THE OFFICIAL PATIENT’S SOURCEBOOK
on
RAUMATIC RAIN NJURY J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2003 by ICON Group International, Inc. Copyright Ó2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Traumatic Brain Injury: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83537-3 1. Traumatic Brain Injury-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
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Dedication To the healthcare professionals dedicating their time and efforts to the study of traumatic brain injury.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to traumatic brain injury. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to traumatic brain injury, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Acute Disseminated Encephalomyelitis
·
The Official Patient's Sourcebook on Agenesis of the Corpus Callosum
·
The Official Patient's Sourcebook on Agnosia
·
The Official Patient's Sourcebook on Arachnoid Cysts
·
The Official Patient's Sourcebook on Arachnoiditis
·
The Official Patient's Sourcebook on Binswanger's Disease
·
The Official Patient's Sourcebook on Brain and Spinal Cord Tumors
·
The Official Patient's Sourcebook on Central Pain Syndrome
·
The Official Patient's Sourcebook on Cerebral Atrophy
·
The Official Patient's Sourcebook on Coma
·
The Official Patient's Sourcebook on Corticobasal Degeneration
·
The Official Patient's Sourcebook on Empty Sella Syndrome
·
The Official Patient's Sourcebook on Headaches
·
The Official Patient's Sourcebook on Locked in Syndrome
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The Official Patient's Sourcebook on Occipital Neuralgia
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The Official Patient's Sourcebook on Olivopontocerebellar Atrophy
·
The Official Patient's Sourcebook on Progressive Multifocal Leukoencephalopathy
·
The Official Patient's Sourcebook on Pseudotumor Cerebri
·
The Official Patient's Sourcebook on Seizures and Epilepsy
·
The Official Patient's Sourcebook on Stroke
·
The Official Patient's Sourcebook on Syncope
·
The Official Patient's Sourcebook on Todd's Paralysis
·
The Official Patient's Sourcebook on Wallenberg's Syndrome
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION...................................................................................... 1
Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4
PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON TRAUMATIC BRAIN INJURY: GUIDELINES ........................................................................................... 9
Overview............................................................................................................... 9 What Is Traumatic Brain Injury? ...................................................................... 10 Epidemiology ...................................................................................................... 12 Pathophysiology.................................................................................................. 14 Functional Recovery and Rehabilitation ............................................................ 16 Common Therapeutic Interventions................................................................... 18 Rehabilitation...................................................................................................... 21 What Research Is Needed?.................................................................................. 24 Conclusions......................................................................................................... 26 Bibliography........................................................................................................ 27 For More Information......................................................................................... 34 More Guideline Sources ..................................................................................... 35 Vocabulary Builder............................................................................................. 45
CHAPTER 2. SEEKING GUIDANCE ....................................................... 49
Overview............................................................................................................. 49 Associations and Traumatic Brain Injury.......................................................... 49 Finding More Associations................................................................................. 56 Finding Doctors.................................................................................................. 58 Finding a Neurologist......................................................................................... 59 Selecting Your Doctor ........................................................................................ 59 Working with Your Doctor ................................................................................ 60 Broader Health-Related Resources ..................................................................... 61 Vocabulary Builder............................................................................................. 62
CHAPTER 3. CLINICAL TRIALS AND TRAUMATIC BRAIN INJURY ....... 63
Overview............................................................................................................. 63 Recent Trials on Traumatic Brain Injury .......................................................... 66 Benefits and Risks............................................................................................... 71 Keeping Current on Clinical Trials.................................................................... 74 General References.............................................................................................. 75 Vocabulary Builder............................................................................................. 76
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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL.................................................. 77 CHAPTER 4. STUDIES ON TRAUMATIC BRAIN INJURY ........................ 79
Overview............................................................................................................. 79 The Combined Health Information Database ..................................................... 79 Federally Funded Research on Traumatic Brain Injury .................................... 87 E-Journals: PubMed Central ............................................................................ 102 The National Library of Medicine: PubMed .................................................... 103 Vocabulary Builder........................................................................................... 122
CHAPTER 5. PATENTS ON TRAUMATIC BRAIN INJURY ..................... 129
Overview........................................................................................................... 129 Patents on Traumatic Brain Injury.................................................................. 130 Patent Applications on Traumatic Brain Injury.............................................. 133 Keeping Current ............................................................................................... 135 Vocabulary Builder........................................................................................... 136
CHAPTER 6. BOOKS ON TRAUMATIC BRAIN INJURY ........................ 139
Overview........................................................................................................... 139 Book Summaries: Federal Agencies .................................................................. 139 Book Summaries: Online Booksellers ............................................................... 142 The National Library of Medicine Book Index ................................................. 143 Chapters on Traumatic Brain Injury ............................................................... 147 Directories......................................................................................................... 150 General Home References ................................................................................. 152 Vocabulary Builder........................................................................................... 153
CHAPTER 7. MULTIMEDIA ON TRAUMATIC BRAIN INJURY .............. 155
Overview........................................................................................................... 155 Video Recordings .............................................................................................. 155 Bibliography: Multimedia on Traumatic Brain Injury .................................... 157
CHAPTER 8. PERIODICALS AND NEWS ON TRAUMATIC BRAIN INJURY ........................................................................................................... 161
Overview........................................................................................................... 161 News Services & Press Releases ....................................................................... 161 Newsletters on Traumatic Brain Injury........................................................... 164 Newsletter Articles ........................................................................................... 164 Academic Periodicals covering Traumatic Brain Injury.................................. 165 Vocabulary Builder........................................................................................... 167
CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 169
Overview........................................................................................................... 169 NIH Guidelines................................................................................................. 169 NIH Databases.................................................................................................. 170 Other Commercial Databases ........................................................................... 177 The Genome Project and Traumatic Brain Injury ........................................... 178
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Specialized References....................................................................................... 182 Vocabulary Builder........................................................................................... 183
CHAPTER 10. DISSERTATIONS ON TRAUMATIC BRAIN INJURY ........ 185
Overview........................................................................................................... 185 Dissertations on Traumatic Brain Injury ........................................................ 185 Keeping Current ............................................................................................... 186 Vocabulary Builder........................................................................................... 187
PART III. APPENDICES .................................................. 189 APPENDIX A. RESEARCHING ALTERNATIVE MEDICINE................... 191
Overview........................................................................................................... 191 What Is CAM? ................................................................................................. 191 What Are the Domains of Alternative Medicine?............................................ 192 Can Alternatives Affect My Treatment? ......................................................... 195 Finding CAM References on Traumatic Brain Injury..................................... 196 Additional Web Resources................................................................................ 204 General References............................................................................................ 206 Vocabulary Builder........................................................................................... 207
APPENDIX B. RESEARCHING NUTRITION ......................................... 209
Overview........................................................................................................... 209 Food and Nutrition: General Principles........................................................... 209 Finding Studies on Traumatic Brain Injury .................................................... 214 Federal Resources on Nutrition........................................................................ 215 Additional Web Resources................................................................................ 216 Vocabulary Builder........................................................................................... 217
APPENDIX C. FINDING MEDICAL LIBRARIES .................................... 219
Overview........................................................................................................... 219 Preparation ....................................................................................................... 219 Finding a Local Medical Library ...................................................................... 220 Medical Libraries Open to the Public............................................................... 220
APPENDIX D. YOUR RIGHTS AND INSURANCE ................................. 227
Overview........................................................................................................... 227 Your Rights as a Patient................................................................................... 227 Patient Responsibilities .................................................................................... 231 Choosing an Insurance Plan............................................................................. 232 Medicare and Medicaid .................................................................................... 234 NORD’s Medication Assistance Programs ..................................................... 237 Additional Resources ........................................................................................ 238
ONLINE GLOSSARIES.................................................... 239 Online Dictionary Directories.......................................................................... 243
TRAUMATIC BRAIN INJURY GLOSSARY ............... 245
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General Dictionaries and Glossaries ................................................................ 258
INDEX................................................................................... 261
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
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Traumatic Brain Injury
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Traumatic Brain Injury has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to traumatic brain injury, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on traumatic brain injury. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on traumatic brain injury should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on
Introduction
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appropriate options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching traumatic brain injury (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to traumatic brain injury. It also gives you sources of information that can help you find a doctor in your local area specializing in treating traumatic brain injury. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with traumatic brain injury. Part II moves on to advanced research dedicated to traumatic brain injury. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on traumatic brain injury. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with traumatic brain injury or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with traumatic brain injury. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with traumatic brain injury.
Scope While this sourcebook covers traumatic brain injury, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that traumatic brain injury is often considered a synonym or a condition closely related to the following: ·
Closed Head Injury
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Traumatic Brain Injury
·
Head Injury
In addition to synonyms and related conditions, physicians may refer to traumatic brain injury using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for traumatic brain injury:4 ·
800-804 skull and facial fractures
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850 concussion
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851 cerebral laceration or contusion
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852 hematoma
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854 other cerebral injury of unspecified nature
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to traumatic brain injury. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
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Introduction
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recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with traumatic brain injury will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with traumatic brain injury is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of traumatic brain injury, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
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PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on traumatic brain injury. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of traumatic brain injury to you or even given you a pamphlet or brochure describing traumatic brain injury. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
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CHAPTER 1. THE ESSENTIALS ON TRAUMATIC BRAIN INJURY: GUIDELINES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines on traumatic brain injury. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on traumatic brain injury can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on traumatic brain injury. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
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There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with traumatic brain injury and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Neurological Disorders and Stroke (NINDS); http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
·
National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
Among those listed above, the National Institute of Child Health and Human Development (NICHD) is especially noteworthy. The mission of the NICHD, a part of the National Institutes of Health (NIH), is to support and conduct research on topics related to the health of children, adults, families, and populations. NICHD research focuses on the idea that events that happen prior to and throughout pregnancy as well as during childhood have a great impact on the health and well-being of adults. The following guideline is one the NICHD provides concerning traumatic brain injury.
What Is Traumatic Brain Injury?6 Traumatic brain injury (TBI), broadly defined as brain injury from externally inflicted trauma, may result in significant impairment of an individual’s physical, cognitive, and psychosocial functioning. In the United States, an estimated 1.5 to 2 million people incur TBI each year, principally as a result of vehicular incidents, falls, acts of violence, and sports accidents. The number of people surviving TBI with impairment has increased significantly in recent years, which is attributed to faster and more effective emergency care, quicker and safer transportation to specialized treatment facilities, and Adapted from The National Institute of Child Health and Human Development (NICHD): http://www.nichd.nih.gov/publications/pubs/traumatic/NIH_Consensus_Statement.htm.
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Guidelines 11
advances in acute medical management. TBI affects people of all ages and is the leading cause of long-term disability among children and young adults. Each year, approximately 70,000 to 90,000 individuals incur a TBI resulting in a long-term, substantial loss of functioning. The consequences of TBI include a dramatic change in the individual’s life-course, profound disruption of the family, enormous loss of income or earning potential, and large expenses over a lifetime. There are approximately 300,000 hospital admissions annually for persons with mild or moderate TBI, and an additional unknown number of traumatic brain injuries (TBIs) that are not diagnosed but may result in long-term disability. Although TBI may result in physical impairment, the more problematic consequences involve the individual’s cognition, emotional functioning, and behavior. These impact interpersonal relationships, school, and work. Cognitive-behavioral remediation, pharmacologic management, assistive technology, environmental manipulation, education, and counseling are among currently used treatments of these sequelae. These treatments are provided in freestanding rehabilitation hospitals, rehabilitation departments in general hospitals, a variety of day treatment or residential programs, skilled nursing facilities, schools, the community, and the home.
The Traumatic Brain Injury Act of 1996 The Traumatic Brain Injury Act of 1996 instructed the Secretary of Health and Human Services, acting through the Director of the National Center for Medical Rehabilitation Research within the National Institute of Child Health and Human Development, to conduct “a national consensus conference on managing traumatic brain injury and related rehabilitation concerns.” The NIH organized a 2½-day conference to evaluate the scientific data concerning rehabilitation practices for persons with TBI. Particular emphasis was placed on rehabilitation of cognitive, behavioral, and psychosocial difficulties associated with mild, moderate, and severe TBI. The conference brought together national and international biomedical researchers and clinicians, as well as persons with TBI and their families. On the second day of the conference, 1½ hours were allocated for brief oral presentations by individuals representing interested organizations regarding the conference issues and by persons wishing to present their own individual statements. After 1½ days of presentations and audience discussion, an independent, non-Federal consensus panel chaired by Dr. Kristjan T. Ragnarsson, Professor and Chair, Department of Rehabilitation
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Medicine, Mount Sinai School of Medicine, weighed the scientific evidence and wrote a draft statement that was presented to the audience on the third day. The statement took into account the panel’s year-long review of the scientific literature. The consensus statement addressed the following key questions: ·
What is the epidemiology of traumatic brain injury in the United States, and what are its implications for rehabilitation?
·
What are the consequences of traumatic brain injury in terms of pathophysiology, impairments, functional limitations, disabilities, societal limitations, and economic impact?
·
What is known about mechanisms underlying functional recovery following TBI, and what are the implications for rehabilitation?
·
What are the common therapeutic interventions for the cognitive and behavior sequelae of TBI, what is their scientific basis, and how effective are they?
·
What are common models of comprehensive, coordinated, multidisciplinary rehabilitation for people with TBI, what is their scientific basis, and what is known about their short-term and long-term outcomes?
·
Based on the answers to these questions, what can be recommended regarding rehabilitation practices for people with TBI?
·
What research is needed to guide the rehabilitation of people with traumatic brain injury?
The primary sponsors of this meeting were the National Institute of Child Health and Human Development and the NIH Office of Medical Applications of Research. The conference was cosponsored by the National Institute on Deafness and Other Communication Disorders, the National Institute of Mental Health, the National Institute of Neurological Disorders and Stroke, the National Institute of Nursing Research, the Office of Alternative Medicine, and the Office of Research on Women’s Health of the NIH; the Agency for Healthy Care Policy and Research; and the Centers for Disease Control and Prevention.
Epidemiology The epidemiology of TBI, including incidence, prevalence, etiology, and natural history, can guide our estimates of the demand for and range of required TBI rehabilitation services. Data from Centers for Disease Control
Guidelines 13
and Prevention (CDC)-sponsored State surveillance projects report annual rates of TBI of 100 per 100,000 persons with 52,000 annual deaths. Prevalence estimates range from 2.5 million to 6.5 million individuals living with the consequences of TBI. These estimates, however, suffer from ascertainment bias since they are based exclusively on information about hospitalized patients and those who die before hospitalization. It is important to separately address mild, moderate, and severe TBI. Until data are available beyond those based on hospitalized patients, it will not be possible to understand and study the full spectrum of the disease. The recent State surveillance systems directed in part by CDC have adopted common data collection and reporting methods, which provide good epidemiologic data about persons with TBI who are hospitalized or die. Newer methodologies to assess the epidemiology of mild TBI that does not result in hospitalization should be developed and its incidence and prevalence rigorously studied. Existing data point to potential areas for prevention of TBI and design of rehabilitation programs. Males are more than twice as likely as females to experience TBI. The highest incidence is among persons 15 to 24 years of age and 75 years and older, with an additional less striking peak in incidence in children ages 5 and younger. Alcohol is reported to be associated with half of all TBI, either in the person causing the injury or in the person with the injury. Approximately 50 percent of TBIs are the result of motor vehicle, bicycle, or pedestrian-vehicle incidents. Safety belts, air bags, infant and child car seats, as well as changes in speed limits, road design, and traffic control have reduced motor vehicle-related deaths and TBI. Additional preventive measures to reduce TBI caused by alcohol-related motor vehicle accidents should be developed and assessed. Falls are the second most frequent cause of TBI among the frail elderly and the very young. Risk factors for falls among the elderly include alcohol, medication, and osteoporosis. Few preventive measures are in place for either the very young or the elderly; however, there have been some changes in the design of walkers, strollers, and shopping carts to help prevent falls among young children. Violence-related incidents account for approximately 20 percent of TBI. These incidents are almost equally divided into firearm and non-firearm assaults. The highest incidence for TBI due to firearms is among people ages 15 to 24. This is also a high-risk age for non-firearm assaults. Programs to
14 Traumatic Brain Injury
prevent street violence must be strengthened, especially through legislation to control use of handguns and to increase their safety. Assault is also a major cause of TBI in the very young. Although unintentional injuries account for 75 percent of TBI in this age group, child abuse is also an issue. Shaken baby syndrome results specifically in TBI and spinal cord injury. Domestic violence affects children and adults of both genders. Although sports- and recreation-related injuries account for 3 percent of hospitalized persons with TBI, approximately 90 percent of sports-related TBIs are mild and may go unreported, thus leading to the underestimate of the actual incidence rate of sports-related TBI. Sports-related TBI occurs most frequently among people ages 5 to 24 who have many decades of life ahead. Risk factors are poorly delineated. There is great promise for prevention of sports-related TBI. Risk factors for these causes of TBI are rarely studied, leaving large gaps in the knowledge of appropriate prevention strategies and the association of those risk factors with etiologies and outcomes. In addition, etiologies and risk factors may affect the selection of rehabilitation strategies. For example, children with TBI secondary to child abuse or street violence may have limited options for community-based rehabilitation. Injuries related to alcohol or drug abuse often necessitate chemical dependency treatment in the rehabilitation process. These epidemiologic profiles indicate that TBI is extremely heterogeneous. This is apparent in the distribution of TBI by age, gender, ethnicity, severity, and cause. Multiple rehabilitation strategies to accommodate these complexities are needed.
Pathophysiology Rarely are the consequences limited to one set of symptoms, clearly delineated impairments, or a disability that affects only one part of a person’s life. Rather, the consequences of TBI often influence human functions along a continuum from altered physiological functions of cells through neurological and psychological impairments, to medical problems and disabilities that affect the individual with TBI, as well as the family, friends, community, and society in general. When other, more urgent medical problems are apparent at onset, mild TBI may be masked, even
Guidelines 15
though it can result in impairments. In many cases, the consequences of TBI endure in original or altered forms across the lifespan, with new problems likely to occur as a result of new challenges and the aging process. The neurological consequences of TBI are many and complex, occurring throughout the neural axis. Any sensory, motor, and autonomic function may be compromised. Most of these complications are apparent within the first days or months following injury, depending on the severity of initial trauma. Some long-term sequelae include a variety of movement disorders, seizures, headaches, ambient visual deficits, and sleep disorders. Non-neurological medical complications include, but are certainly not limited to, pulmonary, metabolic, nutritional, gastrointestinal, musculoskeletal, and dermatologic problems. The cognitive consequences of TBI are similarly broad. All of these consequences can occur singly or in combinations and are variable in terms of their effects on individuals; furthermore, they change in severity and presentation over time. In combination, they produce a myriad of functional problems. Some of the most persistent problems include memory impairment and difficulties in attention and concentration. Deficits in language use and visual perception are common, but often unrecognized. Frontal lobe functions, such as the executive skills of problem-solving, abstract reasoning, insight, judgment, planning, information processing, and organization, are vulnerable to TBI. Common behavioral deficits include decreased ability to initiate responses, verbal and physical aggression, agitation, learning difficulties, shallow selfawareness, altered sexual functioning, impulsivity, and social disinhibition. Mood disorders, personality changes, altered emotional control, depression, and anxiety are also prevalent after TBI. Social consequences of mild, moderate, and severe TBI are many and serious, including increased risk of suicide, divorce, chronic unemployment, economic strain, and substance abuse. These consequences are tragic to individuals and families and place additional burdens on social service agencies, law enforcement, and the courts. As individuals with TBI attempt to resume their usual daily activities, the environment places increasing demands on them, uncovering additional psychosocial consequences. For example, executive dysfunction may become obvious only in the workplace; behavioral changes affecting interpersonal relationships may appear after leaving inpatient care. Spiraling adverse consequences of TBI may become apparent not only for persons with TBI but also for their significant others. Family members report depression, social isolation, and anger. Overall
16 Traumatic Brain Injury
family functioning and relationships are disrupted. Such consequences may continue and, in some instances, worsen with age. Children with TBI have their own set of consequences. Interactions of physical, cognitive, and behavioral sequelae interfere with the task of new learning. The effect of early TBI may not become apparent until later in the child’s development, although there is little explicit literature on the developmental consequences of TBI in infants. There may be a poor fit between the needs of children with TBI and the typical school educational programs. Children with TBI also may have difficulties with peers due to cognitive processing, behavioral problems, or difficulty comprehending social cues. Parents are faced with significant parenting challenges, including coping with changed academic aspirations and family goals. TBI in adolescents has been largely unstudied. It is unclear, therefore, whether the consequences they face are best described by the literature pertaining to adults or children. The economic consequences of TBI are enormous. The annual cost of acute care and rehabilitation in the United States for new cases of TBI is estimated at $9 to $10 billion. Estimates for average lifetime cost of care for a person with severe TBI range from $600,000 to $1,875,000. These figures may grossly underestimate the economic burden of TBI to family and society because they do not include lost earnings, costs to social services systems, and the value of the time and foregone earnings of family members who care for persons with TBI. Access to initial care and subsequent rehabilitation for persons with TBI may depend greatly on insurance coverage, health care personnel, family and community, geographic location, knowledge of available resources, and the ability to navigate the medical care and rehabilitation system successfully.
