Dr. Marilyn Kraus of the University of Illinois at Chicago College of Medicine recently reported a new study that states diffusion tensor imaging can detect changes in the brain that correlate to cognitive deficits in those with mild traumatic brain injury.

In the study, 37 traumatic brain injury patients -- 20 mild and 17 moderate-to-severe -- and 18 healthy volunteers underwent diffusion tensor imaging and neuropsychological testing to evaluate memory, attention and executive function. The researchers found that structural changes in the white matter correlate to observable cognitive deficits related to thinking, memory and attention.

You can read more on Dr. Kraus' study here.

Dr. Marilyn Kraus of the University of Illinois at Chicago College of Medicine recently reported a new study that states diffusion tensor imaging can detect changes in the brain that correlate to cognitive deficits in those with mild traumatic brain injury.

In the study, 37 traumatic brain injury patients -- 20 mild and 17 moderate-to-severe -- and 18 healthy volunteers underwent diffusion tensor imaging and neuropsychological testing to evaluate memory, attention and executive function. The researchers found that structural changes in the white matter correlate to observable cognitive deficits related to thinking, memory and attention.

You can read more on Dr. Kraus' study here.

The Centers for Disease Control and Prevention (CDC) announced in August 2007 funding of the Mount Sinai Injury Control Research Center at the Mount Sinai School of Medicine, New York City. This new center will conduct research on persons with traumatic brain injury (TBI) to better understand the consequences of injury and the needs of injured people, with the aim of enhancing quality of life.

Mount Sinai’s is one of several CDC Injury Control Research Centers, which are located at universities throughout the U.S. and that integrate scientists from a wide spectrum of disciplines to study how to prevent and control injuries more effectively. In addition each ICRC provides technical assistance to injury prevention and control programs within its geographic region.

Amongst the many centers across the U.S., the Mount Sinai ICRC will be unique, as its sole focus will be on TBI, unlike the other centers, which aim their activities at many types of disability. The emphasis on TBI is in recognition of the large number of people who sustain permanent disability annually. CDC estimates that at least 5.3 million Americans, about 2% of the population, sustain lifelong challenges in daily living as a result of TBI. The Mount Sinai ICRC is also taking an unusual path for a center, in that it will focus not on primary prevention, in which the idea is to prevent injuries from happening in the first place. Instead, it will concern itself with “secondary” prevention –  to find better ways to prevent problems from occurring after the initial injury. For example, many people with TBI experience mood problems after injury, and one of Mount Sinai’s research projects will study how to treat that problem if it occurs or prevent it from happening at all – trying to halt one part of the cascade of negative events that often follows brain injury.

“We are pleased to add the Mount Sinai ICRC and their TBI expertise to the diversity of CDC’s ICRC’s. We believe the research they are undertaking will lead to richer, fuller lives for the millions of Americans who are living with TBI.” said Dr. Ileana Arias, Director of CDC’s Injury Center. She went on to say that “connecting research to communities is a primary focus for CDC and we are pleased that Mount Sinai’s ICRC is now part of this critical research network. We hope that their work in TBI will fill a critical gap and can help shape a better understanding of improving the lives of those affected.”

Mount Sinai plans four TBI research projects; they will:

    * Evaluate the validity of the Brain Injury Screening Questionnaire to better determine its utility in screening for unidentified TBI – for finding people who have had an injury in the past but have never linked current problems in functioning to the injury (as often happens as a result of childhood injuries, sports injuries and abuse/assault)
    * Evaluate the I-CAN, a new method for identifying perceived needs of individuals with TBI
    * Conduct a randomized controlled trial (RCT) to determine the impact of aerobic exercise on the mood and cognitive functioning of individuals with TBI
    * Conduct an RCT to evaluate the impact of an intensive, short-term day program for individuals with TBI, focused on improving complex cognitive functioning and the person’s ability to pay attention

Through CDC’s work with ICRCs, each university’s curriculum also fosters comprehensive programs for training. At the Mount Sinai ICRC, a program for training pre- and post-doctoral researchers is planned, as are efforts to shape the curriculum within Mount Sinai School of Medicine to better address injury control and prevention objectives.  A website, educational materials for individuals with TBI, as well as professionally oriented dissemination are all planned as means of effecting prevention of post-TBI secondary disability

 
For more information about CDC’s ICRC program, visit www.cdc.gov/injury. For information about Mount Sinai’s ICRC, visit www.tbicentral.org. 

Myth 5: The effects of TBI are immediate.

James Smith was stopped at a red light when his car was struck in the rear. At the scene, he was dazed and told the rescue squad personnel that he had pain in the back of his neck. He was taken to the local emergency room where again he complained of neck pain. He was examined, evaluated and released a couple hours later. Over the next couple of days and weeks, James began to experience problems with his attention and concentration. He began having difficulty at work and his relationship with his family began to suffer. His doctors ultimately diagnosed a mild traumatic brain injury, though doctors retained and hired by the insurance company disagreed –arguing that because James did not complain of TBI symptoms immediately following the crash he could not be suffering from a traumatic brain injury.

Are these defense doctors correct or are they simply perpetuating a myth? In Greenfield’s Neuropathology, the authors write:

“Under conditions of mild to moderate TBI, it is now apparent that there is a process of delayed axonomy in which the actual disruption of some axons does not occur until some time after the original injury. Axonomy only becoming apparent between six and 12 hours after injury. Thereafter, the proximal segment continued to expand.”

This delay in recognizing the symptoms of traumatic brain injury also was discussed in the National Institute of Health’s consensus statement, writing that as individuals with TBI attempt to resume their usual daily activities, the environment places increasing demands on them uncovering additional psychosocial consequences. For example, executive dysfunction may become obvious only in the workplace.

You can read my other posts on the 10 myths of traumatic brain injuries here.

Myth 4: Negative MRIs, CT scans and EEGs rule out brain injury.

Another misconception is that if a person has sustained or suffered a traumatic brain injury, today’s sophisticated diagnostic tests will detect it. There is a belief that if those tests are negative or normal, no brain injury has been sustained. Unfortunately, this is another myth.

In a seminal piece titled “Mild Traumatic Brain Injury” in the journal Neurology, Dr. Alexander states: “By common clinical agreement, neuroimaging studies are negative.” Other leading professionals in the field of caring for persons with traumatic brain injury are agreement.

In the text Neuropsychiatry of Traumatic Brain Injury, the authors write: “In addition, many patients with a history of minor brain injury will not have abnormalities on even MRI yet can manifest clear evidence of functional impairment on neuropsychological measures.”

Dr. Zasler, in discussing MRIs, CT scans and the like, writes, “Many practicing physicians believe that a patient with a normal CT and normal electroencephalogram is in fact normal.” They should keep in mind, however, the old adage: Absence of proof is not proof of absence. Historically, the lack of positive neurodiagnostic tests in patients with mild TBI may have reflected a simple lack of sensitivity and/or specificity.

You can read my other posts on the 10 myths of traumatic brain injuries here.