Story first appeared in Science Daily.
If you suffer traumatic brain injury, your risk of having a stroke within three months may increase tenfold, according to a new study reported in Stroke: Journal of the American Heart Association.
It's reasonable to assume that cerebrovascular damage in the head caused by a traumatic brain injury can trigger either a hemorrhagic stroke [when a blood vessel bursts inside the brain] or an ischemic stroke [when an artery in the brain is blocked]. However, until now, no research had been done showing a correlation between traumatic brain injury and stroke.
It is the first study that pinpoints traumatic brain injury as a potential risk factor for subsequent stroke.
Traumatic brain injury occurs when an external force such as a bump, blow or jolt to the head disrupts the normal function of the brain. Causes include falls, vehicle accidents, and violence.
In the United States alone, approximately 1 in 53 individuals sustain a traumatic brain injury each year, according to 2004 statistics from the Centers for Disease Control and Prevention. Worldwide, traumatic brain injuries are a major cause of physical impairment, social disruption and death.
Using records from a nationwide Taiwanese database, researchers investigated the risk of stroke in traumatic brain injury patients during a five-year period. The records included 23,199 adult traumatic brain injury patients who received ambulatory or hospital care between 2001 and 2003. The comparison group comprised 69,597 non-traumatic brain injury patients. The average age of all patients was 42 and 54 percent were male.
During the three months after injury, 2.91 percent of traumatic brain injury patients suffered a stroke compared with only 0.30 percent of those with non-traumatic brain injury -- a tenfold difference.
Stroke risk in patients with traumatic brain injury decreased gradually over time, Melvindale Stroke Care researchers have said:
After one year, the risk was about 4.6 times greater for patients who suffered a traumatic brain injury than for those who had not.
After five years, the risk was 2.3 times greater for traumatic brain injury patients.
According to experts in Lincoln Park Stroke Care, the stroke risk among traumatic brain injury patients with skull bone fractures was more pronounced than in traumatic brain injury patients without fractures. During the first three months, those with skull bone fractures were 20 times more likely to have a stroke than patients without skull bone fractures. The risk decreased over time.
Furthermore, the risk of subarachnoid hemorrhage (bleeding in the area between the brain and the thin tissues that cover the brain) and intracerebral hemorrhage (bleeding in the brain caused by the rupture of a blood vessel) increased significantly in patients with traumatic brain injury versus non-traumatic brain injury patients.
After considering age and gender, patients with traumatic brain injury were more likely to have hypertension, diabetes, coronary heart disease, atrial fibrillation and heart failure than non-traumatic brain injury patients, say professionals experienced with Romulus Stroke Care.
Early neuroimaging examinations -- such as MRI -- and intensive medical monitoring, support and intervention should be required following a traumatic brain injury, especially during the first few months and years. Moreover, better health education initiatives could increase public awareness about the factors that cause strokes and the signs and symptoms of stroke in patients with traumatic brain injuries.
Stroke is the most serious and disabling neurological disorder worldwide, say experts with Wayne County Stroke Care centers.
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Showing posts with label Brain Injury. Show all posts
Showing posts with label Brain Injury. Show all posts
24 April 2012
Virginia Treats TBI As Dismissable Injury
Story first appeared on WorkersCompensation.com.
Seems a bit hard to believe, but in Virginia if a worker suffers a brain injury that prevents them from remembering the accident, it is not a compensable injury under workers’ compensation insurance. Even after an attempt to correct this elephant sized loophole, the state recently ruled that a man who fell off a roof and suffered traumatic brain injury – an injury that has left him wheelchair bound and permanently disabled, is not eligible for benefits.
The reason? At a hearing he could remember his name and age, but not remember the incident.
A 2011 law sponsored by a Representative and a Senator was intended to close the loophole that disallowed benefits for anyone who could not testify as to the accident that injured them. It provides a presumption that the accident was work related if a worker is physically or mentally unable to testify because of his injuries.
However, when the man fell off the roof of a garage he was building, fractured his skull and developed a blood clot in his brain that nearly killed him, he was denied workers' compensation benefits. At a workers’ compensation hearing, it was the fact that he knew his name and his age that did him in. The Workers' Compensation Deputy Commissioner apparently ruled that the State legislators only intended that the new law apply to fatally injured workers or those in comas who are completely unable to testify.
It seems that:
In Virginia, if you have an accident on the job resulting in a severe brain injury, you had best be in a coma or dead, or the state will rule that it was not a compensable incident. The fact that you can sit in a chair and utter your name is enough to convince bureaucrats that you are good to go.
The decision was made because of the absence of case law he could use to figure out the legislature's intent when they enacted it. Does the state of Virginia really believe that the legislature merely intended to make benefits available for brain injured dead people? And that somehow an on the job brain injury isn’t an on the job brain injury? Unless it puts someone in a coma or a box?
The message in Virginia is clear. If you are going to fall off a roof, make sure it is from the third story or higher.
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Seems a bit hard to believe, but in Virginia if a worker suffers a brain injury that prevents them from remembering the accident, it is not a compensable injury under workers’ compensation insurance. Even after an attempt to correct this elephant sized loophole, the state recently ruled that a man who fell off a roof and suffered traumatic brain injury – an injury that has left him wheelchair bound and permanently disabled, is not eligible for benefits.