Functional Recovery and Rehabilitation TBI represents an evolving dynamic process that involves multiple interrelated physiological components that exert primary and secondary effects at the level of the individual nerve cell (neuron), the level of connected networks of such neurons (neural networks), and the level of human thought (cognition). Many damaging changes to the connections among neurons (axons) and to the neurons themselves have been described. These include chemical changes to the basic molecules of metabolism
Guidelines 17
(especially calcium), to mechanisms of the human cellular response to injury, and to the quantities of certain molecules that can be dangerous in excess (oxygen free radicals, nitric oxide). A protein substance that is present in Alzheimer’s disease (beta amyloid) also can be deposited in neurons. Communication molecules in the brain (neurotransmitters) have either excitatory or inhibitory effects. The most prevalent of these excitatory molecules are the amino acids glutamate and aspartate, which can occur in massive amounts following TBI, leading to overexcitation and ultimately the death of neurons. At the cognitive level, alterations in neural networks and neurotransmitter systems (especially ones involving the transmitters acetyl choline, dopamine, and serotonin) can affect cognition and behavior. Although the pathophysiology of TBI is under intense investigation in animals, application of these findings to the understanding of neurobiological mechanisms underlying functional recovery in humans remains to be delineated. The relative importance of each mechanism to recovery potential at different stages after TBI remains unclear. The basic mechanisms of injury and recovery have motivated the evaluation of experimental treatments in animals (e.g., protection of neurons from overexcitation or the effects of damaging molecules), whereas basic understanding of the capacity of neurons to grow and form connections with other neurons (cellular plasticity) has motivated others. The injured brain does have some capacity to recover. Elements of neural plasticity include increases of chemicals that promote growth of neural connections (growth factors) and alterations in the number and nature of these connections through changes in neuron structure. Promising strategies in neuroplasticity include nerve growth factors, other mediators of growth, and tissue transplantation. Ultimately, gene therapy may be a way to deliver such growth factors to targeted locations. Interventions to improve neural network and cognitive function may involve particular types of experience and stimulation (e.g., complex environments), with experience-dependent changes demonstrable in the biology of neural connections, small blood vessels, and even the organization of brain layers. The temporal course of recovery is probably lengthy (months to years), and the rate of recovery may vary over time. Recovery may incorporate particular substages that have unique pathophysiology. The temporal course may exhibit regional and functional differences. For example, at the cellular level, a particular type of cell death (apoptosis), which is normally present only during early brain development, may occur in different regions at different times, including many months following injury. At the neural network level, experience-dependent changes related to activity or learning
18 Traumatic Brain Injury
have been demonstrated at various times after experimental brain damage in animals. Cognitive recovery proceeds in overlapping stages, with more marked improvements in particular skills occurring at different times. In addition, great variability in behavior is characteristic after TBI. Mechanisms currently used for reestablishing appropriate and adaptive behaviors in adults with TBI include learning, the development of supportive contexts, and environmental manipulations. These mechanisms focus not only on persons with TBI, but also on their families and the communities in which they live. Given the complexity of the recovery processes, treatment protocols likely will need to be carefully designed and systematically staged to introduce these potential therapeutic interventions consistent with the temporal sequence of pathophysiological and plastic events. The gap between animal model studies of interventions and human clinical practice is particularly wide. Four reasons for this gap are (1) the differences between induced animal injury (e.g., fluid percussion injury) and human TBI, (2) the differences in severity of injury, (3) the timeframes of interventions for particular impairments, and (4) the presence of intolerable side effects. Furthermore, studies in animals are unable to address the complicated behavioral characteristics of human cognition after TBI. Successful study of brain/behavior relationships after TBI may depend on comparing cognitive domains (e.g., learning, attention, concentration, and memory) with biological processes, which can be studied only in humans. Several conclusions from this review are possible. The time course of TBI is prolonged and, in some cases, lifelong. The neural and cognitive mechanisms of injury and recovery are myriad, complex, and interrelated. Different underlying mechanisms are active at different times during recovery; consequently, specific interventions might have beneficial effects at certain times and not others. Although certain rehabilitative interventions probably should be started immediately, others probably should be delayed to maximize effectiveness and minimize adverse effect.
Common Therapeutic Interventions The goals of cognitive and behavioral rehabilitation are to enhance the person’s capacity to process and interpret information and to improve the person’s ability to function in all aspects of family and community life. Restorative training focuses on improving a specific cognitive function, whereas compensatory training focuses on adapting to the presence of a cognitive deficit. Compensatory approaches may have restorative effects at
Guidelines 19
certain times. Some cognitive rehabilitation programs rely on a single strategy (such as computer-assisted cognitive training), while others use an integrated or interdisciplinary approach. A single program can target either an isolated cognitive function or multiple functions concurrently. Despite many descriptions of specific strategies, programs, and interventions, limited data on the effectiveness of cognitive rehabilitation programs are available because of heterogeneity of subjects, interventions, and outcomes studied. Outcome measures present a special problem, since some studies use global “macro”-level measures (e.g., return to work), while others use “intermediate” measures (e.g., improved memory). These studies also have been limited by small sample size, failure to control for spontaneous recovery, and the unspecified effects of social contact. Nevertheless, a number of programs have been described and evaluated. Cognitive exercises, including computer-assisted strategies, have been used to improve specific neuropsychological processes, predominantly attention, memory, and executive skills. Both randomized controlled studies and case reports have documented the success of these interventions using intermediate outcome measures. Certain studies using global outcome measures also support the use of computer-assisted exercises in cognitive rehabilitation. Compensatory devices, such as memory books and electronic paging systems, are used both to improve particular cognitive functions and to compensate for specific deficits. Training to use these devices requires structured, sequenced, and repetitive practice. The efficacy of these interventions has been demonstrated. Psychotherapy, an important component of a comprehensive rehabilitation program, is used to treat depression and loss of self-esteem associated with cognitive dysfunction. Psychotherapy should involve individuals with TBI, their family members, and significant others. Specific goals for this therapy emphasize emotional support, providing explanations of the injury and its effects, helping to achieve self-esteem in the context of realistic selfassessment, reducing denial, and increasing ability to relate to family and society. Although the use of psychotherapy has not been studied systematically in persons with TBI, support for its use comes from demonstrated efficacy for similar disorders in other populations. Pharmacological agents may be useful in a variety of affective and behavioral disturbances associated with TBI. Although specific studies in persons with TBI are few, these agents are typically used in TBI for their
20 Traumatic Brain Injury
direct and indirect pharmacological properties. People with TBI may be more likely to experience detrimental side effects from these drugs than people without TBI; therefore, additional caution should be used in prescribing and monitoring psychopharmacologic treatment. Behavior modification has been used to address the personality and behavioral effects of TBI. It also has been used in retraining persons with TBI in social skills. Many descriptive studies and a single prospective clinical trial provide limited support for the efficacy of this approach. The value of vocational rehabilitation strategies, such as short-term and long-term supported employment and job coaching, is indicated by observational studies. This is particularly important since return to work is among the most significant outcomes of successful rehabilitation. Community colleges and other structured educational institutions may be valuable resources for some persons with TBI. For children, most rehabilitation services occur in the school setting. Children with TBI frequently attend special education services. The effectiveness of these services for children with TBI has not been well studied. Unfortunately, problems specifically related to TBI in children frequently are not identified. Comprehensive interdisciplinary rehabilitation treatment, provided by a diverse team of experienced professionals, is commonly used for persons with TBI. These programs use individually tailored interventions, both restorative and compensatory, in order to achieve both intermediate goals in cognitive functioning and larger scale (global) outcomes. This personalized approach leads to great difficulty in the scientific evaluation of effectiveness, because there is significant heterogeneity among both persons with TBI and their comprehensive treatment programs. Nonetheless, uncontrolled studies and one nonrandomized clinical trial support the effectiveness of these approaches. Other interventions, such as structured adult education, nutritional support, music and art therapy, therapeutic recreation, acupuncture, and other alternative approaches, are used to treat persons with TBI. These methods are commonly used, but their efficacy has not been studied. There are many reports of interventions for family members of individuals with TBI, including psychological and social support and education. Although no empiric studies have evaluated the efficacy of these interventions, they are supported by substantial clinical experience.
Guidelines 21
Despite the relative paucity of rigorous investigation and the heterogeneity of subjects, study design, and outcome, several common and consistently recurring themes emerge from a detailed review of the scientific evaluations of cognitive and behavioral rehabilitation interventions. Evidence supports the use of certain cognitive and behavioral rehabilitation strategies for individuals with TBI in particular circumstances. These interventions share certain characteristics in that they are structured, systematic, goal-directed, and individualized and they involve learning, practice, social contact, and a relevant context. It is important to recognize that a great deal of the scientific evidence to support the use of these approaches derives from relatively limited studies that should be replicated in larger, more definitive clinical trials.
Rehabilitation There are numerous approaches to TBI rehabilitation; most involve a traditional medical perspective. Common acute phase approaches include ICU/acute trauma and neurosurgical care, acute inpatient hospital rehabilitation, and subacute in-hospital care, such as coma management. Postacute approaches to TBI rehabilitation include home-based rehabilitation, outpatient rehabilitation programs, community re-entry programs, comprehensive day treatment programs, residential community reintegration programs, and neurobehavioral programs. Beyond the traditional medical approach, TBI rehabilitation also includes supported living programs, independent living centers, clubhouse programs, rehabilitation within schools, and vocational rehabilitation. An extensive literature has examined the effectiveness of comprehensive rehabilitation programs for persons with TBI. Unfortunately, most studies are not rigorous from a methodological standpoint, so conclusions regarding effectiveness must be approached with caution. Indeed, critical analysis of the literature on TBI rehabilitation yield only a few studies that suggest effectiveness under limited conditions. A major mitigating factor is that research in the area of TBI rehabilitation is exceedingly difficult to conduct, and it has been difficult to obtain funding. Adequate sample sizes and appropriate comparison groups are difficult to achieve in a clinical, rehabilitation environment. Therefore, the fact that most research to date has not been rigorous must not be interpreted to imply that rehabilitation programs are not effective.
22 Traumatic Brain Injury
A major limitation within the field of TBI rehabilitation is the narrow focus of current medical restoration approaches; the focus tends to be on enhancing capabilities of persons with TBI to help them adapt to life circumstances. However, new models of rehabilitation emphasize the parallel importance of environmental modification in order to create enabling conditions for the individual. Unfortunately, enablement approaches are not yet common in the field of TBI rehabilitation, in part because of funding constraints. The current approaches to TBI rehabilitation are also limited by the fact that little attention has been paid to the needs of high-risk age groups (e.g., infants, adolescents, and the elderly) and their families. Similarly, there is little recognition that TBI is frequently a lifetime disability with varying rehabilitation needs over that lifetime. Improvements in the conceptual approaches to TBI rehabilitation are needed. Another difficulty with current models of TBI rehabilitation pertains to the issue of access to rehabilitation services. Specifically, there is a wide discrepancy in the availability of TBI rehabilitation programs across geographic regions and a lack of knowledgeable professionals able to facilitate community-based rehabilitation. Frequently, there are problems accessing rehabilitation services in a timely manner, and major financial barriers make access to TBI rehabilitation services difficult for many individuals. These factors and others make it difficult for persons with TBI and their families to obtain the necessary community support and participate optimally in the rehabilitation process. An additional shortcoming of current approaches to TBI rehabilitation involves limited opportunities for decision-making by persons with TBI and their families. Traditional medical rehabilitation environments often do not foster partnerships with persons with TBI or their significant others. Therefore, the current approaches frequently result in a sense of disenfranchisement due to a lack of shared participation in goal development and program design. In addition, information provided by clinicians to persons with TBI and their families is often insufficient. Fortunately, notable exceptions to this problem are beginning to emerge as rehabilitation environments start to adopt participatory action strategies for both research and treatment endeavors.
Recommended Rehabilitation Practices ·
Rehabilitation services should be matched to the needs, strengths, and capacities of each person with TBI and modified as those needs change over time.
Guidelines 23
·
Rehabilitation programs for persons with moderate or severe TBI should be interdisciplinary and comprehensive.
·
Rehabilitation of persons with TBI should include cognitive and behavioral assessment and intervention.
·
Persons with TBI and their families should have the opportunity to play an integral role in the planning and design of their individualized rehabilitation programs and associated research endeavors.
·
Persons with TBI should have access to rehabilitation services through the entire course of recovery, which may last for many years after the injury.
·
Substance abuse evaluation and treatment should be a component of rehabilitation treatment programs.
·
Medications used for behavioral management have significant side effects in persons with TBI, can impede rehabilitation progress, and therefore should be used only in compelling circumstances.
·
Medications used for cognitive enhancement can be effective, but benefits should be carefully evaluated and documented in each individual.
·
Community-based, nonmedical services should be components of the extended care and rehabilitation available to persons with TBI. These include but are not necessarily limited to clubhouses for socialization; day programs and social skill development programs; supported living programs and independent living centers; supported employment programs; formal education programs at all levels; case manager programs to support practical life skill redevelopment and to help navigate through the public assistance and medical-rehabilitative care systems; and consumer, peer support programs.
·
Families and significant others provide support for many people with TBI. To do so effectively, they themselves should receive support. This can include in-home assistance from home health aides or personal care attendants, daytime and overnight respite care, and ongoing counseling.
·
Rehabilitation efforts should include modification of the individual’s home, social, and work environments to enable fuller participation in all venues.
·
Special programs are needed to identify and treat persons with mild TBI.
·
Specialized, interdisciplinary, and comprehensive treatment programs are necessary to address the particular medical, rehabilitation, social, family, and educational needs of young and school-age children with TBI.
24 Traumatic Brain Injury
·
Specialized, interdisciplinary, and comprehensive treatment programs are necessary to address the particular medical, rehabilitation, family, and social needs of persons older than age 65 with TBI.
·
Educational programs are needed to increase the degree to which community care providers are aware of the problems experienced by persons with TBI.
What Research Is Needed? ·
Epidemiological studies on the risk factors and incidence of TBI are needed for different age groups, gender, and race.
·
The relationship between substance abuse and TBI should be studied.
·
Existing CDC surveillance systems based on hospital discharge summaries or death records should be expanded to include emergency department encounters in order to augment the current database for research.
·
Studies of the placement of persons with TBI in nursing homes and psychiatric facilities are needed to clarify what constitutes appropriate placement.
·
The epidemiology of mild TBI should be studied.
·
The duration, natural history, and life-course manifestations (neurological, cognitive, social, psychological, economic, etc.) of mild, moderate, and severe TBI should be studied.
·
Gender differences in survival rates, patterns of severity, and long-term manifestations of TBI should be studied.
·
The consequences and effects of rehabilitation after TBI in the elderly should be studied.
·
The experience of minority group members with TBI should be studied.
·
Research training is needed in the areas of injury epidemiology and clinical research in order to enhance the quality of all research related to TBI.
·
The time course of TBI should to be studied in animals with respect to injury severity, influence of age and gender, and effects of interventions.
·
Research is needed on the appropriate timing of therapeutic interventions after TBI.
·
Research is needed on the effectiveness of pharmacological interventions for the cognitive, behavioral, and emotional consequences of TBI.
Guidelines 25
·
The neurobiology of TBI in humans should be studied with modern imaging techniques (e.g., positron emission tomography [PET] and functional magnetic resonance imaging [fMRI]) and correlated with neuropsychological findings.
·
Promising treatments of TBI derived from animal studies should be tested in humans.
·
The epidemiology and management of TBI in sports should be studied.
·
Well-designed and controlled studies of the effectiveness of rehabilitation interventions are needed.
·
Economic analysis of TBI, including major determinants of costs, is needed.
·
Innovative rehabilitation interventions for TBI should be developed and studied.
·
The predictors of quality of life for persons with TBI, their families, and significant others should be studied.
·
Studies are needed to evaluate the relationship between specific cognitive deficits and global outcomes.
·
Validation of generic health-related quality of life assessment instruments for use in TBI is needed, as well as the development and validation of TBI-specific instruments.
·
Uniform standards and minimal data sets to describe injury type, severity, and significant interacting variables, which could provide a total injury profile across a continuum of recovery, should be developed.
·
The relationship between the pathophysiology of TBI and the effectiveness of different interventions should be studied.
·
The long-term consequences of TBI of varying severity, including the consequences of aging for a person with TBI, should be studied.
·
The developmental impact of TBI in childhood with respect to the need for special education, mental health, and rehabilitation services should be studied.
·
The effectiveness of community-based rehabilitation for persons with TBI should be studied.
·
Severity risk-adjustment models for studies of persons with TBI should be established.
·
The effectiveness of peer support for persons with TBI, their families, and significant others should be studied.
·
Innovative study methodologies to assess the effectiveness of complex interventions for persons with TBI should be developed and evaluated.
26 Traumatic Brain Injury
Conclusions Traumatic Brain Injury (TBI) results principally from vehicular incidents, falls, acts of violence, and sports injuries, and is more than twice as likely in males as in females. The estimated incidence rate is 100 per 100,000 persons with 52,000 annual deaths. The highest incidence is among persons 15 to 24 years of age and 75 years and older, with an additional less striking peak in incidence in children ages 5 and younger. Since TBI may result in lifelong impairment of an individual’s physical, cognitive, and psychosocial functioning and prevalence is estimated to be 2.5 million to 6.5 million individuals, TBI is a disorder of major public health significance. Furthermore, mild TBI is significantly under diagnosed and the likely societal burden therefore even greater. Given the large toll of TBI and absence of a cure, prevention is of paramount importance. However, the focus of this conference was the evaluation of rehabilitative measures available for the cognitive and behavioral consequences of TBI. Although studies are relatively limited, available evidence supports the use of certain cognitive and behavioral rehabilitation strategies for individuals with TBI. This research needs to be replicated in larger, more definitive clinical trials. Well-designed and controlled studies using innovative methods are needed to evaluate the benefits of different rehabilitation interventions. Increased understanding of the mechanisms of TBI and recovery hold promise for new treatments. Thus, funding for research on TBI needs to be increased. Persons with TBI, their families, and significant others are integral to the design and implementation of the rehabilitation process and research. Consequently, rehabilitation services, matched to the needs of persons with TBI, and community-based non medical services are required to optimize outcomes over the course of recovery. Public and private funding for rehabilitation of persons with TBI must be adequate to meet these acute and long-term needs, especially in consideration of the current healthcare environment where access to these treatments may be jeopardized by changes in payment methods for private insurance and public programs. ·
TBI is a heterogeneous disorder of major public health significance.
·
Consequences of TBI can be lifelong.
·
Given the large toll of TBI and absence of a cure, prevention is of paramount importance. Identification, intervention, and prevention of alcohol abuse and violence provide an important opportunity to reduce TBI and its effects.
Guidelines 27
·
Rehabilitation services, matched to the needs of persons with TBI, and community-based nonmedical services are required to optimize outcomes over the course of recovery.
·
Mild TBI is significantly underdiagnosed, and early intervention is often neglected.
·
Persons with TBI, their families, and significant others are integral to the design and implementation of the rehabilitation process and research.
·
Public and private funding for rehabilitation of persons with TBI should be adequate to meet acute and long-term needs.
