TBI Times 2021 Edition

TIMES 2021 EDITION

THE OFFICIAL MAGAZINE OF THE BRAIN INJURY ASSOCIATION OF CALIFORNIA

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HOT TOPIC

BACK TO

SCHOOL WITH TBI

BY MICHELLE ST. HILAIRE

The Fall is an exciting time for children returning to school to reunite with friends and meet new classmates and teachers.

That being said, for students with traumatic brain injury (TBI), it can also be a stressful time. To add to the stress of returning to school with cognitive challenges, our nation is also facing a new wave of COVID-19 in the form of the Delta variant.

To help make this special time less stressful for students and parents impacted by TBI, Thrive has compiled some informative information on the topic that we hope can make our reader’s transition from summer to the school year more manageable.

trained special educators. However, not all special educators are familiar with the needs of students with brain injuries. On the other hand, not all students with TBI will require special programs.

In some states, a brain injury educational consultant is available through the state’s Office of Special Education. Thi consultant helps special educators in local schools to assess and provide services to students with brain injuries.

Much of the frustration and confusion related to returning to school can be avoided with proper planning. Rehabilitation professionals should communicate with family members and school personnel to help find the most effective ways to hel the student return. School personnel should be contacted as soon as possible after the injury to plan for the student’s return to school. School personnel can also connect the student with services they need while they are not in school.

Specific laws equire schools to provide special services for students with disabilities. The Individuals with Disabilities Education Improvement Act (IDEA) passed in 2004 ensures that students with disabilities receive a free appropriate education that is designed to meet their unique needs and prepare them for employment and independent living. Section 504 of the Rehabilitation Act states that students who are not eligible for special education services under IDEA are eligible for other support at school under Section 504. The Americans With Disabilities Act aims to end discrimination against individuals with disabilities throughout society.

School systems are required to have special programs to help students with disabilities return to school. Most schools have

For more information about these laws, parents can contact their local Department of Education.

THRIVE

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PUBLISHER

DR. NICHOLAS LOLOEE

CHAIRMAN, BRAIN INJURY ASSOCIATION OF CALIFORNIA ERICA CHAVEZ, ESQ.

ADVERTISING DIRECTOR DENÉ JONES

CREATIVE + EDITORIAL DIRECTOR MICHELLE ST. HILAIRE

ART DIRECTOR

ELIZABETH MEADOWS

GRAPHIC DESIGNER CHRISTINA WU

ADVERTISING DESIGNER JUAN MUNOZ

COPY EDITOR

MIKE FREEMAN

All editorial content of Thrive Magazine is the intellectual property of the Publisher and is protected by intellectual property laws. Thrive’s content may not be reproduced, republished, distributed, transmitted, displayed, broadcast, or otherwise used in whole or in part in any manner without the express written permission of the intellectual property owner. © 2021 BIACAL. All rights reserved.

The views expressed in Thrive Magazine are those of the authors and not necessarily those of the Publisher. The Publisher expressly disclaims and does not assume responsibility for the validity of any claims or any statements made, including content errors, omissions, or infringing content.

Any reliance placed on any claims or statements is assumed by the reader at the reader’s own risk.

Advertisements and offers are the responsibility of the individual advertising entities and do not constitute a legal offer by the Publisher.

EDITORIAL INQUIRIES: editorial@thrivetbi.com TO ADVERTISE IN TBI TIMES CONTACT CINDI WILLIAMS : cindi@biacal.org

To learn more, visit our booth.

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CONTENTS

THE LATEST IN BRAIN IMAGING

14

PUBLISHER’S LETTER

18 COVER STORY Oscar De La Hoya is back in the ring and hitting back against brain injury 24 THE SCIENCE OF CTE A look at chronic traumatic encephalopathy with insight from Dr. Bennet Omalu 30 THE LINK BETWEEN TBI AND DEPRESSION An exploration of how depression affects many traumatic brain injury (TBI) survivors 34 NOT YOUR GRANDPARENTS’ BRAIN SCANS How breakthroughs in brain imaging and nuclear medicine are helping doctors diagnose TBI 38 WAKING UP TO A NEW REALITY Trauma survivor Marcus Trammell’s amazing story of recovery and his mission to help others on similar journeys

ALTERNATIVE TBI TREATMENTS

THE CRANIOCERVICAL JUNCTION AND MTBI

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THRIVE’S MISSION Thrive is a magazine for and about accident victims, their families, and caregivers and tells stories of people who are not just surviving but thriving after trauma. Our content is comprised of informative articles and research in both the medical and legal arenas as well as personal narratives of hope and healing. Our mission is to support and inspire trauma survivors, helping them to improve their quality of life.

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CONTENTS

TBI SURVIVORS WHO ARE THRIVING

42 PSYCHEDELIC HEALING A comprehensive look at psychedelics as a potential treatment for TBI 44 TBI TREATMENT: A MULTIDISCIPLINARY APPROACH An informative Q&A with a top neurosurgeon and a top neuropsychiatrist on how these two specialties contribute to TBI treatment 50 THE 2021 TBI MED LEGAL CONFERENCE A look inside the exciting event bridging the gap between medicine and law in the area of brain injury 64 SURVIVORS WHO THRIVE Inspiring stories of TBI survivors 70 EXAMINE The latest in TBI research and treatment 84 RESOURCE GUIDE A comprehensive listing of TBI resources 90 READING ROOM Must-reads for TBI survivors and their families and caregivers 96 LAST LOOK A look at how COVID-19 affects the brain

PSYCHEDELICS AS A POTENTIAL TREATMENT FOR TBI

HYPERBARIC OXYGEN THERAPY FOR TBI

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PUBLISHER’S LETTER

I am proud and excited to introduce you to TBI Times, the very FIRST magazine of its kind. Our commitment is to provide readers with the latest groundbreaking scientific esearch on polytrauma and traumatic brain injury (TBI), helping them to navigate the complicated journey to restoring health after trauma. Our end goal is to assist trauma survivors in making informed and educated choices about their treatment based on concrete and reliable information. In addition, we provide inspiration through real-life stories of trauma survivors Published by The Brain Injury Association of California (BIACAL), TBI Times’ content is written with unique insight into both the medical and legal aspects of life after trauma. The magazine’s Fall edition is the official publication the TBI Med Legal Conference, a dynamic gathering of medical and legal professionals created and produced by BIACAL. The conference bridges the gap between medicine and law in the area of brain injury by bringing together the nation’s top TBI medical and legal professionals. The conference has reached a progressively larger audience each year and provides a dynamic opportunity to network and share ideas and resources.

I hope you enjoy reading these inspiring and informative stories and I look forward to presenting our next issue.

Dr. Nicholas Loloee Publisher

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FEATURE

THE

GOLDEN BOY IS BACK

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FEATURE

N Oscar De La Hoya prepares to step back into the ring while simultaneously hitting back against brain injury.

TOP PHOTO COURTESY OF FEATUREFLASH PHOTO AGENCY

BY MICHELLE ST. HILAIRE

THRIVE

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FEATURE

PHOTO COURTESY OF BY SERGEY NIVENS

“If I can do anything to help boxers avoid CTE and other brain injuries, I will.”

THRIVE

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B

orn in East Los Angeles into a family of boxers, Oscar De La Hoya made his professional debut on November 23, 1992, by scoring a first- ound TKO victory.

This was just the beginning of a career that would span 17 years and numerous championships. De La Hoya has won titles in six weight classes with championships as a junior lightweight, lightweight, super lightweight, welterweight, super welterweight, and middleweight. And he’s not stopping there. The 48-year-old De La Hoya planned to return to the ring on September 11th in Las Vegas to face former UFC champion, Vitor Belfort, before he contracted COVID-19 and landed in the hospital. “I was in the hospital

for three days fi hting COVID-19. It hit me really hard. I was in the best shape of my life [before getting sick] and I can’t wait to get back in the ring,” said De La Hoya. With another match on his mind, it seems De La Hoya will be making two comebacks, one from COVID-19 and another from his 12-year retirement.

The cap adds a critical second layer of protection, using a gel-based technology that disperses energy upon impact, making trauma less likely.

PHOTO COURTESY OF FEATURE FLASH PHOTO AGENCY

PHOTO COURTESY OF BY SERGEY NIVENS

De La Hoya hasn’t taken his time off lying down. In fact, in his spare time from serving as Chairman and CEO of his own promotions company, Golden Boy Promotions, he has worked to bring awareness to Chronic Traumatic Encephalopathy (CTE), specifically how fighters can otect themselves from this deadly degenerative brain disease brought on by repeated blows to the head — something that all professional fighters will inevitably encounte .

Known in the boxing world as ‘Punch Drunk Syndrome’, CTE is pervasive in fighting cultu e. A silent killer, the damage CTE causes is delayed and symptoms can lie dormant for many years. A study published in Neurology compared 204 active and retired boxers with a control group. The results demonstrate that three diffe ent brain regions shrink in active boxers compared with controls.

The degree of shrinkage and the diffe ent regions that shrank suggest that several disease processes related to repetitive head injury may be attacking the gray matter of the brain simultaneously.

“Fighters put everything on the line every time they step in the ring and, far too often, it results in serious damage,” said De La Hoya. “While head trauma can happen in an instant, far more often the damage comes from repeated punches during a lifetime of fighting and sparring.

Even with his legendary boxing record, De La Hoya has taken many blows to the head and he knows this puts him at risk for long-term brain injury. Out of this desire to help himself and his fellow athletes maintain their brain health and to do his part in helping to create a safety-driven culture in the sport of boxing came a partnership with Skulltec, a protective athletic gear company. Skulltec’s line of products uses patented technology proven to disperse energy and reduce impact. Specificall , De La Hoya has endorsed the Skullcap — designed to be worn under any headgear.

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The study also measured blood levels of two proteins that indicate brain injury or neurological malfunction. Both were elevated in boxers compared with controls. Furthermore, shrinkage was more pronounced among retired fighters, suggesting that the more trauma fighters sustain over time, the more long-term consequences there are for brain health.

With evidence like this, there’s no doubt that CTE should be a serious consideration for any fighte . It certainly is for De La Hoya: “If I can do anything to help boxers avoid CTE and other brain injuries, I will.”

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We know that what happened to you is unimaginable. Our goal is to help you have the best possible experience in the legal system.

We are a dedicated team of attorneys and staff who have specialized training and education related to mild and major brain injury needs, recovery and litigation nuances.

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Meet the team at www.Rafiilaw.com Tel. 310.777.7877

THE OFFICIAL MAGAZINE OF THE TBI MED LEGAL CONFERENCE

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HEALTHY BRAIN

PHOTO COURTESY OF BOSTON UNIVERSITY

BRAIN WITH CTE

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FEATURE

THE SCIENCE OF

CTE

[CHRONIC TRAUMATIC ENCEPHALOPATHY] An in-depth look at full-contact sports’ silent killer.

BY MICHELLE ST. HILAIRE

Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disease of the brain found in people with a history of repetitive brain trauma. CTE affects athletes who participate i sports which expose them to repeated head trauma such as boxing, football, and hockey. Military veterans are also at risk, with certain military service sectors carrying a high potential for head trauma.