The reason? At a hearing he could remember his name and age, but not remember the incident.
A 2011 law sponsored by a Representative and a Senator was intended to close the loophole that disallowed benefits for anyone who could not testify as to the accident that injured them. It provides a presumption that the accident was work related if a worker is physically or mentally unable to testify because of his injuries.
However, when the man fell off the roof of a garage he was building, fractured his skull and developed a blood clot in his brain that nearly killed him, he was denied workers' compensation benefits. At a workers’ compensation hearing, it was the fact that he knew his name and his age that did him in. The Workers' Compensation Deputy Commissioner apparently ruled that the State legislators only intended that the new law apply to fatally injured workers or those in comas who are completely unable to testify.
It seems that:
In Virginia, if you have an accident on the job resulting in a severe brain injury, you had best be in a coma or dead, or the state will rule that it was not a compensable incident. The fact that you can sit in a chair and utter your name is enough to convince bureaucrats that you are good to go.
The decision was made because of the absence of case law he could use to figure out the legislature's intent when they enacted it. Does the state of Virginia really believe that the legislature merely intended to make benefits available for brain injured dead people? And that somehow an on the job brain injury isn’t an on the job brain injury? Unless it puts someone in a coma or a box?
The message in Virginia is clear. If you are going to fall off a roof, make sure it is from the third story or higher.
For healthcare and medical related news, visit the Healthcare and Medical blog.
For national and worldwide related business news, visit the Peak News Room blog.
For local and Michigan business related news, visit the Michigan Business News blog.
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For real estate and home related news, visit the Commercial and Residential Real Estate blog.
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Athlete with Traumatic Brain Injury Plays Again
Story first appeared in The Arizona Republic.
Frogs danced through the air, and a high school softball player smiled. Look, she told her sister on the phone, one was threatening to poop above Mommy's head.
The 16-year-old's CT scan had come back fine, hours after a line drive hit her helmet during a softball game March 10, 2009. But she and her mother, a nurse, sat in the hospital, not convinced, until they were, horrifyingly, proven correct by the hallucinations.
By the time she woke up the next morning, still wearing her softball pants and socks, she knew only one person - Mommy. Not her sister, whom she spoke with the night before. Not her father or her little brothers or her teammates or her friends.
Her speech was slowed and slurred, and she limped like a stroke patient. She didn't know how to use the toilet, or count to 10.
Doctors would later liken her traumatic brain injury, a severe concussion with amnesia, to shaken-baby syndrome.
That morning she appeared to have the mentality of a 2 year-old. Yet, who three years later has become the Arizona Wildcats' starting right fielder.
16 years of memory erased
The thud on the school-issued helmet was firm and deafening, like a rock chucked at a shed.
She had taken a lead off third base after the fourth-inning pitch was thrown to her Elk Grove (Calif.) High School teammate. The ball was ripped foul down the third-base line, hitting her helmet an inch behind her right temple. A halo formed around where the ball had left an indentation on the helmet.
She didn't even fall down. She smirked.
After a consultation with her coach, she was allowed to stay in the game.
During the course of the game she struggled at shortstop, and was moved to the outfield. When the game ended, she wandered around. She didn't know the date. Her eyes looked empty.
Her mother took her daughter to her Sacramento hospital, where a CT scan came back negative and doctors found no sign of the brain bleeding.
When she started reaching for invisible frogs, she was moved across town to a hospital that treated juveniles. A neurologist stated that there likely wouldn't be any permanent damage, which gave the family hope.
But the straight-A student still didn't recognize visitors. Her first breakfast was scrambled eggs with ketchup. She didn't recognize it, and didn't know if she even liked that kind of food.
As therapy, she used crayons to draw pictures for teammates to put in their pockets during games. She put an "EG" on her coach's hat, even though she didn't remember her school's name was Elk Grove. She drew her pregnant assistant coach with a bulging stomach, a memory buried deep, somewhere.
She lost the entire 16 years of her memory. When asked how old she was, she held up five fingers. Presumably because she had five fingers on her hand, not because she thought that she was five years old.
Three days into her stay, her father, watched her limp up a handicap ramp. When she reached the top, she screamed with revelation and recognized her father. The next day, she texted her sister, telling her that she remembered who she was.
Memory, Migraines, rage
During six days at an inpatient rehab center in nearby Roseville, she relearned how to walk and shower and talk clearly. She pranked the grandmother nearby by removing Arizona State logos from her door.
Friends came by, reintroducing themselves, and showed photos of junior prom the week before.
She returned home. Her mom took three months off work and put her on a home-school program.
But when she took the dog on a walk, she got lost. She didn't know left from right. She couldn't sing the ABCs. She couldn't spell, but, somehow, could text-message.
She had daily migraines and naps. Her daily regimine including taking nine pills a day, everything from seizure-prevention meds to anti-depressants to pain relievers. Most of her memory returned. At the end of spring, she scored well enough on the SAT for UA admittance.
