Brain Injury Law Blog : Head Injury : Coma : Personal Injury : Las Vegas Nevada Lawyer & Attorney Tim Titolo

 How does the brain keep track of similar but distinct memories?  Scientists at the SALK Institute FOR Biological Studies think they have made inroads on answering the question.

Have you ever misplaced your keys and racked your brain to remember where you put them?  When you eventually find them, you can thank your Hippocampus which is responsible for storing and retrieving memories laid down in different environments.

Scientists discovered the location in the brain - the dentate gyrus - that enables us to keep memories of different environments separate.  The findings, which clarifies how the brain stores and distinguishes between memories, may help us understand how neurodegenerative diseases such as Alzheimer's rob us of these abilities.

 The findings help clarify the mechanisms that underpin memory formation and explain systems that are disrupted by injury and diseases of the nervous system.

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A Damaged Brain Can Rewire Itself

It has generally been thought that once a brain is damaged, the damage is permanent.  But a new study shows that the brain can actually rewire itself.  This is different from what we previously knew about how the brain repairs connections that are not too badly damaged. 

We knew, for example, that the connections between axons and dendrites, the connections to the neuron, could reconnect if the shear, or damage, was close to the cell body in certain instances.  This new finding shows scientists that the prefrontal cortex also allows for entirely new pathways to reroute connections damaged in the brain.

When the brain's primary "learning center" is damaged, complex new neural circuits arise to compensate for the lost function.

The findings suggest that since the brain is heavily interconnected -- you can get from any neuron in the brain to any other neuron via about six synaptic connections. So there are many alternate pathways the brain can use, but it normally doesn't use them unless it's forced to. Once we understand how the brain makes these decisions, then we're in a position to encourage pathways to take over when they need to, especially in the case of brain damage.

These findings, hopefully will give us answers to how we treat Alzheimer's, and other brain damaged, individuals.

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I came across a cool site dealing with The Brain: A User's Guide to Emotions.  Neuroscientists are unraveling the inner workings of the Brain, the site states. 

We know more than ever before about the mysteries of where emotions originate in the brain and the connections between instinct, intelligence and emotion. This work is yielding fascinating insights that we can use to understand how we react to situations and people. The brain, which is a much more flexible organ that previously thought, can be consciously retrained to be more emotionally flexible, understanding and sensitive. The emotional functions of the brain are interwoven at many levels. These maps provide an overview of the major areas of the brain involved in processing emotions.

There are great illustrations and information.  Check it out: The Brain: A User's Guide to Emotions.

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Rep. Pascrell Introduces Legislation Requiring Stronger Standards for Youth Football Helmets

Bill Would Help Protect Young Athletes from Sports-Related Traumatic Brain Injuries

The Brain Injury Association of America asked me to pass this legislative update on to my readers.

WASHINGTON - U.S. Representative Bill Pascrell, Jr. (D-NJ-09), co-founder and co-chair of the Congressional Brain Injury Task Force, was joined by Rep. Tom Rooney (R-FL) today in introducing bipartisan legislation aimed at protecting youth athletes from the dangers of sports-related traumatic brain injuries. The Youth Sports Concussion Act of 2013 would ensure that new and reconditioned football helmets for high school and younger players meet safety standards that address concussion risk and the needs of youth athletes. The bill also increases potential penalties for using false injury prevention claims to sell helmets and other sports equipment. Companion legislation was also introduced in the U.S. Senate by Sen. Tom Udall (D-NM).

"The dangers multiple concussions pose to our young athletes is well known, so it's imperative we do everything possible to protect them on the playing field," said Rep. Pascrell. "I've fought to ensure there are resources available to young athletes that sustain a brain injury, and this legislation will bring us one step closer to preventing these devastating injuries to begin with. The only thing standing between athletes and serious injury is their equipment, which is why manufactures must be held to the highest possible standard. We cannot jeopardize the health and safety of our young athletes by allowing inferior equipment into their locker rooms."

"As a father of three sons who can't wait to play tackle football, I want to do everything we can to protect young people from suffering head injuries on the field," Rooney said. "We can't completely eliminate the risks of playing youth sports, but we can make sure that helmets and other equipment meet the highest safety standards for our kids."

Although football helmet safety technology has improved since the days of leather helmets, today's helmet safety standards may not be informed by current understanding of concussion risks. For example, the current industry standard primarily protects against serious injury from a severe, direct blow. However, it does not specifically address the risk of a concussion caused by less severe impacts or by rotational acceleration resulting from hits that spin the head and brain. The standard for reconditioning used football helmets also does not specify how often old helmets must be recertified.