·
Access to needed long-term rehabilitation may be jeopardized by changes in payment methods for private insurance and public programs.
·
Increased understanding of the mechanisms of TBI and recovery hold promise for new treatments.
·
Well-designed and controlled studies are needed to evaluate benefits of different rehabilitation interventions.
·
Basic and common classification systems of TBI are needed.
·
The evaluation of TBI interventions will require innovative research methodologies.
·
Funding for research on TBI needs to be increased.
Bibliography Overview Hart T, Jacobs HE. Rehabilitation and management of behavioral disturbances following frontal lobe injury. J Head Trauma Rehabil 1993;8:1-12. Whyte J. Assessing medical rehabilitation practices: distinctive methodologic challenges. In: Fuhrer MJ, editor. The promise of outcomes research. Baltimore: Brookes; 1997. p. 43-59. Whyte J, Hart T, Laborde A, Rosenthal M. Rehabilitation of the patient with traumatic brain injury. In: DeLisa J, Gans BM, Bockenek, WL, Currie DM, Geiringer SR, Gerber LH, Rehabilitation medicine: principles and practice. 3rd ed. Philadelphia: Lippincott-Raven; 1998. p. 1191-1239. Whyte J, Laborde A, DiPasquale MC. Assessment and treatment of the vegetative and minimally conscious patient. In: Rosenthal M, Griffith ER,
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Kreutzer JS, Pentland B, editors. Rehabilitation of the adult and child with traumatic brain injury. 3rd ed. Philadelphia: FA Davis. In press.
Epidemiology of TBI Centers for Disease Control and Prevention. Traumatic injury in the United States: an interim report to congress. Atlanta (GA): Centers for Disease Control and Prevention; in press. Krause J, McArthur D. Epidemiology of brain injury. In: Cooper PR, editor. Head injury. 4th ed. Baltimore: Williams & Wilkins; in press. National Center for Health Statistics. Data file documentation, national hospital discharge survey, 1980-1995. Rockville (MD): National Center for Health Statistics, Centers for Disease Control and Prevention; 1997. Sosin D, Sniezek JE, Waxweiller RJ. Trends in death associated with traumatic brain injury, 1979 through 1992: success and failures. JAMA 1995;273(22):1778-80.
Consequences of Traumatic Brain Injury Corrigan JD. Community integration following traumatic brain injury. Neurorehabilitation 1994;4:109-121. Corrigan JD, Smith-Knapp K, Granger CV. Outcomes in the first 5 years after traumatic brain injury. Arch Phys Med Rehabil 1998;79:298-305. Dijkers M. Measuring the long-term outcomes of traumatic brain injury: a review of the Community Integration Questionnaire. J Head Trauma Rehabil 1997;12(6):74-91. Dikmen SS, Temkin NR, Machamer JE, Holubkov AL, Fraser RT, Winn HR. Employment following traumatic head injuries. Arch Neurol 1994;51:177-186. Gervasio A, Kreutzer J. Kinship and family members’ psychological distress after traumatic brain injury: a large sample study. J Head Trauma Rehabil 1997;12(3):14-26.
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Gronwall D, Wrightson P. Delayed recovery of intellectual function after minor head injury. Lancet 1974;2:605-9. Hall KM. Functional assessment in traumatic brain injury. In: Rosenthal M, Griffith ER, Kreutzer JS, Pentland B, editors. Rehabilitation of the adult and child with traumatic brain injury. 3rd ed. Philadelphia: F.A. Davis. In press. Hall KM, Mann N, High WM, Wright J, Kreutzer JS, Wood D. Functional measures after traumatic brain injury: ceiling effects of the FIM, FIM+FAM, DRS and CIQ. J Head Trauma Rehabil 1996;12(5):27-39. Harrison-Felix C, Newton CN, Hall KM, Kreutzer JS. Descriptive findings from the traumatic brain injury model systems national data base. J Head Trauma Rehabil 1996;11(5):1-14. Kreutzer J, Gervasio A, Camplair P. Primary caregiver’s psychological status and family functioning after traumatic brain injury. Brain Inj 1994;8(3):197-210. Kreutzer J, Serio C, Bergquist S. Family needs following brain injury: a quantitative analysis. J Head Trauma Rehabil 1994;(3):104-15. Levin HS, Culhane KA, Mendelsohn D, Lilly MA, Bruce D, Fletcher JHM, et al. Cognition in relation to MRI in head injured children and adolescents. Arch Neurol 1993;50:897-905. Lezak MD. Living with the characterologically altered brain injured patient. J Clin Psychiatry 1978;39:111-23. Sander AM, Kreutzer JS, Rosenthal M, Delmonico R, Young ME. A multicenter longitudinal investigation of return to work and community integration following traumatic brain injury. J Head Trauma Rehabil 1996;11:70-84. Satz P, Zaucha K, McCleary C, Light R, Asarnow R, Becker D. Mild head injury in children and adolescents: a review of studies (1969-1995). Psychol Bull 1997;122:107-31. Williams DH, Levin HS, Eisenberg HM. Mild head injury classification. Neurosurgery 1990;27:422-8.
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Mechanisms Underlying Recovery from Traumatic Brain Injury Arnsten AFT, Smith DH. Pharmacological strategies for neuroprotection and rehabilitation following brain trauma. In: Stuss DT, Winocur G, Robertson IH, editors. Cognitive neurorehabilitation. Cambridge (UK): Cambridge Press. In press. Black JE, Jones TA, Nelson CA, Greenough WT. Neuronal plasticity and the developing brain. In: Alessi N, Coyle JT, Harrison SI, Eth S, editors. The handbook of child and adolescent psychiatry. Vol 6. New York: John Wiley & Sons; 1998. p. 31-53. Conti AC, Raghupathi R, Lee VMY, Trojanowski JQ, McIntosh TK. Experimental brain injury induces regionally distinct apoptosis during the acute and delayed post-traumatic period. J Neurosci. In press. Erb DE, Povlishock JT. Neuroplasticity following traumatic brain injury: a study of GABAergic terminal loss and recovery in the cat dorsal lateral vestibular nucleus. Exp Brain Res 1991;83:253-67. Greenough WT, Black JE, Klintsova AY, Bates KE, Weiler IJ. Experience and plasticity in brain structure: possible implications of basic research findings for developmental disorders. In: Broman S, et al., editors. The changing nervous system: consequences of early brain disorders. Oxford University Press. In press. Greenough WT, Comery TA, Irwin SI, Black JE, Weiler IJ. Discussion: synapse stabilization and fragile X protein synthesis in the rodent brain. In: Hann DM, et al., editors. Advancing research on developmental plasticity: integrating the behavioral science and neuroscience of mental health. Washington (DC): U.S. Government Printing Office. In press. Jones TA, Hawrylak N, Klintsova AY, Greenough WT. Brain damage, behavior, rehabilitation, recovery and brain plasticity. Mental Retardation and Developmental Disabilities Research Reviews. In press. McIntosh TK, Juhler M, Wieloch T. Novel pharmacologic strategies in the treatment of experimental traumatic brain injury. J Neurotrauma. In press. Phillips LL, Lyeth BG, Hamm RL, Reeves TM, Povlishock JP. Glutamate antagonism during secondary deafferentation enhances cognition and axodendritic integrity after traumatic brain injury. Hippocampus. In press.
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Phillips LL, Lyeth BG, Hamm RL, Povlishock JT. Combined fluid percussion brain injury and entorhinal cortical lesion: a model for assessing the interaction between neuroexcitation and deafferentation. J Neurotrauma 1994;11:641-56. Povlishock JT, Christman CW. The pathobiology of traumatically induced axonal injury in animals and humans: a review of current thoughts. J Neurotrauma 1995;12:555-64. Povlishock JT, Jenkins LW. Are the pathobiological changes evoked by traumatic brain injury immediate and irreversible? Brain Pathol 1995;5:415-26. Saatman KE, Murai H, Bartus RT, Smith DH, Hayward NJ, Perri BR, et al. Calpain inhibitor AK295 attenuates motor and cognitive deficits following experimental brain injury in the rat. Proc Natl Acad Sci U S A 1996;93:3428-33. Stuss DT, Pogue J, Buckle L, Bondar, J. Characterization of stability of performance in patients with traumatic brain injury: variability and consistency on reaction time tests. Neuropsychology 1994;8(3):316-24. Stuss DT, Stetham LL, Hugenholtz H, Picton T, Pivik J, Richard MT. Reaction time after traumatic brain injury: fatigue, divided and focused attention, and consistency of performance. J Neurol Neurosurg Psychiatry 1989;52:742-8.
Common Cognitive Rehabilitation Interventions Aronow HU. Rehabilitation effectiveness with severe brain injury: translating research into policy. J Head Trauma Rehabil 1995;2:24-36. Ben-Yishay Y, Diller L. Cognitive remediation in traumatic brain injury: update and issues. Arch Phys Med Rehabil 1993;74:204-13. Damasio AR. Descartes’ error. New York: Avon Books; 1994. Greenwood RJ, McMillan TM,Brooks DN, Dunn G, Brock D, Dinsdale S, et. al. Effects of case management after severe head injury. BMJ 1994;308:1199-1205.
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Haffey WJ, Abrams DL. Employment outcomes for participants in a brain injury work reentry program: preliminary findings. J Head Trauma Rehabil 1991;6:24-34. Helffenstein D, Wechsier R. The use of interpersonal process recall (PR) in the remediation of interpersonal and communication skill deficits in the newly brain injured. Clin Neuropsychol 1982;4:139-43. Mackay LE, Bernstein BA, Chapman PE, Morgan AS, Milazzo LS. Early intervention in severe head injury: long-term benefits of a formalized program. Arch Phys Med Rehabil 1992;73:635-41. Mann L. On the trail of process: a historical perspective on cognitive processes and their training. New York: Grune and Stratton; 1979. Merzenich M, Wright B, Jenkins W, Xerri C, Byl N, Miller S, et al. Cortical plasticity underlying perceptual, motor, and cognitive skill development: implications for neurorehabilitation. Cold Spring Harbor symposia on quantitative biology, Vol. 41, Cold Spring Harbor Laboratory Press; 1996. Niemann H, Ruff RM, Baser CA. Computer-assisted attention retraining in head-injured individuals: a controlled efficacy study of an outpatient program. J Consult Clin Psychol 1990;58:811-7. Ponsford JL, Kinsella G. Evaluation of a remedial programme for attentional deficits following closed-head injury. J Clin Exp Neuropsychol 1998;10(6):693-708. Prigatano GP. Principles of Neuropsychological Rehabilitation. New York: Oxford University Press. In press. Ruff RM, Mueller J, Jurica PJ. Estimating premorbid functioning levels after traumatic brain injury. Neurorehabilitation 1996;7:39-53. Vygotsky LS. Mind in society: the development of higher psychological processes. Cole M, John-Steiner V, Scribner S, Souberman E, editors and translators. Cambridge (MA): Harvard University Press; 1978. Wilson BA, Evans JJ, Emslie H, Malinek V. Evaluation of NeuroPage: a new memory aid. J Neurol Neurosurg Psychiatry 1997;63(1):113-5. Ylvisaker M, Feeney T. Collaborative brain injury intervention: positive everyday routines. San Diego: Singular Publishing Group; 1998.
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Overview of TBI Rehabilitation Models Corcoran MA, Gitlin LN. The role of the physical environment in occupational performance. In: Christiansen C, Baum C, editors. Occupational therapy: enhancing performance and well-being. Thorofare (NJ): Slack, Inc; 1997. Dresser R. Mentally disabled research subjects: the enduring policy issues. JAMA 1996;276(1):67-72. Haimowitz S, Delano SJ, Oldham JM. Uninformed decisionmaking: the case of surrogate research consent. Hastings Center Report 1997;27(6):916. Institute of Medicine. Disability in America: a national agenda for prevention. Pope AM, Tarlov AR, editors. Washington (DC): National Academy Press; 1991. Institute of Medicine. Enabling America: assessing the role of rehabilitation science and engineering. Brandt EN Jr, Pope AM, editors. Washington (DC): National Academy Press; 1997. Keyserlingk EW, Glass K, Kogan S, Gauthier S. Proposed guidelines for the participation of persons with dementia as research subjects. Kramer MS, Shapiro SH. Scientific challenges in the application of randomized trials. JAMA 1984;252:2739-45. National Center for Medical Rehabilitation Research. Research plan for the National Center for Medical Rehabilitation Research. Washington (DC): National Institutes of Health; 1993. Ottenbacher KJ. Why rehabilitation research does not work (as well as we think it should). Arch Phys Med Rehabil 1995;76:123-9. Shamoo AE, O’Sullivan JL. The ethics of research on the mentally disabled. In: Monagle JF, Thomasma DC, editors. Health care ethics: critical issues for the 21st century. Gaithersburg (MD): Aspen Publishers Inc; 1998. p. 239-50.
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Whitehead J. The design and analysis of sequential clinical trials. New York: John Wiley & Sons; 1997. Whyte J. Toward a methodology for rehabilitation research. Am J Phys Med Rehabil 1994;73:428-35.
For More Information7 For more information, contact: Acoustic Neuroma Association 600 Peachtree Parkway Suite 108 Cumming, GA 30041
[email protected] http://www.anausa.org Tel: 770-205-8211 Fax: 770-205-0239 Brain Injury Association 105 North Alfred Street Alexandria, VA 22314
[email protected] http://www.biausa.org Tel: 703-236-6000 800-444-6443 Fax: 703-236-6001 Brain Trauma Foundation 523 East 72nd Street 8th Floor New York, NY 10021
[email protected] http://www.braintrauma.org Tel: 212-772-0608 Fax: 212-772-0357
Adapted from The National Institute of Neurological Disorders and Stroke (NINDS): http://www.ninds.nih.gov/health_and_medical/disorders/tbi_doc.htm.
7
Guidelines 35
Family Caregiver Alliance 690 Market Street Suite 600 San Francisco, CA 94104
[email protected] http://www.caregiver.org Tel: 415-434-3388 800-445-8106 Fax: 415-434-3508 National Rehabilitation Information Center (NARIC) 1010 Wayne Avenue Suite 800 Silver Spring, MD 20910-5633
[email protected] http://www.naric.com Tel: 301-562-2400 800-346-2742 Fax: 301-562-2401 National Stroke Association 9707 East Easter Lane Englewood, CO 80112-3747
[email protected] http://www.stroke.org Tel: 303-649-9299 800-STROKES (787-6537) Fax: 303-649-1328 National Institute on Disability and Rehabilitation Research (NIDRR) 600 Independence Ave., S.W. Washington, DC 20013-1492 http://www.ed.gov/offices/OSERS/NIDRR Tel: 202-205-8134
More Guideline Sources The guideline above on traumatic brain injury is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to traumatic brain injury. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with traumatic brain injury. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the
36 Traumatic Brain Injury
following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following as being relevant to traumatic brain injury: ·
Guides on: Sports Fitness http://www.nlm.nih.gov/medlineplus/sportsfitness.html Speech and Communication Disorders http://www.nlm.nih.gov/medlineplus/speechcommunicationdisord ers.html Accidents http://www.nlm.nih.gov/medlineplus/accidents.html Head and Brain Injuries http://www.nlm.nih.gov/medlineplus/headandbraininjuries.html Disasters and Emergency Preparedness http://www.nlm.nih.gov/medlineplus/disastersandemergencyprep aredness.html Sports Injuries http://www.nlm.nih.gov/medlineplus/sportsinjuries.html
If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
Guidelines 37
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on traumatic brain injury and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Los Angeles Caregiver Resource Center: Part of a Statewide System of Regional Resource Centers Serving Families and Care Givers of Brain Impaired Adults Source: Los Angeles, CA: Los Angeles Caregiver Resource Center. 1991. [6 p.]. Contact: Available from Los Angeles Caregiver Resource Center. 3715 McClintock Avenue, Los Angeles, CA 90089-0191. (213) 740-8711 or (800) 540-4442. PRICE: Free. Summary: This brochure describes the Los Angeles Caregiver Resource Center, a program of the Andrus Older Adult Center at the University of California. The Center is part of a statewide system of regional resource centers serving families and caregivers of adults with permanent brain impairment due to Alzheimer's disease and other dementing illnesses, stroke and other cerebrovascular accidents, traumatic brain injury, brain tumors, and other conditions. The Center assists these caregivers directly by providing the following services: information and community resources, support groups, family consultations, respite care, legal and financial consultations, and workshops on issues related to caregiving. Families who reside in Los Angeles County are eligible for some or all of the services. The brochure describes these services and provides contact information for further inquiries.
·
Del Oro Caregiver Resource Center for Caregivers of Brain Impaired Adults Source: Carmichael, CA: Del Oro Caregiver Resource Center. 6 p.
38 Traumatic Brain Injury
Contact: Available from Del Oro Caregiver Resource Center. 5713A Marconi Avenue, Suite 300, Carmichael, CA 95608. (800) 635-0220 or (916) 971-0893. PRICE: Free. Summary: This brochure describes the goals, services, and eligibility requirements of a program provided by a California Regional Resource Center to aid adults who suffer from brain impairment due to various causes (Alzheimer's, Parkinson's, Huntington's and other degenerative diseases of the brain; stroke; traumatic brain injury; brain tumors). The Center was founded in 1984 to establish a coordinated resource system to meet the needs of brain impaired adults through assistance to their families, professionals, and other caregivers. The Center supplies information and referral services to caregivers of brain impaired adults, and provides contractual services for legal and financial advice, family counseling, respite care, and diagnostic assessment. ·
After Traumatic Brain Injury: Helping Someone You Love During Early Rehabilitation Source: San Bruno, CA: Krames-Staywell. 1997. 16 p. Contact: Available from Krames-Staywell. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. Website: www.krames.com. PRICE: $1.50 each; bulk copies available. Order number 1812-TXDT. Summary: This booklet helps families and caregivers understand their role as a family member undergoes rehabilitation after traumatic brain injury (TBI). The booklet emphasizes that recovering from brain injury is a lifelong process. Topics covered include the members of the patient rehabilitation team, the role of the family member, the physiology of the brain, how brain injury happens, the different types of brain injury (tearing, bleeding, swelling), how thinking skills are affected, strategies for helping patients with their thinking skills (to improve memory, link ideas, relearn language), strategies for help with the patient's senses (to regain balance, address problems with sight or sound, and deal with time), behavioral changes that may accompany brain injury and how to deal with them (to handle feelings, control agitation, and regain social skills), how to handle other physical problems (to improve posture and motion, reduce muscle and joint problems, reduce swallowing problems, and control seizures), and strategies to support family relationships. The booklet offers practical strategies for family members to apply in everyday activities. The brochure is filled with line drawings of families in various settings. The tollfree number of the National Brain Injury Association (800-444-6443) is provided as a resource.
Guidelines 39
·
Help for Apraxia Source: Oceanside, CA: Academic Communication Associates. 1995. 5 p. Contact: Available from Academic Communication Associates. P.O. Box 586248, Oceanside, CA 92058-6249. (619) 758-9593; Fax (619) 758-1604; Email:
[email protected]; http://www.acadcom.com. PRICE: Single copy free; $13.00 for package of 10 booklets. Item Number 49912-T6. Summary: This brochure familiarizes readers with apraxia, a neurological communication disorder that is often observed following a stroke or a traumatic brain injury. Individuals with apraxia exhibit speech difficulties in situations where they make conscious, voluntary efforts to produce speech. The author outlines behaviors commonly observed in apraxia and lists guidelines for remediation. The author stresses that words commonly used in the classroom or in the work environment should be emphasized to help the individual communicate effectively in these situations. The brochure concludes with a brief section emphasizing the importance of a team approach in any apraxia treatment program.
·
Traumatic Brain Injury: A Guide for the Patient and Family Source: Stow, OH: Interactive Therapeutics, Inc. 1993. 61 p. Contact: Available from Interactive Therapeutics, Inc. P.O. Box 1805, Stow, OH 44224. (800) 253-5111 or (216) 688-1371; Fax (330) 923-3030; Email:
[email protected]. PRICE: $4.50 each for 1 to 25 copies; bulk rates available. Summary: This booklet is intended to serve as an introduction to traumatic brain injury (TBI) and as a reference to other sources of information to guide patients and their families as they learn about TBI. Four sections cover brain function, TBI and how it affects the brain, what to expect during recovery and rehabilitation, and living and coping with TBI. The chapter on possible impairments from TBI includes a section on speech and language disorders, covering aphasia, communication problems, dysarthria, and apraxia of speech. The booklet concludes with an extensive glossary of terms.