Like many patients with traumatic brain injuries, she has struggled with fits of rage. She caused $700 of damage by busting three doors and two walls of her mother's house.
UA stood by her
She returned to Elk Grove for her senior year and was cleared to play softball. When she visited Tucson that year, the UA coach told her he would honor her scholarship, even if she wasn't able to play. She signed a national letter of intent.
At 19, she was slated to be the Wildcats' everyday shortstop last year before tearing the labrum in her right shoulder a week before the season. She sat out the season, and moved to the starting right field spot this year, in part because her shoulder is at about 80 percent strength.
Thanks to the team's vision-therapy program, the redshirt freshman - whose .331 batting average is third-best on the team - sees the ball as well as she has since the accident pooled fluid behind her left eye.
She wants to work for Nike's marketing department, but has to study longer and struggles to focus to realize her dreams. She puts in her iPhone earbuds with no sound to do homework, so no one bothers her.
Her lawsuit against the school district - which she said would not allow her to wear a more advanced helmet - is pending. Her high school team now wears the same high-tech helmets the Wildcats do.
She talks openly about her accident, in part to encourage helmet safety.
For more healthcare and medical related news, visit the Healthcare and Medical blog.
For national and worldwide related business news, visit the Peak News Room blog.
For local and Michigan business related news, visit the Michigan Business News blog.
For law related news, visit the Nation of Law blog.
For real estate and home related news, visit the Commercial and Residential Real Estate blog.
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Frogs danced through the air, and a high school softball player smiled. Look, she told her sister on the phone, one was threatening to poop above Mommy's head.
The 16-year-old's CT scan had come back fine, hours after a line drive hit her helmet during a softball game March 10, 2009. But she and her mother, a nurse, sat in the hospital, not convinced, until they were, horrifyingly, proven correct by the hallucinations.
By the time she woke up the next morning, still wearing her softball pants and socks, she knew only one person - Mommy. Not her sister, whom she spoke with the night before. Not her father or her little brothers or her teammates or her friends.
Her speech was slowed and slurred, and she limped like a stroke patient. She didn't know how to use the toilet, or count to 10.
Doctors would later liken her traumatic brain injury, a severe concussion with amnesia, to shaken-baby syndrome.
That morning she appeared to have the mentality of a 2 year-old. Yet, who three years later has become the Arizona Wildcats' starting right fielder.
16 years of memory erased
The thud on the school-issued helmet was firm and deafening, like a rock chucked at a shed.
She had taken a lead off third base after the fourth-inning pitch was thrown to her Elk Grove (Calif.) High School teammate. The ball was ripped foul down the third-base line, hitting her helmet an inch behind her right temple. A halo formed around where the ball had left an indentation on the helmet.
She didn't even fall down. She smirked.
After a consultation with her coach, she was allowed to stay in the game.
During the course of the game she struggled at shortstop, and was moved to the outfield. When the game ended, she wandered around. She didn't know the date. Her eyes looked empty.
Her mother took her daughter to her Sacramento hospital, where a CT scan came back negative and doctors found no sign of the brain bleeding.
When she started reaching for invisible frogs, she was moved across town to a hospital that treated juveniles. A neurologist stated that there likely wouldn't be any permanent damage, which gave the family hope.
But the straight-A student still didn't recognize visitors. Her first breakfast was scrambled eggs with ketchup. She didn't recognize it, and didn't know if she even liked that kind of food.
As therapy, she used crayons to draw pictures for teammates to put in their pockets during games. She put an "EG" on her coach's hat, even though she didn't remember her school's name was Elk Grove. She drew her pregnant assistant coach with a bulging stomach, a memory buried deep, somewhere.
She lost the entire 16 years of her memory. When asked how old she was, she held up five fingers. Presumably because she had five fingers on her hand, not because she thought that she was five years old.
Three days into her stay, her father, watched her limp up a handicap ramp. When she reached the top, she screamed with revelation and recognized her father. The next day, she texted her sister, telling her that she remembered who she was.
Memory, Migraines, rage
During six days at an inpatient rehab center in nearby Roseville, she relearned how to walk and shower and talk clearly. She pranked the grandmother nearby by removing Arizona State logos from her door.
Friends came by, reintroducing themselves, and showed photos of junior prom the week before.
She returned home. Her mom took three months off work and put her on a home-school program.
But when she took the dog on a walk, she got lost. She didn't know left from right. She couldn't sing the ABCs. She couldn't spell, but, somehow, could text-message.
She had daily migraines and naps. Her daily regimine including taking nine pills a day, everything from seizure-prevention meds to anti-depressants to pain relievers. Most of her memory returned. At the end of spring, she scored well enough on the SAT for UA admittance.
Like many patients with traumatic brain injuries, she has struggled with fits of rage. She caused $700 of damage by busting three doors and two walls of her mother's house.
UA stood by her
She returned to Elk Grove for her senior year and was cleared to play softball. When she visited Tucson that year, the UA coach told her he would honor her scholarship, even if she wasn't able to play. She signed a national letter of intent.
