stem cells used on tbiThe loss of working memory is one of the more common complications after a moderate to severe traumatic brain injury, and can frequently become disabling enough to cause a loss of independent living.

Researchers have been testing the use of stem cells as a therapy for brain disorders, including the complications resulting from traumatic brain injury. However, both the most effective time of administration of stem cells, and the complications most likely to respond to stem cell therapy have been unclear. A recent animal study found that stem cell therapy administered in the first few days of a traumatic brain injury 1) decreased inflammation, 2) decreased lesion size, and 3) improved working memory for up to ten weeks after administration. In addition, the stem cell therapy was associated with new neural development in the hippocampus, the area of the brain related to memory.

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Building “resilience” to traumatic brain injuryThe two most common strategies against traumatic brain injury are 1) prevention of injury and 2) reduction of secondary damage (i.e., inflammation and cell death after the primary injury.  A third potential strategy focuses on the theoretical “preconditioning” of the brain to injury such that the brain becomes tolerant to the effect of a traumatic brain injury (TBI).

Researchers have previously focused on preconditioning for high-risk stroke patients, but newer studies have turned the spotlight on TBI in high-risk sports or elective surgeries. A recent review highlighted various preconditioning strategies such as increased exercise, heat stress, hyperbaric oxygen therapy, or volatile anesthetics that all show potential for decreasing injury, as well as associated cognitive and motor impairments.

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poor-sleep_braininjurySleep dysfunction is common after a traumatic brain injury, and can negatively affect mood, cognition and pain, as well as diminishing the potential for recovery. Even though the negative of effect of sleep on recovery is well-established, it is not routinely assessed in clinics.

A recent review assessed the current gaps for assessing sleep dysfunction after a traumatic brain injury. They found that people with a traumatic brain injury tend to under-report sleep problems to their doctors. In order for a sleep dysfunction to be accurately diagnosed, patients should be assessed with a 1) subjective tool that can depict sleep patterns and daytime functioning over a duration of time, and 2) an objective measure that can help diagnose specific sleep patterns such as periodic movement disorder or narcolepsy.

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AABI_copper_deficiencyMyelin is the white, fatty sheath that covers the axon area of a neuron, supporting the rapid transmission of information from one neuron to another. After a traumatic brain or spinal cord injury, myelin concentration can be significantly reduced, sometimes limiting recovery.

Some scientists believe that myelin is also dependant on the mineral copper for its activity and defense, and that our population may show general deficiencies in copper levels in the brain. Although the hypothesis has not yet been tested, some scientists feel that copper levels could be important to assess in people who have survived a traumatic brain injury. Clinical trials in the future may help to determine if copper levels are related to brain injury severity, and if copper treatment could aid in recovery.

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traumatic_brain_injury_long_term_outcomesTraditional predictors of long-term outcome after a severe traumatic brain injury (TBI) include the motor score from the Glasgow Coma Scale, papillary reaction, and age. However, these predictors are more reliable for predicting mortality or severe disability. A recent study sought to determine the best predictor of cognitive functioning after severe TBI.

The researchers compared the outcomes of severe TBI patients who had more than 12 hours of intensive care treatment. Using a battery of neuropsychological assessments and the Glasgow Outcome Scale (GOS), they found that a GOS score at the time of discharge from the hospital was significantly less likely to long-term outcome that the GOS score at the time of discharge from rehabilitation. In addition, they found that patients who were under the age of 40 were more likely to have a favorable long-term outcome.

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allaboutbraininjury_languageLanguage is a complex cognitive function, requiring several areas of the brain to oversee the motor function of speech and the articulation of intelligible sentences, as well as nuances such as the ability to comprehend irony or non-literal concepts. A traumatic brain injury during childhood can significantly impact language ability, with impairments sometimes being delayed by developmental milestones.

The correlation of brain areas to language impairment after pediatric traumatic brain injury is still not well understood. A recent study used diffusion-weighted tractography (a type of scan) to determine that injury to the white matter tracts in the brain (namely the corpus callosum, arcuate fasciculus, and uncinate fasciculus) predicts poor language outcome over the long-term. The language impairments especially involved sentence formation and semantic association. When both the corpus callosum and the left arcuate fasciculus were injured, the “dual blow” created the most serious language impairments.

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detecting_brain_injury_premiesAlthough medical advances have increased survival rates in preterm babies, neurodevelopmental impairments frequently persist and can result in long-term cognitive impairments such as reduced language skills, attention problems, poor social skills, and lowered IQ scores. The detection of neural injury in the preterm infant is important for planning preventative, protective, and rehabilitative strategies.

A recent research review discussed diffusion-weighted magnetic resonance imaging (dMRI) as an effective diagnostic tool for detecting white matter injury in preterm births. The white matter injury found using dMRI in preterm births was correlated to cognitive deficits at later ages, from adolescence to early adulthood. The researchers discussed the potential for using dMRI not only for the detection of white matter injury, but also as a tool for assessing the efficacy of clinical interventions used to reduce further injury and recover function.

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Neuroimaging biomarker of TBIA common point-of-view about mild traumatic brain injury, or concussion, is that its effects are short-lived, and that the patient will return to normal without intervention. Although most people may indeed spontaneously recover fully after a mild traumatic brain injury, it is also becoming clear that neurological changes may persist in the brain—even after the patient is no longer experiencing outward symptoms or complications.

In a recent review of structural neuroimaging techniques that are more sensitive to subtle brain changes, a recent research review outlined the potential to show the long-term effects of mild traumatic brain injury using neuroimaging. For instance, magnetic resonance imaging (MRI) can show abnormalities in white matter or in levels of hemosiderin (a blood byproduct), and diffusion tensor imaging (DTI) can illustrate changes in white matter tracts. However, in order for these biomarkers to be clinically useful, there needs to be an understanding of the underlying pathologies that they represent, and an ability to analyze them appropriately.

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apathyApathy is a common effect of traumatic brain injury, but one that is not well understood. Apathy has traditionally been defined as emotional indifference, but the reality of apathy is far more complex. For people who have suffered from a traumatic brain injury, apathy is better illustrated as diminished goal-directed behavior. Goal-directed behavior is defined as a set of processes, including motivation, emotion, cognition, and motor skills that are initiated into action in order to reach a goal. The “direction” part of goal-directed behavior comes from the understanding of the relationship between the action and an outcome. Apathy is therefore not as simple as a lack of motivation or emotion. It is a much more complex syndrome that is related to injury to specific parts of the brain.

Injury to the dorsolateral prefrontal cortex, orbitofrontal cortex, insula, and white matter tracts can be linked to apathy. A diagnosis of apathy can be made when a person displays (in absence of a change in consciousness) diminished motivation in relation to previous behavior, and four weeks of at least two of the following: 1) diminished goal-directed behavior, 2) diminished goal-directed cognitive activity, and 3) diminished emotions.

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finger_tapping_testFinger tapping is a common neurological assessment in which the neurologist asks the patient to tap his finger as fast as possible. Slowed or abnormal finger tapping can be a sign of brain disturbances, including traumatic brain injury.

In a recent study, computerized finger tapping was found to be a sensitive measure of motor impairment after a mild TBI. The researchers compared the slowed finger tapping of mild TBI patients to malingering subjects, and found that the finger tapping of the malingering subjects was abnormally slower than that of the mild TBI patients.

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Scarlett Law Group, Attorneys, San Francisco, CA

Contact Us

Scarlett Law Group

536 Pacific Avenue
Barbary Coast Bldg
San Francisco, CA 94133

1-800-262-7576

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