Football in particular has gained a lot of attention around CTE. “You are supposed to be tough. You are supposed to play through pain. You are not supposed to cry. We are taught that early on in the game as kids. Tough sport. Brutal sport. It’s like being a gladiator. People want to see the big hits. And as a player, you don’t want to admit you are injured.” says NFL Hall of Fame running back Eric Dickerson.

PHOTO COURTESY OF BOSTON UNIVERSITY

Patients can present with symptoms of CTE many years after head trauma has occurred. This is possible because repeated brain trauma triggers a slow progression of brain tissue degeneration.

These changes in the brain can begin months, years, or even decades after the last brain trauma has occurred.

CTE eludes diagnosis due to symptom overlap with other brain disorders such as Alzheimer’s disease and Parkinson’s disease as well as psychiatric disorders like clinical depression. Because of the commonalities between CTE and these disorders, a CTE diagnosis can only be made after death, when an autopsy can reveal whether the known brain changes of CTE are present.

That being said, when CTE is suspected, neurological testing and psychiatric screening can be used to rule out other issues.

THE SILENT KILLER

Even when concussions are asymptomatic, they can still contribute to brain degeneration, making CTE a silent killer. The culprit in this degeneration is an abnormal protein called tau, which is also associated with dementia. However, research has found that with CTE a unique pattern of abnormal tau is present which builds up in the tissues and around the blood vessels.

SYMPTOMS OF CTE AND DIAGNOSIS

The symptoms of CTE can mimic dementia, even being called ‘dementia pugilistic’ when it was first discove ed. Many scientists disagree on the symptoms of CTE and research is still underway, but the disease has been associated with memory and thinking problems, confusion, personality changes, and/ THRIVE

or erratic behavior including aggression, depression, and even suicidal thinking. Other symptoms may include problems paying attention and organizing thoughts as well as difficul with balance and motor skills.

Dr. Robert Cantu, Professor of Neurosurgery at Boston University Medical School and Co-Director of the Center for the Study of Traumatic Encephalopathy (CTE) says “The question is whether, even after they are asymptomatic, players might still be recovering in ways we don’t know much about. It has shown thrivetbi.com 25

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“The fundamental issue is not concussions but repeated blows to the head—with or without concussions, with or without helmets. We must mitigate the exposure of athlete’s brains to all types of blows to the head.”

- DR. BENNET OMALU THRIVE

PHOTO COURTESY OF ALEX KRAVTSOV

FEATURE

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DR. BENNET OMALU

Dr. Omalu was the first to identify, describe, and name Chronic Traumatic Encephalopathy (CTE) as a disease entity in football players and wrestlers. In his crusade to bring awareness to CTE, Dr. Omalu has testified twice before the United States Congress and has provided hundreds of testimonies as an expert witness in federal and state courts across the United States in CTE cases.

HOLLYWOOD TAKES ON CTE

Concussion is a 2015 American biographical sports drama film written and directed by Peter Landesman, based on the exposé Game Brain by Jeanne Marie Laskas, published in 2009 by GQ magazine. Set during the 2000s, the film stars Will Smith as Dr. Bennet Omalu, a forensic pathologist who fights against the National Football League trying to suppress his research on chronic traumatic encephalopathy brain degeneration suffered by professional football players.

that up to 3 or 4 weeks after concussion and the disappearance of symptoms, there are subtle diffe ences in brain activity — suggesting recovery may not be complete. This is the stuff tha nags at any doctor making return-to-play decisions.”

three, 75% of patients are considered cognitively impaired.

At stage four, researchers found that most patients developed a profound loss of attention and concentration, executive dysfunction, language difficulties, explosivi , aggressive tendencies, paranoia, depression, and gait and visuospatial difficulties

PHOTO COURTESY OF KATHY HUTCHINS (RIGHT) AND COLUMBIA PICTURES (LEFT)

PHOTO COURTESY OF ALEX KRAVTSOV

THE SCIENCE BEHIND THE PATHOLOGY

To understand the science behind CTE, you first need to understand its diffe ent stages. In stage one, symptoms are fairly mild and can include headaches as well as loss of attention and concentration. The physical characteristics of a brain with stage one CTE are unremarkable and sometimes nonexistent — stage one CTE shows no visible pathology.

When present, they are only microscopically detectable and most commonly localized to the frontal, temporal, insular, septal, and parietal areas of the brain.

Studies of patients in stage four also site that the most common causes of death for those with CTE are respiratory failure, cardiac disease, suicide, overdose, and symptoms associated with end-stage dementia and malignancy.

In stage two, CTE can present with symptoms of depression or explosive mood swings and short-term memory loss, in addition to stage one symptoms. Less common stage two symptoms can include executive dysfunction, language difficulties, and impulsivi . The physical characteristics of a brain with stage two CTE are more prominent than in stage one and include mind enlargement of the frontal ventricles as well as other areas of the brain. In addition, detectable levels of tau protein are present in the frontal and temporal areas. Also present in the brain are pre-neurofibrillary tangles (NF s) which are aggregates of tau protein.

In stages three and four, the most advanced stages of CTE, patients exhibit all of the symptoms of the first two stages with the severity of symptoms drastically increased. At stage THRIVE

In the latter stages of CTE, the brain shows macroscopic changes with structural changes becoming evident in stage four. In the final stage of CTE, the e is a reduction in brain weight, mild frontal and temporal atrophy, and enlargement of the lateral and third ventricles. The presence of NFTs becomes prevalent as well, showing up both superficially and deep within the brain. n short, the entire brain becomes overtaken with pathology.

RESEARCH AND TREATMENT

Millions of dollars are being invested in CTE research by organizations such as the National Institute of Neurological Disorders, the Stroke and Brain Injury Research Institute, and the Alzheimer’s Association.

As a result, better imaging techniques are becoming available and there is hope that in the future CTE will be diagnosable before death. This will inevitably bring forth treatment options for patients suffering f om CTE. There is currently no cure or treatment for the disease which makes this research very important for the numerous people suffering f om it.

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Many m at depres sion e tr to d ie f li a a re q u e sp ecia lized ent v a h ts is tr ia h ge m Psyc ication mana gists d e m in g in in tra ho lo counsel. Psyc vide o ls a n a c d n a ro y trained to p are specificall depression, however, r counseling fo be medication. In ri can not presc social workers are e addition, som with people suffering rk trained to wo e symptoms. Often, iv from depress ysicians are a good ph primary care hen looking for help. w starting point

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FEATURE

THE LINK BETWEEN TRAUMATIC BRAIN INJURY AND DEPRESSION

Depression is common after traumatic brain injury (TBI). About half of all people with TBI are affected by depression within the first year after injury.

PHOTO COURTESY OF ASLYSUN

BY GREY NOLAN

Every year, 1.7 million people in the US sustain a traumatic brain injury (TBI). Psychiatric disorders frequently complicate the course of recovery from TBI and occur at rates exceeding those of the general population. Major depression is the most common psychiatric disorder following TBI, affecting an estimated 29.4% of patients in the first year post-injury alone. TBI-associated depression contributes to higher suicide risk, altered executive function, poorer social reintegration, and vocational outcomes, and decreased quality of life.

“One example of how TBI can be connected with mood or anxiety disorders is when the cognitive complications associated with the TBI result in profound changes in the patient’s life. If they can no longer work and experience financial ha dship or loss in purpose, this can lead to depression and anxiety,” says Dr. Emin Gharibian, Psy.D., founder, and director of Verdugo Psychological Associates.

Research has shown that the specific a ea of the brain affecte by the TBI translates directly to the potential side effects patient may experience. For example, injuries on the right side of the head are more likely to cause manic symptoms, and injuries on the left side of the head are more likely to cause depressive symptoms. Frontal-cortex injuries can lead to behaviors that are typically associated with personality disorders. This is because the frontal-cortex region of the brain is directly responsible for emotional regulation.

TBI has long been associated with changes in mood, personality, and behavior. Research suggests that psychiatric disorders may be present at increased rates after TBI and for this reason, TBI is considered by some medical professionals to be a risk factor for psychiatric diagnosis.

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FEATURE

The chronic and relapsing course of TBI-associated depression poses a challenge to the management of afflicted patients. Two-thirds of patients depressed at 1-year post-injury remain so in the second year, and the risk of depression remains elevated for 20 to 30 years after the injury. The high prevalence, chronicity, and potentially irreversible consequences of post-TBI depression underscore the importance of developing interventions targeting this disorder.

There are many ways to cope with post-TBI depression.

Talking to close family or friends about how you are feeling is a great way to minimize isolation. Isolation exacerbates depression so it should be avoided if at all possible. If you are struggling with being in a crowd or around people, try to meet with one close friend in a quiet location. Research shows that listening to uplifting music, engaging in a creative activity, or reading a book are effective ways of copin with depression. Exercise is also a strongly proven antidote for depression. Just a few minutes each day will produce significant esults. Most importantly, seek the support of a professional who has experience treating patients with TBI.

The length of time it takes for a patient with TBI to recover directly influences their chances of facing long term depression. With an extended recovery time, a patient’s socialization, work, autonomy, or even their ability to communicate will be affected. Changes in your typical routines and habits have a direct effect on your mental state and quality of life. Because of that, lingering TBI symptoms are strong activators of the behavioral inhibition system, causing symptoms of depression.

Once the behavioral inhibition system is disturbed, the ability to feel pleasure or satisfaction can be lost.

A TBI patient’s prognosis as it relates to depression is highly dependent on the type of TBI they experience. Patients who sustain an mTBI (minor TBI) tend to recover quickly, within one to three weeks, with little to no lingering symptoms.

In these cases, depression is less of a concern. In a small percentage of mTBI injuries, patients may experience side effects for up to th ee months, and as mentioned previously, longer recovery times can lead to long-term depression.

RESEARCH HAS SHOWN THAT DAMAGE TO THE LEFT HEMISPHERE OF THE BRAIN MAY CAUSE DEPRESSIVE SYMPTOMS. - DR. EMIN GHARIBIAN, PSY.D.

For TBI patients, not only is that inhibition system overactive, but they’ve lost many of the activities that could jumpstart their behavioral activation system (which would help calm down the inhibition system and allow feelings of reward and pleasure again).

Complicated mTBIs can cause more cognitive impairment than uncomplicated mTBIs, and in the latter, recovery can take up to six months and mirror the recuperation associated with a moderate TBI. Sustaining a TBI can be a lifelong challenge and can require a range of resources and strategies that extend far beyond initial recovery. When depression is a factor in recovery, it can be even more challenging.

Neuropsychologists and neuropsychiatrists are not only important for diagnosis and first phases of treatment but can also be an important part of a long-term treatment plan which addresses mood and emotional wellbeing, helping TBI survivors thrive in their daily lives long after their injury.

Other factors to consider are sleep and pain. Many TBI patients experience disruption to their normal sleep patterns, and sleep deprivation itself can result in depressive symptoms. Additionally, the symptoms of depression can make it harder to sleep, so they work together to make everything feel worse. Coping with continuous pain is another factor. It is difficult for the brain chemistry to return to its normal state if it is reacting to pain signals.