·
Augmentative Communication: Consumers Source: Rockville, MD: American Speech-Language-Hearing Association (ASHA). 199x. 36 p. Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 897-0157. Website: www.asha.org. PRICE: $1.50 per booklet. Item Number 0210251.
40 Traumatic Brain Injury
Summary: This consumer information booklet describes the use of augmentative communication for people who can hear but have little or no usable speech. Such severe communication disabilities can result from severe language delay, cerebral palsy, mental retardation, autism, traumatic brain injury (TBI), or stroke. In addition, a variety of specific neuromuscular disorders, such as amyotrophic lateral sclerosis (ALS), dystonia, Huntington's disease, multiple sclerosis, and muscular dystrophy can also cause severe speech problems. Augmentative communication is defined as any method other than speech, to send a message from one person to another. Techniques of augmentative communication range from specialized gestures and sign language to communication aids such as sign boards to highly specialized computerbased techniques. The booklet emphasizes the implementation of an effective augmentative communication system, regardless of level of sophistication, requires a detailed multidisciplinary assessment, training for the user(s), and regular re-evaluation. The booklet outlines the roles of members of the patient care team, including the speech language pathologist, the occupational therapist, the physical therapist, physicians, the educator, social worker, psychologist, rehabilitation engineer, computer programmer, vocational counselor, audiologist, orthotist, and manufacturers or distributors of communication devices. The author encourages readers to become active partners in their own care or the care of their children with communication disorders. The booklet includes a resource list of professional and consumer groups concerned with augmentative communication. An appendix provides a glossary of some of the terms used in augmentative communication. The booklet is illustrated with black and white photographs. ·
One Sip at a Time: Making the Best of Swallowing Problems Source: Atlanta, GA: Pritchett and Hull Associates, Inc. 1995. 32 p. Contact: Available from Pritchett and Hull Associates. 3440 Oakcliff Road, Northeast, Suite 110, Atlanta, GA 30340-3079. (800) 241-4925. Fax (800) 752-0510. PRICE: $3.15 each. Summary: This booklet helps caregivers understand swallowing problems and the steps that can be taken to help overcome them. The booklet notes that dysphagia (trouble with swallowing) is often caused by a traumatic brain injury (TBI) or stroke. While in the hospital, the patient gets therapy to learn how to swallow and eat again. When the patient is ready to go home, the role of the caregiver becomes very important. The booklet outlines recommendations for before the loved one comes home, including arranging for a relief person, making sure instructions are clear and understood, and knowing the goals the health
Guidelines 41
team has set for the patient; strategies for soon after the patient returns home, including ways to help the patient feel more in control of his or her own progress; what to eat and drink, including soft foods, chopped foods, and a soft diet, and the differences between extra thick, thick, and thin liquids; utilizing the services of a dietitian and a speech language pathologist (SLP); the different types of swallowing problems; techniques to improve swallowing; adaptive equipment, including special utensils, plates and cups; preventing the problem of silent aspiration; and when to call the doctor or SLP. The booklet concludes with a review of safety problems and what to do, as well as with a reminder that caregivers also need a support system. The booklet includes a number of charts and forms for recordkeeping and listing resources. Simple, cartoonlike line drawings illustrate each of the concepts presented. ·
Information Package: Resource Center on Substance Abuse Prevention and Disability Source: Washington, D.C.: Resource Center on Substance Abuse Prevention and Disability. 1993. (information package). Contact: Available from Resource Center on Substance Abuse Prevention and Disability. 1819 L Street, N.W., Suite 300, Washington, D.C. 20036. Voice (800) 628-8442 or (202) 628-8080; TTY (202) 628-3812; Fax (202) 6283812. PRICE: Single copy free. Summary: This information packet is designed for those working in the field of alcohol and other drug abuse services, as well as for those involved in the disability and rehabilitation fields. The packet includes fact sheets on alcohol and drug abuse prevention, the Americans With Disabilities Act, attention deficit disorders, blindness and visual impairments, deafness and hearing loss, hidden disabilities, learning disabilities, mental illness, mental retardation, mobility limitations, spinal cord injury, traumatic brain injury, disability and enabling, disability and the family, disability and health implications, and service delivery settings. Each fact sheet lists truths and myths about the subject, provides information about resource organizations and publications, and includes references. An order form for additional copies of the fact sheets is also included.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by
42 Traumatic Brain Injury
using the keyword “traumatic brain injury” or synonyms. The following was recently posted: ·
Early management of patients with a head injury. A national clinical guideline. Source: Scottish Intercollegiate Guidelines Network.; 2000 August; 43 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2138&sSearch_string=Traumatic+Brain+Injury
·
Evidence based clinical practice guideline for management of children with mild traumatic head injury. Source: Cincinnati Children's Hospital Medical Center.; 2000; 9 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1388&sSearch_string=Traumatic+Brain+Injury
·
Guidelines for prehospital management of traumatic brain injury. Source: Brain Trauma Foundation/National Highway Traffic Safety Administration.; 2000; 81 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2514&sSearch_string=Traumatic+Brain+Injury
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Head injury in children. Source: Singapore Ministry of Health/National Medical Research Council (Singapore Ministry of Health)/National Committee on Neuroscience (Singapore).; 2001 March; 38 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2060&sSearch_string=Traumatic+Brain+Injury
·
Part I. Guidelines for the management of severe traumatic brain injury. In: Management and prognosis of severe traumatic brain injury. Source: American Association of Neurological Surgeons/Brain Trauma Foundation.; 2000; 165 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2347&sSearch_string=Traumatic+Brain+Injury
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·
Part II. Early indicators of prognosis in severe traumatic brain injury. In: Management and prognosis of severe traumatic brain injury. Source: American Association of Neurological Surgeons/Brain Trauma Foundation.; 2000; 116 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2348&sSearch_string=Traumatic+Brain+Injury
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Practice management guidelines for the management of mild traumatic brain injury. Source: Eastern Association for the Surgery of Trauma.; 2000; 29 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2019&sSearch_string=Traumatic+Brain+Injury
·
Rehabilitation of persons with traumatic brain injury. Source: National Institutes of Health (NIH) Consensus Development Panel on Rehabilitation of Persons With Traumatic Brain Injury.; 1998 October; 30 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1330&sSearch_string=Traumatic+Brain+Injury
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Rehabilitation of Persons with Traumatic Brain Injury Summary: This consensus statement covers the epidemiology and consequences of traumatic brain injury, implications for rehabilitation, common models of rehabilitation, and research needs. Source: National Institutes of Health, U.S. Department of Health and Human Services http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6377
44 Traumatic Brain Injury
·
Traumatic Brain Injury Summary: This fact sheet defines traumatic brain injury as an acquired injury to the brain caused by an external physical force. Source: National Information Center for Children and Youth with Disabilities, U.S. Department of Education http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3418
·
Traumatic Brain Injury Information Page Summary: A general overview of traumatic brain injury that includes a description of the disorder, treatment, prognosis and research information. Source: National Institute of Neurological Disorders and Stroke, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3042
·
Traumatic Brain Injury: Cognitive and Communication Disorders Summary: Describes the causes of traumatic brain injury and the cognitive and communication problems that result from the injury. Source: National Institute on Deafness and Other Communication Disorders Information Clearinghouse http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6700
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to traumatic brain injury. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific
Guidelines 45
disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
·
drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Aphasia: Defect or loss of the power of expression by speech, writing, or signs, or of comprehending spoken or written language, due to injury or disease of the brain centres. [EU] Aspiration: The act of inhaling. [EU] Autonomic: Self-controlling; functionally independent. [EU]
46 Traumatic Brain Injury
Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Calpain: Cysteine proteinase found in many tissues. Hydrolyzes a variety of endogenous proteins including neuropeptides, cytoskeletal proteins, proteins from smooth muscle, cardiac muscle, liver, platelets and erythrocytes. Two subclasses having high and low calcium sensitivity are known. Removes Z-discs and M-lines from myofibrils. Activates phosphorylase kinase and cyclic nucleotide-independent protein kinase. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]
Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Chronic: Persisting over a long period of time. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dysarthria: Imperfect articulation of speech due to disturbances of muscular control which result from damage to the central or peripheral nervous system. [EU] Dysphagia: Difficulty in swallowing. [EU] Dystonia: Disordered tonicity of muscle. [EU] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] LH: A small glycoprotein hormone secreted by the anterior pituitary. LH plays an important role in controlling ovulation and in controlling secretion of hormones by the ovaries and testes. [NIH] Lobe: A more or less well-defined portion of any organ, especially of the
Guidelines 47
brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective tissue, and by their shape. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropsychology: A branch of psychology which investigates the correlation between experience or behavior and the basic neurophysiological processes. The term neuropsychology stresses the dominant role of the nervous system. It is a more narrowly defined field than physiological psychology or psychophysiology. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Pulmonary: Pertaining to the lungs. [EU]
48 Traumatic Brain Injury
Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as EPILEPSY or "seizure disorder." [NIH] Socialization: The training or molding of an individual through various relationships, educational agencies, and social controls, which enables him to become a member of a particular society. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Stabilization: The creation of a stable state. [EU] Subacute: Somewhat acute; between acute and chronic. [EU] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU]
Seeking Guidance 49
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with traumatic brain injury. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with traumatic brain injury. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Traumatic Brain Injury As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
50 Traumatic Brain Injury
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American Academy of Physical Medicine And Rehabilitation Address: American Academy of Physical Medicine And Rehabilitation One IBM Plaza, Suite 2500, Chicago, IL 60611-3604 Telephone: (312) 464-9700 Toll-free: (800) 445-8106 Fax: (312) 464-0227 Email: None Web Site: http://www.aapmr.org/ Background: The American Academy of Physical Medicine and Rehabilitation (AAPMandR) is a national medical society representing 5,600 physicians who are specialists in the field of physical medicine and rehabilitation. They are called physiatrists. Physiatrists focus on restoring function. They care for patients with acute and chronic pain, and musculoskeletal problems like back and neck pain, tendinitis, pinched nerves and fibromyalgia. They also treat people who have experienced catastrophic events resulting in paraplegia, quadriplegia, or traumatic brain injury as well as individuals who have suffered strokes, orthopedic injuries, or neurologic disorders such as multiple sclerosis, polio, or ALS. The Academy represents more than 87 percent of U.S. physiatrists and international colleagues from 37 countries. AAPMandR serves its member physicians to maximize patient function and quality of life by advancing excellence in physiatric practice.
·
Brain Injury Association, Inc Address: Telephone: (703) 236-6000 Toll-free: (800) 444-6443 Fax: (703) 236-6001 Email:
[email protected] Web Site: http://www.biausa.org
Seeking Guidance 51
Background: The Brain Injury Association, Inc. (BIA) is a national voluntary health organization dedicated to promoting awareness, understanding, and prevention of brain injuries and ensuring improved outcomes for children and adults with such injuries through education, advocacy, and community support services. Established in 1980, the Brain Injury Association provides information, assistance, and a variety of programs and services to people with brain injuries and their families, health care professionals, and the general public. The BIA networks with and provides guidance to state associations as well as hundreds of chapters and support groups that offer a range of services including care/case management, respite care, recreational opportunities, and, in some cases, housing, transportation, and emergency financial assistance. The BIA also lobbies before Congress and the Administration; encourages state agencies to develop and fund appropriate services for people with brain injuries; offers a toll-free Family Helpline; provides emergency financial assistance through its 'Thumbs Up Fund'; and offers the 'Brain Injury Resource Center,' an interactive multimedia computer system with comprehensive brain injury information that is available at rehabilitation facilities, trauma centers, and hospitals across the country. To increase awareness of brain injuries among professionals, the BIA also participates in and promotes the development of practice guidelines for severe brain injury and rehabilitation; facilitates task forces that address end of life quality, managed care, and pediatric and adolescent issues; sponsors several annual educational conferences; and publishes manuals, directories, magazines, and books including 'National Directory of Brain Injury Rehabilitation Services,' 'Analysis, Understanding, and Presentation of Cases Involving Traumatic Brain Injury,' and 'An Educator's Manual: What Educators Need to Know About Students with Brain Injury.' The BIA also has educational programs to help promote public awareness including a 'Wear a Helmet' campaign and a coordinated effort with the National Highway Traffic Safety Administration entitled 'Campaign Safe and Sober' focused on reducing impaired driving and increasing safety belt use. The BIA also has a quarterly magazine entitled 'TBI Challenge!' that serves as the BIA's main communication vehicle to its over 13,400 members consisting of affected individuals, family members, professionals, and the general public. Relevant area(s) of interest: Head Injury ·
Coma Recovery Association, Inc Address: Coma Recovery Association, Inc. 100 East Old Country Road, Suite 9, Mineola, NY 11501 Telephone: (516) 746-7714 Toll-free: (800) 444-6443
52 Traumatic Brain Injury
Fax: (516) 746-7706 Background: The Coma Recovery Association (CRA) is a not-for-profit organization dedicated to acting as a support group for friends and families of individuals who have survived coma and head injury. Established in 1980, CRA works to provide information and referrals to affected families to offer support and enable them to make informed choices regarding treatment, rehabilitation, and socialization alternatives. CRA is also an advocate for higher quality care, education, and research for individuals and families affected by coma and/or head injury. The Association also hosts conferences and offers educational materials including a regular newsletter entitled 'Coma Recovery Association' and brochures entitled 'Traumatic Brain Injury' and 'Neurological Dysfunctions.'. Relevant area(s) of interest: Coma, Head Injury ·
Family Caregiver Alliance Address: Family Caregiver Alliance 425 Bush Street, Suite 500, San Francisco, CA 94108 Telephone: (415) 434-3388 Toll-free: (800) 445-8106 Fax: (415) 434-3508 Email:
[email protected] Web Site: http://www.caregiver.org Background: The Family Caregiver Alliance, formerly called the Family Survival Project, is a not-for-profit, self-help, advocacy organization dedicated to assisting and supporting caregivers of brain-impaired adults through education, research, services and advocacy. Brain-impaired individuals include those who may have experienced a traumatic brain injury or stroke or been diagnosed with a brain tumor, Alzheimer's Disease, Parkinson's Disease, or other disorders affecting brain function. Established in 1977, The Family Caregiver Alliance provides several services to caregivers in the State of California. For example, the Alliance gives appropriate referrals, including support groups; promotes patient and family advocacy and legislation that is beneficial to affected individuals and families; and supports and promotes research. The Alliance also offers a variety of educational and support materials to caregivers both in California and throughout the United States; such information is provided through its database, directory, quarterly newsletter, reports, brochures, and audio- visual aids. Relevant area(s) of interest: Head Injury
Seeking Guidance 53
·
Healing Exchange Brain Trust Address: Healing Exchange Brain Trust Kendall Square Box 425743, Cambridge, MA 02142-0014 Telephone: (617) 623-0066 Fax: (617) 623-2203 Email:
[email protected] Web Site: http://www.braintrust.org Background: The Healing Exchange Brain Trust is a nonprofit organization dedicated to providing, promoting, and improving communication opportunities for individuals who are personally affected by or who professionally treat or study localized neurologic disorders (e.g., brain tumors) and subsequent or related health care concerns. In 1993, the e- mail discussion list known as the 'BRAINTMR mailing list' was founded by a brain tumor survivor. The Healing Exchange Brain Trust was later established in 1997 in order to expand on the purpose and objectives of the BRAINTMR mailing list, utilize new technology, and address new topics. The Trust is dedicated to creating, maintaining, offering, or endorsing communication vehicles to promote national and international networking among affected individuals, family members, friends, health professionals, and researchers. In addition, the Trust is committed to conveying its knowledge, experiences, and resources to the broader health care community and the public to foster acceptance, understanding, and aid for individuals affected by neurologic conditions; to increase public awareness; and to further develop innovative resources. The Healing Exchange Brain Trust also seeks to emphasize ways in which affected individuals, family members, and health care professionals may work together to achieve healing and well-being. The Trust's programs and services include offering the BRAINTMR mailing list, which serves as an online forum for discussion of topics related to all types of brain tumors; maintaining a web site that includes a 'virtual space' known as the 'Healing Exchange' where people may exchange information and mutual support concerning brain disorders; and attending national and international conferences to show affected individuals, families, health professionals, and researchers the benefits of online communication and resources. The Trust's web site includes instructions discussing how to join the BRAINTMR mailing list; information concerning the Trust's mission, goals, programs, and services; and guestbook, events, and news areas.
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·
National Head Injury Foundation, Inc. (and Family Helpline) Address: National Head Injury Foundation, Inc. (and Family Helpline) 1776 Massachusetts Avenue NW, Suite 100, Washington, D.C. 20036 Telephone: (202) 296-6443 Toll-free: (800) 444-6443 Fax: (202) 296-8850 Email:
[email protected] Web Site: http://www.biausa.org Background: Established in 1980, the National Head Injury Foundation, Inc. (NHIF) is a voluntary not-for-profit organization dedicated to promoting advocacy for people who have survived traumatic brain injury (TBI); securing and developing community based services for survivors of TBI and their families; supporting research that will enhance the lives of affected people; and promoting the prevention of brain injuries through public awareness, education, and legislation. The National Head Injury Foundation has a nationwide network of more than 800 support groups; provides direct financial assistance to people with a brain injury and their families; hosts nationwide conferences and symposia for physicians, rehabilitation specialists, trial lawyers, pharmaceutical representatives, and other professionals; and promotes a multifaceted public awareness campaign. The Foundation also spearheads a network of information exchange through its toll-free Family Helpline; Defense and Veterans Head Injury Program; advisory groups (e.g., the Survivor and Family Councils); and the Brain Injury Resource Center, an interactive computer-based multimedia system. The Foundation also offers a national directory of head injury services; a quarterly magazine, 'TBI Challenge!'; regular newsletters; and an extensive library that includes TBI research indexes, TBI professional series, books, videos, audiotapes, brochures, information packets, training materials, article reprints, and posters. Relevant area(s) of interest: Head Injury
·
Parent Pals (A Gifted and Special Education Web Site on the Internet for Parents) Address: Parent Pals (A Gifted and Special Education Web Site on the Internet for Parents) Telephone: (312) 464-9700 Toll-free: (800) 445-8106 Email:
[email protected] Web Site: http://www.parentpals.com
Seeking Guidance 55
Background: Parent Pals, a Gifted and Special Education Web site on the Internet, provides a variety of information and services for parents of children who are gifted or who have certain disabilities including Attention Deficit Disorder, autism, hearing impairment, emotional disturbances, learning disabilities, mental retardation, mobility impairment, speech and language impairment, stuttering, visual impairment, traumatic brain injury, and/or other health impairments. Parent Pals provides newsletters from therapists, teachers, and psychiatrists; general information on such topics as special education services, early intervention services, and individualized education programs (IEPs); a dictionary of terms used in special education; and an index of definitions concerning certain disorders. The site also provides specific educational and therapy games to enhance children's learning and language skills. These teaching ideas are organized by four levels, ranging from level 1 with preschool tasks to level 4 for gifted students. Parent Pals also provides weekly tips for parents of gifted children or children with certain disabilities. In addition, the site offers dynamic links to additional web sites in several different categories including 'education links,' 'therapy links,' 'special education legislation links,' and 'medical links.' Parent Pals is located at http://www.parentpals.com. ·
Perspectives Network, Inc Address: Perspectives Network, Inc. P.O. Box 1859, Cumming, GA 300281859 Telephone: (770) 844-6898 Toll-free: (800) 685-6302 Fax: (770) 844-6898 Email:
[email protected] Web Site: http://www.tbi.org Background: The Perspectives Network, Inc. (TPN) is a nonprofit organization dedicated to identifying and encouraging individual potential by providing various forums and opportunities wherein affected individuals, family members and friends, professionals and community members are encouraged to discuss issues relating to treatment, recovery, and reentry as well as creating positive changes following traumatic and acquired brain injury. TPN was established in 1990 by Dena K. Taylor, a brain injury survivor herself. The Perspectives Network provides information and education, but perhaps most importantly, it provides hope to those who survived a brain injury and to those who care for them. Educational materials include a quarterly magazine with an international circulation written by survivors, family members, and professionals; fact brochures; and a lending library and file
56 Traumatic Brain Injury
archives containing books, videos, and topical articles. Program activities include peer communication networks for survivors, spouses, offspring, parents, and siblings; brain injury awareness workshops; support groups; and education. TPN can be reached at its e-mail address at dktaylorattbi.org or its website at http://www.tbi.org. Relevant area(s) of interest: Closed Head Injury ·
Think First Foundation Address: Think First Foundation 22 South Washington Street, Park Ridge, IL 60068 Telephone: (847) 692-2740 Toll-free: (800) 844-6556 Fax: (847) 692- 2394 Email:
[email protected] Web Site: http://www.thinkfirst.org Background: The Think First Foundation (TFF) is a not-for-profit voluntary organization dedicated to preventing brain and spinal cord injuries through education of individuals, community leaders, and creators of public policy. Established in 1986, TFF was founded by the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. Consisting of more than 200 chapters, TFF produces educational materials including a catalog entitled '1997 Catalog, Think First,' the 'Think First Fact Sheet,' and brochures. The Foundation conducts high school presentations, develops local programs engaging in public policy initiatives, supports public and community awareness projects, and has the 'Think First For Kids' program which is implemented in elementary schools by local teachers. TFF includes more than 200 active local programs throughout the United States, Chile, Canada, Mexico, and Brazil. Each program includes a sponsoring licensed physician and program coordinator who participate in the Think First high school program. More than five million students have attended Think First program presentations. TFF maintains a web site on the Internet at http://www.thinkfirst.org.
