Traumatic Brain Injury (TBI)

Living in Alaska I am 30% more likely than my lower-48 relatives to acquire Traumatic Brain Injury (TBI). Most TBI is caused by vehicle accidents, followed by falls, and then assault. Alaska is snowy and icy for about 6 months of the year...lots of opportunity for accidents and falls. Plus, we have a high rate of domestic violence. Additionally, there seems to be a cultural component in TBI - if you are an Alaska Native person, or if you live in the rural northwest of Alaska, you may be up to 4.5 times more likely to get TBI than other Americans.

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Traumatic Brain Injury comes in two types: Closed Head Injury, and Open Head Injury.

Closed Head Injury means that the brain is not exposed to the elements during the injury. However, it is still very dangerous. In 20% of fatal cases, there is no skull fracture present. This is especially true when TBI happens to kids because children have more flexible skulls than adults.

Open Head Injury means the brain is exposed to the elements during the injury. It is much more rare than Closed Head Injury, and is usually caused by gunshot wounds.

Remember Phineas Gage? He's probably the most famous case of Open Head Injury in textbooks.

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In 1848 Phineas was 25 years old and working in Vermont as a railway construction foreman. It was his job to set explosive charges with a tamping iron, when something went wrong and the iron bar was forced through his head. Amazingly, he woke up on the way to the doctor. He lived for 12 years after his injury, but friends and family say he was never the same person. His personality changed dramatically due to his brain injury.

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What's the Damage?
The damage caused by TBI is unique to each injury based upon what part of the brain is affected. For more information about about the different structures and functions of the brain, see my previous blog post called What's In a Brain? Since most TBI is caused by whiplash damage due to a motor vehicle accident, that's what we'll focus on for the rest of this blog post. 

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The brain is made up of soft and delicate tissue. When it smashes around inside the skull it can get injured. This type of injury results in tearing of bridging veins and broken blood vessels. The blood vessels spill blood into the surrounding tissue, damaging or killing sensitive brain cells called axons.

Additionally, the brain's balance and sensitivity to neuropeptides, electrolytes, and excitatory amino acids can be altered due to brain injury. This leads to problems with a variety of functions, including mood regulation and sleep/wakefullness.

Other common problems include:
     Frontal lobe damage (the front of the brain): confusion, irritability, trouble with memory, slower processing speed, slower reaction time, problems with attention and goal setting.
     Occipital lobe damage (the back of the brain): vision problems such as "seeing stars" or light sensitivity...differences in what is seen vs. ow the body feels in space...dizziness, nausea, vertigo, and motion sensitivity. 
     Temporal lobe damage (the sides of the brain): problems with comprehension of simple instructions, naming objects, interpreting facial features, social relationships, emotional perception, and expression of emotion.

What to do? 

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Brain damage is dangerous. Please take it seriously. Lots of people hit their head, see stars, shake it off and keep going. It's a myth that you need to lose consciousness to really hurt your brain. Click the links below to see video stories of a teen who shook off some TBI and got back in the game when she should have gotten help instead. 

Keeping quiet can keep you out of the game - a teen's story.

Keeping quiet can keep you out of the game - a mother's story.

Prevent TBI:
Wear a helmet
Wear a seatbelt
Always drive sober and make sure you always have a sober ride 
Use ice grippers on you shoes in the winter
Get help immediately if you get hurt
If you see someone got hurt, make sure they get help

After TBI:
Get a neuropsychological evaluation if you notice any changes in function or personality. This is a special test that helps figure out if there is any brain damage, where the brain damage is, and what to do about it.

Follow the recommendations of your doctor...these may include medications, but also referrals to speech therapists, physical therapists, occupational therapists, vocational rehabilitation, student support services, counseling, etc.

Help your brain heal itself by getting lost of exercise - good blood flow is needed for the brain to heal. Also, consider contacting a counselor who does neurofeedback - a special  type of therapy to help your brain heal.

