology and Neuroscience Reports, “increasingly symptoms previously presumed to be specific to PTSD or TBI are being identified in both disorders.” These include symptoms more commonly associated with TBI such as headache, dizziness, balance and vision problems. Evidence has also demonstrated that patients with a history of TBI are more likely to meet criteria for PTSD than others with similar intensity injuries and that patients who are also diagnosed with PTSD are significantly more likely to report persistent cognitive or sensory problems after a TBI. Read More
Understanding these mechanisms is key to providing more effective care. The paper notes, based on the literature review, that headache occurs in up to 88% of sports-related concussions, followed closely and concomitantly by photophobia. Approximately 8-35% of post traumatic headaches will “chronicize” (become a long-term problem.) Read More
In prior posts I have discussed the growing understanding in the scientific community that vision is often disrupted in subtle ways following a concussion (both the ability of the eyes to track and higher level visual processing). I noted that the introduction to a recent issue of the respected journal NeuroRehabilitation was devoted entirely to vision disturbance following TBI.
In 2003 CDC sent a report to Congress on “mild” traumatic brain injuries. (MTBI, also sometimes called “concussion.”) The report cautioned that, contrary to past understanding, “mild” brain injuries can cause serious, permanent problems:
“In recent decades, public health and health care communities have become increasingly aware that the consequences of mild traumatic brain injury (MTBI) may not, in fact, be mild. Epidemiologic research has identified MTBI as a public health problem of large magnitude, while clinical research has provided evidence that these injuries can cause serious, lasting problems.”
Funded by the Brain Injury Association of New Hampshire, a group of researchers at Dartmouth assessed the effectiveness of the program by conducting semi-structured interviews of 13 participants with traumatic brain injury and 3 caregivers who had completed the 6 week, 6 session program. The results are published in the February, 2019 issue of Disability Rehabilitation.
Kevin Pearce, a Vermont resident and world leading professional snowboarder, suffered a near fatal traumatic brain injury while training for the 2010 winter Olympics. Kevin’s remarkable resilience since his injury has inspired millions through the award-winning HBO documentary, The Crash Reel. Read More
Researchers from Berkeley, Duke, UNC Chapel Hill and University of Arizona used a new type of MRI called “diffusion kurtosis imaging” (“DKI”) to take brain scans of 16 high school football players, ages 15 to 17, before and after a single season of football. DKI is an extension of Diffusion Tensor Imaging, (DTI) discussed in prior posts. Early studies suggest that it outperforms DTI in capturing certain microstructural changes in the brain. The football players who were scanned all wore helmets and none of them were diagnosed with a concussion. The researchers also measured head impact exposure during every practice and game using the Head Impact Telemetry (HIT) system, which has been widely used in other head impact studies. The study, which is the cover story of the November issue of the journal Neurobiology of Disease, is one of the first to look at how impact sports affect the brains of children at this age.
There’s promising research on the use of melatonin for acute treatment of traumatic brain injury (TBI) and for treatment of sleep disturbance following TBI coming from two recent peer-reviewed papers. One, published in the Journal of Neurotrauma, reviews the literature and performs meta-analyses of the data in studies examining the use of melatonin shortly after injury.
A new study published in the Journal of the American Medical Association adds to a growing body of evidence pointing to traumatic brain injuries, of all levels of severity, as an important risk factor for suicide.