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
Seeking Guidance 57
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about traumatic brain injury. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “traumatic brain injury” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “traumatic brain injury”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “traumatic brain injury” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with traumatic brain injury. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific
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diseases. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Select the option called “Organizational Database (ODB)” and type “traumatic brain injury” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with traumatic brain injury must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: · 10
Check with the associations listed earlier in this chapter. This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
Seeking Guidance 59
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 11 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
Finding a Neurologist The American Academy of Neurology allows you to search for member neurologists by name or location. To use this service, go to http://www.aan.com/, select “Find a Neurologist” from the toolbar. Enter your search criteria, and click “Search.” To find out more information on a particular neurologist, click on the physician’s name. If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
Selecting Your Doctor12 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 12 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 11
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she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about traumatic brain injury?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for traumatic brain injury?
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor13 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
13
Seeking Guidance 61
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:14 You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
14
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·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Paraplegia: Paralysis of the legs and lower part of the body. [EU] Quadriplegia: Severe or complete loss of motor function in all four limbs which may result from brain diseases; spinal cord diseases; peripheral nervous system diseases; neuromuscular diseases; or rarely muscular diseases. The locked-in syndrome is characterized by quadriplegia in combination with cranial muscle paralysis. Consciousness is spared and the only retained voluntary motor activity may be limited eye movements. This condition is usually caused by a lesion in the upper BRAIN STEM which injures the descending cortico-spinal and cortico-bulbar tracts. [NIH] Tendinitis: Inflammation of tendons and of tendon-muscle attachments. [EU] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU]
Clinical Trials 63
CHAPTER 3. CLINICAL TRIALS AND TRAUMATIC BRAIN INJURY Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning traumatic brain injury.
What Is a Clinical Trial?15 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for traumatic brain injury is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
15
64 Traumatic Brain Injury
What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
·
Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on traumatic brain injury.
·
Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for traumatic brain injury compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on traumatic brain injury carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on traumatic brain injury. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham
Clinical Trials 65
treatment.” This treatment, like a placebo, has no effect on traumatic brain injury and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how traumatic brain injury develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for traumatic brain injury. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo
66 Traumatic Brain Injury
surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Traumatic Brain Injury The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to traumatic brain injury.16 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
Genotype Influence on Recovery After Traumatic Brain Injury Condition(s): Brain Injury Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs Medical Research Service Purpose - Excerpt: Genetic differences in response to brain injury may reasonably be expected to play a role in the initial consequences of traumatic brain injury and in the rate of recovery from such injury. Study Type: Observational Contact(s): Florida; James A. Haley Veterans' Hospital, Tampa, Florida, 33612, United States; Recruiting; Fiona Crawford, Ph.D. 813-974-3722
[email protected]; Michael Mullan, Principal Investigator. Study chairs or principal investigators: Fiona Crawford, Ph.D.; Rodney Vanderploeg, Ph.D.; Robert Thatcher, Ph.D.; Andres Salazar, M.D.
16
These are listed at www.ClinicalTrials.gov.
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00018499;jsessionid=3AA76 C3EE990A3B2C22C7A1BDDF0EE7B ·
Magnesium sulfate for brain injury Condition(s): Brain Injuries; Head Injury; Brain Concussion Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: The purpose of the study is to determine whether magnesium sulfate, given within 8 hours of a moderate or severe traumatic brain injury improves survival, decreases the number of people developing seizures, improves the survivors' mental and psychological functioning, including the ability to return to daily life, live independently, and return to work or school. Phase(s): Phase III Study Type: Interventional Contact(s): Pamela Nelson, R.N. 1-206-521-1856
[email protected]; Washington; University of Washington, Seattle, Washington, 98104, United States; Recruiting. Study chairs or principal investigators: Nancy Temkin, Ph.D., Principal Investigator; University of Washington Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004730;jsessionid=3AA76 C3EE990A3B2C22C7A1BDDF0EE7B
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Pediatric Traumatic Brain Injury: Methylphenidate Effects on Early Recovery Condition(s): Brain Injuries Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Research Resources (NCRR); Murray Fellowship Purpose - Excerpt: Traumatic Brain Injury (TBI) is the leading cause of acquired long term disability among children and young adults. Deficits in attention and memory are common and persist for years after moderate or severe TBI. The similarity between these symptoms and those of children with AD/HD, the efficacy of methylphenidate in the treatment of AD/HD, and the efficacy of methylphenidate in improving recovery of animals with brain injuries, support the need to study methylphenidate effects in children with TBI. This investigation of
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methylphenidate in children with moderate to severe TBI aims to: (1) Assess the acute effects of 2 different dosages of methylphenidate on attention and reaction time when the medication is administered to children early in recovery; (2) Assess the ability of 8 weeks of methylphenidate to improve the rate of recovery of cognitive, memory, and attentional skills in children with TBI; (3) Identify the frequency of common methylphenidate side effects in children with TBI. Phase(s): Phase IV Study Type: Interventional Contact(s): Pennsylvania; Childrens Hospital Of Philadelphia, Philadelphia, Pennsylvania, 19104, United States; Recruiting; Nathan J. Blum, MD 215-590-7525 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00035139;jsessionid=3AA76 C3EE990A3B2C22C7A1BDDF0EE7B ·
Progesterone Treatment of Blunt Traumatic Brain Injury Condition(s): Traumatic Brain Injury Study Status: This study is currently recruiting patients. Sponsor(s): Emory University; National Institutes of Health (NIH) Purpose - Excerpt: The purpose of this study is to determine if progesterone treatment safely reduces brain swelling and damage after injury. Phase(s): Phase I; Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00048646;jsessionid=3AA76 C3EE990A3B2C22C7A1BDDF0EE7B
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Study of Neurobehavioral Outcome in Children or Adolescents With Closed Head Injuries Condition(s): Head Injuries, Closed Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Research Resources (NCRR); Baylor College of Medicine Purpose - Excerpt: Objectives: I. Determine the relationship of closed head injury (CHI) severity, focal brain lesions, and the age at injury to the
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development of working memory, inhibition, and metacognitive skills in children or adolescents with CHI of varying severity. II. Assess the development of working memory, inhibition, and metacognitive skills in relation to discourse functions, scholastic achievement, and adaptive behavior in these patients. III. Determine the relationship between impaired inhibition, metacognitive skills, and the emergence of psychiatric disorder in these patients. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00006128;jsessionid=3AA76 C3EE990A3B2C22C7A1BDDF0EE7B ·
Study of the Approximate Entropy of Adrenocorticotropic Hormone and Cortisol Secretion in Patients With Head Injury Condition(s): Brain Injury; Craniocerebral Trauma Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Research Resources (NCRR); University of Texas Purpose - Excerpt: Objectives: I. Determine the randomness of adrenocorticotropic hormone (ACTH) and cortisol secretion using approximate entropy in patients who have sustained a head injury. II. Determine the correlation between randomness of ACTH and cortisol secretion and stages of sleep in these patients. Study Type: Observational Contact(s): Texas; Transitional Learning Community, Galveston, Texas, 77550, United States; Recruiting; Brent Masel 409-762-6661; University of Texas Medical Branch, Galveston, Texas, 77555-0209, United States; Recruiting; Randall Urban 409-772-1176. Study chairs or principal investigators: Randall Urban, Study Chair; University of Texas Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00006270;jsessionid=3AA76 C3EE990A3B2C22C7A1BDDF0EE7B
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Testing a Possible Cause of Reduced Ability of Children to Process Speech in Noise Condition(s): Central Auditory Disease; Healthy Study Status: This study is currently recruiting patients.
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Sponsor(s): National Institute on Deafness and Other Communication Disorders (NIDCD) Purpose - Excerpt: This study aims to increase our understanding of the difficulty people have recognizing the spoken word, especially in noisy situations. Subjects must be between 12 and 18 years old with no history of voice disorder, autism, stuttering, aphasia, multiple sclerosis, traumatic brain injury, severe language disorders, and psychiatric disorders. Group A subjects must show reduced speech-in-noise scores and Group B subjects must demonstrate speech-in-noise scores within normal limits. The child will perform a series of hearing tasks that will take from 1.5 to 2 hours, with a break halfway through. A routine hearing test will be given. The child will sit in a sound-treated room wearing earphones and will depress a button in response to sound or to repeat words. The words may be in quiet or mixed with noise. In a test called "immitance," air pressure change and tones will be sent through a miniature probe in the ear for about 1 minute. TEOAE (transient-evoked otoacoustic emission) testing will test the inner ear with clicking sounds. At times, noise will be presented through a probe in the opposite ear. The child will listen to a series of recordings of speech in quiet and in noise and will be asked to repeat what is heard. These recordings will include monosyllabic words with some part of the sounds cut out; words presented with several voices speaking together; two words presented at the same time, one to each ear (child must repeat both words); and two sentences presented at the same time, one to each ear (child must repeat sentence presented to chosen ear). The only risk in this study is tiredness from listening. Study Type: Observational Contact(s): Maryland; National Institute on Deafness and Other Communication Disorders (NIDCD), 9000 Rockville Pike, Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222
[email protected]; TTY 1-866411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00001957;jsessionid=3AA76 C3EE990A3B2C22C7A1BDDF0EE7B
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Benefits and Risks17 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for traumatic brain injury. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
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If the treatment is effective, then it may improve health or prevent diseases or disorders.
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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
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People who take part in trials contribute to scientific discoveries that may help other people with traumatic brain injury. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient.
What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention. This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291.
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How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent. What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
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Know how the researchers plan to carry out the study, for how long, and where.
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Know what is expected of you.
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Know any costs involved for you or your insurance provider.
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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
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Talk openly with doctors and ask any questions.
After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
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Receive any new information about the new treatment.
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Continue to ask questions and get answers.
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Maintain your privacy. Your name will not appear in any reports based on the study.
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Know whether you participated in the treatment group or the control group (once the study has been completed).
What about Costs? In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Questions Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
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What are the standard treatments for traumatic brain injury? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
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How long will the treatment last? How often will I have to come back for follow-up exams?
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What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
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How will my health be monitored?
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Where will I need to go for the clinical trial? How will I get there?
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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
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Will I be able to see my own doctor? Who will be in charge of my care?
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Will taking part in the study affect my daily life? Do I have time to participate?
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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “traumatic brain injury” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinica l_Trials
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General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
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The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
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Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
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Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: ACTH: Adrenocorticotropic hormone. [EU] Auditory: Pertaining to the sense of hearing. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Methylphenidate: A central nervous system stimulant used most commonly in the treatment of attention-deficit disorders in children and for narcolepsy. Its mechanisms appear to be similar to those of dextroamphetamine. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Schizophrenia: A severe emotional disorder of psychotic depth characteristically marked by a retreat from reality with delusion formation, hallucinations, emotional disharmony, and regressive behavior. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU]
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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on traumatic brain injury. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on traumatic brain injury. In Part II, as in Part I, our objective is not to interpret the latest advances on traumatic brain injury or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with traumatic brain injury is suggested.
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CHAPTER 4. STUDIES ON TRAUMATIC BRAIN INJURY Overview Every year, academic studies are published on traumatic brain injury or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on traumatic brain injury. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on traumatic brain injury and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and traumatic brain injury, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer,
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and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “traumatic brain injury” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Social-Environmental Approach to Communication and Behavior after Traumatic Brain Injury Source: Seminars in Speech and Language. 14(1): 76-87. February 1993. Summary: This article describes the rationale for a social-environmental approach to communication and behavior rehabilitation after severe brain injury. The authors present a perspective that involves a blending of speech-language pathology and behavioral psychology services in a holistic and contextual approach to the interaction of communicative and behavioral challenges. The authors stress the importance of everyday people as primary agents of change and recovery. Training procedures, which have been found useful in creating a positive communication culture for rehabilitation, are outlined. Procedures described include inservice training, coaching, and peer training. 1 figures. 3 tables. 42 references. (AA-M).
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Intensive Voice Treatment and Respiration Treatment for HypokineticSpastic Dysarthria After Traumatic Brain Injury Source: American Journal of Speech-Language Pathology. 10(1): 51-64. February 2001. Contact: Available from American Speech-Language-Hearing Association (ASHA). Subscription Sales Coordinator, 10801 Rockville Pike, Rockville, MD 20852-3279. (888) 498-6699. Fax (301) 897-7358. Website: www.asha.org. Summary: This article reports on a study in which the short term efficacy of the Lee Silverman Voice Treatment (LSVT) and the short and long term efficacy of LSVT exercises combined with respiration treatment and physical therapy (Combination Treatment) were examined in a young man. The patient was diagnosed with mixed hypokinetic spastic dysarthria (a motor speech impairment) 20 months after sustaining a traumatic brain injury (TBI). The efficacy of the LSVT, an intensive 4 week program that focuses on increased vocal effort, is well documented
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for idiopathic Parkinson's disease. The authors note that their account is the first known published use of LSVT with TBI. Breathing and speech function were assessed by spirometry, respiratory kinematics, intelligibility, and other selected acoustic and auditory perceptual measures. Improvements generally were minor and inconsistent after LSVT, although sound pressure level (SPL) and loudness increased notably. After an additional 6 weeks of intensive Combination Treatment, the patient demonstrated gains for resting and speech breathing. In addition, SPL increased further and sentence intelligibility improved substantially. The gains were maintained to varying degrees after 10 weekly sessions of Combination Treatment. Although several measures returned to baseline 3 months after treatment ceased, some improvements in resting and speech breathing remained. Most importantly, improvements in vocal SPL and sentence intelligibility persisted in this patient. On the basis of these results, Combination Treatment, including LSVT, respiration treatment, and physical therapy, is recommended for individuals with mixed hypokinetic spastic dysarthria and upper body hypertonicity regardless of etiology (cause). 3 figures. 4 tables. 26 references. ·
Acoustic Characteristics of Voice After Severe Traumatic Brain Injury Source: Laryngoscope. 110(7): 1157-1161. July 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Summary: This article reports on a study undertaken to describe the acoustic characteristics of voice in individuals with motor speech disorders after traumatic brain injury (TBI). The prospective study of 100 individuals with TBI was based on consecutive referrals for motor speech evaluations. Subjects were audiotape recorded while producing sustained vowels and single word and sentence intelligibility tests. Laryngeal airway resistance was estimated, and voice quality was rated perceptually. Results indicated that none of the subjects showed vocal parameters within normal limits. The most frequently occurring abnormal parameter across subjects was amplitude perturbation, followed by voice turbulence index. Twenty three percent of subjects evidenced deviation in all five parameters measured. The perceptual ratings of breathiness were significantly correlated with both the amplitude perturbation quotient and the noise to harmonics ratio. The author concludes that vocal quality deviation is common in motor speech disorders after TBI and may affect intelligibility. 2 figures. 26 references.
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Prevalence of Speaking and Hearing Disabilities Among Adults with Traumatic Brain Injury from a National Household Survey Source: Brain Injury. 11(2): 103-114. February 1997. Contact: Available from Taylor and Francis Inc. 1900 Frost Road, Suite 101, Bristol, PA 19007. Website: www.tandf.co.uk. Summary: This article reports on a study undertaken to provide prevalence estimates of the sociodemographic characteristics and extent of speaking and hearing disabilities among a community based sample of adults (15 years and older) who have survived traumatic brain injury (TBI). The research is based on the Canadian Health and Activity Limitation Survey (1986 to 1987), a national household survey of self reported disabilities. Results indicate that adults with TBI with speaking or hearing disabilities tend to be male, middle aged or older, urban dwellers, of relatively low income levels, who are limited at work. Over 75 percent of adults with speaking difficulties report difficulty being understood by people outside their immediate family context. Hearing difficulties rise dramatically from 75 percent occurring with one communication partner, to over 96 percent occurring with three partners. The mean duration of disabilities is 12.7 years for speaking and 13.5 years for hearing. More than 80 percent of adults with communicative difficulties have co-occurring disabilities of mobility and agility. The authors discuss the implications of the results for the functional assessment of adults with TBI and service delivery decision making. 4 tables. 20 references.
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Treatment Efficacy: Cognitive-Communicative Disorders Resulting from Traumatic Brain Injury in Adults Source: Journal of Speech and Hearing Research (JSHR). 39(5): S5-S17. October 1996. Summary: This article contends that there is both scientific and clinical evidence that individuals with cognitive-communicative disorders resulting from traumatic brain injury (TBI) benefit from the services of speech-language pathologists. Cognitive-communication impairments are the result of deficits in linguistic and nonlinguistic cognitive functions. The role of the speech-language pathologist includes assessment of all aspects of communication, as well as the communicative implications of cognitive deficits, and swallowing. Speech-language pathologists also provide treatment planning and programming, as determined by the individual's stage of recovery; client and family training and counseling; and interdisciplinary consultation. The author illustrates the effectiveness of speech and language intervention by
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scientific and clinical evidence from group-treatment and single-subject studies as well as case studies. 5 tables. 92 references. (AA-M). ·
Traumatic Brain Injury in Adolescence: Assessment and Reintegration Source: Seminars in Speech and Language. 16(1): 32-45. February 1995. Summary: For many educators and school-based clinicians, traumatic brain injury (TBI) is a new and possibly confusing disability category. In this article, the authors explain the usefulness of this category and outline several major themes in communication-related assessment and intervention associated with this population. The authors emphasize the cognitive, behavioral, and psychosocial dimensions of disability because they often dominate the outcome picture after TBI, especially for adolescents, and because they are easily misinterpreted. The discussion of intervention themes is directed primarily at the important goal of successfully including students with TBI in their community schools despite possibly significant cognitive and psychosocial challenges. The authors also emphasize the importance of an interdisciplinary approach as the best way to deliver services to this population. 2 tables. 74 references. (AA-M).
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Educational Considerations in Traumatic Brain Injury: The Role of the Speech-Language Pathologist Source: Language, Speech, and Hearing Services in Schools. Volume 24: 67-75. April 1993. Summary: This article describes the role of speech-language pathologists in service provision to children and youth with traumatic brain injury (TBI). The author notes that the speech pathologist's role in educational settings has become blurred with that of numerous disciplines. The author considers the federal legislation, PL 101-476 (IDEA), which designates a separate educational disability category for brain injury. The author discusses associated variables in TBI, including severity and outcome, cognitive defects, speech and language profiles, assessment, and diagnostic treatment. The article concludes with a section considering the use of the speech language pathologist as the case manager for these children. The professional preparation of the speech language pathologist provides a sound foundation for working with the cognitive, linguistic, and motor speech problems that result from neurological insult following TBI and that can affect educational reintegration. In addition, case management requires knowledge of relevant resources and awareness of medical and educational policies and legislature mandates. 2 tables. 54 references. (AA-M).