The Youth Sports Concussion Act of 2013 sets a deadline, nine months after enactment, for improvements by industry groups to the voluntary standard for football helmets. If that deadline is not met, the Consumer Product Safety Commission (CPSC) must set mandatory football helmet standards to protect children's safety.

Sports are the second leading cause of traumatic brain injury for people who are 15 to 24 years old, behind only motor vehicle crashes. Every year American athletes suffer up to an estimated 3.8 million sports-related concussions. More than one million American high school students play football, including nearly 8,000 high school students in New Mexico.

Rep. Pascrell has been raising awareness of traumatic brain injury dangers and treatments for 13 years, including the passage of his Concussion Treatment and Care Tools (ConTACT) Act, which provides for national protocols to be established for managing sports-related concussions.

In March, Rep. Pascrell hosted the 12th Annual Brain Injury Awareness Day on Capitol Hill, a conference that educates Members of Congress and their staffs on the full range of effects of brain injury, the challenges and recoveries of persons living with brain injury, and the services and supports available to them.

Supporters of the Youth Sports Concussion Act of 2013 include: NFL, NFL Players Association, Major League Baseball, MLB Players Association, NBA, NHL, NCAA, Major League Soccer (MLS) Players Union, American Academy of Neurology, American Academy of Pediatrics, Brain Injury Association of America, Brain Trauma Foundation, Cleveland Clinic, Consumer Federation of America, Consumers Union, Natl. Consumers League, Safe Kids USA, Natl. Assoc. of State Head Injury Administrators, Natl. Athletic Trainers Association, Natl. Fed. of State High School Associations (NFHS), NOCSAE, US Lacrosse and US Soccer Federation.

TBI Act Reauthorization 2013

On Wednesday, March 13, 2013, the TBI Act, H.R. 1098, was introduced by Reps. Pascrell and Rooney, co-chairs of the Congressional Brain Injury Task Force. This bill will reauthorize the current programs relating to TBI and also will move the state grant and protection and advocacy grant programs from the Maternal and Child Health Bureau to another agency with the U.S. Department of Health and Human Services. The move acknowledges the impact of TBI across the age span, including older adults and returning service members/veterans. The Congressional Brain Injury Task Force recommends relocating the program to better coordinate with federal agencies regarding long-term services and supports available to individuals with other disabilities, particularly the long-term services and supports provision of the Affordable Care Act. BIAA thanks Reps. Pascrell and Rooney for introducing this important legislation. Please call your Member of Congress and ask them to co-sponsor H.R. 1098 today!
 

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Testing for Traumatic Brain Injury in sporting events and wars can be difficult. Typically testing requires big equipment like MRI machines. These machines cannot practically be available on the sport or battle field where the injury occurs.

Now researchers are attempting to bridge testing ability and have developed a tablet based testing system that can be used on the field. The Notre Dame team has developed a tablet-based testing system that captures the voice of an individual and analyzes the speech for signs of a potential concussion anytime, anywhere, in real time.

The system sounds simple enough: An individual speaks into a tablet equipped with the Notre Dame program before and after an event. The two samples are then compared for TBI indicators, which include distorted vowels, hyper nasality and imprecise consonants. Notre Dame's system offers a variety of advantages over traditional testing, such as portability, high accuracy, low cost and a low probability of manipulation (the results cannot be faked); it has also proven very successful.

2012 and 2013 boxing bouts have utilized the new tests and have provided important information regarding traumatic brain injury. Hopefully these new tests will counter those injuries that often go unrecognized and later result in permanent disability.

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The impact of legislation regarding Traumatic Brain Injury (TBI) is of interest to my readers.  Therefore I present the following by the Brain Injury Association of America.

TBI Act Reauthorization 2013

On Wednesday, March 13, 2013, the TBI Act, H.R. 1098, was introduced by Reps. Pascrell and Rooney, co-chairs of the Congressional Brain Injury Task Force. This bill will reauthorize the current programs relating to TBI and also will move the state grant and protection and advocacy grant programs from the Maternal and Child Health Bureau to another agency with the U.S. Department of Health and Human Services. The move acknowledges the impact of TBI across the age span, including older adults and returning service members/veterans. The Congressional Brain Injury Task Force recommends relocating the program to better coordinate with federal agencies regarding long-term services and supports available to individuals with other disabilities, particularly the long-term services and supports provision of the Affordable Care Act. BIAA thanks Reps. Pascrell and Rooney for introducing this important legislation. Please call your Member of Congress and ask them to co-sponsor H.R. 1098 today!