Stroke

What is a Stroke?

Stroke is the third leading cause of death in the United States. Basically, a stoke happens when blood supply to the brain is disrupted. There are two main types of stroke. One is called "ischemic" and happens when a clot blocks blood flow to the brain. Without a good blood supply, brain tissue becomes starved and dies. The other type of stroke is called "hemoragic" and happens when a weakened blood vessel breaks and spills blood into the brain. Pools of blood are toxic to our delicate brain tissue. Sometimes a stroke is called a "brain attack."





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 Different problems arise depending on where the damage from the brain attack occurs. The most common type of stroke is an ischemic stoke in the external carotid artery. This leads to damage in the left hemisphere of the brain. (I talk about the different parts of the brain, and what they do, in a previous post called "What's in a Brain?")

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A quick response to stroke is the best way to save brain functioning. Even though the damage caused by stroke is hidden inside our brains, the symptoms associated with stroke are easy to spot. They include sudden numbness or weakness, especially on one side of the body; sudden confusion or trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, or loss of balance or coordination; or sudden severe headache with no known cause.

WARNING SIGNS OF STROKE:

S = SPEECH, or any problems with language.
T = TINGLING, or any numbness in the body.
R = REMEMBER, or any problems with memory.
O = OFF BALANCE, problems with coordination.
K = KILLER HEADACHE.
E = EYES, or any problems with vision.

STROKE is a medical emergency. Call 9-1-1. 

Risk and Prevention

High blood pressure is the number one risk factor for stroke. Other risk factors include smoking, heart disease, diabetes, a history of head/neck injuries, and age - if you're over 65 you're more likely to have a stroke than the general population.

Healthy living is the best way to prevent stroke. We all know what that means...eat well, exercise, reduce stress, socialize, challenge your brain, stop smoking and visit with your doctor. 



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 Life After Stroke

Medication and surgery are often medical treatments for stroke. However, a "brain attack" can have long-lasting affects on movement, cognition, language, emotions, memory, and pain. The brain is a flexible organ that can adapt to damage. While full recovery may not be possible, people who survive stroke can regain a lot of what was lost, and learn a new meaning of living well. 

The first step is often a neuropsychological assessment. A specialy trained psychologist will do some tests to determine exactly what areas of the brain were damaged by the stroke, and what treatments are recommended to address those issues. Then a plan can be created that may include:

Physical therapy to help relearn walking, sitting, lying down, and switching from type of movement to another.

Occupational Therapy to help relearn eating, drinking, dressing, bathing, cooking, reading, writing, and toileting.

Speech Therapy to help relearn language and communication skills, including swallowing.

Psychological/Psychiatric Therapy to alleviate mental and emotional problems.

There is hope. Recovery is possible. For an inspirational story of a woman who survived a stroke, check out this video or read My Stroke of Insight by Dr. Jill Bolte Taylor.





What's in a brain?

In later posts I will be discussing brain damage and diseases. However, a basic understanding of brain structures and function is needed first. This post is meant to be a very basic version of brain anatomy that is easy to follow for people who are just learning about how the brain works.

The big three

A huamn brain has three main parts. The cerebrum, the cerebellum, and the brain stem.

The area that separates us from moose is called the cerebrum. Moose have a cerebrum, but it's about half the size and theoretically provides only about half the functioning ability. The cerebrum is the largest part of the human brain, and is also the outer layer of the brain. It has two parts: a right and a left hemisphere. (Pictured below is the left hemisphere.) The cerebrum is responsible for higher level functioning like  interpreting touch, vision, hearing, language, reasoning, emotions, learning, and fine control of movement.


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The cerebellum is responsible for balance, coordination, and posture. It is also the area of the brain where we keep our muscle memories. The cerebellum is what keeps me upright while downhill skiing. It also helps me remember how to play Blackbird on the guitar, and how to tie my shoes.