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'Potential' Contributions of Cognitive Behavior Modification to the Rehabilitation of Individuals with Traumatic Brain Injury Source: Seminars in Speech and Language. 14(1): 18-31. 1993. Summary: This article, directed toward health professionals, describes cognitive behavior modification (CBM) and its potential application for people having traumatic brain injury. The article provides information on self-instructional training, stress inoculation training, and cognitive restructuring procedures. It presents a therapeutic framework and basis for further dialogue between CBM theorists and practitioners, including speech-language pathologists involved in client rehabilitation. References are included.
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Traumatic Brain Injury and Severe Expressive Communication Impairment: The Role of Augmentative Communication Source: Seminars in Speech and Language. 14(1): 61-73. February 1993. Summary: This article provides information on the use of augmentative and alternative communication (AAC) in treating individuals with traumatic brain injury (TBI) and resulting severe expressive communication disorders. The author presents information on a cognitive framework for assessment and intervention, phases of recovery following TBI, application of augmentative communication across phases of recovery, the use of multiple techniques, interdisciplinary involvement, partner advocacy and involvement, and short-and longterm intervention goals. The author uses case examples to illustrate the concepts presented. The author concludes that, whether the challenge is to establish basic communication or to determine how sophisticated communication technology might improve an individual's chances for educational or vocational re-entry, it is clear that augmentative communication has a central place in the rehabilitation of many individuals with TBI. 4 tables. 18 references. (AA-M).
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Communication Outcome Following Traumatic Brain Injury Source: Seminars in Speech and Language. 13(4): 239-251. November 1992. Summary: This article summarizes the communication disorders associated with traumatic brain injury (TBI). Topics covered include aphasic language disorders; non-aphasic language disorders; prefrontal injury; executive system dysfunction and communication; cognitive factors including attention, awareness, perception, memory, learning, organization, and social cognition; and motor speech outcome. The author stresses that an understanding of the interesting features of
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prefrontal injury yields profound insights for the valid assessment and treatment of individuals with TBI. 1 figure. 63 references. ·
Neurophysiologic and Neuroradiologic Features of Intractable Epilepsy After Traumatic Brain Injury in Adults Source: Archives of Neurology. 57(11):1611-1616, November 2000. Summary: To determine the frequency of mesial temporal lobe as opposed to neocortical epilepsy in patients with intractable epilepsy resulting from traumatic brain injury (TBI) after the age of 10 years, researchers studied a group of 23 patients by simultaneous videotape and scalp electroencephalographic recording of typical seizures; magnetic resonance imaging; neuropsychologic studies and, when appropriate, intracarotid amobarbital testing. Two patients underwent anterior temporal lobectomies. Eight patients (35 percent) had mesial temporal lobe epilepsy, based on the finding of (1) hippocampal sclerosis on a magnetic resonance imaging scan, (2) consistent interictal and ictal electroencephalographic recordings, (3) evidence of temporal lobe dysfunction on neuropsychologic testing, and (4) characteristic seizure semiology. Two of these patients underwent anterior temporal lobectomies with clinical benefit, and hippocampal sclerosis was confirmed pathologically. Two patients were not treated surgically because of bilateral temporal lobe dysfunction noted on intracarotid amobarbital testing. Eleven patients had neocortical epilepsy. One had primary generalized epilepsy. In three the site of seizure onset was not localized. The researchers conclude that mesial temporal lobe epilepsy can result from TBI in adolescents and adults as well as in children, and can often be bilateral and associated with multifocal injury. This information may be useful in developing prophylactic therapy for posttraumatic epilepsy. 3 tables, 35 references.
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Risks of Epilepsy After Traumatic Brain Injury Source: Seizure. 9(7):453-457, October 2000. Summary: Researchers investigated the incidence of traumatic brain injury (TBI) and identified characteristics of brain injuries that relate to the development of seizures. The study involved identifying 5,984 episodes of TBI (that included loss of consciousness, posttraumatic amnesia, or skull fracture) in one Minnesota county between the years 1935 and 1984. Seizures after TBI were obtained through medical records. Of those 5,984 cases, 4,541 were followed for seizures. The cohort was followed from the date of recovery from the TBI to the occurrence of a subsequent unprovoked seizure, a subsequent TBI, death, intracranial surgery, migration from the area, or to the end of the study period (1995).
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Researchers classified injuries as mild (loss of consciousness or amnesia less than 10 minutes), moderate (loss of consciousness 30 minutes to 1 day or a skull fracture), or severe (loss of consciousness of more than 1 day, subdural hematoma, or brain contusion). Results indicated that the incidence of TBI from 1975 to 1984 peaked at 800 per 100,000 in males age 15 to 24 years. The relative risk of seizures was 1.5 after mild injuries, with no increase after 5 years; 2.9 after moderate injuries; and 17.2 after severe injuries. Among those with severe TBI, the risk of seizures was elevated during the first year of followup and remained significantly elevated throughout followup. Significant risk factors included brain contusion with subdural hematoma, loss of consciousness or amnesia of 1 day or more, skull fracture, and age over 65 years. The researchers conclude that TBI is a significant public health problem that contributes to the occurrence of seizures and epilepsy. 2 figures, 4 tables, 10 references. ·
Supporting Families After Head Injury: Implications for the SpeechLanguage Pathologist Source: Seminars in Speech and Language. 14(1): 44-60. February 1993. Summary: People with brain injury face many paradoxical forces that can interfere with community life and are subject to expectations that are not compatible with the reality of living with a brain injury. This article examines how speech-language pathologists can help people live with traumatic brain injury (TBI). The author describes how the community responds to people with TBI, presents competing models for understanding disability, and discusses how best to understand TBI within these models. Models covered include the developmental disabilities model, the medical model, and the independent living model. The author also discusses family systems and how family members assimilate the experience of brain injury in their lives. The author urges speech language clinicians to support families from the perspective of family strengths rather than that of a dysfunctional family, and has advocated community-based support and services rather than institutional care. When a member of a family becomes brain injured, any sense of control and predictability is gone. For families to regain the mastery and predictability they need, a strong social support network is required. 32 references. (AA-M).
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Dental Hygiene Treatment for a Traumatic Brain Injury Patient Source: Journal of Practical Hygiene. 10(1): 27-31. January-February 2001. Contact: Available from Montage Media Corporation. 1000 Wyckoff Avenue, Mahwah, NJ 07430-3164. (201) 891-3200.
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Summary: A traumatic brain injury (TBI) can be either a closed head injury or a penetration injury. This article discusses closed head trauma and the possible emotional side effects and potential cognitive effects. Although the effects of a TBI can be varied in their type and severity, the authors emphasize the importance of dental hygienists understanding the potential influence of a TBI on a patient's emotional and physical well being. In addition, the authors review the literature that addresses the dental hygiene practices needed to improve or maintain the oral and overall health of traumatic brain injury patients. The authors present a case report to demonstrate the dental hygiene management of a patient who experienced a traumatic brain injury due to an automobile accident. One way the clinician can aid a patient with memory loss is through the use of a laminated chart that should show pictures of brushing, flossing, and use of the recommended oral rinse. Diet therapy can also be helpful, especially to counter the effects of medications on dry mouth (xerostomia). The authors also consider the importance of including the patient's caregiver when providing care or instructions to the patient. The dental hygienist should address the patient first and then repeat the instructions for the caregiver. TBI patients need additional time to develop responses to questions and stimuli, and require patience and understanding from health care professionals. 5 figures. 21 references.
Federally Funded Research on Traumatic Brain Injury The U.S. Government supports a variety of research studies relating to traumatic brain injury and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.18 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit CRISP at http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen. You can perform targeted searches by various criteria including geography, date, as well as topics related to traumatic brain injury and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, 18 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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many federally funded studies use animals or simulated models to explore traumatic brain injury and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for traumatic brain injury: ·
Project Title: ACUTE ASTROCYTE TRAUMATIC BRAIN INJURY
PATHOLOGY
AFTER
Principal Investigator & Institution: Lyeth, Bruce G.; Professor; Neurological Surgery; University of California Davis 1 Shields Ave Davis, Ca 95616 Timing: Fiscal Year 2003; Project Start 1-DEC-2002; Project End 0-NOV2006 Summary: (provided by applicant): The long-term objective of this research is to examine mechanisms of acute astrocyte damage and death following traumatic brain injury and to develop treatment strategies for attenuating these injury mechanisms. We address anatomical and functional consequences of traumatic brain injury using neuroanatomical, neuroimaging, and behavioral techniques with the goal of understanding the pathological mechanism and developing therapeutic strategies. Traumatic brain injury is a significant health problem that results in more than 230,000 hospitalizations and 50,000 deaths per year in the USA. Survivors of TBI are often left with long-term disability. Astrocytes are the most numerous type of gila cells and provide many important functions to support neurons including exchange of metabolic and nutritional material, clearance of neurotransmitters, and maintenance of ion concentrations in the vicinity of neurons. Astrocyte function is likely to have great importance after traumatic brain injury when extracellular glutamate and potassium concentrations are elevated. Severe damage to astrocytes occurs within hours after traumatic brain injury in brain regions that later exhibit significant neuronal cell degeneration and loss. We hypothesize that the early damage to astrocytes is due, in part, to large increases in intracellular sodium that enter astrocytes through sodium-dependent glutamate transporters and by activation of the type 1 sodium proton exchanger. The resulting increased intracellular sodium promotes reversal of the astrocyte sodium-calcium exchanger creating an excess of intracellular calcium that ultimately leads to astrocyte death. We will test and refine these hypotheses using established cell culture injury models. We will subject cells to traumatic injury and manipulate various sodium and calcium transporters while measuring intracellular ion concentrations and cell viability. This information will be used to
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explore novel pharmacological manipulations targeted at these sodium and calcium injury mechanisms. In these in vivo therapeutic studies we will measure astrocyte and neuronal viability using anatomical markers, measure brain edema using magnetic resonance imaging, and measure functional outcome using behavioral measures of sensorimotor function and learning and memory following traumatic brain injury in the rat. Website: http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen ·
Project Title: DELAYED CELL DEATH FOLLOWING TRAUMATIC BRAIN INJURY Principal Investigator & Institution: Lee, Stefan M.; ; Harbor-Ucla Research & Educ Inst at Harbor-Ucla Medical Center Torrance, Ca 90502 Timing: Fiscal Year 2001; Project Start 1-DEC-1998; Project End 0-NOV2002 Summary: In the intact central nervous system, cellular energy production is an efficient process which balances energy demands by matching fuel consumption and delivery. This tight relationship between energy production and cerebral blood flow is necessitated by the high metabolic demands of the brain. From our previous work, it is apparent that experimental traumatic brain injury produces a breakdown of this critical balance resulting in a pathologic imbalance between glucose metabolism, oxygen consumption and cerebral blood flow. Specifically, the acute metabolic response to neural injury is characterized by an immediate increase in glucose metabolism and a reduced oxidative capacity for glucose metabolism. Paradoxically, this marked increase in glucose metabolism following traumatic brain injury is accompanied by a persistent decrease in cerebral blood flow. The proposed studies reconcile these provocative findings and provide support for the hypothesis that the uncoupling between metabolism and blood flow profoundly affects the long-term viability of injured neurons and determines the eventual outcome after he ad injury. Thus, we hypothesize that experimental traumatic brain injury induces a state in which: i) glucose metabolism increases dramatically for the first several hours in an attempt to reestablish neuronal homeostasis, and ii) insufficient amount of energy (ATP) is produced by damaged neurons to meet this increased energy demand due to a compromised cellular metabolic machinery and dysfunctional neurovascular system. The specific aims of this project are: i) to determine whether injury- induced uncoupling of glucose metabolism and cerebral blood flow results in delayed cell death, ii) to determine the physiological cause for this uncoupling, and iii) to determine the cellular mechanism by which injured neurons undergo delayed cell death following traumatic brain injury. In order to
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implement these specific aims, we will utilize state of the art techniques including double-label autoradiography, video image of neurovascular changes, long-term electrophysiological recordings using chronicallyimplanted microelectrodes, chronic microdialysis of neurochemical and ionic changes, and quantitative morphometrics. The completion of these studies will provide new and much needed insights into the mechanisms by which cortical contusions evolve into wide-spread lesions, and the ways we can alter or reverse the pathophysiologic response in order to improve functional outcome following head injury. Website: http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen ·
Project Title: EPIDEMIOLOGY OF TRAUMATIC BRAIN INJURY Principal Investigator & Institution: Bazarian, Jeffrey J.; Emergency Medicine; University of Rochester Rochester, Ny 14627 Timing: Fiscal Year 2001; Project Start 4-SEP-2001; Project End 1-AUG2006 Summary: (provided by applicant): A Mentored PatientOriented Research Career Development Award (K23) is proposed. The overall goal of this proposal is to give the candidate a rigorous training in research methods, such that the proposed project can be successfully completed and an independent research career be launched. The complexity and scope of the proposed project, as well as the applicant's career goals, necessitate the acquisition of sophisticated research skills. The applicant's immediate career objectives are to better understand the principles and methods of clinical research, and to apply them in an effort to set up a traumatic brain injury (TBI) surveillance system. The applicant's longterm career goals are to have established a method of TBI surveillance that can be used as a model for Monroe County, NY and the nation and better defined the epidemiology and outcome from minor TBI. A 5year, highly structured and mentored training plan is proposed. During the first 2 years, formal training leading to a degree in Masters of Public Health in Clinical Investigation at the University of Rochester Medical Center (URMC) will be undertaken. Areas to be covered include research theory, methods and ethics, with special emphasis on injury surveillance methodology. The mentor will provide instruction and guidance in the practical application of these skills, while the proposed research project is begun. During the following 3 years, the research project will be more carefully developed and implemented, data collected and proposed hypotheses tested, all under the careful guidance of the mentor. The proposed research plan, entitled "Epidemiology of Traumatic Brain Injury," is a prospective observational cohort study of all patients presenting to the Emergency Department (ED) of the URMC
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meeting the CDC-defined case definition of TBI. Detailed demographic and epidemiologic data, including mechanism and geographic location of injury, will be collected before exiting the ED. Outcome data will be collected via structured telephone interview on the subgroup of TBI patients who meet the study definition of minor TBI. This will permit the testing of several hypotheses related to the epidemiology and outcome from minor TBI, the determination of the most complete method of surveillance datacollection in an ED setting, and the estimation of the economic impact of minor TBI on Monroe County, NY. Website: http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen ·
Project Title: INCREASED VASCULAR TRAUMATIC BRAIN INJURY
RESISTANCE
AFTER
Principal Investigator & Institution: Bryan, Robert M.; Professor and Director of Research; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2001 Summary: Traumatic brain injury decreases cerebral blood flow (CBF) in humans and other mammals. The magnitude of the decrease in CBF and the affected regions of the brain dependent on the type and severity of the injury. Not only can the decrease in CBF, if sufficiently severe, directly damage tissues, but the decrease may also make the brain more susceptible to secondary injury. The aim of this project is provide an in depth understanding of the mechanism responsible for the decrease in CBF. Once understood, strategies could be developed which restore CBF by interfering with the mechanism. Restoration of CBF to the pre-injury rate may reduce the susceptibility of the brain to secondary injury. In the first specific aim we will determine the site along the vascular tree where resistance increases following controlled cortical impact (CI) injury in the rat. Studies are proposed to calculate segmental vascular resistances in the cerebral circulation in sham-injured and CCI-injured rats. Segmental resistances will be calculated after measuring regional cerebral blood flow and microvascular pressure in pial arteries, arterioles, venules, and veins. To extend and complement the studies of segmental resistance, we will determine if the vascular resistance is increased after brain injury as a result of decreased capillary perfusion. In the second specific aim, we will determine if the increased vascular resistance after CCI injury is a result of increased vascular tone (or a state of hyperconstriction). We will employ both in vivo and in vitro studies of cerebral arteries and arterioles to determine where the increased tone occurs in the vascular tree. Additionally, we will determine if the increased tone after injury is a result of a reduction in nitric oxide production or dysfunction of
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potassium channels in the vascular smooth muscle. We and others have demonstrated that L-arginine restores CBF following traumatic brain injury. The purpose of the third specific aim is to better understand the mechanism of L-arginine effect in restoring CBF. We will determine if Larginine restores CBF by decreasing the vascular resistance at the site where it is increased after CCI injury. Finally, we will determine if Larginine restores tone (or contractile state) of the vascular smooth muscle. The specific aim complements and extends studies in the other two projects of this Program Project proposal. We believe that the specific aims in Project 2 of this grant proposal can be successfully accomplished with the techniques and expertise in our group. We further believe that information obtained will be a major step in understanding the pathophysiology of circulatory control after traumatic brain injury. Website: http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen ·
Project Title: PROGESTERONE TRAUMATIC BRAIN INJURY
TREATMENT
OF
BLUNT
Principal Investigator & Institution: Kellermann, Arthur L.; Medicine; Emory University 1380 S Oxford Rd Atlanta, Ga 30322 Timing: Fiscal Year 2001; Project Start 1-AUG-2001; Project End 1-JUL2004 Summary: Traumatic brain injury (TBI) is a major cause of premature death and disability worldwide. Few effective treatments exist. Based on encouraging results from studies with animals, we hypothesize that early administration of progesterone to victims of moderate to severe TBI reduces secondary brain injury and improves neurological outcomes. Prior to proceeding with a full-scale clinical trial, we propose to conduct a pilot study by identifying and recruiting eligible subjects at a single level I trauma center. Consenting subjects will be randomly assigned to receive either IV infusion of progesterone or an equivalent volume of placebo. The study team, which will be blinded to treatment status, will monitor each subject's clinical progress and assess outcome at one month post-injury. The primary objectives of this pilot study are to: 1) achieve proper dosing of the study drug, 2) gather data on drug safety, and 3) generate preliminary evidence of efficacy. The secondary objective is to identify the most appropriate clinical subgroup(s) for subsequent treatment in a multi-center trial. To identify the correct dosage and infusion rate to achieve a steady state serum progesterone concentration (SSSPC) level of 450 nmole/L + 100 in our subjects, we will statistically examine the SSSPCs of the first ten subjects randomized to progesterone. To test the safety of the progesterone infusion, we will monitor patients for several unlikely, but potential complications of progesterone
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administration. To assess the potential efficacy of the progesterone for TBI, we will compare treatment groups with respect to duration of coma, death at one month post-injury, and most important, neurological outcome at one month post-injury. Three measures of neurological outcome will be used: the Glasgow Outcome Score, the Disability Rating Scale, and the Galveston Orientation and Amnesia Test. Once these objectives are accomplished, we will apply the lessons learned in this pilot study to mount a multi-center, randomized, double blind, placebocontrolled clinical trial of intravenous progesterone for treatment of traumatic brain injury. If the therapeutic benefits observed in animals are replicated in humans, administration of intravenous progesterone should produce several benefits, including: a) decreased duration of coma; b) decreased mortality; and c) improved neurological function. If these hypotheses are verified, this it will represent a major advance in the treatment of traumatic brain injury. Website: http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen ·
