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Traumatic Brain Injury Healing Tips

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How to Prevent Neurons from Dying after Brain Injury

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Electrical stimulation of the brain by applying current to the eye may help retinal nerve cells to survive injury. While these neurons may not be restored to full function, they are prevented from dying. But to achieve survival, their interconnections, the dendritic tree, needs to disconnect rapidly for the protective action to unfold. In a study published in Scientific Reports, researchers from Magdeburg University (Germany) and The Chinese University of Hong Kong report that for rats and mice, repetitive transorbital alternating current stimulation (rtACS) may help preserve visual neurons from cell death after injury.

Because the tissue at the back of the eye, the retina, is part of the brain, researchers can directly observe how brain cells react in the living animal. The researchers repeatedly monitored neurons in both rat and mouse retinas after an optic nerve injury and measured neuronal death after this lesion. Surprisingly, a neuroprotective treatment with electrical alternating current stimulation increased cellular survival in the eye´s retina, but it also induced a fast and complete stripping-off of the neuron’s dendritic tree. The dendrites are like a tree receiving many thousands of signals from other neurons. This enables them to process visual information and then transmit the signals along the optic nerve towards the brain. By retracting its dendrites, the cell withdraws itself from this intercellular communication network and becomes silent — which helps its survival.

The test animals were divided into groups and subjected to both real and sham treatments. For the rats, optic nerve crush (ONC) was used to induce an injury in some of the animals to mimic glaucoma. Some animals and not others (sham) were treated with rtACS, resulting in three test groups: ONC/rtACS, ONC/Sham, and Sham/Sham. Using in vivo confocal neuroimaging (ICON) and measurements of Visual Evoked Potentials (VEP), the researchers could determine whether a neuron had survived and whether it was still functioning. The ONC and the first rtACS stimulation were done on day zero. ICON was performed on day 4, followed by rtACS or sham stimulation. On day 7 post ONC another ICON was performed.

For the mice, a confocal laser ophthalmoscope was used to image the dendritic structures of the retina for three groups of subjects, ONC/rtACS, ONC/Sham and Sham/rtACS. The mice received rtACS on days 0, 3, 6, 9 and 12 after ONC and images were taken on days 3, 7 and 14.

According to lead author Petra Henrich-Noack, PhD, Institute of Medical Psychology, Otto-von-Guericke University, Magdeburg, Germany, “With our experiments, we have detected so far unknown ‘silent survivor cells’ in the brain and it will be exciting to find out whether they later die or can be reactivated.” Surprisingly, neurons in the retina of animals that survived better when treated with rtACS lost their dendritic tree completely within the first 3 days after the lesion. The authors suggest that this early structural isolation might protect the neurons from the “toxic” excitation that is known to appear soon after brain damage.

 

 

Story Source:

Materials provided by Institute for Medical Psychology, Otto-v.-Guericke University Magdeburg. Note: Content may be edited for style and length.

Journal Reference:

Petra Henrich-Noack, Elena G. Sergeeva, Torben Eber, Qing You, Nadine Voigt, Jürgen Köhler, Sebastian Wagner, Stefanie Lazik, Christian Mawrin, Guihua Xu, Sayantan Biswas, Bernhard A. Sabel, Christopher Kai-Shun Leung. Electrical brain stimulation induces dendritic stripping but improves survival of silent neurons after optic nerve damage. Scientific Reports, 2017; 7 (1) DOI: 10.1038/s41598-017-00487-z

 

 

Sleep is Important in the Healing of TBI

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There is a link between the amount of sleep the patient gets and the rate at which their brain heals.

A study of 30 people that were hospitalized for moderate to severe traumatic brain injuries found that sleep quality and brain function improved in tandem, researchers reported in the journal Neurology.

“Patients who still had low levels of consciousness and cognitive functioning would “sleep for a couple of minutes and then wake up for a couple of minutes,” both day and night, says Nadia Gosselin.