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PHOTO COURTESY OF FRENZEL

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IMAGE COURTESY OF MICHAEL BRAHAM

FEATURE

Diffusion Tensor Imaging (DTI) Scan THRIVE

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FEATURE

NOT YOUR GRANDPARENTS’

BRAIN SCANS

Breakthroughs in brain imaging and nuclear medicine are making traumatic brain injury more diagnosable than ever.

IMAGE COURTESY OF MICHAEL BRAHAM

BY MICHELLE ST. HILAIRE

Diagnosing traumatic brain injury (TBI) can be complicated.

Currently, doctors use a variety of methods to determine if a patient has a TBI. A medical exam is the first step to diagnose a potential brain injury which includes a neurological exam.

This exam evaluates thinking motor function, sensory function, coordination, eye movement, and reflexes.

Although it is well acknowledged within the medical community that they cannot detect TBIs, CT and MRI scans are typically the next step because they can rule out a more serious brain injury. Although these protocols aid health care providers who are trained in the intricacies of diagnosing TBIs, none on their own can provide a definitive diagnosis.

However, there is promising research showing that more advanced imaging may take center stage in the diagnosis of both TBI and mTBI (mild traumatic brain injury).

This next-level imaging falls into two categories: Nuclear Medicine in the form of single-photon emission computerized tomography (SPECT) and positron emission tomography (PET) scans and Diffusion ensor Imaging (DTI) scans.

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SPECT AND PET SCANS

SPECT is a nuclear imaging scan that integrates computed tomography (CT) and a radioactive tracer. The tracer is what allows doctors to see how blood flows to brain tissue. Befo e the SPECT scan, a tracer is injected into your bloodstream.

The tracer is radiolabeled, meaning it emits gamma rays that can be detected by the CT scanner. The computer collects the information emitted by the gamma rays and displays it on the CT cross-sections. These cross-sections can be added back together to form a 3D image of your brain. The radioactive tracers will pass through your body and be detected by the scanner.

PET scans, however, also use radiotracers for additional purposes other than monitoring blood flo . PET scans also visualize and measure physiological processes such as regional chemical composition and absorption. In both SPECT and PET scans, diffe ent tracers are used depending on the purpose of the scan. In the case of TBI screening, Fluorodeoxyglucose (FDG) is the most widely used radiotracer.

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FEATURE

MRI SCAN

IMAGE COURTESY OF SPRINGSKY

SPECT SCAN

A SPECT scan differs f om a PET scan in that with SPECT the tracer stays in your bloodstream rather than being absorbed by surrounding tissues, thereby limiting the images to areas where blood flows. SPECT scans a e cheaper and more readily available than higher resolution PET scans, though both scans can detect minute molecular biological changes in the brain, which is not possible for MRI or CT scans.

According to Dr. Daniel Amen, a brain health expert, “Brain SPECT imaging identifies a eas of the brain hurt by TBI. CT and MRI scans show if there is any damage to the anatomy or structure of your brain, but these scans cannot tell how your brain is functioning. In fact, after a TBI, CT or MRI scans will often appear normal when there is functional damage to the brain that can be detected with SPECT.”

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DTI SCAN

DTI scans are a relatively new magnetic resonance imaging (MRI) technique that is used to evaluate microstructural changes in the brain by measuring water molecules in tissue. Its imaging capabilities are based on the ability to determine the orientation and diffusion characteristics o white matter. Recent advances in the resolution of DTI have made it possible to visualize potential changes in various neural tracts associated with brain injury. DTI is used in conjunction with conventional MRI techniques to provide 2-dimensional and 3-dimensional visualization of changes to white matter in the brain. DTI scans can provide image contrast that was previously unattainable using conventional MRI techniques.

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FEATURE

DTI SCAN SHOWING TBI

IMAGE COURTESY OF SPRINGSKY

IMAGE COURTESY OF PRISM CLINICAL IMAGING

NORMAL DTI SCAN

“ADVANCED MRI/DTI IS REVOLUTIONIZING THE WAY WE CAN OBJECTIVELY DIAGNOSE BRAIN INJURY, TUMORS, DEGENERATION, AND AUTO-IMMUNE DISEASES.” - R. David Cruickshank, President/CEO, Equinox Health/Brain Mapping Solutions Inc. According to Lauren J. O’Donnell, Ph.D. of the Golby Neurosurgical Brain Mapping Laboratory, DTI is a sensitive probe of cellular structure that works by measuring the diffusion of water molecules. Unlike th diffusion in a glass of pu e water, which would be the same in all directions (isotropic), the diffusion measu ed in tissue varies with direction (anisotropic). The measured macroscopic diffusion anisot opy is due to microscopic tissue heterogeneity. In the white matter of the brain, diffusion anisot opy is primarily caused by cellular membranes, with some contribution from myelination and the packing of the axons. Anisotropic diffusion ca indicate the underlying tissue orientation.

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WHAT ADVANCED IMAGING TECHNIQUES MEAN FOR TBI PATIENTS

Being able to thrive with TBI means getting the proper diagnosis, which is the first step in getting the appropriate treatment. SPECT, PET, and DTI scans are making this possible for more patients. The amount of detail and diagnostic information made available by these scans can help doctors create customized treatment plans for patients with TBI. With more research being done every year to develop advanced imaging modalities, the future is brighter for patients suffering from TBI.

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FEATURE

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FEATURE

WAKING UP TO A NEW REALITY Marcus Trammell’s life changed in a split second after a near-fatal car crash. He chose to make his journey back to health one that would benefit many.

BY SLANE BARKER

PHOTOS COURTESY OF MARCUS TRAMMELL

Just after 5pm on a Friday afternoon, Marcus Trammell got behind the wheel with two goals in mind — to support a friend’s Nashville eatery during the COVID-19 pandemic and to pick up dinner for friends. He pulled into a nondescript strip mall off of a nondescript oad and instantly his life changed forever. “As I was pulling in, a drunk driver hit my car on the passenger side. She was going 75 mph,” said Trammell. “The police said later they thought I’d die at the scene, but I woke up in the hospital.”

Upon waking, Trammell didn’t remember who he was, but he did remember having a family. “I knew I had a son, but I couldn’t remember his name. I could just remember walking with him on a bright, sunny day. That’s all I had,” said Trammell. That was enough. From that moment forward, a relentless determination to fight back to health for his famil sustained him. “The early days were extremely tough. I still didn’t know exactly what had happened, but I did have a very specific ecollection of having a family, my wife and newborn son. That’s what drove me,” said Trammell. I decided then that I would do whatever I had to do to get out of that bed and help raise my child.”

Trammell’s physical injuries were extensive. He suffe ed from a fractured skull, broken collarbone, broken ribs, fractured lumbar spine, and a brain hemorrhage. The severity of his THRIVE

Marcus Trammell’s vehicle after his accident.

injuries required him to be placed in an induced coma for several weeks at Vanderbilt University Adult Hospital (VUAH), where he received his initial care. The first stages o recovery involved Trammell relearning many basic functions such as swallowing and walking. Following his time at VUAH, Trammell required a month of inpatient rehabilitation and nearly a year later he’s still navigating the challenging landscape of recovery from a traumatic brain injury, though his progress has been amazing.

Trammell is certainly not alone. An estimated 4.8 million drivers were seriously injured in crashes just last year. One thing that sets him apart, however, is his commitment to help others who have experienced similar tragedies resulting in traumatic brain injury by sharing his story. His website, theheadfix.com, sha es his experience in great detail and gives readers a window into the diverse range of treatments he has received. In addition to practical information, Trammell also uses the site to share inspiring and uplifting anecdotes of others who have traveled a similar path. He’s also produced a 10-minute documentary film outlining his ecovery journey which can be viewed on the site.

It was, in part, a decision to move to his home state of Michigan during his recovery that awakened his desire to inspire others.

“I grew up in Michigan, and my family and I decided that the woods and water there would be restorative. I swam every day in Lake Superior, walked in the woods, and spent time in nature reading books and listening to head trauma podcasts,” said Trammell. “It was during that time when I decided that no matter what, I would make something of this suffering, to get i out to others that there is hope, that there is joy.”

And just over a year after his accident, Marcus Trammell exudes hope and joy. He has returned to his post as associate director of the Wendland-Cook Program in Religion and Justice at Vanderbilt University Divinity School, is driving again, and perhaps most importantly, raising his son Eero alongside his wife Heidi. Of course, challenges still exist and recovery is ongoing, but Marcus Trammell is “choosing the path of posttraumatic growth.”

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FEATURE

PSYCHEDELIC

HEALING Psychedelics have been studied in connection with mental health for decades. Now they are being looked at as a potential treatment for TBI.

PHOTOS COURTESY OF ANITRAM

BY GEORGE PLATT

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A psychedelic experience is a temporary altered state of consciousness induced by the consumption of a serotonergic psychedelic substance. For example, an acid trip is a psychedelic experience brought on by the use of LSD, while a mushroom trip is a psychedelic experience brought on by the use of psilocybin. Psychedelic experiences are induced in many contexts including exploratory, recreational, religious, and mystical. However, science is beginning to recognize the therapeutic bene ts of these substances in the treatment of TBI.

THE CHEMICAL COMPOUNDS

Several psychedelic compounds are being studied as treatments for TBI. Two that are at the forefront of this research are psilocybin and ibogaine. Psilocybin is one of the many compounds found in magic mushrooms (aka psilocybin mushrooms or psychedelic mushrooms). It is a prodrug (a biologically inactive compound which can be metabolized in the body to produce a drug) of psilocin, the main compound responsible for the psychedelic effect of magic mush ooms.

Ibogaine, which is extracted from the iboga shrub, was used

by West African communities for centuries in both rituals and healing ceremonies. This psychedelic did not make its way into the Western world until 1864. In 1970, the FDA classifie ibogaine as a Schedule I drug alongside other psychoactive drugs such as psilocybin and LSD. However, in recent years — with the resurgence of psychedelics in therapeutic research — the regulatory landscape is once again becoming more favorable.

“Ibogaine could be crucial for the treatment of brain trauma and neuropathic pain.” says a spokesperson for MINDCURE, a mental health and wellness company. “The substance has been thought to stimulate the growth of new dopamine neurons and repair and reset the brain’s reward system.”

PHOTOS COURTESY OF ANITRAM

THE COMPANIES BEHIND THE RESEARCH

Many companies and organizations are researching psychedelics for the treatment of TBI. MINDCURE recently announced its efforts towa ds researching psychedelics for the treatment of TBIs. The company identified opportunities for th treatment of traumatic brain injuries using ibogaine. Leading the charge for MINDCURE’s trauma and head injury research is Dr. Engle, Board Certified in Psychiatry and Neu ology, with a clinical practice that combines functional medicine, integrative psychiatry, and neuro-cognitive restoration. He is also the author of the book The Concussion Repair Manual. Dr. Engle calls this era in brain health a “psychedelic renaissance in the redemption of modern psychiatric care.” In other words, this is where the market is headed. Not only are there more decriminalization efforts being made against psychedelics, bu we also see increased FDA approvals for its therapeutic use, as well as renowned hospitals like Johns Hopkins launching psychedelic research.