At 19, she was slated to be the Wildcats' everyday shortstop last year before tearing the labrum in her right shoulder a week before the season. She sat out the season, and moved to the starting right field spot this year, in part because her shoulder is at about 80 percent strength.
Thanks to the team's vision-therapy program, the redshirt freshman - whose .331 batting average is third-best on the team - sees the ball as well as she has since the accident pooled fluid behind her left eye.
She wants to work for Nike's marketing department, but has to study longer and struggles to focus to realize her dreams. She puts in her iPhone earbuds with no sound to do homework, so no one bothers her.
Her lawsuit against the school district - which she said would not allow her to wear a more advanced helmet - is pending. Her high school team now wears the same high-tech helmets the Wildcats do.
She talks openly about her accident, in part to encourage helmet safety.
For more healthcare and medical related news, visit the Healthcare and Medical blog.
For national and worldwide related business news, visit the Peak News Room blog.
For local and Michigan business related news, visit the Michigan Business News blog.
For law related news, visit the Nation of Law blog.
For real estate and home related news, visit the Commercial and Residential Real Estate blog.
For technology and electronics related news, visit the Electronics America blog.
For organic SEO and web optimization related news, visit the SEO Done Right blog.
20 April 2012
Sports Related Head Trauma Causes Loss in Memory
Story first appeared on Physical Therapy Products.
Recently released research suggests there might be a point at which blows to the head or other head trauma suffered in combat sports begins to affect memory and thinking abilities. This new study, which is scheduled to be presented as part of the Emerging Science program at the American Academy of Neurology’s 64th Annual Meeting in New Orleans April 21-28, goes on to say that head trauma can lead to chronic traumatic encephalopathy (CTE) in the brain.
The author of the study and a member of the American Academy of Neurology (AAN), St. Paul, Minn, says that while it already known boxing and other sports are linked to brain damage, little is known about how this process develops and who may be on the path to developing CTE. Although CTE is only diagnosed through autopsy after death, symptoms include memory loss, aggression, and difficulty thinking.
For the study, data from 35 boxers and 43 mixed martial arts athletes with an average age of 29 years who were a part of the ongoing Professional Fighters Brain Health Study were examined. The participants took computer tests that measured memory and thinking skills, as well as underwent MRI brain scans. In addition, researchers recorded years of fighting and number of fights for each participant based on self-reporting and published records. They then split the participants into two groups: those who fought for 9 years or fewer and those who had been fighting for more than 9 years.
According to the results, in both groups those with more years of fighting and more fights per year were more likely to have lower brain volumes in three areas of the brain. In those who had spent less time in the industry, no relationship was found between years of fighting or the number of fights per year and the results on memory and thinking tests. However, among those who had fought for 9 years or more, the individuals who had more fights per year performed worse on the thinking and memory tests than those with fewer fights per year.
There appears to be a threshold at which continued repetitive blows to the brain begin to cause measurable changes in memory and thinking, despite brain volume changes that can be found earlier.
For more healthcare and medical related news, visit the Healthcare and Medical blog.
For national and worldwide related business news, visit the Peak News Room blog.
For local and Michigan business related news, visit the Michigan Business News blog.
For law related news, visit the Nation of Law blog.
For real estate and home related news, visit the Commercial and Residential Real Estate blog.
For technology and electronics related news, visit the Electronics America blog.
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Recently released research suggests there might be a point at which blows to the head or other head trauma suffered in combat sports begins to affect memory and thinking abilities. This new study, which is scheduled to be presented as part of the Emerging Science program at the American Academy of Neurology’s 64th Annual Meeting in New Orleans April 21-28, goes on to say that head trauma can lead to chronic traumatic encephalopathy (CTE) in the brain.
The author of the study and a member of the American Academy of Neurology (AAN), St. Paul, Minn, says that while it already known boxing and other sports are linked to brain damage, little is known about how this process develops and who may be on the path to developing CTE. Although CTE is only diagnosed through autopsy after death, symptoms include memory loss, aggression, and difficulty thinking.
For the study, data from 35 boxers and 43 mixed martial arts athletes with an average age of 29 years who were a part of the ongoing Professional Fighters Brain Health Study were examined. The participants took computer tests that measured memory and thinking skills, as well as underwent MRI brain scans. In addition, researchers recorded years of fighting and number of fights for each participant based on self-reporting and published records. They then split the participants into two groups: those who fought for 9 years or fewer and those who had been fighting for more than 9 years.
According to the results, in both groups those with more years of fighting and more fights per year were more likely to have lower brain volumes in three areas of the brain. In those who had spent less time in the industry, no relationship was found between years of fighting or the number of fights per year and the results on memory and thinking tests. However, among those who had fought for 9 years or more, the individuals who had more fights per year performed worse on the thinking and memory tests than those with fewer fights per year.
There appears to be a threshold at which continued repetitive blows to the brain begin to cause measurable changes in memory and thinking, despite brain volume changes that can be found earlier.
For more healthcare and medical related news, visit the Healthcare and Medical blog.
For national and worldwide related business news, visit the Peak News Room blog.
For local and Michigan business related news, visit the Michigan Business News blog.
For law related news, visit the Nation of Law blog.