Project Title: TRAUMATIC BRAIN INJURY AND MARROW STROMAL CELLS Principal Investigator & Institution: Mahmood, Asim; Neurosurgery; Case Western Reserve Univ-Henry Ford Hsc Henry Ford Health Science Ctr Detroit, Mi 48202 Timing: Fiscal Year 2002; Project Start 1-MAR-2002; Project End 8-FEB2006 Summary: (Verbatim from applicant's abstract) This project is designed to investigate the effects of intravenous transplantation of bone marrow stromal cells on the rat brain after traumatic brain injury. Traumatic brain injury continues to be an important cause of human morbidity and as many as 50,000 Americans are killed and an equal number are disabled by head trauma each year. Currently, we have no therapeutic intervention to repair the biostructural neuronal damage and treatment consists of evacuating mass lesions and providing an optimal milieu for the brain to recover. In this application, we will transplant marrow stromal cells intravenously in the adult female Wistar rat after head injury with the intention of improving brain function. Adult female Wistar rats will be injured using the controlled cortical impact model of head trauma. After injury, bone marrow stromal cells harvested from the tibia and femur of normal male adult rats will be injected into the tail vein of the female rat. The marrow stromal cells will be identified by Y chromosomes. Following transplantation, the animals will be sacrificed at different time points and brain sections will be stained for immunohistochemistry to examine for proliferation of the marrow
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stromal cells and the phenotypes of newly generated cells. Using immunohistochemistry and enzyme-linked immunosorbent assay (ELISA), the expression of neurotrophic factors following marrow stromal cell transplantation will also be studied. The safety of marrow stromal cell treatment of traumatic brain injury will be evaluated and a battery of functional outcome measurements will be performed to test for enhanced recovery resulting from treatment. If intravenous transplantation of marrow stromal cells succeeds in improving functional outcome, a new avenue will be opened for further development of therapeutic interventions to improve outcome of traumatic brain injury. Website: http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen ·
Project Title: CASPASE MEDIATED NEURONAL DEATH AFTER HEAD INJURY Principal Investigator & Institution: Clark, Robert S.; Associate Professor; Anestheslgy/Critical Care Med; University of Pittsburgh at Pittsburgh 4200 5Th Ave Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 1-FEB-1999; Project End 1-JAN2003 Summary: Caspase activation is the first committed step in the programmed-cell death cascade, a tightly regulated sequence of cellular and molecular events that systematically leads to the death of a cell. Increasing evidence suggests that activation of caspases produces secondary neuronal death after traumatic brain injury in experimental models. Importantly, pharmacologic and molecular inhibitors of the caspases attenuate programmed cell-death after cerebral ischemia and traumatic brain injury in rodents, although reports are limited. Our hypothesis is that activation of caspases after traumatic brain injury contributes to neuronal death and that inhibiting induction and/or activity of caspases reduces secondary neuropathologic injury after traumatic brain injury. Specific aims to address this hypothesis will: 1) characterize the temporal, regional, cellular, and subcellular expression and activity of Caspase-3 using a rat model that mimics severe human traumatic brain injury, 2) examine the upstream regulation the upstream regulation of caspases by cytosolic cytochrome c and nitric oxide after severe traumatic brain injury in rats and mice, 3) test the effects of several pharmacologic caspase inhibitors on neuropathologic and functional outcome after severe traumatic brain injury in rats, 4) examine the expression of other caspases (Caspases-2 and -9) after severe traumatic brain injury in rats, and 5) examine the expression of currently identified caspase (Caspases -2 -9) after severe traumatic brain injury in rats, and 5) examine the expression of currently identified caspases (Caspases 1-10)
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after severe traumatic brain injury in humans. Traumatic brain injury is a major cause of mortality and morbidity in adults and children in the United States. Secondary brain injury contributes to mortality and morbidity in adults and children in the United States. Secondary rain injury contributes to mortality and morbidity and currently only few, non-specific therapies are available. Caspase-mediated programmed-cell death may contribute to secondary neuronal death after traumatic brain injury in experimental models and in humans as well. Pharmacologic treatment strategies aimed at reducing caspase induction and/or activation to subsequently reduce secondary neuronal death will be tested in models of traumatic brain injury in vivo. If caspase inhibitors reduce programmed-cell death and improve neurologic outcome after severe traumatic brain injury in vivo, a novel, clinically relevant treatment strategy for victims of severe head injury will be available. Website: http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen ·
Project Title: CONTROLLED DEPRESSION AFTER TBI
TRIAL
OF
SERTRALINE
FOR
Principal Investigator & Institution: Bombardier, Charles H.; Rehabilitation Medicine; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 0-SEP-2000; Project End 1-MAY2005 Summary: Persons with traumatic brain injury (TBI) experience high rates of depression, especially during the first six months following their injuries. Neurological and psychosocial factors appear to contribute to depression in this population. Depression following TBI is associated with poor cognitive, behavioral, and functional outcomes. Preliminary studies suggest that people with TBI and major depression may not respond to antidepressant treatment in the same way as depressed persons without TBI, post TBI depression may respond well to selective serotonin reuptake inhibitor (SSRI) antidepressants, that and effective antidepressant treatment is associated with improvements in health status, neuropsychological function, and post-concussive symptoms. No large randomized placebo-controlled studies have been conducted and basic questions remain about the treatment and outcomes of major depression among persons with traumatic injury. As a consequence, depression is not usually assessed after traumatic brain injury, and optimal rehabilitation guidelines for identifying and treating depression have not been established. To address this gap, the proposed study would follow a large consecutive sample of persons hospitalized for moderate to severe TBI to identify those who develop major depression. With those who develop major depression, a 12-week, randomized,
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double-blind, controlled trial of sertraline would be conducted. The trial would test the hypothesis that sertraline reduces depression related symptoms, as measured by the Hamilton Rating Scale for Depression. Secondary hypotheses to be tested include whether sertraline leads to greater improvement in neuropsychological test performance, postconcussive symptoms and self-reported health status as measured by the SF 36. Website: http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen ·
Project Title: COOPERATIVE TRIALS NETWORK
MULTICENTER
TBI
CLINICAL
Principal Investigator & Institution: Temkin, Nancy R.; Associate Professor; Neurological Surgery; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2002; Project Start 5-SEP-2002; Project End 0-JUN2007 Summary: (provided by applicant): Traumatic brain injuries represent an important health problem: they occur with high frequency, the population affected contains many previously healthy young people, and they are associated with high mortality and morbidity. This proposal is to become one of up to 8 sites in a Traumatic Brain Injury Clinical Trials Network that will collect longitudinal data on people with traumatic brain injury and conduct (with separate funding) multi-center clinical trials of interventions to improve the treatment and outcome of people who sustain a traumatic brain injury. The aims of the application are to achieve the goals of the Traumatic Brain Injury Network by collaborating with other Network sites and with NICHD staff to recruit patients into Network studies, by evaluating and treating patients according to Network protocols, by proposing and suggesting modifications to clinical intervention protocols, and by proposing and suggesting modifications to outcome measures. The proposal summarizes the abilities of the University of Washington to contribute to the Network and proposes a concept protocol that the Network might consider for one of the multicenter trials. Using a randomized. double-blind design, the concept protocol evaluates magnesium sulfate as a neuroprotectant and antiepileptogenic agent following head injury. Magnesium sulfate is a widely used, well-tolerated compound that has been shown in the laboratory to be effective in reducing seizures and also in limiting neuronal damage and in improving functional outcome following experimental head injury. Specifically, the study will test the hypothesis that magnesium sulfate, when given within 8 hours of a moderate or severe head injury, (a) increases survival, (b) decreases seizures, and (c) improves
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neurobehavioral functioning. Additionally, the study will assess the effects of timing of dosage (e.g. <4 hours vs. 4-8 hours), gender, and race, and determine the rate of adverse events. Website: http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen ·
Project Title: EFFECTS OF O2 RADICALS AND PERIVASCULAR NERVES IN TRAUMA Principal Investigator & Institution: Dewitt, Douglas S.; Professor and Director; Anesthesiology; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2001; Project Start 1-DEC-1986; Project End 1-JAN2004 Summary: (Verbatim from the Applicant's Abstract) Traumatic brain injury (TBI) increases cerebral vascular resistance, damages cerebral vascular endothelial cells and the blood brain barrier and reduces cerebral vasodilatory responses to hypotension, hypoxia and hemodilution. Our overall hypothesis is that traumatic brain injury increases superoxide anion radicals which react with increased NO to form OONO-, impairing the function of cerebral vascular smooth muscle and perivascular nerves. Aim 1 is to determine the association between NO, O2-, and CBF decreases after traumatic brain injury. NO, superoxide, and CBF will be measured in rats after moderate traumatic brain injury. Studies will be done to see if arginine supplementation restores CBF despite increases in O2- production. Immunohistochemical staining for nitrotyrosine will be used to determine if TBI and L-arginine treatment increases OONO- production. Aim 2 is to determine if traumatic brain injury reduces the activity of eNOS and/or increases the potentially damaging iNOS and nNOS isoforms, using arginine to citrulline conversion assays with specific inhibitors and mRNA expression studies. Aim 3 is to determine if traumatic brain injury affects the cerebral vascular responses to endothelium-dependent vasodilator ACh, activators of ATP-sensitive potassium channels like aprikalim, or reduced perfusion pressure, using arteries harvested following traumatic brain injury. Aim 4 is to determine the effects of TBI and OONOexposure on perivascular vasodilatory neurotransmitters CGRP, ACh, and anadamide. Website: http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen
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Project Title: NEUROTROPHIC FACTOR GENE THERAPY FOR BRAIN INJURY Principal Investigator & Institution: Kozlowski, Dorothy A.; Biological Sciences; De Paul University 1 E Jackson Blvd Chicago, Il 60604
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Timing: Fiscal Year 2002; Project Start 5-APR-2002; Project End 1-MAR2005 Summary: (provided by applicant): The main objective of this application is to begin to develop a new therapeutic approach for traumatic brain injury - neurotrophic factor gene therapy with adenoviral vectors. While great strides have been made in the management of traumatic brain injury, no treatments exist which prevent and minimize neuronal loss following brain injury, the main cause of long-term disabilities in headinjured patients. Animal studies have revealed many potential therapeutic agents for brain injury, however, these compounds are administered in a global manner, producing possible side effects detrimental to the maintenance of the trauma patient. Gene therapy is a way in which to chronically present these therapeutic agents to a specific area of the brain, using genetically engineered viruses, without major global side effects. In order to develop gene therapy for traumatic brain injury, two factors must be addressed: 1) the production of novel genes in injured brain tissue, induced by an adenoviral vector, must be demonstrated, measured, and optimized in the rat and 2) the neuroprotective ability of a therapeutic gene in an animal model of brain injury must be demonstrated. These are the focus of the specific aims of this proposal. They are: 1) to determine the optimal viral vector concentration that will provide the greatest number of infected brain cells with minimal amounts of neural toxicity when injected into the normal and injured cortex, 2) to examine the neuroprotective effects of virally mediated glial cell line-derived neurotrophic factor (GDNF) or brainderived neurotrophic factor (BDNF) expression in the cortex following a cortical contusion, and 3) to explore whether a virally mediated neurotrophic factor (either GDNF or BDNF) injected after a cortical contusion can rescue and protect neurons and behavioral function. In addition, this proposal will measure transgene expression in compromised cortical tissue. Together, these studies will develop a framework for further investigations of gene therapy for traumatic brain injury. Future questions will address the therapeutic windows of opportunity, long-term behavioral and cognitive function, and the optimization of new therapeutic genes and viral vectors for traumatic brain injury. In addition, these studies will provide a comprehensive research-training program for undergraduates in the fields of neurobiology, molecular biology, and animal behavior. Website: http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen
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Project Title: PROTEOLYTIC MECHANISMS OF BRAIN INJURY Principal Investigator & Institution: Hayes, Ronald L.; Professor and Director; Neuroscience; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2001; Project Start 5-SEP-2000; Project End 1-AUG2004 Summary: (Verbatim from the Applicant's Abstract) While caspase-3 has been widely implicated in apoptosis, rapid progress in understanding mechanisms of apoptotic cell death is difficult in in vivo models of traumatic brain injury (TBI). Traumatic brain injury is multifactorial, primarily including tissue deformation and secondary hypoxia and ischemia, all of which could result in release of excitotoxic levels of glutamate. We have developed a battery of in vitro systems to study separately three major pathological components of traumatic brain injury: (1) biomechanical stretch injury, (2) ischemia and/or hypoxia (oxygen and/or glucose deprivation)and (3) glutamate-induced excitotoxicity. Aim 1 will characterize caspase-3 and calpain activation in these in vitro models and examine the contribution of these two families of cysteine proteases to archetypal apoptotic and necrotic cell death phenotypes. Researchers have described at least two major apoptotic cell death pathways in mammals regulating cspase-3 activation: (1) a mitochondrial pathway requiring cspase-9 activation and (2) a receptor mediated signal transduction pathway principally involving tumor necrosis factor (TNF-a) and requiring caspase-8/10 activation. Both of these pathways could regulate caspase-3 activation. AIM 2 will examine the mitochondrial cell death pathway since this pathway is well characterized in non- neuronal systems, the requisite cellular machinery is present in neurons and data implicate a mitochondrial contribution to neuronal injury and apoptotic cell death. Aim 3 will examine TNF-a receptor coupled pathway since laboratory and clinical studies suggest that traumatic brain injury increases levels of TNF-a that could contribute to apoptotic neuronal death. Aim 4 will test the generality of in vitro mechanisms of cell death characterized in Aims 1-3 in a clinically relevant in vivo model of traumatic brain injury. Our general hypothesis is that caspase-3 activation by casepase-9 and/or caspase 8/10 is an important common mediator of apoptotic cell death following CNS injury. Calpain activation contributes primarily to necrosis and, to a lesser extent, apoptosis. Website: http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen
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Project Title: THE BRAIN PARENCHYMAL AND VASCULAR RESPONSE TO TRAUMA Principal Investigator & Institution: Povlishock, John T.; Professor and Chair; Anatomy and Neurobiology; Virginia Commonwealth University 901 W Franklin St Richmond, Va 23284 Timing: Fiscal Year 2001; Project Start 5-JUL-1986; Project End 0-JUN2006 Summary: (Adapted From The Abstract Provided By Applicant): This competitive application seeks continued support for graduate, M.D./Ph.D., and post-doctoral training in the clinical and laboratory investigation of traumatic brain injury and/or its sequelae. This training grant utilizes faculty expertise drawn from the Departments of Anatomy, Neurology, Pharmacology, Psychology and Neurosurgery. Each of the participating faculty has an extensive track record in studying either the direct neural vascular consequences of traumatic brain injury or some of its potential sequelae in terms of ischemia and/or epilepsy. The participating faculty use stateoftheart techniques to address issues relevant to the pathobiology of traumatic brain injury and its treatment. The current training grant requests support for 4 pre-doctoral and four post-doctoral students. It is anticipated that 50% of the pre-doctoral trainees will be enrolled in the M.D./Ph.D. track, while 50% of the postdoctoral trainees will possess the M.D. degree. Particular emphasis will be placed upon the recruitment of under-represented minority fellows utilizing a strong mechanism already in place at the Medical College of Virginia, Virginia Commonwealth University. It is anticipated that this training program will result in the production of M.D., M.D./Ph.D. and Ph.D. graduates exceptionally welltrained in multiple areas related to the study of traumatic brain injury. It is our longrange hope that such welltrained clinical and basic scientists will continue their research in this area and, thereby, contribute to an enhanced body of knowledge leading to better and more rational treatments of traumatic braininjured humans. Website: http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen
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Project Title: TRAUMA TO DEVELOPING BRAIN-OXIDATIVE EVENTS AND RECOVERY Principal Investigator & Institution: Noble, Linda J.; Professor and Vice Chair; Neurological Surgery; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2002; Project Start 1-DEC-2001; Project End 0-NOV2004
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Summary: (provided by applicant): Traumatic brain injury is the leading cause of disability in children and is often associated with significant cognitive and motor deficits. Recent studies indicate that traumatic brain injury impairs motor and cognitive function to a greater extent in children less that 4 years of age than in older children. One explanation for this increased vulnerability may be related to the timing of the injury, which occurs during the critical period of development, characterized by rapid growth of neural structures. Although there has been a considerable effort directed toward understanding the pathobiology of traumatic brain injury in the mature adult brain, little is known about the consequences of traumatic brain injury in the child, particularly during the critical period of development. We hypothesize that traumatic brain injury during the critical period of development causes neuronal injury and death within specific regions of the brain, resulting in persistent functional deficits. We further hypothesize that oxidative stress, resulting from production of H202 and inadequate scavenging systems, are important determinants of neuronal injury and behavioral deficits in the immature, traumatized brain. Three aims are proposed. In the first aim we will develop a model of acute cortical contusion injury in the immature (postnatal day 21) mouse. Neuronal cell loss and glial reactivity, quantitatively defined at the light microscopic level, will be evaluated in concert with assessments of cognitive and motor function up to 6 months post-injury. In the second aim, we will measure indicators of oxidative stress/injury in this model, including lipid peroxidation and glutathione levels, H202 production, and antioxidants. In the third aim we will determine if reducing oxidative stress will limit neuronal injury and promote cognitive and motor recovery. Regional neuronal vulnerability and motor and cognitive deficits will be evaluated. Oxidative stress will be reduced by transgenic overexpression of glutathione peroxidase or by treatment with the spin-trap antioxidant PBN. These studies reflect a collaboration between Dr. Linda Noble, who has expertise in experimental traumatic brain injury, Dr. Donna Ferriero , an expert on mechanisms of oxidative injury in neonatal hypoxiaischemia, and Dr. Jacob Raber, who has developed well defined, sensitive measures of cognitive and motor function in the mouse. This combined expertise offers a focused effort to better understand the vulnerability of the immature brain to traumatic injury and to develop the most optimal therapeutic approaches. Website: http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen
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Project Title: VASC MECHS OF SECONDARY INSULTS IN SEVERE BRAIN INJURY Principal Investigator & Institution: Robertson, Claudia S.; Professor; Neurology; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2001; Project Start 6-JUL-1999; Project End 0-JUN2004 Summary: The overall hypothesis of this proposal is that traumatic brain injury (TBI) causes a reduction in CBF in the early post-injury period that contributes to the brain damage by 2-mechanisms: 1-if the reduction in CBF is severe enough and lasts long enough, ischemic injury (primary ischemia; occurs 2- if the reduction is CBF is more modest, ischemic injury may not occur, but the brain is more susceptible to secondary insults (secondary ischemia). Global reductions in CBF severe enough to result in ischemic injury (CBF,18 ml/100g/min) occur with very severe injuries and this finding is associated with a high mortality rate. Regional reductions in CBF severe enough to result in ischemic injury (rCBF<18 ml/100g/min) occur more commonly and are typically found in areas of brain contusion and underlying evacuated extracerebral hematomas. Even more commonly, a moderate reduction in CBF which is compensated by increased cerebral oxygen extraction occurs during the first few hours after TBI. This program projects will approach the problem of vascular changes after traumatic brain injury with both clinical and laboratory studies. There are 3 projects and 3 cores in the program project. Project 1. Regulation of Cerebral Blood Flow after Traumatic Brain Injury. Project 2. Increased Vascular Resistance after Traumatic Brain Injury. Project 3. L-arginine Treatment of a Reduced CBF after Traumatic Brain Injury. Core A. Administrative Core Core B. Statistical and Modeling Core Core C. Analytical Lab Core Website: http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen
E-Journals: PubMed Central19 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).20 Access
19 Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 20 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age.