FROM MENTAL HEALTH TO BRAIN HEALTH

It has been well established that psychedelics have the potential to help psychiatric patients. “Psychedelic compounds have the potential to bring significant imp ovement to the lives of many individuals suffering f om mental illness,” said Brian Barnett, M.D., Center for Behavioral Health, the Cleveland Clinic.

The movement from psychedelics for mental health symptoms to psychedelics for overall brain health seems obvious and researchers have been looking at this progression for decades. For example, the Johns Hopkins School of Medicine opened the Center for Psychedelic and Consciousness Research in Baltimore. “Our scientists have shown that psychedelics have real potential as medicine, and this new center will help us explore that potential,” Paul B. Rothman, M.D., dean of the Johns Hopkins University School of Medicine and CEO of Johns Hopkins Medicine, said on the Center’s website. With $17 million in funding from private donors, the Center is the firs research center of its kind in the U.S. and the largest such center in the world.

Although more research is needed, it seems clear that science is working towards and possibly close to harnessing psychedelics for good and TBI patients will certainly benefit.

Wesana Health is a private life sciences company that has announced plans for TBI research. CEO Dennis Carcillo is a former National Hockey League player. Throughout his NHL THRIVE

career, Carcillo sustained several TBIs. As the cumulative toll from these injuries increased, Carcillo sought treatment but nothing seemed to work. “I thought I was hopeless because I tried everything. I read every paper. And I couldn’t help myself.

That’s when suicidal ideation crept in for the first time in m life. It got really scary.” said Carcillo. “After my first effort self-medicating with psilocybin, I felt like the brain fog and fatigue started to lift. It just got better progressively as the days went on.” After six months, Carcillo was told his brain scans showed noticeable improvement. Today, as Wesana’s CEO, Carcillo wants to bring psilocybin-based relief to other TBI suffe ers, but via licensed-and-approved drugs, and alongside formal psychotherapy.

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FEATURE

TBI TREATMENT REQUIRES A MULTIDISCIPLINARY APPROACH. Neurosurgeon Dr. Fardad Mobin, M.D. and neuropsychiatrist Dr. Rod Amiri, M.D. shed light on two key roles in the treatment of TBI.

BY MICHELLE ST. HILAIRE

Traumatic brain injury (TBI) is a common and often serious condition that occurs in accidents involving an impact to the head. In many cases, the victim does not realize the full extent of their injury until months or even years after the trauma has occurred and symptoms surface. This can result in great personal suffering and even monetary epercussions for example a personal injury case being settled before it is clear that the victim has a brain injury.

Although fragile bones can mend, TBI can leave a person’s life irrevocably changed, permanently damaging their relationships, work, mental capacity, and quality of life. For these reasons, it is important for those who have experienced head trauma to be acutely aware of the potential of TBI so that they may seek out treatment as soon as possible. TBIs can range from mild (concussions) to severe, with causes ranging from simple slip and fall injuries or major motor vehicle collisions to full-contact sports injuries.

From a physiological perspective, TBI trauma occurs as a consequence of a sudden acceleration or deceleration or by a complex combination of both movement and sudden impact. Depending on the severity of the injury, the required treatment may be minimal or multidimensional and can THRIVE

include various types of intervention. This is called team-based treatment and is defined as p ofessionals from a range of disciplines working together to deliver comprehensive care that addresses as many of the patient’s needs as possible. In this treatment model, care can be provided by a range of professionals functioning as a team under one organizational umbrella or by professionals from a range of organizations brought together as a unique team. As a patient’s condition changes over time, the composition of the team may change to reflect the changing clinical and psychosocia needs of the patient.

There are many options available to doctors when taking a multifaceted approach to diagnosing and treating TBI. Symptom triggers can be successfully identified th ough cognitive therapy, surgical intervention is also appropriate in some cases, and medication can play an important role in managing symptoms.

Thrive talked to two authorities in their fields, D . Fardad Mobin, M.D. (a neurosurgeon), and Dr. Rod Amiri, M.D. (a neuropsychiatrist) to learn how these two specialties contribute to the successful treatment of TBI.

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FEATURE

In more severe cases of TBI, neurosurgery may be a necessary part of treatment. A neurosurgeon is a medical doctor who specializes in evaluating, diagnosing, and treating conditions of the brain, spine, and nervous system.

Neurosurgeons have extensive training, knowledge, and experience performing some of the most complex surgical procedures the human body can undergo and can also diagnose and treat conditions affecting the st uctures that support the nervous system including the skull, spinal vertebrae, spinal discs, and blood vessels.

Dr. Fardad Mobin, M.D. is a highly-skilled, board-certified neurosurgeon. He has performed over 2,000 surgeries and is recognized for his exceptional operative skills as well as his excellent patient care. Dr. Mobin is a graduate of the Rensselaer Polytechnic Institute in Troy, New York, holds a medical degree from the University of California Davis School of Medicine, and has completed a fellowship at the University of California, Los Angeles.

THRIVE MAGAZINE: How would you describe a neurosurgical approach to the treatment of TBI? DR. Mobin: Neurosurgeons are at the frontline when it comes to caring for TBI patients. We are routinely consulted by emergency room physicians and trauma surgeons to take an active role in the management of individuals with acute traumatic brain injury, from mild uncomplicated head injuries to severe life-threatening intracranial injuries. The first goal o neurosurgical intervention is to relieve the build-up of pressure within the enclosed cranium and prevent brain herniation. The

Dr. Fardad Mobin, M.D.

NEUROSURGERY

next course of action is to rescue the brain tissue at risk of irreversible damage. Neurosurgical intervention consistently involves control of intracranial pressure by performing craniotomies to control and evacuate intracranial bleeds and restore normal pressure within the cranium. The neurosurgeon is an active player in postoperative critical care, working hand in hand with the ICU team to manage the multitude of parameters that are critical to the recovery of TBI patients.

TM: Can neurosurgery alone ever successfully treat TBI? DM: No. Both acute and chronic phases of TBI require a multidisciplinary treatment team. Neurosurgeons play a very important role in the treatment of both the acute and chronic phases of TBI, however, the coordinated care of several disciplines including neurosurgeons, trauma surgeons, physiatrists, physical therapists, neuroradiologists, neurocognitive psychiatrists, and speech therapists, to name a few, are necessary for the successful treatment of TBI.

TM: Specificall , how do neurosurgeons neuropsychiatrists work together to treat TBI? DM: Individuals with TBI can suffer f om an array of brain functionality issues, often manifesting as personality change, short-term or long-term memory loss, cognitive decline, and difficulty with focus and information ocessing.

Neuropsychiatrists can perform detailed cognitive testing to link the observed deficits to any underlying st uctural injuries. This information will then help guide the patient’s rehabilitation program.

TM: Is neurosurgery used in the treatment of mild, moderate, and severe TBI? DM: Yes. The discipline of neurosurgery places a great deal of concentration on the treatment of acute brain injury, and neurosurgical training concentrates on both surgical and medical care of TBI. Neurosurgeons are uniquely positioned to conduct life-saving procedures to relieve intracranial pressure and employ the critical care necessary to prevent secondary brain damage. For more information on Dr. Mobin: (310) 829-5888 or spinesurgeonla.com.

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FEATURE

Neuropsychiatrists also play an essential role when treating patients who have experienced TBI and are trained in the diagnosis and treatment of a wide range of conditions. The main focus of neuropsychiatry is understanding the psychological and psychiatric symptoms that arise from brain injury and disease and how to go about treating them.

Dr. Rod Amiri, M.D. is a board-certified psychiatris and diplomate of the American Board of Psychiatry and Neurology as well as the American Board of Addiction Medicine. Based in Los Angeles, California, Dr. Amiri is also an injury specialist (CBIS) certified by the Brai Injury Association of America. Committed to the everevolving and growing understanding of the psychological and psychiatric impacts of TBI, his concentration on the psychological symptoms of brain injury and disease gives him a unique perspective when it comes to treating the mental health side effects of TBI THRIVE MAGAZINE: In your opinion, how important is a multidisciplinary approach to the treatment of TBI? DR. AMIRI: When we take a multifaceted approach to treating the symptoms of TBI we have many tools at our disposal, increasing the odds of a patient making a successful recovery. Cognitive therapy is important to identify symptom triggers, in many cases, surgical intervention is warranted, and at times medication plays a role in managing symptoms. This is why it is so important to approach treatment from many angles.

Dr. Rod Amiri, M.D.

NEUROPSYCHIATRY is why a team approach is advantageous so that we can cover as many bases as possible to benefit the patient

TM: What is the connection between the specific nature of a TB and the psychological symptoms a patient may experience?

DA: There is no question that physical damage to the brain can cause cognitive, emotional, and behavioral issues. Research has shown that the specific area of the brain affected by TBI translates directly to the potential side effects a patient may experience. F r example, injuries on the right side of the head are more likely to cause manic symptoms, injuries to the left side of the head are more likely to cause depressive symptoms, and frontal-cortex injuries can lead to personality-disrupting symptoms such as impulsivity and disinhibition.

TM: What role does psychiatric medication play in TBI recovery?

DA: Medication is just one component of TBI treatment. A simple analogy would be that therapy is akin to an elite athlete’s training while finding the ideal medication for a patient is ak n to finding the ideal diet for that athlete. ake Michael Phelps, for instance. He would not have been successful at the Olympics if he was eating unhealthy foods. He needed a certain diet to achieve success.

TM: If patients experience psychological symptoms associated with TBI, what might they expect?

DA: The short- and long-term psychological effects depend o the severity and location of the injury as well as the age of the patient and their overall mental state before the TBI, especially if there were pre-existing psychological or functionality issues.

The ideal treatment approach depends on multiple factors. This

THRIVE

Although the medications we use in TBI patients are often the same as those used to address primary psychological disorders, it is important to start a TBI patient on a very low dosage. This is because TBI-induced psychological symptoms are inherently diffe ent from typical psychiatric issues. For more information on Dr. Amiri: (424) 360-0155 or connectwellnesscenter.com. thrivetbi.com 47

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The nation’s leading TBI doctors and lawyers teach attendees how to handle a traumatic brain injury case from injury through trial. Doctors speak about making the medical aspect of TBI cases understandable to all while lawyers cover the pre-litigation and litigation strategies and skills needed to bring home the best settlements and verdicts.

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TBI MED LEGAL CONFERENCE

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TBI MED LEGAL CONFERENCE

After many years litigating brain injury cases, Erica Chavez, Esq. recognized the need to connect the dots between medical and legal professionals working in brain injury, with the end goal of helping traumatic brain injury (TBI) survivors.

Her vision became a reality when she helped launch the TBI Med Legal Conference, the largest and most successful conference focussed on TBI in the nation. Through this exciting annual event, Ms. Chavez saw an opportunity to bring together the elite in brain injury physicians and attorneys to share the wealth of professional knowledge they have gained through their work with brain injury survivors.

In addition to her work uniting medical and legal professionals in brain injury, Ms. Chavez is also passionate about educating TBI survivors on the resources available to them, championing for accident victims who have experienced lifealtering brain injuries. Her expertise in brain injury litigation gives her the knowledge to help TBI victims obtain the maximum compensation for their injuries, subsequently improving their quality of life.