The results increase the possibility that patients with brain injuries possibly recover even quicker if hospitals would take measures  to restore normal sleep patterns, Gosselin says. Drugs are one option, she says. Another is making sure patients are exposed to sunlight or its equivalent during the day and at night rest in a dark, quiet environment.

“I think bad sleep can have bad consequences for brain recovery,” she concludes.

New Test to Quickly Identify Mild Traumatic Brain Injury

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A new test using peripheral vision reaction time could lead to earlier diagnosis and more effective treatment of mild traumatic brain injury, often referred to as a concussion. Identify Brain Injury

A new test using peripheral vision reaction time could lead to earlier diagnosis and more effective treatment of mild traumatic brain injury, often referred to as a concussion, according to Peter J. Bergold, PhD, professor of physiology and pharmacology at SUNY Downstate Medical Center and corresponding author of a study newly published online by the Journal of Neurotrauma.

While most patients with mild traumatic brain injury or concussion fully recover, a significant number do not, and earlier diagnosis could lead to better management of patients at risk for developing persistent symptoms, according to Dr. Bergold and his co-authors.

Lingering symptoms may include loss of concentration and/or memory, confusion, anxiety, headaches, irritability, noise and light sensitivity, dizziness, and fatigue.

“Mild traumatic brain injury is currently diagnosed with subjective clinical assessments,” says Dr. Bergold. “The potential utility of the peripheral vision reaction test is clear because it is an objective, inexpensive, and rapid test that identifies mild traumatic brain injury patients who have a more severe underlying injury.”

Dr. Bergold’s co-authors include colleagues from the University of Texas Southwestern Medical Center; The University of Texas at Dallas; Washington University; the National Institute of Neurological Disorders and Stroke; the Uniformed Services University of the Health Sciences; and SUNY Downstate.

The article published by the Journal of Neurotrauma is titled “Measurement of Peripheral Vision Reaction Time Identifies White Matter Disruption in Patients with Mild Traumatic Brain Injury.”

[embedyt] http://www.youtube.com/watch?v=aKZnMC5vzhU[/embedyt]

Story Source:

Materials provided by SUNY Downstate Medical Center. Note: Content may be edited for style and length.

Journal Reference:

  1. Kyle B. Womack, Christopher Paliotta, Jeremy F. Strain, Johnson S. Ho, Yosef Skolnick, William W. Lytton, L. Christine Turtzo, Roderick McColl, Ramon Diaz-Arrastia, Peter J. Bergold. Measurement of Peripheral Vision Reaction Time Identifies White Matter Disruption in Patients with Mild Traumatic Brain Injury. Journal of Neurotrauma, 2017; DOI:10.1089/neu.2016.4670

SUNY Downstate Medical Center. “New test may quickly identify mild traumatic brain injury with underlying brain damage.” ScienceDaily. ScienceDaily, 16 February 2017. <www.sciencedaily.com/releases/2017/02/170216120538.htm>.

 

What is a Diffuse Axonal Injury? (DAI)

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“As tissue slides over tissue, a shearing injury occurs. This causes the lesions that are responsible for unconsciousness, as well as the vegetative state that occurs after a severe head injury. A diffuse axonal injury also causes brain cells to die, which cause swelling in the brain.”
DAI is characterized by axonal separation, in which the axon is torn at the site of stretch and the part distal to the tear degrades. While it was once thought that the main cause of axonal separation was tearing due to mechanical forces during the trauma, it is now understood that axons are not typically torn upon impact; rather, secondary biochemical cascades, which occur in response to the primary injury (which occurs as the result of mechanical forces at the moment of trauma) and take place hours to days after the initial injury, are largely responsible for the damage to axons.
Though the processes involved in secondary brain injury are still poorly understood, it is now accepted that stretching of axons during injury causes physical disruption to and proteolytic degradation of the cytoskeleton.[1] It also opens sodium channels in the axolemma, which causes voltage-gated calcium channels to open and Ca2+ to flow into the cell. The intracellular presence of Ca2+ unleashes several different pathways, including activating phospholipases and proteolytic enzymes, damaging mitochondria and the cytoskeleton, and activating secondary messengers, which can lead to separation of the axon and death of the cell.