For real estate and home related news, visit the Commercial and Residential Real Estate blog.
For technology and electronics related news, visit the Electronics America blog.
For organic SEO and web optimization related news, visit the SEO Done Right blog.
10 January 2012
Brain Injuries Change Lives
First appeared in NY Times
At a crowded vigil on Sunday night in Tucson, Representative Gabrielle Giffords held her husband’s hand as she stepped up to the lectern to recite the Pledge of Allegiance.
It had been one year since a shooting at a Tucson supermarket killed six people, injured 12 others and left her with a severe brain injury. Ms. Giffords’s appearance was greeted by an enthusiastic crowd that applauded her remarkable progress toward recovery.
The man next to her, fighting tears, offered his own remarks. “For the past year, we’ve had new realities to live with,” said her husband, the astronaut Mark E. Kelly. “The reality and pain of letting go of the past.”
Captain Kelly was speaking of the survivors of the shooting. But his words echoed the sentiments of many brain injury survivors and their spouses as they grapple with interpersonal challenges that take much longer than a year to overcome.
Until recently, there had been little evidence-based research on how to rebuild marriages after such a tragedy. Indeed, doctors frequently warn uninjured spouses that the marriage may well be over, that the personality changes that can result from brain injury may do irreparable harm to the relationship.
Captain Kelly and Ms. Giffords largely have kept private their own experiences in this regard, and they declined to be interviewed for this article. Still, therapists are beginning to understand the obstacles that couples like them face, and what they are learning may lead to new counseling techniques to help restore the social links that give lives meaning.
Contrary to conventional wisdom, many relationships do survive after a spouse suffers a brain injury. Some studies find divorce rates well below the national average among these couples. A 2007 investigation found that the divorce rate was around 17 percent in couples followed for as long as 90 months after a spouse sustained a brain injury.
That is not to say these couples are always happy.
“Two or three years later, they want a whole lot more than simply to be alive,” said an author of the 2007 study, Jeffrey S. Kreutzer, a psychologist at Virginia Commonwealth University in Richmond. “While people may technically be married, the quality of their relationship has been seriously diminished.”
Dr. Kreutzer and other psychologists at V.C.U. are among the few therapists in the country trying to develop marriage counseling techniques tailored to couples dealing with brain injuries. Traditional marriage counselors often hope to restore people and their relationships to their original luster. For Dr. Kreutzer and his team, recovery often means teaching uninjured spouses to forge a relationship with a profoundly changed person — and helping injured spouses to accept that they are changed people.
The research is still in early stages, and in many ways the therapeutic toolbox is not much different from that of regular marriage counseling: Couples coping with a brain injury are taught to communicate better, to focus on positive developments and things they like about each other, and to set aside time to inject a little romance and fun into a life that can be consumed by doctors’ appointments and paperwork.
But other traditional techniques can backfire with these couples, the researchers have learned. For example, said Emilie Godwin, another V.C.U. psychologist, encouraging partners to remember what sparked their love in the first place can mean “highlighting the things that have probably been lost.”
“You’re asking people to just look forward, to not look back at all,” she said. “To try to recreate a relationship.”
The Stranger in the Living Room
About a month after surgery to remove a brain tumor in 2006, Terry Curtis turned to his wife, Vicky, and offered her a divorce.
“I told her she was free to leave,” he said. “I’m not the person you married.”
Mr. Curtis knew he had become cold, impulsive and incapable of focusing his attention. But it would be 18 months before doctors explained to the couple that complications from surgery had caused a brain injury.
Mrs. Curtis, 60, was once drawn to her husband’s “sparkle,” she said. After the injury, he “flat-lined” emotionally, and he suffers from depression, anxiety and a lack of motivation.
Her husband sometimes makes erratic decisions, she added, like the time he decided to take a do-it-yourself approach to the plumbing at their home in Coralville, Iowa. “Not a good picture when I got home,” Mrs. Curtis said. “And you can yell at him like a little kid, but he didn’t know any better.”
Once a software programming analyst, Mr. Curtis, 57, has “a lot fewer interests” than he did before the injury, and he estimates he has lost 90 percent of his friends.
“It’s a new you,” he said, “and they just can’t cope with that.”
Brain injury can be isolating, psychologists say, as the mental symptoms may last well beyond the obvious injuries. Strangers and friends often do not understand the root of a survivor’s socially inappropriate behavior.
Even relatives well versed in the changes wrought by brain injury constantly struggle not to take outbursts or remarks personally, therapists said.
“The word that describes it is just ‘lonely,’ ” said Mrs. Curtis of her role as caregiver. “My life is sitting in the living room quiet while my husband just sleeps.”
Guilt is the tie binding many people to a dependent stranger inhabiting their spouse’s body after a brain injury, Dr. Kreutzer said. But guilt is not unique to the caregiver who might fantasize about getting away. Studies show that few of the injured can work and that about half suffer from major depression; many feel inadequate because of their inability to provide financial and emotional support.
But Mrs. Curtis said she was staying with her husband not out of guilt or an obligation to take care of him — though she couldn’t say she had never contemplated leaving.
“If I was that unhappy, I would make the arrangements for him to be taken care of and get out,” she said.