Ms. Chavez believes that information is power and can help brain injury survivors triumph over this silent killer. She continues her mission to improve the lives of TBI survivors with her involvement in the 2021 TBI Med Legal Conference.

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TBI MED LEGAL CONFERENCE

FOUR AMAZING DAYS IN SUNNY SAN DIEGO, CALIFORNIA BIACAL MED-LEGAL_8/12.indd 31

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4 8 + 200 DAYS

TRACKS

SPEAKERS

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AMAZING THINGS HAPPEN FROM MORNING TO NIGHT. BIACAL MED-LEGAL_8/12.indd 33

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TBI MED LEGAL CONFERENCE

Experience the energy and excitement of TBI Med Legal.

Whether you are a seasoned brain injury litigator, medical professional, are handling your fi st TBI case, or are interested in performing civil work on a lien, this comprehensive program will provide you with the tools you need to successfully handle brain injury cases from beginning to end.

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SPEAKERS LIST OF SPEAKERS ACCURATE AT TIME OF PRINTING.

JOSEPH H. LOW, ESQ.

KACIE VINEL, ESQ.

KEITH BREMER, ESQ.

KEITH MITNICK, ESQ.

MARCEL PONTON, PH.D., QME

MARIUSZ ZIEJEWSKI, PHD

MARY ALEXANDER, ESQ.

MAURO FIORE, JR., ESQ.

MICHAEL FREEMAN, , MD, PHD, MPH, FAAFS

MICHAEL LOBATZ, MD

MICHAEL NEFF, ESQ.

MICHAEL SANCHEZ, ESQ.

MICHAEL SCHONBUCH, ESQ.

MIKE ALDER, ESQ.

MIKE ARIAS, ESQ.

MIKE KELLY, ESQ.

MINH NGUYEN, ESQ.

MORGAN ADAMS, ESQ.

OLIVIER TAILLIEU, ESQ.

OREGON HUNTER, MD

PEJ BEN COHEN, ESQ.

PETER ISQUITH, PHD

R. REX PARRIS, ESQ.

RANDALL BENSON, MD

RANDY SCARLETT, ESQ.

RANDY URBAN, MD

RON C. SAVAGE, ED.D.

SANA KHAN, MD, PH.D.

SCOTT AUERBACH, PT

SEAN CLAGGETT, ESQ.

SHARON GRANDINETTE, MS-ED, CBIST

SHAWN LALEZARY, ESQ.

SPENCER LUCAS, ESQ.

STEVEN BENVENISTI, ESQ.

STEVEN J. BRADY, ESQ.

STEVEN VARTAZARIAN, ESQ.

STUART CASPER, ESQ.

THERESA BOWEN-HATCH, ESQ.

THOMAS DEMPSEY, ESQ.

TODD MASEL, MD

TOM FEHER, ESQ.

TONY STRICKLAND, MS, PHD

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TBI MED LEGAL CONFERENCE

PATRICK MALONE, ESQ.

ERIN BIGLER, PHD

BOB SIMON, ESQ.

ANDREW ELLIS, ESQ.

ANTHONY GAMBOA JR, PHD

ARASH HOMAMPOUR, ESQ.

BILL BARTON, ESQ.

BOB MORGENSTERN, ESQ.

BOBBY SADIAAN, ESQ.

BRUCE H. STERN, ESQ.

CAROL HYLAND, MA, MS, C.D.M.S. C.L.C.P.S.

DAN GARDNER, MD

ADRIAN YOUNG, MD

ARTHUR C. CROFT, PH.D., D.C., M.SC., M.P.H., F.A.C.O.

AIMEE KIRBY, ESQ.

ALIREZA BAGHERIAN, DC, CCEP, QME, DAIPM, F/ABVE

BEN COUGHLAN, ESQ.

BENJAMIN FRISHBERG, MD

BRENT MASEL, MD

BRIAN BEECHER, ESQ.

BRIAN PANISH, ESQ.

CHARLES G. MONNETT, ESQ.

CHRIS DOLAN, ESQ.

CLAUDE MUNDAY, PHD

DAN AMBROSE, ESQ.

DAVID E ROSS, MD

DAVID HOVDA, PHD

DAVID R. PATTERSON, MD

DEBORAH CHANG, ESQ.

DEBORAH L. DOHERTY, MD

DR. AARON DESHAW, ESQ.

EDGAR ANGELONE, PH.D.

EUSTACE DE ST. PHALLE

FERNANDO G. MIRANDA, M.D.

FRANK BRANSON, ESQ.

GENE SULLIVAN, ESQ.

GEOFF MANLEY, MD

GEOFFREY S. WELLS, ESQ

GRACE GRIESBACH, PH.D.

GREG O’SHANICK, MD

HON. R. BRUCE MINTO, RET.

IBIERE SECK, ESQ.

JAMES BOSTWICK, ESQ.

JAN ROUGHAN, BSN, PHN, RN,CRRN, CNLCP, CCM

JEFF RUDMAN, ESQ.

JOE BARRETT, ESQ.

JOHN CARPENTER, ESQ.

JOHN ROMANO, ESQ.

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SCHEDULE

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TBI MED LEGAL CONFERENCE

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LEGENDARY PARTIES EVERY NIGHT TBI Med Legal conferences are known for their legendary parties, complete with baby sloths, strolling magicians, Cirque dancers serving wine while hanging from chandeliers, champagne fountains, tequila and whiskey tastings...all overlooking the San Diego Marina while rubbing shoulders with the rock stars of the brain injury litigation community.

LET’S DO THIS! An experience you won’t forget.

FOR MORE INFORMATION: TBIMEDLEGALCON.COM 833-MEND-TBI

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TBI MED LEGAL CONFERENCE

THE TBI MED LEGAL CONFERENCE

BEHIND THE SCENES The TBI Med Legal Conference brings together hundreds of medical and legal professionals for a one-of-a-kind experience. Many talented professionals have come together to perform the planning and administrative tasks required to make this event a success. The Brain Injury Association of California would like to thank one of these team members, Dené Jones, for her hard work and dedication. Ms. Jones’ extensive medical and legal experience has helped to make the TBI Med Legal conference one of the most successful brain injury conferences in the nation.

DENÉ JONES OPERATIONS

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PHOTOS COURTESY OF SHUTTERSTOCK

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SURVIVORS WHO

THRIVE A celebration of traumatic brain injury heroes who are not just surviving, but thriving.

PHOTOS COURTESY OF SHUTTERSTOCK

To share your TBI survivor story, email us at editorial@thrivetbi.com.

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AS AN ATHLETE, I APPRECIATED THE CHALLENGE AND THE GOALORIENTED NATURE OF MY TREATMENT.

JAMIE Though her initial recovery phase was considered to be a success, the challenges Jamie still faced with her cognitive function being severely compromised caused her to experience depression. Like a true athlete, she pushed through to the next phase of recovery. “As an athlete, I appreciated the challenge and the goal-oriented nature of my treatment,” said Jamie.

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“These elements were missing from my life since I was no longer competing, so they were a welcomed motivation.”

Jamie balanced hard work with rest and recuperation, which are both necessary to get the most out of TBI treatment.

This approach was paying off and Jamie could feel th improvement, though she was still anxious about the measurable results. After receiving the results of her fNCI scan (a type of functional MRI that measures blood flow in the brai as the patient executes a battery of cognitive tasks), it was clear there was no need for Jamie to be anxious. “I wept with relief and joy when I found out just how dramatic the improvements in my brain function were,” said Jamie.

Recovery from a TBI can be slow and it requires a commitment to treatment. Jamie exemplifies this app oach and has reaped the rewards. “I’ve noticed an improvement in my day-to-day life, including having an easier time making and following through with plans, finding the right wo ds to communicate what I’m thinking or feeling, and keeping up with conversations.” Jamie’s message for other severe TBI survivors: “Don’t just settle — heal!”.

PHOTO COURTESY OF AERIALVISION

One of the world’s top freestyle skiers, Jamie was the firs woman in the world to land a double backflip at an X-Game event and had also won the FIS Junior World Championships.

And she wasn’t stopping there. Jamie continued to compete and further her career as a freestyle skier. While competing in British Columbia in 2015, Jamie had a horrific accident. After a technical miscalculation caused her skis to become lodged in the snow, Jamie’s head impacted the ground with an immense force due to her fast speed. She was airlifted to the hospital and placed in a medically induced coma for eight days. Jamie had sustained a massive traumatic brain injury. She had lost all mobility in the entire right side of her body. With the help of her family members, she began the arduous process of relearning how to perform simple tasks such as drinking water, picking up small objects, and climbing the stairs.

AN ATHLETE’S COMMITMENT TO RECOVERY

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SURVIVORS WHO THIRVE

DAVID

FIGHTING BACK TO A NEW NORMAL

As a professional mixed martial arts fighte , David had experienced several concussions throughout his career.

“I’ve had some tough fights and have gotten knocked out a few times,” says David. These ‘tough fights’ left their mark and David began experiencing the symptoms associated with severe post-concussion syndrome, including severe depression, anxiety, vertigo, sensitivity to light and noise, and memory loss.

David’s symptoms became so intense that he wasn’t able to go about his normal activities. “I felt super dizzy after trying to exercise and would have to lie down,” says David. “I could never seem to find the keys to my ca , or even remember where I parked my car!” Finally, David was forced to put his career as a fighter on hold while h sought treatment.

In years past, a person having a similar experience to David’s would be limited to obtaining treatment for each symptom they were experiencing. Today, remarkable advancements in neuro-optometric and neuroplasticity therapies are offering new hope to those who have suff ed for years without a predefined t eatment path.

PHOTO COURTESY OF PHOTOFRIDAY

PHOTO COURTESY OF AERIALVISION

I FEEL LIKE MY BRAIN HAS BEEN TURNED ON AGAIN. I’M SO PLEASED WITH MY PROGRESS.

David embarked on a recovery journey and has benefited greatly from these advancements combined with traditional therapies. It was hard work but he stayed the course. “I feel like my brain has been turned on again,” says David. “I’m so pleased with my progress.”

Though David did not return to fighting, he has c eated his new normal: a happy and productive life that includes a new career in jiu-jitsu and plenty of quality time with family and friends.

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SURVIVORS WHO THIRVE

AIMEE

NO NEED TO SUFFER SILENTLY

Aimee experienced a severe traumatic brain injury after a serious motor vehicle accident in 2001. She struggled with TBI symptoms for nearly seventeen years before receiving treatment, which is the case for many TBI survivors. Aimee’s symptoms included changes in personality, severe headaches, loss of memory, dizziness, and light and sound sensitivity. Her inability to sleep due to many of these symptoms also led to a diagnosis of narcolepsy.

IT’S POSSIBLE TO GO FROM NOT HAVING ANY HOPE TO HAVING YOUR LIFE BACK.

Aimee has continued to engage in an ongoing treatment plan and is seeing more improvement, which is adding to her quality of life. “I encourage anyone who is suffering f om longterm symptoms of TBI to seek treatment,” says Aimee. “Don’t put it off any longe . It’s possible to go from not having any hope to having your life back.”