Tips on How To Recover from a TBI

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Recovering from a Brain Injury could be a long and grueling process, especially if you do not have the information to better assist you to heal.  In this post, we go over how to help accelerate the healing of your brain.

Recover – Get a lot of rest around evening time, and rest amid the day.
Maintain a strategic distance from exercises that are physically requesting (e.g., substantial housecleaning, weightlifting/working-out) or require a considerable measure of fixation (e.g., adjusting your checkbook). They can exacerbate your manifestations and moderate your recuperation.

Stay away from exercises, for example, contact or recreational games, that could prompt to another blackout (it is best to maintain a strategic distance from fast entertainment mecca rides that can exacerbate your side effects or even cause a blackout).
At the point when your medicinal services proficient says you are alright, come back to your typical exercises bit by bit, not at the same time.
Since your capacity to respond might be slower after a blackout, ask your social insurance proficient when you can securely drive an auto, ride a bicycle, or work overwhelming gear.
Converse with your medicinal services proficient about when you can come back to work. Get some information about how you can help your boss comprehend what has transpired.
Consider chatting with your boss about coming back to work step by step and about changing your work exercises or timetable until you recoup (e.g., work half-days).
Take just those medications that your medicinal services proficient has endorsed.
Try not to drink mixed refreshments until your social insurance proficient says you are all around ok. Liquor and different medications may moderate your recuperation and put you at danger of further damage.
Record the things that might be harder than regular for you to recollect.
In case you’re effectively occupied, attempt to do one thing at any given moment. For instance, don’t attempt to sit in front of the TV while settling supper.
Counsel with relatives or dear companions when settling on essential choices.
Try not to disregard your fundamental needs, for example, eating great and getting enough rest.
Maintain a strategic distance from supported PC utilize, including PC/computer games ahead of schedule in the recuperation procedure.
A few people report that flying in planes aggravates their side effects soon after a blackout.

TBI Recovery Phases, Short/Long-Term Impacts

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Like almost everything else in life, recovering from a TBI is a process. This article will make you aware of the different stages of that process.

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Common stages

In the first few weeks after a brain injury, swelling, bleeding or changes in brain chemistry often affect the function of healthy brain tissue. The injured person’s eyes may remain closed, and the person may not show signs of awareness. As swelling decreases and blood flow and brain chemistry improve, brain function usually improves. With time, the person’s eyes may open, sleep-wake cycles may begin, and the injured person may follow commands, respond to family members, and speak. Some terms that might be used in these early stages of recovery are:

  • Coma: The person is unconscious, does not respond to visual stimulation or sounds, and is unable to communicate or show emotional responses.
  • Vegetative State: The person has sleep-wake cycles, and startles or briefly orients to visual stimulation and sounds.
  • Minimally Conscious State: The person is partially conscious, knows where sounds and visual stimulation are coming from, reaches for objects, responds to commands now and then, can vocalize at times, and shows emotion.

A period of confusion and disorientation often follows a TBI. A person’s ability to pay attention, agitation, nervousness, restlessness or frustration may appear. Sleeping patterns may be disrupted. The person may overreact to stimulation and become physically aggressive. This stage can be disturbing for family because the person behaves so uncharacteristically.

Inconsistent behavior is also common. Some days are better than others. For example, a person may begin to follow a command (lift your leg, squeeze my finger) and then not do so again for a time. This stage of recovery may last days or even weeks for some. In this stage of recovery, try not to become anxious about inconsistent signs of progress. Ups and downs are normal.

Later stages of recovery can bring increased brain and physical function. The person’s ability to respond may improve gradually.