Counseling has helped Mrs. Curtis, who works in administration at the University of Iowa, to manage her expectations, both for Mr. Curtis’s recovery and her own responses.
“We’ll have a whole day where he’s just fine, and it’s just like the old Terry,” she said last month. “And then he’ll say something out of whack, and I’ll say, ‘Oh, yeah, it’s 2011.’ ”
Psychologists say this type of halting progress adds to what they call “ambiguous loss.” Every day, reminders of the damage appear and disappear, and often couples struggle with grief that is never fully resolved and must constantly be reassessed.
Though the Curtises have not quite let go of the “old Terry,” their relationship is not identical to what they had before his injury. It has become a “combination,” Mrs. Curtis said.
Said Dr. Godwin: “People hold on to hope that just as when they survived the crash and they had this miraculous recovery, that they will overcome these challenges that other people may not in this miraculous way. That’s not going to happen.”
But some couples do manage to put their lives, and relationships, back together in the years after a traumatic brain injury. In 2002, while Hugh Rawlins was in an induced coma, half his skull removed to allow his brain to swell, doctors told his wife, Rosemary, that he might be angry, even abusive to their 14-year-old twin daughters — when and if he learned to talk again.
Mr. Rawlins had been struck by a car while riding his bike near his home in Glen Allen, Va. As he entered rehab, doctors warned that the couple might soon face bankruptcy and divorce.
But after years of halting rehabilitation and a devastating, failed attempt to return to his old job, Mr. Rawlins is a financial executive at a midsize engineering company. An avid surfer before the accident, he rides the waves off North Carolina’s Outer Banks, where the couple spends almost every weekend.
He never became the aggressive misanthrope doctors warned about. And he’s back on the bike.
But each positive step in Mr. Rawlins’s recovery has posed difficult challenges for his wife. Fearful, she hid the car keys as he learned to drive again. His determination to ride his bike sent her into therapy.
“All of a sudden I was in this position of always telling what you can do, what you can’t do — it’s horrible,” said Mrs. Rawlins, who documented her family’s ordeal in “Learning by Accident,” a self-published memoir.
Mr. Rawlins may have suffered a traumatic brain injury, but it was Mrs. Rawlins who, like many others caregivers, ultimately received a diagnosis of post-traumatic stress disorder.
Despite progress toward stable relationships, many couples stay trapped in a pattern in which the uninjured spouse does everything for the survivor, even when it’s no longer necessary, researchers have found. “No one likes to have their freedom stolen from them,” said Dr. Godwin.
Before they entered counseling, fights over Mr. Rawlins’s limits sometimes ended in a silent stalemate.
“There’s always a bit of the rebellion in me, and she’d pull me back just as a mother would or a father would to their teenager,” said Mr. Rawlins, now 55. “Sometimes she was right, and sometimes I could do it.”
The accident rocked the couple out of their “midlife doldrums,” Mrs. Rawlins said. As Dr. Kreutzer tells his patients, some post-injury changes can be positive. Mrs. Rawlins was thrilled to find her once wry and stoic husband is much less emotionally inhibited.
“The touchy-feely stuff, that shows more in me now,” he acknowledged.
More and more, Mrs. Rawlins believes that her husband is back to his “old self.”
She’s just no longer sure she remembers who that was.
At a crowded vigil on Sunday night in Tucson, Representative Gabrielle Giffords held her husband’s hand as she stepped up to the lectern to recite the Pledge of Allegiance.
It had been one year since a shooting at a Tucson supermarket killed six people, injured 12 others and left her with a severe brain injury. Ms. Giffords’s appearance was greeted by an enthusiastic crowd that applauded her remarkable progress toward recovery.
The man next to her, fighting tears, offered his own remarks. “For the past year, we’ve had new realities to live with,” said her husband, the astronaut Mark E. Kelly. “The reality and pain of letting go of the past.”
Captain Kelly was speaking of the survivors of the shooting. But his words echoed the sentiments of many brain injury survivors and their spouses as they grapple with interpersonal challenges that take much longer than a year to overcome.
Until recently, there had been little evidence-based research on how to rebuild marriages after such a tragedy. Indeed, doctors frequently warn uninjured spouses that the marriage may well be over, that the personality changes that can result from brain injury may do irreparable harm to the relationship.
Captain Kelly and Ms. Giffords largely have kept private their own experiences in this regard, and they declined to be interviewed for this article. Still, therapists are beginning to understand the obstacles that couples like them face, and what they are learning may lead to new counseling techniques to help restore the social links that give lives meaning.
Contrary to conventional wisdom, many relationships do survive after a spouse suffers a brain injury. Some studies find divorce rates well below the national average among these couples. A 2007 investigation found that the divorce rate was around 17 percent in couples followed for as long as 90 months after a spouse sustained a brain injury.
That is not to say these couples are always happy.
“Two or three years later, they want a whole lot more than simply to be alive,” said an author of the 2007 study, Jeffrey S. Kreutzer, a psychologist at Virginia Commonwealth University in Richmond. “While people may technically be married, the quality of their relationship has been seriously diminished.”