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PHOTO COURTESY OF JUERGEN BAUER

After years of suffering silentl , Aimee finally decided t seek treatment. She participated in occupational therapy, neuromuscular therapy, and Dynavision (multi-tasking coordination and cognition exercise), and began to see results.

Aimee’s distress was soon replaced with a sense of hopefulness.

“I noticed that I was using words I hadn’t remembered using in a long time and remembering things without relying on lists,” says Aimee. I just began feeling more like myself.” Of course, there are still challenges. Aimee continues to experience recurring headaches, however, they are much less frequent than they were before treatment.

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THE MEDITATION HELPED ME. IT QUIETED MY MIND AND GAVE ME THE SERENITY TO NOTICE THE PROGRESS I WAS MAKING.

JASON PHOTO COURTESY OF ZAKIROV ALEKSEY

PHOTO COURTESY OF JUERGEN BAUER

During the summer of 2016, on a hike in the beautiful mountains of his home state of Utah, Jason’s life changed forever. Being an adventure seeker, when Jason reached the base of a dramatic 70-foot waterfall, he decided to continue to the top of the cascade where he could enjoy majestic views.

memory, and ability to talk. He continued treatment for two years and was finally able to eturn to college, an absolute triumph considering the extent and severity of his injuries.

Though Jason had made an amazing recovery, he felt he could improve more. “I still wasn’t satisfied, I still didn’t fee the way I did before the accident,” says Jason. “There has to be more I can do.” In his quest to fine-tune his ecovery, Jason pursued a multidisciplinary approach to therapy which included neuromuscular, cognitive, occupational, and vision therapy. Meditation also played an important role in this phase of his recovery. “The meditation helped me,” says Jason. “It quieted my mind and gave me the serenity to notice the progress I was making.”

This leg of his hike was a dangerous one, where one misstep could mean disaster. On that day, as Jason reached the top of the falls, the worse thing possible happened — he slipped and fell 70 feet to the base of the falls. He landed in a shallow pool of water and was rendered unconscious from the impact.

After being spotted by fellow hikers, rescuers were alerted and Jason was airlifted out of the canyon and rushed to the nearest hospital. Upon arrival, the decision was made to place Jason in a medically induced coma.

Going the extra mile was certainly worth it for Jason. “He is 95% recovered and feeling extremely optimistic about his future,” says Jason’s family. And if his previously exhibited drive is any indication of what’s to come, there’s no doubt that Jason will achieve that last five pe cent.

Doctors weren’t sure if Jason would survive. He remained in a coma for three months and finally woke to a new eality.

His long and arduous recovery journey was just beginning.

Jason worked hard and slowly began to regain his motor skills, THRIVE

GOING THE EXTRA MILE

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ILLUSTRATION COURTESY OF MARISH

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EXAMINE ILLUSTRATION COURTESY OF MARISH

The latest in traumatic brain injury research and treatment.

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EXAMINE

‘BRAIN GLUE’ HELPS REPAIR CIRCUITRY IN TBI

BY GREY NOLAN

In a new study at the University of Georgia, researchers have demonstrated the long-term benefits of a hyd ogel, which they call ‘brain glue,’ for the treatment of traumatic brain injury (TBI).

The gel protects against loss of brain tissue after a severe injury and might aid in functional neural repair.

The study shows the long-term benefits of brain glue for th treatment of TBI. The new study provides evidence that not only does the gel protect against loss of brain tissue after a severe injury, but it also might aid in functional neural repair. Brain damage following significant TBI commonly esults in extensive tissue loss and long-term disability. There currently are no clinical treatments to prevent the resulting cognitive impairments or tissue loss. As reported in Sciences Advances, the new finding i the first to p ovide visual and functional evidence of the repair of brain neural circuits involved in the reach-to-grasp movement in brain glue-implanted animals following severe TBI. “Our work provides a holistic view of what’s going on in the recovery of the damaged region while the animal is accomplishing a specific each-and-grasp task,” said lead investigator Lohitash Karumbaiah, an associate professor in the University of Georgia’s College of Agricultural and Environmental Sciences.

Brain glue was designed to mimic the structure and function of the meshwork of sugars that support brain cells. The gel contains key structures that bind to basic fib oblast growth factors and brainderived neurotrophic factors, two protective protein factors that can enhance the survival and regrowth of brain cells after severe TBI.

ILLUSTRATION COURTESY OF WHITEHOUNE

In a prior short-term study, Karumbaiah and his team showed that brain glue significantly p otected brain tissue from severe TBI damage. In this new research, to harness the neuroprotective capacity of the original, they further engineered the delivery surface of protective factors to help accelerate the regeneration and functional activity of brain cells. After 10 weeks, the results were apparent.

“Animal subjects that were implanted with the brain glue showed repair of severely damaged tissue of the brain,” said Karumbaiah. “The animals also elicited a quicker recovery time compared to subjects without these materials.”

To measure the glue’s effectiveness, the team used a tissue clearing method to make brain tissue optically transparent, which allowed them to visually capture the immediate response of cells in the reach-to-grasp circuit using a 3D imaging technique.

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EXAMINE

HYPERBARIC OXYGEN THERAPY FOR TBI

BY NAOMI KHAN

CLINICAL REPORT VA Evidence-based Synthesis Program (ESP) investigators found that HBOT did not provide a clinically relevant improvement in post-concussive symptoms after 8 to 10 weeks of treatment, nor did it cause any serious adverse effects. That being said, ESP states in their conclusions that many limitations were encountered when conducting their study, making their findings inconclusive.

PHOTO COURTESY OF NAKLEYKA

ILLUSTRATION COURTESY OF WHITEHOUNE

Hyperbaric oxygen therapy (HBOT) is defined as th use of oxygen at higher than atmospheric pressure for the treatment of underlying disease processes and the diseases they produce. Modern HBOT in which 100% O2 is breathed in a pressurized chamber dates back to the 1930s when it was first used for the t eatment of decompression illness in divers. There are currently 13 FDA-approved uses for HBOT.

Researchers started investigating HBOT as a TBI treatment in the 1960s because of its ability to slow cell death, suppress inflammation, and boost cell and blood vessel growth. Most of the research was conducted on animals until recently because of the ethical issues involved in experimenting on humans with severe brain injury.

One of the biggest issues complicating research of HBOT in brain injury is the ability to conduct randomized, double-blind, placebo-controlled studies. Brain injury varies widely from person to person, making it difficult find TBI patients to study who have similar injury severity and affected egions.

Though traumatic brain injury (TBI) treatment is not an FDA-approved use for HBOT, many physicians have used it as an “off-label” t eatment with notable results. Though not yet scientifically p oven, it has been said that HBOT can dramatically and permanently improve symptoms of chronic TBI months or even many years after trauma.

This assertion is generally met with skepticism within the medical establishment because it is widely accepted that any post-concussion symptoms persisting more than 6 months after a head injury are due to permanent brain damage that cannot be repaired. Therefore, treatment has been limited to symptom management and rehabilitative services, and any claim suggesting that fundamental healing is possible is not considered mainstream.

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Finding an objective way to measure the effects of HBOT is also an obstacle with several published studies failing to use a placebo. However, recently researchers have devised and used a placebo for HBOT in their studies, usually by increasing the air pressure without changing the oxygen content of the air being delivered. It’s imperfect (since air pressure increases while oxygen stays the same), but it does improve the reliability of results and possibly paves the way for HBOT as an acknowledged treatment for TBI. thrivetbi.com 73

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EXAMINE

THE CRANIOCERVICAL JUNCTION AND MILD TRAUMATIC BRAIN INJURY

BY GREY NOLAN

Review. In this article, the author wrote “following a trauma, structures such as the cervical spine, the vestibular ocular system, and the temporomandibular joint can be injured.”

The article also notes that “neck pain, headaches, dizziness, and balance dysfunction are common symptoms associated with both mTBI and cervical spine injury.” Addressing neck injuries, the article suggests, may lead to better mTBI recovery.

The craniocervical junction (CCJ) is a complex transitional region between the base of the skull and the upper cervical spine. It is comprised of the occiput, atlas, and axis and plays a vital role in craniospinal hydrodynamics, the relationship between blood and cerebrospinal fluid volume, p essure, and flow in the compartments of the cranial vault and spinal canal. The CCJ also encloses the encephalic vasculature of the central nervous system. Housing such important system components, it isn’t surprising that any damage to this area of the spine can lead to numerous neurologic symptoms, many of which mimic the symptoms of brain injury.

In recent years studies have shown that injury to the CCJ may cause or contribute to symptoms of mild traumatic brain injury (mTBI), including headache, dizziness, balance and coordination problems, cognitive deficits, fatigue, insomnia, and emotional changes such as irritability, depression, and anxiety. In 2015, Dr. John Leddy and his team at the University of Buffalo published an article suggesting just that and other articles have followed adding credibility to Dr. Leddy’s findings. For example, the Journal of Sports Medicine wrote about the topic in an article titled Cervical Spine Involvement in Mild Traumatic Brain Injury: A THRIVE

While randomized controlled trial testing on this hypothesis is currently in progress, the notion raises the question of how MRIs should be performed when diagnosing mTBI. Doctors typically order an MRI of the skull in a patient showing symptoms of brain injury. However, it is possible, based on the articles aforementioned, that an MRI of the cervical spine would help in developing an effective t eatment plan for mTBI patients. thrivetbi.com

ILLUSTRATION COURTESY OF MAGIC MINE

A leading researcher in the chiropractic field, D . Scott Rosa, has also written about how injury to the CCJ may cause or contribute to mTBI symptoms. He refers to this as “Craniocervical Junction Syndrome” and has treated many high-profile patients, including Jim McMahon, former Chicago Bears quarterback.

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EXAMINE

AN ANTI-INFLAMMATORY DIET CAN REPAIR THE BRAIN

BY APRIL DANIELS

Traumatic brain injury (TBI) rapidly induces inflammation.

This inflammation is p oduced both by endogenous brain cells and circulating inflammatory cells. ogether they drive they inflammatory esponse when damaged cells release chemicals, including histamine, bradykinin, and prostaglandins. These chemicals cause blood vessels to leak fluid into the tissues, causing swelling Even after the initial injury, a prolonged state of brain inflammation may linger for years. Eating an anti-inflammator diet can counteract long and short-term inflammation The basics of an anti-inflammatory diet include eatin more plants, as whole plant foods have the antiinflammatory nutrients that your body needs. So eating rainbow of fruits, veggies, whole grains, and legumes is the best place to start. These are some specific examples I ncorporating Antioxidants This helps prevent, delay, or repair some types of cell and tissue damage. They’re found in colorful fruits and veggies like berries, leafy greens, beets, and avocados, as well as beans and lentils, whole grains, ginger, turmeric and, green tea. ating Omega-3s E Omega-3 fatty acids play a role in regulating your body’s inflammatory p ocess and could help regulate pain related to inflammation. Find these healthy fats in fish like salmon tuna, and mackerel, as well as smaller amounts in walnuts, pecans, ground flaxseed, and so .