Length of Recovery:

The fastest improvement happens in about the first six months after injury. During this time, the injured person will likely show many improvements and may seem to be steadily getting better. The person continues to improve between six months and two years after injury, but this varies for different people and may not happen as fast as the first six months. Improvements slow down substantially after two years but may still occur many years after injury. Most people continue to have some problems, although they may not be as bad as they were early after injury. Rate of improvement varies from person to person.

Long-term impacts:

It is common and understandable for family members to have many questions about the long-term effects of the brain injury on the injured person’s ability to function in the future. Unfortunately, it is difficult to determine the long-term effects for many reasons.

  • First, brain injury is a relatively new area of treatment and research. We have only begun to understand the long-term effects in patients one, five, and ten years after injury.
  • Brain scans and other tests are not always able to show the extent of the injury, so it is sometimes difficult early on to fully understand how serious the injury is.
  • The type of brain injury and extent of secondary problems such as brain swelling varies a great deal from person to person.
  • Age and pre-injury abilities also affect how well a person will recover.

We do know that the more severe the injury the less likely the person will fully recover. The length of time a person remains in a coma and duration of loss of memory (amnesia) following the coma are useful in predicting how well a person will recover.

The Rancho Los Amigos Levels of Cognitive Functioning (RLCF) is one of the best and most widely used ways of describing recovery from brain injury. The RLCF describes ten levels of cognitive (thinking) recovery. Research has shown that the speed at which a person progresses through the levels of the RLCF can predict how fully a person will recover.

The Rancho Los Amigos Levels of Cognitive Functioning:

Level 1– No Response: Person appears to be in a deep sleep.

Level 2– Generalized Response: Person reacts inconsistently and not directly in response to stimuli.

Level 3– Localized Response: Person reacts inconsistently and directly to stimuli.

Level 4– Confused/Agitated: Person is extremely agitated and confused.

Level 5– Confused-Inappropriate/Non-agitated: Person is confused and responses to commands are inaccurate.

Level 6– Confused-Appropriate: Person is confused and responds accurately to commands.

Level 7– Automatic-Appropriate: Person can go through daily routine with minimal to no confusion.

Level 8– Purposeful-Appropriate: Person has functioning memory, and is aware of and responsive to their environment.

Level 9– Purposeful-Appropriate: Person can go through daily routine while aware of need for stand by assistance.

Level 10– Purposeful-Appropriate/Modified Independent: Person can go through daily routine but may require more time or compensatory strategies.

 

Recovery two years after brain injury

Based on information of people with moderate to severe TBI who received acute medical care and inpatient rehabilitation services at a TBI Model System, two years post-injury:

  • Most people continue to show decreases in disability.
  • 34% of people required some level of supervision during the day and/or night.
  • 93% of people are living in a private residence.
  • 34% are living with their spouse or significant other; 29% are living with their parents.
  • 33% are employed; 29% are unemployed; 26% are retired due to any reason; and 3% are students.

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Disclaimer

This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.

Source

Our health information content is based on research evidence whenever available and represents the consensus of expert opinion of the TBI Model Systems directors.

Our health information content is based on research evidence and/or professional consensus and has been reviewed and approved by an editorial team of experts from the TBI Model Systems.

Authorship

Understanding TBI was developed by Thomas Novack, PhD and Tamara Bushnik, PhD in collaboration with the Model System Knowledge Translation Center. Portions of this document were adapted from materials developed by the Mayo Clinic TBIMS, Baylor Institute for Rehabilitation, and from Picking up the pieces after TBI: A guide for Family Members, by Angelle M. Sander, PhD, Baylor College of Medicine (2002).

Understanding TBI: Part 3 – The Recovery Process. (n.d.). Retrieved February 14, 2017, from http://www.msktc.org/tbi/factsheets/Understanding-TBI/The-Recovery-Process-For-Traumatic-Brain-Injury