The brain stem is the part of the brain that connects the cerebellum and cerebrum to the spinal cord. It controls automatic functions like breathing, heart rate, swallowing, body temperature, vomiting, digestion, etc. Damage here is usually fatal.

Left brain vs. right brain

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The left and right hemispheres of the brain are connected by an information highway called the corpus callosum. The two hemispheres have a reputation for operating individually, but they really act in concert. This myth of independence may come from the fact that each hemisphere generally controls the movement on the opposite side of the body. For example, a stroke in the left hemisphere of the brain may result in weakness in the right arm.

The left hemisphere of the brain generally controls arithmetic, and language skills such as comprehension, writing, grammar and syntax. The right hemisphere of the brain generally controls artistic abilities, and recognition of non-verbal communication skills such as pitch, tone, and facial features. To have a meaningful conversation with someone, you must have both brain hemispheres working together to understand the words being said, and the manner in which those words are delivered.

Inside the brain



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Inside the brain are a series of structures that help determine emotional states, modify perceptions based on those states, and intiate involuntary movements.
The thalamus is an information relay center for the brain. It helps decide what to focus on, alerts us to pain, and starts memory formation.

The hypothalamus wakes us up in the morning, gives us adrenaline during a job interview, and regulates emotions.

The amygdala is the home of the "fight or flight" response. It is also involved in regulating emotions like anger and pleasure.

The olfactory bulb processes smell.

The thalamus, hypothalamus, amygdala and olfactory bulb all connect to the hippocampus. The hippocampus is a memory filing system. It stores long-term memories in the cerebrum, and then retrieves those memories later. In the above diagram, it's easy to see that memory is highly linked to emotions, attention, and smell.

Be good to your brain.

What's good for the...


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Easy steps to take to keep your brain healthy and active...
(Below info borrowed from Alzheimer's Resource of Alaska)

• Exercise - Walk or exercise moderately for at least 30 minutes per day.
• Maintain a healthy, well-balanced diet - Eat brain-healthy foods and control portion sizes. A low-fat diet including vegetables, fruits, nuts and fish is recommended for brain health.
• Keep your brain active - stimulate your brain with learning new things, or activities like crossword-puzzles and reading.
• Socialize - you can even socialize while exercising.
• Reduce stress and anxiety - you know what works best for you, but you may want to consult with a counselor.
• Stop smoking.
• Talk to your doctor if you have concerns about weight, cholesterol, blood pressure, or memory.

Moose Brains

Those who know me may have heard rumors of moose brains...

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The rumors are true!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

This semester I am studying Biological Bases of Behavior. My assigned topic is anatomy of the nervous system. However, studying anatomy in 2D is futile. So, my hunting hook-ups are bringing me a moose brain. Moose hunting season opened on August 20th, 2011. My moose brain will be delivered August 21st, 2011. Stay tuned for pictures and anatomical insights...

You may wonder if moose brains are anything like human brains. I wonder that too. However, Dr. Jill assures me that mammalian brains are pretty similar. Dr. Jill is a brain scientist who survived a stroke and wrote a book about her experience. Very cool stuff.

Dr. Jill says, "The portion of our brain that separates us from all other mammals is the outer undulated and convoluted cerebral cortex. Although other mammals do have a cerebral cortex, the human cortex has approximately twice the thickness and is believed to have twice the function (p. 15)."

Human cerebral cortex; Retrieved from: http://farm3.static.flickr.com/2012/1971826491_601f359b84.jpg

Dr. Jill says some other really interesting things. Of course being a stroke survivor, she says everyone should know the

WARNING SIGNS OF STROKE:

S = SPEECH, or any problems with language.
T = TINGLING, or any numbness in the body.
R = REMEMBER, or any problems with memory.
O = OFF BALANCE, problems with coordination.
K = KILLER HEADACHE.
E = EYES, or any problems with vision.

STROKE is a medical emergency. Call 9-1-1. 

Take care of yourself and your big, bad, beautiful brain!