5 ANTI-INFLAMMATORY FOOD SWAPS

ating Less Red Meat E Red meat can be pro-inflammator . Substituting your lunchtime beef with fish, nuts, or soy-based p otein a few times a week can be very beneficial

PHOTO COURTESY OF MARILYN BARBONE

ILLUSTRATION COURTESY OF MAGIC MINE

1. Replace processed sugar with natural sweeteners

liminating Processed Foods E Sugary cereals and drinks, deep-fried food, and pastries are all pro-inflammatory offenders. They can conta plenty of unhealthy fats that are linked to inflammation But eating whole fruits, veggies, grains, and beans can be quick if you prep ahead for multiple meals.

2. Replace canola oil with extra-virgin olive oil 3. Replace cow-derived dairy with products made from goat or sheep milk

In addition to healing damage caused to the brain immediately following TBI, an anti-inflammatory diet als minimizes the potential for post-TBI conditions such as fatigue, depression, anxiety, migraine, and seizures.

4. Replace traditional bread with a gluten-free option 5. Replace alcoholic beverages with naturally flavored sparkling water THRIVE

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EXAMINE

STUDIES LOOK AT CBD AS A TREATMENT FOR TBI

BY LAURA TRESCOT

CBD products are extracted from hemp or marijuana, which are essentially the same cannabis plant but are cultivated diffe ently, hemp plants being grown to contain less than 0.3% THC. Numerous clinical trials in which traumatic brain injury (TBI) patients are being treated with CBD oil from hemp, which has virtually no THC, are showing positive results.

In the United States, the first big study on cannabinoid treatment for concussion is being done by the University of Miami which received a $16 million grant. The research is a five-yea , three-stage study that will assess the effectiveness of a new cannabinoid-based pill to treat concussion injuries. This partnership aims to propel this research and potential treatment forward by using two classes of drugs in a combination that scientists believe will reduce brain inflammation and the immune esponse. The study will also test the cannabinoid-based pill on a small pilot group of acute and chronic TBI patients.

Another new study being conducted at the University of Miami is investigating if using a pill form of cannabidiol (CBD) and the psychedelic drug psilocybin effectivel treat and possibly prevent symptoms of two conditions that commonly occur together: mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD). Up to 40% of people impacted by TBI also suffer f om PTSD, according to a University of Miami press release. A preclinical trial on animals is in progress. The university expects this phase to last around 9 to 12 months. Researchers hope to transition to human clinical trials and file th treatment with the FDA in 2021.

A study published in Brain Injury in October 2019 found that even though cannabis use didn’t affect concussion recovery time, it was associated with a lower symptom burden in the third and fourth weeks after injury.

A December 2018 study in the journal Neurology indicates that medical cannabis (marijuana) helps concussion patients with concussion symptoms, especially pain, mood, sleep, and quality of life. The study also specifies the optimal forms of medical cannabis for the patients in the study in terms of ratios of CBD to THC and methods of intake, such as a tincture (oral) or a vapor pen (inhaling).

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In a study published in The Journal of Neurotrauma Vol. 38, No. 14, pre-clinical traumatic brain injury (TBI) research suggests that cannabinoids have neuroprotective and psychotherapeutic properties. Studies demonstrate that TBI patients are using medical and recreational cannabis to treat their symptoms, highlighting inconsistencies between public policy, perception of potential efficacy, and the dearth of empirical evidence.

We conclude that randomized controlled trials and prospective studies with appropriate control groups are necessary to fully understand the efficacy and potential adverse effects of medical cannabis for TBI.

PHOTO COURTESY OF IRA EVVA

CLINICAL REPORT

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EXAMINE

BIOMARKERS CAN DIAGNOSE MILD TBI

BY NAOMI KHAN

Certain plasma microRNAs could serve as diagnostic biomarkers in mild traumatic brain injury (mTBI), a new study shows. The biomarkers were discovered in an animal model and successfully used to diagnose mTBI in a subgroup of patients.

coding genes. Blood plasma samples were sequenced from an animal model both after mild and severe TBI. The miRNAs showing the greatest potential based on the sequencing data were selected for further analysis.

“We have been developing a suitable analysis and measurement method especially for miRNAs that can be found in small amounts in plasma, and this method is based on digital droplet PCR,” Dr. Noora Puhakka from the A. I. Virtanen Institute for Molecular Sciences at the University of Eastern Finland says.

PHOTO COURTESY OF ROMAN ZAIETS

PHOTO COURTESY OF IRA EVVA

mTBI is difficult to detect by contemporary convention imaging methods. Most patients do not exhibit visible structural damage to the brain. Even without visible structural damage, it is extremely important to diagnose mTBI since patients’ ability to work and their overall quality of life might deteriorate. There is a major unmet medical need to identify accurate, affo dable, and widely accessible diagnostic biomarkers that could be used to better diagnose patients with mTBI and to guide them to symptomatic, timely, and rehabilitative treatment.

“Humans and animals share many identical miRNAs, and this makes them excellent candidates for translational studies, where results achieved in animal models are sought to be applied in humans. However, it has proven challenging to reproduce results from diffe ent studies and diffe ent sets of data. This is why assessing the quality of measurement methods and reproducibility is an extremely important part of biomarker research.”

Blood-based biomarkers enable minimally invasive and costeffective diagnostics. Earlier studies have shown that many biomarkers hold promise for characterizing the severity of traumatic brain injury, and they can provide molecularlevel information about the ongoing pathological changes.

In the newly published study, researchers set out to find microRNAs that could serve as biomarkers to diagnose traumatic brain injury (TBI). MicroRNAs, or miRNAs, are small RNA molecules that regulate the expression of proteinTHRIVE

The objective of the newly published study was to identify plasma miRNA biomarkers that are sensitive and specific to mTBI in an animal model and to explore whether they could also be used to diagnose mTBI in humans.

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EXAMINE

ACUPUNCTURE OFFERS MANY BENEFITS AFTER TBI

BY GEORGE PLATT

CLINICAL REPORT Researchers from South Medical University conclude that acupuncture provides relief of limb paralysis due to traumatic brain injury (TBI). In a study combining acupuncture with drug therapy, patients had superior outcomes compared with patients receiving only drug injections. The researchers conclude that the addition of acupuncture to the standard drug treatment regimen improves limb motor function and daily life activity capabilities.

Acupuncture is a traditional Chinese practice that is primarily used to treat chronic pain. However, it can also relieve the anxiety, depression, and insomnia that often affect patient after a traumatic brain injury (TBI). This makes acupuncture a possibly beneficial practice for brain injury survivors Acupuncture originated in China over 2,000 years ago.

It involves placing thin needles into the skin at certain points in the body. These points, called meridians, are thought to trigger the body’s natural healing responses.

This has huge implications for TBI patients since this would enable them to recover more fully from any brain damage that may have occurred. Studies have also found that acupuncture increases blood flow to the brain, which lets the brain ge more of the critical nutrients it needs to heal. It does this by releasing vasodilators into the bloodstream, which causes your blood vessels to relax and expand.

According to traditional Chinese medicine, the body has a natural flow of ene gy called qi. When qi gets congested, a person can become susceptible to pain, anxiety, and disease. By puncturing the body in the correct spots, acupuncture can clear away the congestion and restore the body’s natural balance. A more modern way of explaining how this works is that acupuncture gently stimulates the nerves and causes an inflammatory esponse. These responses activate the body’s natural healing process.

Acupuncture also triggers the release of endorphins in the brain. Endorphins are hormones that activate your body’s opiate receptors, which means they act as natural painkillers. This effect makes acupunctu e an alternative treatment for conventional pain management after traumatic brain injury.

Perhaps the most exciting benefit that acupunctu e can offer brain injury patients is the ability to egenerate brain THRIVE

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cells. One study in 2017 found that acupuncture increased the production of BDNF. BDNF stands for brain-derived neurotrophic factor, a growth factor that acts as a fertilizer for your brain. BDNF triggers your brain to initiate a process known as neurogenesis. Neurogenesis is similar to neuroplasticity, except where neuroplasticity refers to the brain’s ability to rewire itself, neurogenesis involves the creation of new brain cells.

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EXAMINE

TBI TREATMENT DIFFERS FOR MEN AND WOMEN

BY APRIL DANIELS

New research has determined that the window of opportunity to provide possible treatments for patients suffering f om traumatic brain injuries (TBIs) differs depending on whether the patient is male or female.

Building on this, scientists from The University of Texas Health Science Center at Houston (UTHealth) and Arizona State University have teamed up on the first study looking at sex-targeted drug delivery for TBI in a five-yea , $2.5 million project funded by the National Institutes of Health (NIH).

The study will be used to help design nanoparticle delivery systems targeting both sexes for treatment of TBI.

A TBI is an acute force trauma that occurs to the head as a result of a fall or an object hitting the head with any amount of force. The body responds with an acute response to the injury, followed by a chronic phase as it tries to heal. Under normal circumstances the blood vessels in the brain are very selective about what they allow to enter the brain, helping to protect it from substances that might hurt neuron cells and to create a very carefully controlled blood-brain barrier.

However, during this second phase of healing following a TBI, those blood vessels are compromised and substances might be allowed to seep in.

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“Under normal circumstances, most drugs, even when encapsulated within nanoparticles, do not reach the brain at an effective concentration due to the p esence of the blood-brain barrier. However, after a TBI this barrier is compromised, allowing us a window of opportunity to deliver those drugs to the brain where they can have a better chance of exerting a therapeutic effect,” said D .

Rachael Sirianni, Ph.D., associate professor of neurosurgery at McGovern Medical School at UTHealth. Sirianni’s collaborator and co-lead investigator on this grant, Dr. Sarah Stabenfeldt, PhD, was the first to demonstrate that the window of opportunity created in the blood-brain barrier diffe ed between men and women, and it was this key finding that led to them applying for the NIH grant

“With these nanoparticle systems, we’re looking at how we can revisit a drug that showed promise in preclinical studies or clinical trials but then failed,” Stabenfeldt said.

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RESOURCE GUIDE Guidance and resources for trauma survivors and their families.