Dr. Kreutzer and other psychologists at V.C.U. are among the few therapists in the country trying to develop marriage counseling techniques tailored to couples dealing with brain injuries. Traditional marriage counselors often hope to restore people and their relationships to their original luster. For Dr. Kreutzer and his team, recovery often means teaching uninjured spouses to forge a relationship with a profoundly changed person — and helping injured spouses to accept that they are changed people.
The research is still in early stages, and in many ways the therapeutic toolbox is not much different from that of regular marriage counseling: Couples coping with a brain injury are taught to communicate better, to focus on positive developments and things they like about each other, and to set aside time to inject a little romance and fun into a life that can be consumed by doctors’ appointments and paperwork.
But other traditional techniques can backfire with these couples, the researchers have learned. For example, said Emilie Godwin, another V.C.U. psychologist, encouraging partners to remember what sparked their love in the first place can mean “highlighting the things that have probably been lost.”
“You’re asking people to just look forward, to not look back at all,” she said. “To try to recreate a relationship.”
The Stranger in the Living Room
About a month after surgery to remove a brain tumor in 2006, Terry Curtis turned to his wife, Vicky, and offered her a divorce.
“I told her she was free to leave,” he said. “I’m not the person you married.”
Mr. Curtis knew he had become cold, impulsive and incapable of focusing his attention. But it would be 18 months before doctors explained to the couple that complications from surgery had caused a brain injury.
Mrs. Curtis, 60, was once drawn to her husband’s “sparkle,” she said. After the injury, he “flat-lined” emotionally, and he suffers from depression, anxiety and a lack of motivation.
Her husband sometimes makes erratic decisions, she added, like the time he decided to take a do-it-yourself approach to the plumbing at their home in Coralville, Iowa. “Not a good picture when I got home,” Mrs. Curtis said. “And you can yell at him like a little kid, but he didn’t know any better.”
Once a software programming analyst, Mr. Curtis, 57, has “a lot fewer interests” than he did before the injury, and he estimates he has lost 90 percent of his friends.
“It’s a new you,” he said, “and they just can’t cope with that.”
Brain injury can be isolating, psychologists say, as the mental symptoms may last well beyond the obvious injuries. Strangers and friends often do not understand the root of a survivor’s socially inappropriate behavior.
Even relatives well versed in the changes wrought by brain injury constantly struggle not to take outbursts or remarks personally, therapists said.
“The word that describes it is just ‘lonely,’ ” said Mrs. Curtis of her role as caregiver. “My life is sitting in the living room quiet while my husband just sleeps.”
Guilt is the tie binding many people to a dependent stranger inhabiting their spouse’s body after a brain injury, Dr. Kreutzer said. But guilt is not unique to the caregiver who might fantasize about getting away. Studies show that few of the injured can work and that about half suffer from major depression; many feel inadequate because of their inability to provide financial and emotional support.
But Mrs. Curtis said she was staying with her husband not out of guilt or an obligation to take care of him — though she couldn’t say she had never contemplated leaving.
“If I was that unhappy, I would make the arrangements for him to be taken care of and get out,” she said.
Counseling has helped Mrs. Curtis, who works in administration at the University of Iowa, to manage her expectations, both for Mr. Curtis’s recovery and her own responses.
“We’ll have a whole day where he’s just fine, and it’s just like the old Terry,” she said last month. “And then he’ll say something out of whack, and I’ll say, ‘Oh, yeah, it’s 2011.’ ”
Psychologists say this type of halting progress adds to what they call “ambiguous loss.” Every day, reminders of the damage appear and disappear, and often couples struggle with grief that is never fully resolved and must constantly be reassessed.
Though the Curtises have not quite let go of the “old Terry,” their relationship is not identical to what they had before his injury. It has become a “combination,” Mrs. Curtis said.
Said Dr. Godwin: “People hold on to hope that just as when they survived the crash and they had this miraculous recovery, that they will overcome these challenges that other people may not in this miraculous way. That’s not going to happen.”
But some couples do manage to put their lives, and relationships, back together in the years after a traumatic brain injury. In 2002, while Hugh Rawlins was in an induced coma, half his skull removed to allow his brain to swell, doctors told his wife, Rosemary, that he might be angry, even abusive to their 14-year-old twin daughters — when and if he learned to talk again.
Mr. Rawlins had been struck by a car while riding his bike near his home in Glen Allen, Va. As he entered rehab, doctors warned that the couple might soon face bankruptcy and divorce.
But after years of halting rehabilitation and a devastating, failed attempt to return to his old job, Mr. Rawlins is a financial executive at a midsize engineering company. An avid surfer before the accident, he rides the waves off North Carolina’s Outer Banks, where the couple spends almost every weekend.
He never became the aggressive misanthrope doctors warned about. And he’s back on the bike.
But each positive step in Mr. Rawlins’s recovery has posed difficult challenges for his wife. Fearful, she hid the car keys as he learned to drive again. His determination to ride his bike sent her into therapy.
“All of a sudden I was in this position of always telling what you can do, what you can’t do — it’s horrible,” said Mrs. Rawlins, who documented her family’s ordeal in “Learning by Accident,” a self-published memoir.
