Traumatic Brain Injury Blog

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Rehabilitation

April 7, 2020

Neck Injury as Potential Contributor to Concussion Symptoms

In 2015, Dr. John Leddy and his groundbreaking concussion team at the University of Buffalo published a peer reviewed article cautioning that symptoms after head injury, including cognitive symptoms, that have traditionally been ascribed to brain injury can originate, at least in part, from injury to the neck, He counseled that the cervical spine should be examined and, if injured, should be treated to address these symptoms. “Brain or strain? Symptoms alone do not distinguish physiologic concussion from cervical/vestibular injury.

A review of the literature published not long after the Leddy article, in the Journal of Sports Medicine, sounded a similar theme. “Cervical Spine Involvement in Mild Traumatic Brain Injury: A Review.” It noted that many post-concussion symptoms can be explained by injuries to structures near or in the head, other than the brain itself. “For example,” the authors note, “following a trauma, structures such as the cervical spine, the vestibular ocular system and the temporomandibular joint can be injured.” They note, for example, that “neck pain, headaches, dizziness and balance dysfunction are common symptoms associated with both mTBI and WAD” (cervical spine injury.) Addressing neck injuries, they suggest, may lead to better concussion recovery. A randomized controlled trial testing this hypothesis is currently in process. Read More

March 27, 2020

Neuroendocrine issues, often overlooked following TBI, leave patients with unnecessary chronic symptoms

In prior posts I have discussed the growing evidence that traumatic brain injuries, even so-called “mild” traumatic brain injuries (mTBI), can lead to neuroendocrine dysfunction (NED) – most commonly growth hormone (GH) deficiency due to pituitary dysfunction. Although growth hormone deficiency often results in physical symptoms such as loss of lean muscle mass and strength, increased body fat around the waist, and dyslipidemia, other common GH deficiency symptoms overlap with the symptoms of “persistent post-concussion”- such as fatigue, poor memory, anxiety, depression, emotional lability, poor attention and poor concentration.

My earliest post on this issue discussed the August 2012 Department of Defense (DOD) clinical recommendations for screening for neuroendocrine dysfunction in “mild” traumatic brain injury (“mTBI”) cases – where indicative symptoms persist for more than three month or appear within three years. The guidelines contemplated a simple blood test, but subsequent studies, also discussed in this blog, showed that the only reliable means of detecting GH deficiency is provocative testing, which is expensive and takes several hours (the guidelines do suggest further assessment by an endocrinologist, even where the screening test is negative, if symptoms of NED persist.) Read More

January 28, 2020

Improving sleep with morning exposure to blue light leads to quicker recovery from uncomplicated mTBI

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.

A recent double-blind, placebo-controlled study by researchers at the University of Arizona, published in Neurobiology of Disease 134 (2020) 104579 (funded by the US Army Medical Research and Development Command ) demonstrated that morning exposure to blue wavelength light improves sleep quality and leads to measurable cognitive improvements and positive changes in brain anatomy and function as measured by functional and structural MRIs. Read More

January 7, 2020

Gut Microbiota as a Compelling Therapeutic Avenue for Traumatic Brain Injury

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).

In a January 23, 2018 post this author summarized evidence that a TBI can trigger pathology in the Gut-Brain Axis and increase infections.  The Walter Reed researchers dive deeper into this issue. Summarizing the research, they explain that “brain injury induces disruptions in the composition of the gut microbiota, i.e. gut dysbiosis, which has been shown to contribute to TBI-related neuropathology and impaired behavioral outcomes.” (emphasis added.) Read More

December 2, 2019

Traumatic Brain Injury and PTSD may Not be Separable; Evidence Demonstrates Shared Symptoms and Pathophysiology

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

July 22, 2019

Potential paradigm shift in the treatment of mild traumatic brain injury (concussion)-use of vision therapy to improve high level cognitive functions

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.

A new study just published in the journal Restorative Neurology and Neuroscience has produced evidence that a particular vision training exercise – movement figure-ground discrimination – may be very effective in improving high-level cognitive functions such as focusing and switching attention, working memory, processing speed and reading. “Dynamic cognitive remediation for Traumatic Brain Injury (TBI) significantly improves attention, working memory, processing speed, and reading speed.” Read More

April 16, 2019

Dartmouth Study Recognizes LoveYourBrain Yoga as an Effective Tool for Community Based Rehabilitation For People with Traumatic Brain Injury

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

October 4, 2018

Use of Melatonin for Treatment of TBI and Sleep Disturbance Following TBI

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.

The other, published in the journal BMC Med, reports on a randomized controlled trial examining the efficacy of melatonin in treating sleep disturbance following TBI.

Melatonin is an important hormone made by the pineal gland that helps control a person’s sleep and wake cycles. Read More

August 2, 2018

Pituitary Dysfunction Following TBI: Update on the Importance of Stimulation Testing

In our May, 2014 post, we reported on research showing that traumatic brain injury, including mild traumatic brain injury (mTBI), can damage and cause dysfunction in the pituitary gland resulting in deficiencies in key hormones released by the pituitary gland, such as Growth Hormone (GH). As we explained in that post, the anatomy of the pituitary gland makes it particularly susceptible to the sheering injuries seen in TBI. The pituitary gland, which is housed in a bony structure at the base of the skull, controls the function of most other endocrine glands and is therefore sometimes called the “master gland.” Read More

May 31, 2018

Cognitive Training Reduces Depression and Changes Brain Structure in Individuals with Chronic TBI Symptoms

Research scientists at the Center for Brain Health at the University of Texas at Dallas have just published a study, funded by the US Department of Defense, supporting the effectiveness of “strategy-based” cognitive training at reducing symptoms of depression commonly found in patients with chronic (greater than 6 months) traumatic brain injury (TBI) symptoms.

The training was an integrative program designed to improve cognitive control by exerting more efficient thinking strategies for selective attention and abstract reasoning. The training did not directly target psychiatric symptoms such as depression, but was nonetheless effective at reducing those symptoms. Read More