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RESOURCES

RESOURCE GUIDE

RESOURCE CENTERS

MEDICAL INSURANCE

CALIFORNIA BRAIN INJURY SUPPORT CENTER braininjurysupportcenter.com

PATIENT ADVOCATE FOUNDATION (PAF) patientadvocate.org 800 532 5274

TRAUMATIC BRAIN INJURY RESOURCES traumaticbraininjury.com FAMILY CAREGIVER ALLIANCE caregiver.org 800 445 8106 SCHURIG CENTER FOR BRAIN INJURY RECOVERY schurigcenter.org 415 461 6771 SANDIEGO BRAIN INJURY FOUNDATION sdbif.org 619 294 6541 BRAIN TRAUMA FOUNDATION braintrauma.org BRAIN INJURY COALITION braininjurycoalition.info 530 342 3118 HEAD TRAUMA SUPPORT PROJECT OF SACRAMENTO headtraumasupportproject.org 916 568 6660 CHILDREN’S HOSPITAL LOS ANGELES chla.org 323 660 2450 ST. JUDE BRAIN INJURY NETWORK tbioc.org JODI HOUSE BRAIN INJURY SUPPORT CENTER jodihouse.org NATIONAL SUICIDE PREVENTION LIFELINE suicidepreventionlifeline.org 800 273 8255

COVERED CALIFORNIA coveredca.com SUPPORT GROUPS BRAINSTORMING 4 US Apple Valley, CA brainstorming4us.com 760 946 2481

HEMET VALLEY HEAD TRAUMA SUPPORT GROUP Hemet, CA 909 767 1680 NEW PATHWAYS WESTSIDE BRAIN INJURY SUPPORT GROUP Inglewood, CA 310 674 7050 SADDLEBACK BRAIN INJURY SUPPORT GROUP Laguna Hills, CA 949 452 7255

BRAIN ANGELS SUPPORT GROUP FOR CAREGIVERS 714 488 4992

BRAIN INJURY SURVIVORS SUPPORT GROUP Larkspur, CA 415 461 6771

BRAIN INJURY SUPPORT GROUP Bakersfi ld, CA 661 834 2086

POMONA BRAIN INJURY SUPPORT GROUP Pomona, CA 909 596 0955

ABI SUPPORT GROUP Burlingame, CA 650 595 0783

TBI SUPPORT GROUP Oxnard, CA 805 642 4390

EDEN MEDICAL CENTER STROKE AND BRAIN INJURY SUPPORT GROUP Castro Valley, CA 510 889 5064

BRAIN INJURED GUIDANCE GROUP (BIGG) Redding, CA 530 221 1452

SPINAL CORD INJURY SUPPORT AND EDUCATION GROUP Encinitas, CA 760 633 6709 HEAD INJURY AND TRAUMA SPINAL SUPPORT SYSTEM (HITSSS) Escondido, CA 800 986 4487 HEADS UP Eureka, CA 707 443 8951

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PARTICIPANTS IN PROGRESS Sacramento, CA 916 456 1837 SUPPORT GROUPS FOR STUDENTS WITH ACQUIRED BRAIN INJURY San Bernardino, CA 909 888 6511 CHALLENGED WOMEN’S SUPPORT INITIATIVE (CWSI) San Diego, CA 858 939 6709

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RESOURCE GUIDE

REHABILITATION

LEGAL

MEDICARE medicare.gov

DISABILITY RIGHTS CALIFORNIA disabilityrightsca.org 510 267 1200

CASA COLINA casacolina.org 866 724 4127 POMEROY REHABILITATION CENTER prrcsf.org 415 665 4100 CENTER FOR NEUROSKILLS neuroskills.com 800 922 4994

BRAIN INJURY ASSOCIATION OF AMERICA–PREFERRED ATTORNEYS biausa.org/professionals/ preferred-attorneys DEPARTMENT OF LABOR DISABILITY GUIDE dol.gov 866 633 7365

FINANCIAL

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NEED HELP PAYING BILLS needhelppayingbills.com

BRAINLINE brainline.org/children-tbi

DEPARTMENT OF SOCIAL SERVICES cdss.ca.gov

FOR VETRANS

SOCIAL SECURITY AND DISABILITY ssa.gov PATIENT ADVOCATE FOUNDATION (PAF) patientadvocate.org 800 532 5274 HOUSING SALVATION ARMY salvationarmyusa.org 800 728 7825 SANDIEGO BRAIN INJURY FOUNDATION HOWARD HOUSE sdbif.org/howard-house 619 294 6541 ADAM’S HOUSE adamshouse.net 928 772 6301

KIDS WITH BRAIN INJURIES cokidswithbraininjury.com

SARATOGA WARHORSE saratogawarhorse.org US DEPARTMENT OF VETRAN AFFAIRS va.gov EMPLOYMENT JOB ACCOMODATION NETWORK askjan.org GENERAL INFORMATION SHEPHARD CENTER braininjury101.org BRAINLINE brainline.org BRAIN & LIFE brainandlife.org THRIVE

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TBI ADVOCACY NAVIGATING LIFE AFTER A BRAIN INJURY CAN

be complex. Patients may not get all the insurance coverage they’re entitled to, or their rights might be violated by a doctor who does not keep medical information confid ntial. On a more basic level, a traumatic brain injury (TBI) survivor may simply need someone to help with basic daily needs. In all of these cases, advocacy becomes integral in allowing TBI survivors to lead a happy and fulfilled li e.

Essentially, brain injury advocacy involves identifying barriers to a better life and addressing those concerns with the right people and organizations. This may involve advocating for better healthcare, more adequate medical treatment, more appropriate accommodations for a person’s disability, or better legal representation.

It is an option for patients to hire an advocate, such as a case manager or attorney, but many rely on family members and friends to fill t is role. Anyone can become an effective advocate for themselves or someone they are caring for if given access to the appropriate resources.

Advocacy generally falls into four categories. Selfadvocacy involves taking action to represent and advance your interests. Peer advocacy involves taking action to represent the rights and interests of someone other than yourself. Systems advocacy involves taking action to influ nce social, political, and economic systems to bring about change for groups of people. Legal advocacy involves taking action to use attorneys and the legal or administrative systems to establish or protect legal rights.

Many times self-advocacy is not an option for TBI survivors due to the nature of their injuries and can hinder progress and healing. Mental rest is a very important part of healing from TBI. Patients often struggle to communicate effectively and the stress involved in frequent interaction with a variety of caregivers and administrators can leave them feeling discouraged. In these circumstances, peer advocacy plays an important role in recovery.

Though advocacy can be a difficult and timeconsuming activity, it can also be rewarding. Through advocacy, people have been able to change state and federal laws so that they become more favorable toward people with brain injury.

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READING ROOM

READING

ROOM Must reads for traumatic brain injury survivors and their families.

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READING ROOM

TBI – To Be Injured

Being with Rachel

Over My Head

Carol Gieg, a licensed clinical social worker, has always thrived on helping other people solve problems. But one day — unknown to her — she’d soon be facing serious problems of her own. After dropping her husband off at work, she went on a bike ride. As someone who enjoyed hiking and staying active, it was a routine day. Somehow, she suffered an accident as well as seizures. By the time she arrived at the hospital, her brain was bleeding, and it was unclear if she’d survive.

Many others could tell similar stories. Brain injuries cause more deaths than any other sports injury. In fact, a traumatic brain injury (TBI) occurs every fifteen seconds and is the number one cause of death in children and young adults, according to the Brain Injury Research Institute. Whether you’re coping with an injury yourself or have a loved one seeking to discover a new normal, you’ll be inspired by this story of surviving and thriving after a brain injury.

The call came at 6 A.M. Karen Brennan’s twenty-five-year-old daughter, Rachel had been in a motorcycle accident. She was in a coma. Her CAT scan, the neurosurgeon said, was “very, very ugly.” Instantly, Karen Brennan’s life of comfortable dailiness becomes “passionate necessary-ness.”

Cautioned that her daughter will not be the “same person,” Brennan waits and hopes through weeks of intensive care, months of coma, and Rachel’s determined efforts to walk again. Being with Rachel is for readers who want to be reminded of why books matter.

Karen Brennan’s memoir advocates illustrates and demonstrates the superhuman power of family, its ability to triumph in the face of worst-case scenarios, institutional aloofness, bad luck, and the evil influence of conventional wisdom. The family that emerges here is one built on a great deal of passion. This book beautifully documents a vital investigation into the nature of memory and narrative.

Over My Head is an inspiring story of how one woman comes to terms with the loss of her identity and the courageous steps (and hilarious missteps) she takes while learning to rebuild her life. The author, a 45-year-old doctor and clinical professor of medicine describes the aftermath of a brain injury eleven years ago which stripped her of her beloved profession. For years she was deprived of her intellectual companionship and the ability to handle the simplest undertakings like shopping for groceries or sorting the mail. Her progression from confusion, dysfunction, and alienation to a full, happy life is told with restraint, great style, and considerable humor. Until her injury in July 1988, Claudia L. Osborn taught and practiced internal medicine in a busy inner-city Detroit hospital. She is currently an Associate Clinical Professor of Internal Medicine at MSU and makes her home in Grosse Pointe, Michigan.

Carol Gieg

Karen Brennan

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Claudia L. Osborn

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LAST LOOK

HOW DOES

COVID-19 AFFECT THE BRAIN?

BY MICHELLE ST. HILAIRE

A large portion of COVID-19 patients—possibly as high as 30 percent, according to an estimate from the U.S. National Institutes of Health—suffer some type of neu ological or psychiatric symptoms. Even more troubling is that for many of these individuals, these cognitive issues can linger for weeks or months after the initial infection.

Post-COVID clinics across the country, created initially for patients who had been admitted to intensive care units with severe COVID-19 symptoms, are filled with patients who we e never hospitalized but are suffering f om lingering symptoms, including brain fog and other cognitive issues.

“The expectation was that all these people in the ICU would have really protracted recovery periods,” says Walter Koroshetz, director of the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health. “The big surprise was the number of people who never required hospitalization but were having persistent trouble.” Koroshetz is co-leading a study at NIH to understand why some COVID-19 patients recover faster than others and to learn the biological reasons why others don’t get well even months later.

Other viruses like West Nile, Zika, and the virus that causes chickenpox and shingles are known to directly affect the brain.

When COVID-19 patients first started eporting cognitive and neurological side effects last yea , scientists wondered if SARSCoV-2 might do the same thing.

So far, research hasn’t provided much evidence that COVID-19 physiologically affects the brain. A Columbia University study of 40 people who died of COVID-19 found no evidence of viral RNA or proteins in samples of patient brain cells. The results were published in April in the journal Brain. The authors suggest that previous reports of viruses detected in brain cells may be due to contamination during the autopsy.

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There are currently two leading hypotheses of why COVID-19 patients experience cognitive issues.

The first is that the infection somehow triggers inflammatio in the brain. Some COVID-19 patients have suffe ed encephalitis, or swelling of the brain, which can cause confusion and double vision, and in serious cases, speech, hearing, or vision problems. If left untreated, patients can develop cognitive problems. How COVID-19 may lead to brain inflammation is not clea .

When researchers at Stanford looked at brain tissue from eight patients who died of COVID-19, they also observed signs of inflammation compa ed to 14 control brains. Using a technique called single-cell RNA sequencing, they found that hundreds of genes associated with inflammation we e activated in brain cells from COVID-19 patients compared to controls.

A second possible explanation for cognitive issues is that COVID-19 may restrict blood flow to the brain. In patients who have died of COVID-19, researchers have found evidence of brain tissue damage caused by hypoxia, or the lack of oxygen.

“The brain is an organ that requires a lot of oxygen to do its job,” says Billie Schultz, a psychiatrist at the Mayo Clinic in Rochester, Minnesota, who specializes in rehabilitating stroke and traumatic brain injury (TBI) patients.

Two hypotheses are shaping among scientists of what the future might hold for people facing cognitive issues as a result of COVID-19. One is that, like many stroke and TBI patients, spontaneous recovery will occur, in which the brain heals itself within three to six months. The other is that, over time, the cognitive issues could develop into dementia. Of course, science hopes the former proves to be true. thrivetbi.com 96

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