Mr. Rawlins may have suffered a traumatic brain injury, but it was Mrs. Rawlins who, like many others caregivers, ultimately received a diagnosis of post-traumatic stress disorder.
Despite progress toward stable relationships, many couples stay trapped in a pattern in which the uninjured spouse does everything for the survivor, even when it’s no longer necessary, researchers have found. “No one likes to have their freedom stolen from them,” said Dr. Godwin.
Before they entered counseling, fights over Mr. Rawlins’s limits sometimes ended in a silent stalemate.
“There’s always a bit of the rebellion in me, and she’d pull me back just as a mother would or a father would to their teenager,” said Mr. Rawlins, now 55. “Sometimes she was right, and sometimes I could do it.”
The accident rocked the couple out of their “midlife doldrums,” Mrs. Rawlins said. As Dr. Kreutzer tells his patients, some post-injury changes can be positive. Mrs. Rawlins was thrilled to find her once wry and stoic husband is much less emotionally inhibited.
“The touchy-feely stuff, that shows more in me now,” he acknowledged.
More and more, Mrs. Rawlins believes that her husband is back to his “old self.”
She’s just no longer sure she remembers who that was.
17 October 2010
Brain-Injury Studies open to Youth, Adults
IndyStar
Medical studies that make the news usually involve large numbers of patients. But research can focus on rarer events, such as traumatic brain injuries.
Dr. Brenna McDonald, an assistant professor of radiology and Indianapolis neurologist at the Indiana University School of Medicine, is enrolling patients for two trials that delve into the aftermath of traumatic brain injuries.
One study focuses on children who have sustained a mild brain injury, such as a concussion. The other compares treatments for adults who had a traumatic brain injury of any severity.
People interested in participating in either trial can call (317) 274-6633.
Question: Please tell me about the study on children.
Answer: It targets children 8 to 15 years old who had a mild traumatic brain injury or concussion six to 12 months ago. What we're looking at are any residual or lasting problems that we can detect with structural brain imaging or cognitive tests.
We don't really know if there are meaningful or lasting results in this population. There has been a lot of worry about risk. We know for kids who are severely injured there are likely to be lasting consequences.
Q: Is much known about the effect of a brain injury?
A: Not for mild injury. We don't have a really good sense if there's a reason to be concerned about lasting effects. We don't know in younger kids what we should be worried about, if we should be worried at all, and how worried we should be.
For moderately to severely injured kids, a program of rehabilitation may be recommended that typically includes speech, physical and occupational therapy. Depending on the level of cognitive problems, we may make recommendations in terms of academic intervention. That can run the whole range of possible educational interventions.
Q: How many do you hope to enroll?
A: We're looking for between 15 and 30 kids over the next year or two. Participation in the study is about six hours, and it can be done over one or two days.
Q: What about the other study?
A: We're recruiting adults who have sustained a traumatic brain injury of any severity at least four months but no more than five years ago. The study includes medication treatment and therapeutic treatment. . . . The goal of all treatments is to try to improve memory or attention complaints.
It's a relatively brief time commitment of about seven weeks. This is designed by a colleague who designed the treatment program initially to address similar cognitive complaints after cancer chemotherapy. We have some preliminary data suggesting it can be effective for this.
Dr. Brenna McDonald, an assistant professor of radiology and Indianapolis neurologist at the Indiana University School of Medicine, is enrolling patients for two trials that delve into the aftermath of traumatic brain injuries.
One study focuses on children who have sustained a mild brain injury, such as a concussion. The other compares treatments for adults who had a traumatic brain injury of any severity.
People interested in participating in either trial can call (317) 274-6633.
Question: Please tell me about the study on children.
Answer: It targets children 8 to 15 years old who had a mild traumatic brain injury or concussion six to 12 months ago. What we're looking at are any residual or lasting problems that we can detect with structural brain imaging or cognitive tests.
We don't really know if there are meaningful or lasting results in this population. There has been a lot of worry about risk. We know for kids who are severely injured there are likely to be lasting consequences.
Q: Is much known about the effect of a brain injury?
A: Not for mild injury. We don't have a really good sense if there's a reason to be concerned about lasting effects. We don't know in younger kids what we should be worried about, if we should be worried at all, and how worried we should be.
For moderately to severely injured kids, a program of rehabilitation may be recommended that typically includes speech, physical and occupational therapy. Depending on the level of cognitive problems, we may make recommendations in terms of academic intervention. That can run the whole range of possible educational interventions.
Q: How many do you hope to enroll?
A: We're looking for between 15 and 30 kids over the next year or two. Participation in the study is about six hours, and it can be done over one or two days.
Q: What about the other study?
A: We're recruiting adults who have sustained a traumatic brain injury of any severity at least four months but no more than five years ago. The study includes medication treatment and therapeutic treatment. . . . The goal of all treatments is to try to improve memory or attention complaints.
It's a relatively brief time commitment of about seven weeks. This is designed by a colleague who designed the treatment program initially to address similar cognitive complaints after cancer chemotherapy. We have some preliminary data suggesting it can be effective for this.
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