FY 2014 Appropriations

This week, BIAA submitted FY2014 written testimony to the Senate Appropriations Subcommittee on Labor Health and Human Services and Related Agencies. In March, BIAA submitted FY2014 written testimony to the House Appropriations Subcommittee on Labor Health and Human Services and Related Agencies. Both letters proposed funding increases for TBI Act programs and the TBI Model Systems of Care Program. To read BIAA's testimony please clickhere.
 

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 A new study reveals that hypertension combined with at least one risk factor for developing Alzheimer's increases the chances of dementia.

"The identification of hypertension as an additional risk factor for amyloid plaque deposition is encouraging as we may be able to prevent, or at least slow, pathological aging in some individuals through lifestyle modification or pharmacological intervention," the study concludes. 

The study was conducted by Karen Rodrigue, PhD of the University of Texas at Dallas.

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Gulf War Illness and Traumatic Brain Injury.

New research confirms a link between physical changes and brain fibers that process pain. This new study concludes that veterans, compared to unaffected subjects, have significant axonal damage.

Medical symptoms have been reported by more than one-fourth of the 697,000 veterans deployed to the 1990-1991 Persian Gulf War. These symptoms, termed Gulf War Illness, range from mild to severe or debilitating and can include widespread pain, fatigue, and headache, as well as cognitive and gastrointestinal dysfunctions.

Gulf War Illness was most prevalent in veterans who served in forward areas of Iraq and Kuwait, where it was most strongly associated with use of a medication given to 1991 Gulf War troops.  Taking medications were designed to protect troops from effects of nerve agents. The study found that Gulf War Illness prevalence was nearly six times higher in veterans who served in Iraq or Kuwait, where all ground battles took place during the 1991 conflict, compared to veterans who remained on board ship during the war.

A potential biomarker for Gulf War Illness may be on the horizon as well as a possible target for therapy aimed at regenerating these neurons.

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The North American Brain Injury Society (NABIS) is having their 11th Annual Conference on Brain Injury at the Intercontinental Hotel in New Orleans, Louisiana.  The conference will be held on September 18-21, 2013.  NABIS is requesting Abstracts for the Conference.  To learn more click NABIS.

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Injured Areas of the Brain Draw on Other Areas for Function

A recent study supports the Brain's compensating for itself after injury.  I remember learning long ago that a blind person has a greater hearing ability than a person who is not blind.  Well now I have come across a study that seems to support that.

Scientists at Carnegie Mellon University's Center for Cognitive Brain Imaging (CCBI), using a combination of neural imaging methods, investigated how the human brain adapts to injury. The research is published in Cerebral Cortex, (R. A. Mason, C. S. Prat, M. A. Just. Neurocognitive Brain Response to Transient Impairment of Wernicke's Area. Cerebral Cortex, 2013; DOI: 10.1093/cercor/bhs423)  The findings show that when one brain area loses functionality, a "back-up" team of secondary brain areas immediately activates, replacing the unavailable area.

This has far reaching implications.  For instance, a situation I deal with frequently in my practice is a client who sustained a traumatic brain injury but was walking and talking afterward.  Such behavior raises significant questions from insurance companies and their lawyers as to whether a brain injury occurred.  But these new findings provide an answer.  Walking and Talking after an injury does NOT rule out traumatic brain injury.

Marcel Just, one of the scientists involved in the study, states:

"The human brain has a remarkable ability to adapt to various types of trauma, such as traumatic brain injury and stroke, making it possible for people to continue functioning after key brain areas have been damaged....It is now clear how the brain can naturally rebound from injuries and gives us indications of how individuals can train their brains to be prepared for easier recovery. The secret is to develop alternative thinking styles, the way a switch-hitter develops alternative batting styles. Then, if a muscle in one arm is injured, they can use the batting style that relies more on the uninjured arm."

Read more about the findings. 

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 Sleep Apnea

Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.  This usually presents when someone is snoring.

Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.  The condition goes largely unnoticed by the person suffering from it since they normally fall back to sleep and are unaware of the interruption.  A sleeping partner usually notices.

Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into light sleep.

As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness.

Sleep Apnea Causes Damage

 Untreated sleep apnea can:

• Increase the risk of high blood pressure, heart attack, stroke, obesity, and diabetes
• Increase the risk of, or worsen, heart failure
• Make arrhythmias, or irregular heartbeats, more likely
• Increase the chance of having work-related or driving accidents

Women With Sleep Apnea Are More Susceptible To Brain Damage Than Are Men

 Approximately 10 years ago, this UCLA research team was the first to show that men with obstructive sleep apnea have damage to their brain cells.   Sleep Apnea causes the oxygen level in the blood to drop, eventually resulting in damage to many cells in the body.

The latest, multi-year study, "Sex Differences in White Matter Alterations Accompanying Obstructive Sleep Apnea,"  the researchers looked at patients who were diagnosed with obstructive sleep apnea at the UCLA Sleep Laboratory.

"This study revealed that, in fact, women are more affected by sleep apnea than are men and that women with obstructive sleep apnea have more severe brain damage than men suffering from a similar condition," says Paul Macey, assistant professor and associate dean of information technology and innovations at the UCLA School of Nursing.

To find out more go to the Journal Sleep VOLUME 35, ISSUE 12. 

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 Frontal Lobe

I am finishing this series of Breaking Down the Brain with an exploration of the Frontal Lobes.  The frontal lobes are considered our emotional control center and home to our personality. There is no other part of the brain where lesions can cause such a wide variety of symptoms (Kolb & Wishaw, 1990).

The frontal lobes regulate motor function, problem solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual behavior. The frontal lobes are extremely vulnerable to injury due to their location at the front of the cranium.  MRI studies show that the frontal area is the most common region of injury following mild to moderate traumatic brain injury (Levin et al., 1987).

Flat affect, loss of facial expression, is associated with frontal lobe damage.  

Another area often associated with frontal damage is that of behavioral spontaneity.  This was the case with the famous case of Phineas Gage.   In 1848,a twenty-five-year-old railroad construction foreman Phineas Gage was packing powder and sand into a hole in rock, and the powder detonated. A 13-pound iron rod was driven through Gage's cheek, out of the top of his head to land 30-some yards behind him. One of the more amazing anecdotes of this event was that Gage was brought to town–conscious–and he sat on his porch relating the details of the accident to his landlord while a doctor was summoned from the next town.  Although he suffered an infection soon after, and his family prepared a coffin for him, he soon recovered, even though the rod damaged one or both of his brain’s frontal lobes.

The frontal lobes are involved in several functions of the body including:

• Motor Functions
• Higher Order Functions
• Planning
• Reasoning
• Judgement
• Impulse Control
• Memory

 This is the most often damaged part of the brain when concussed in a motor vehicle crash, fall or assault.  The frontal lobes sit right on top of the cranium's bony structure near the eye sockets. Therefore, when concussed, the brain slides along those bony structures and gets damaged.

You can read more about Phineas Gage and the frontal lobes in my previous posts:

Phineas Gage and Yasser Lopez Offer Modern Brain Injury Research More Data 

Phineas Gage

Functions Associated with Lobes of the Brain

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 Temporal Lobe

We continue Breaking Down the Brain by looking at the Temporal Lobe.  The temporal lobes are one of the four main lobes or regions of the cerebral cortex. Structures of the limbic system, including the olfactory cortex, amygdala, and the hippocampus are located within the temporal lobes.

The temporal lobes play an important role in organizing sensory input, auditory perception, language and speech production, as well as memory association and formation.

• The limbic system supports a variety of functions including emotion, behavior, motivation, long-term memory, and olfaction.
• The Olfactory Cortex is the sensory system used for the sense of smell.
• The Amygdala performs a primary role in the processing of memory and emotional reactions.
• The Hippocampus plays an important role in the consolidation of information from short-term memory to long-term memory and spatial navigation.*

The Functions of the Temporal Lobe include:

• Auditory Perception
• Memory
• Speech
• Emotional Respones
• Visual Perception

Kolb & Wishaw (1990) have identified eight principle symptoms of temporal lobe damage:

1) disturbance of auditory sensation and perception,

2) disturbance of selective attention of auditory and visual input,

3) disorders of visual perception,

4) impaired organization and categorization of verbal material,

5) disturbance of language comprehension,

6) impaired long-term memory,

7) altered personality and affective behavior,

8) altered sexual behavior.

Again, damage to the temporal lobe from car crash, fall, assault or other event may not result in impairments of all these areas.  Often there is selective impairments to a few areas making it difficult for others to understand.  This can make relationships and socialization with others difficult. Neuropsychological testing helps medical providers identify impairments and propose treatment.

Seizures of the temporal lobe can have dramatic effects on an individual's personality. Temporal lobe epilepsy can cause perseverative speech, paranoia and aggressive rages (Blumer and Benson, 1975). Severe damage to the temporal lobes can also alter sexual behavior (e.g. increase in activity) (Blumer and Walker, 1975).

You can read more about the temporal lobes in my previous blog posts:

Changes Observed after Brain Injury

Functions Associated with Lobes of the Brain

Psychiatric Issues in Traumatic Brain Injury

Imaging and Diagnosis of Alzheimer's

* Definitions from Wikipedia

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