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to this growing archive of e-journals is free and unrestricted.21 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “traumatic brain injury” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for traumatic brain injury in the PubMed Central database: ·
A population-based study of potential brain injuries requiring emergency care. by Pickett W, Ardern C, Brison RJ.; 2001 Aug 7; http://www.pubmedcentral.gov/articlerender.fcgi?artid=81328
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Enhanced Expression of the Developmentally Regulated Extracellular Matrix Molecule Tenascin Following Adult Brain Injury. by Laywell ED, Dorries U, Bartsch U, Faissner A, Schachner M, Steindler DA.; 1992 Apr 1; http://www.pubmedcentral.gov/articlerender.fcgi?rendertype=abstract &artid=48716
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Erythropoietin crosses the blood --brain barrier to protect against experimental brain injury. by Brines ML, Ghezzi P, Keenan S, Agnello D, de Lanerolle NC, Cerami C, Itri LM, Cerami A.; 2000 Sep 12; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&arti d=27058
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Estrogen receptor [alpha], not [beta], is a critical link in estradiolmediated protection against brain injury. by Dubal DB, Zhu H, Yu J, Rau SW, Shughrue PJ, Merchenthaler I, Kindy MS, Wise PM.; 2001 Feb 13; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&arti d=29363
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.22 If the publisher has a Web site that The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 22 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web 21
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offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with traumatic brain injury, go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “traumatic brain injury” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “traumatic brain injury” (hyperlinks lead to article summaries): ·
A multidisciplinary community based rehabilitation programme improved social functioning in severe traumatic brain injury. Author(s): Dawson DR. Source: Evidence-Based Mental Health. 2002 August; 5(3): 84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12180451&dopt=Abstract
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A prospective study and review of pre-morbid characteristics in children with traumatic brain injury. Author(s): Demellweek C, Baldwin T, Appleton R, Al-Kharusi A. Source: Pediatric Rehabilitation. 2002 April-June; 5(2): 81-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12490051&dopt=Abstract
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A prospective study of short- and long-term neuropsychological outcomes after traumatic brain injury in children. Author(s): Yeates KO, Taylor HG, Wade SL, Drotar D, Stancin T, Minich N. Source: Neuropsychology. 2002 October; 16(4): 514-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12382990&dopt=Abstract
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A rapid screen of the severity of mild traumatic brain injury. Author(s): Comerford VE, Geffen GM, May C, Medland SE, Geffen LB. Source: J Clin Exp Neuropsychol. 2002 June; 24(4): 409-19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12187455&dopt=Abstract
sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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A review of the use of single-photon emission computerized tomography as a diagnostic tool in mild traumatic brain injury. Author(s): Davalos DB, Bennett TL. Source: Applied Neuropsychology. 2002; 9(2): 92-105. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12214827&dopt=Abstract
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Activity-related quality of life in rehabilitation and traumatic brain injury. Author(s): Johnston MV, Miklos CS. Source: Archives of Physical Medicine and Rehabilitation. 2002 December; 83(12 Suppl 2): S26-38. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12474169&dopt=Abstract
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Age does not influence DNA fragmentation in the hippocampus after fatal traumatic brain injury in young and aged humans compared with controls. Author(s): Fowler J, MacKinnon MA, Raghupathi R, Saatman KE, McIntosh TK, Graham DI. Source: Clin Neuropathol. 2002 July-August; 21(4): 156-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12143927&dopt=Abstract
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Anesthetic management of traumatic brain injury. Author(s): Bedell E, Prough DS. Source: Anesthesiology Clinics of North America. 2002 June; 20(2): 41739. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12166003&dopt=Abstract
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Apolipoprotein E4 influences amyloid deposition but not cell loss after traumatic brain injury in a mouse model of Alzheimer's disease. Author(s): Hartman RE, Laurer H, Longhi L, Bales KR, Paul SM, McIntosh TK, Holtzman DM. Source: The Journal of Neuroscience : the Official Journal of the Society for Neuroscience. 2002 December 1; 22(23): 10083-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12451108&dopt=Abstract
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Applicability of the 15-item versions of the Judgement of Line Orientation Test for individuals with traumatic brain injury. Author(s): Mount DL, Hogg J, Johnstone B. Source: Brain Injury : [bi]. 2002 December; 16(12): 1051-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12487719&dopt=Abstract
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Assessment of prognostic factors in severe traumatic brain injury patients treated by mild therapeutic cerebral hypothermia therapy. Author(s): Yamamoto T, Mori K, Maeda M. Source: Neurological Research. 2002 December; 24(8): 789-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12500702&dopt=Abstract
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Association between cerebrospinal fluid interleukin-6 concentrations and outcome after severe human traumatic brain injury. Author(s): Singhal A, Baker AJ, Hare GM, Reinders FX, Schlichter LC, Moulton RJ. Source: Journal of Neurotrauma. 2002 August; 19(8): 929-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12225653&dopt=Abstract
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Association of mild traumatic brain injury with bipolar disorder. Author(s): Sagduyu K. Source: The Journal of Clinical Psychiatry. 2002 July; 63(7): 594. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12143915&dopt=Abstract
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Axis I and II psychiatric disorders after traumatic brain injury: a 30year follow-up study. Author(s): Koponen S, Taiminen T, Portin R, Himanen L, Isoniemi H, Heinonen H, Hinkka S, Tenovuo O. Source: The American Journal of Psychiatry. 2002 August; 159(8): 1315-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12153823&dopt=Abstract
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Brain atrophy in mild or moderate traumatic brain injury: a longitudinal quantitative analysis. Author(s): MacKenzie JD, Siddiqi F, Babb JS, Bagley LJ, Mannon LJ, Sinson GP, Grossman RI.
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Source: Ajnr. American Journal of Neuroradiology. 2002 October; 23(9): 1509-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12372740&dopt=Abstract ·
Brief report: prevalence of post-traumatic stress disorder symptoms after severe traumatic brain injury in a representative community sample. Author(s): Williams WH, Evans JJ, Wilson BA, Needham P. Source: Brain Injury : [bi]. 2002 August; 16(8): 673-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12167192&dopt=Abstract
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Caregiver burden during the year following severe traumatic brain injury. Author(s): Marsh NV, Kersel DA, Havill JA, Sleigh JW. Source: J Clin Exp Neuropsychol. 2002 June; 24(4): 434-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12187457&dopt=Abstract
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Chronic stress, sense of belonging, and depression among survivors of traumatic brain injury. Author(s): Bay E, Hagerty BM, Williams RA, Kirsch N, Gillespie B. Source: Journal of Nursing Scholarship : an Official Publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau. 2002; 34(3): 221-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12237983&dopt=Abstract
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Clinical policy: neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. Author(s): Jagoda AS, Cantrill SV, Wears RL, Valadka A, Gallagher EJ, Gottesfeld SH, Pietrzak MP, Bolden J, Bruns JJ Jr, Zimmerman R. Source: Annals of Emergency Medicine. 2002 August; 40(2): 231-49. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12140504&dopt=Abstract
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Cognitive correlates of apathy in traumatic brain injury. Author(s): Andersson S, Bergedalen AM.
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Source: Neuropsychiatry, Neuropsychology, and Behavioral Neurology. 2002 September; 15(3): 184-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12218711&dopt=Abstract ·
Comparison of cognitive impairment associated with major depression following stroke versus traumatic brain injury. Author(s): Tateno A, Murata Y, Robinson RG. Source: Psychosomatics. 2002 July-August; 43(4): 295-301. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12189255&dopt=Abstract
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Comparison of MRI and electrophysiological studies for detecting brainstem lesions in traumatic brain injury. Author(s): Wedekind C, Hesselmann V, Klug N. Source: Muscle & Nerve. 2002 August; 26(2): 270-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12210392&dopt=Abstract
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Complications of mild traumatic brain injury. Assessing and treating post-concussion symptoms. Author(s): Sotir C. Source: Adv Nurse Pract. 2001 February; 9(2): 42-7; Quiz 47-8. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12416053&dopt=Abstract
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Could automated template based quantification of benzodiazepine receptors in brain single photon emission tomography with 123I NNC 13-8241 be used to demonstrate neuronal damage in traumatic brain injury? Author(s): Kauppinen T, Ahonen A, Tuomivaara V, Hiltunen J, Bergstrom K, Kuikka J, Torniainen P, Hillbom M. Source: Nuclear Medicine Communications. 2002 November; 23(11): 1065-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12411834&dopt=Abstract
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Cyclooxygenase-2, prostaglandin synthases, and prostaglandin H2 metabolism in traumatic brain injury in the rat. Author(s): Kunz T, Marklund N, Hillered L, Oliw EH.
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Source: Journal of Neurotrauma. 2002 September; 19(9): 1051-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12482118&dopt=Abstract ·
Cytochrome c release and caspase activation after traumatic brain injury. Author(s): Sullivan PG, Keller JN, Bussen WL, Scheff SW. Source: Brain Research. 2002 September 13; 949(1-2): 88-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12213303&dopt=Abstract
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Decompressive craniectomy following traumatic brain injury: ICP, CPP and neurological outcome. Author(s): Schneider GH, Bardt T, Lanksch WR, Unterberg A. Source: Acta Neurochir Suppl. 2002; 81: 77-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12168363&dopt=Abstract
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Decompressive surgery in the treatment of traumatic brain injury. Author(s): Piek J. Source: Current Opinion in Critical Care. 2002 April; 8(2): 134-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12386514&dopt=Abstract
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Decreased Length of stay, cost savings and descriptive findings of enhanced patient care resulting from and integrated traumatic brain injury programme. Author(s): Khan S, Khan A, Feyz M. Source: Brain Injury : [bi]. 2002 June; 16(6): 537-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12148505&dopt=Abstract
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Detecting malingered neurocognitive dysfunction using the reliable digit span in traumatic brain injury. Author(s): Mathias CW, Greve KW, Bianchini KJ, Houston RJ, Crouch JA. Source: Assessment. 2002 September; 9(3): 301-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12216787&dopt=Abstract
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Detecting malingered performance with the Wisconsin card sorting test: a preliminary investigation in traumatic brain injury. Author(s): Greve KW, Bianchini KJ, Mathias CW, Houston RJ, Crouch JA.
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Source: The Clinical Neuropsychologist. 2002 May; 16(2): 179-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12221480&dopt=Abstract ·
Differential profiles of verbal learning in traumatic brain injury. Author(s): Demery JA, Pedraza O, Hanlon RE. Source: J Clin Exp Neuropsychol. 2002 September; 24(6): 818-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12424655&dopt=Abstract
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Do psychological variables modify motor recovery among patients with mild arm paresis after stroke or traumatic brain injury who receive the Arm Ability Training? Author(s): Platz T, Denzler P. Source: Restorative Neurology and Neuroscience. 2002; 20(1-2): 37-49. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12237495&dopt=Abstract
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Donepezil for cognitive deficits following traumatic brain injury: a case report. Author(s): Bourgeois JA, Bahadur N, Minjares S. Source: The Journal of Neuropsychiatry and Clinical Neurosciences. 2002 Fall; 14(4): 463-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12426418&dopt=Abstract
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Downregulation of Matrix Metalloproteinase-9 and Attenuation of Edema via Inhibition of ERK Mitogen Activated Protein Kinase in Traumatic Brain Injury. Author(s): Mori T, Wang X, Aoki T, Lo EH. Source: Journal of Neurotrauma. 2002 November; 19(11): 1411-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12490006&dopt=Abstract
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Dynamic imaging in mild traumatic brain injury: support for the theory of medial temporal vulnerability. Author(s): Umile EM, Sandel ME, Alavi A, Terry CM, Plotkin RC. Source: Archives of Physical Medicine and Rehabilitation. 2002 November; 83(11): 1506-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12422317&dopt=Abstract
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Early indicators of prognosis in 846 cases of severe traumatic brain injury. Author(s): Jiang JY, Gao GY, Li WP, Yu MK, Zhu C. Source: Journal of Neurotrauma. 2002 July; 19(7): 869-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12184856&dopt=Abstract
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Effect of hyperventilation on extracellular concentrations of glutamate, lactate, pyruvate, and local cerebral blood flow in patients with severe traumatic brain injury. Author(s): Marion DW, Puccio A, Wisniewski SR, Kochanek P, Dixon CE, Bullian L, Carlier P. Source: Critical Care Medicine. 2002 December; 30(12): 2619-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12483048&dopt=Abstract
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Effects of divided attention on episodic memory in chronic traumatic brain injury: a function of severity and strategy. Author(s): Mangels JA, Craik FI, Levine B, Schwartz ML, Stuss DT. Source: Neuropsychologia. 2002; 40(13): 2369-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12417466&dopt=Abstract
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Effects of magnesium sulfate on brain mitochondrial respiratory function in rats after experimental traumatic brain injury. Author(s): Xu M, Dai W, Deng X. Source: Chinese Journal of Traumatology = Chung-Hua Ch'uang Shang Tsa Chih / Chinese Medical Association. 2002 December; 5(6): 361-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12443578&dopt=Abstract
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Elevated intracranial IL-18 in humans and mice after traumatic brain injury and evidence of neuroprotective effects of IL-18-binding protein after experimental closed head injury. Author(s): Yatsiv I, Morganti-Kossmann MC, Perez D, Dinarello CA, Novick D, Rubinstein M, Otto VI, Rancan M, Kossmann T, Redaelli CA, Trentz O, Shohami E, Stahel PF.
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Source: Journal of Cerebral Blood Flow and Metabolism : Official Journal of the International Society of Cerebral Blood Flow and Metabolism. 2002 August; 22(8): 971-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12172382&dopt=Abstract ·
EMA analysis of tongue function in children with dysarthria following traumatic brain injury. Author(s): Murdoch BE, GoozEe JV. Source: Brain Injury : [bi]. 2003 January; 17(1): 79-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12519650&dopt=Abstract
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Evidence-based emergency medicine. Corticosteroids for traumatic brain injury. Author(s): Bazarian JJ. Source: Annals of Emergency Medicine. 2002 November; 40(5): 515-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12399795&dopt=Abstract
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Expression profiling following traumatic brain injury: a review. Author(s): Marciano PG, Eberwine JH, Ragupathi R, Saatman KE, Meaney DF, McIntosh TK. Source: Neurochemical Research. 2002 October; 27(10): 1147-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12462413&dopt=Abstract
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Functional and psychosocial outcome one year after severe traumatic brain injury and early-onset rehabilitation therapy. Author(s): Lipper-Gruner M, Wedekind Ch, Klug N. Source: Journal of Rehabilitation Medicine : Official Journal of the Uems European Board of Physical and Rehabilitation Medicine. 2002 September; 34(5): 211-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12392235&dopt=Abstract
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Functional recovery in pediatric traumatic brain injury during inpatient rehabilitation. Author(s): Dumas HM, Haley SM, Ludlow LH, Rabin JP.
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Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2002 September; 81(9): 661-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12172518&dopt=Abstract ·
Gender differences in learning and memory after pediatric traumatic brain injury. Author(s): Donders J, Hoffman NM. Source: Neuropsychology. 2002 October; 16(4): 491-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12382988&dopt=Abstract
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Hemodynamic actions of acute ethanol after resuscitation from traumatic brain injury. Author(s): Fabian MJ, Proctor KG. Source: The Journal of Trauma. 2002 November; 53(5): 864-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12435936&dopt=Abstract
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Hypertonic saline solution and decompressive craniectomy for treatment of intracranial hypertension in pediatric severe traumatic brain injury. Author(s): Berger S, Schwarz M, Huth R. Source: The Journal of Trauma. 2002 September; 53(3): 558-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12352497&dopt=Abstract
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In this issue... Mild traumatic brain injury and spinal cord injury. Author(s): Ausman JI. Source: Surgical Neurology. 2002 July; 58(1): 1-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12361634&dopt=Abstract
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Incidence of intracranial hypertension related to jugular bulb oxygen saturation disturbances in severe traumatic brain injury patients. Author(s): Schoon P, Benito Mori L, Orlandi G, Larralde C, Radrizzani M. Source: Acta Neurochir Suppl. 2002; 81: 285-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12168327&dopt=Abstract
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Increased Diffusion in the Brain of Professional Boxers: A Preclinical Sign of Traumatic Brain Injury?
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Author(s): Zhang L, Ravdin LD, Relkin N, Zimmerman RD, Jordan B, Lathan WE, Ulug AM. Source: Ajnr. American Journal of Neuroradiology. 2003 January; 24(1): 52-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12533327&dopt=Abstract ·
Increased S-nitrosothiols and S-nitrosoalbumin in cerebrospinal fluid after severe traumatic brain injury in infants and children: indirect association with intracranial pressure. Author(s): Bayir H, Kochanek PM, Liu SX, Arroyo A, Osipov A, Jiang J, Wisniewski S, Adelson PD, Graham SH, Kagan VE. Source: Journal of Cerebral Blood Flow and Metabolism : Official Journal of the International Society of Cerebral Blood Flow and Metabolism. 2003 January; 23(1): 51-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12500091&dopt=Abstract
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Inflammatory response in acute traumatic brain injury: a double-edged sword. Author(s): Morganti-Kossmann MC, Rancan M, Stahel PF, Kossmann T. Source: Current Opinion in Critical Care. 2002 April; 8(2): 101-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12386508&dopt=Abstract
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Interlabial contact pressures exhibited in dysarthria following traumatic brain injury during speech and nonspeech tasks. Author(s): Goozee JV, Murdoch BE, Theodoros DG. Source: Folia Phoniatrica Et Logopaedica : Official Organ of the International Association of Logopedics and Phoniatrics (Ialp). 2002 JulyAugust; 54(4): 177-89. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12169804&dopt=Abstract
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Intravascular coagulation: a major secondary insult in nonfatal traumatic brain injury. Author(s): Stein SC, Chen XH, Sinson GP, Smith DH. Source: Journal of Neurosurgery. 2002 December; 97(6): 1373-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12507136&dopt=Abstract
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Is 'gamma' (40 Hz) synchronous activity disturbed in patients with traumatic brain injury? Author(s): Slewa-Younan S, Green AM, Baguley IJ, Felmingham KL, Haig AR, Gordon E. Source: Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology. 2002 October; 113(10): 1640-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12350441&dopt=Abstract
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Life satisfaction following spinal cord and traumatic brain injury: a comparative study. Author(s): Hicken BL, Putzke JD, Novack T, Sherer M, Richards JS. Source: Journal of Rehabilitation Research and Development. 2002 MayJune; 39(3): 359-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12173756&dopt=Abstract
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Linguistic outcomes following traumatic brain injury in children. Author(s): Ewing-Cobbs L, Barnes M. Source: Semin Pediatr Neurol. 2002 September; 9(3): 209-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12350042&dopt=Abstract
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Management of hyperthermia in traumatic brain injury. Author(s): Cairns CJ, Andrews PJ. Source: Current Opinion in Critical Care. 2002 April; 8(2): 106-10. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12386509&dopt=Abstract
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Measurement of impaired self-awareness after traumatic brain injury: a comparison of the patient competency rating scale and the awareness questionnaire. Author(s): Sherer M, Hart T, Nick TG. Source: Brain Injury : [bi]. 2003 January; 17(1): 25-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12519645&dopt=Abstract
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Measuring unmet needs and services among persons with traumatic brain injury. Author(s): Heinemann AW, Sokol K, Garvin L, Bode RK.
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Source: Archives of Physical Medicine and Rehabilitation. 2002 August; 83(8): 1052-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12161825&dopt=Abstract ·
Mild traumatic brain injury (MTBI): assessment and treatment procedures used by speech-language pathologists (SLPs). Author(s): Duff MC, Proctor A, Haley K. Source: Brain Injury : [bi]. 2002 September; 16(9): 773-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12217203&dopt=Abstract
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Molecular mechanisms in the pathogenesis of traumatic brain injury. Author(s): Ray SK, Dixon CE, Banik NL. Source: Histol Histopathol. 2002 October; 17(4): 1137-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12371142&dopt=Abstract
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Motor skill and mobility recovery outcomes of children and youth with traumatic brain injury. Author(s): Dumas HM, Carey T. Source: Phys Occup Ther Pediatr. 2002; 22(3-4): 73-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12506822&dopt=Abstract
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Multiple caspases are activated after traumatic brain injury: evidence for involvement in functional outcome. Author(s): Knoblach SM, Nikolaeva M, Huang X, Fan L, Krajewski S, Reed JC, Faden AI. Source: Journal of Neurotrauma. 2002 October; 19(10): 1155-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12427325&dopt=Abstract
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Neural and marrow-derived stromal cell sphere transplantation in a rat model of traumatic brain injury. Author(s): Lu D, Li Y, Mahmood A, Wang L, Rafiq T, Chopp M. Source: Journal of Neurosurgery. 2002 October; 97(4): 935-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12405384&dopt=Abstract
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Neuroimmunophilin ligand V-10,367 is neuroprotective after 24-hour delayed administration in a mouse model of diffuse traumatic brain
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injury. Author(s): Kupina NC, Detloff MR, Dutta S, Hall ED. Source: Journal of Cerebral Blood Flow and Metabolism : Official Journal of the International Society of Cerebral Blood Flow and Metabolism. 2002 October; 22(10): 1212-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12368660&dopt=Abstract ·
Neurological, cognitive and attributional predictors of posttraumatic stress symptoms after traumatic brain injury. Author(s): Williams WH, Evans JJ, Needham P, Wilson BA. Source: Journal of Traumatic Stress. 2002 October; 15(5): 397-400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12392227&dopt=Abstract
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Neuroprotection and traumatic brain injury: theoretical option or realistic proposition. Author(s): Faden AI. Source: Current Opinion in Neurology. 2002 December; 15(6): 707-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12447109&dopt=Abstract
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Neuropsychological assessment and employment outcome after traumatic brain injury: a review. Author(s): Sherer M, Novack TA, Sander AM, Struchen MA, Alderson A, Thompson RN. Source: The Clinical Neuropsychologist. 2002 May; 16(2): 157-78. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12221479&dopt=Abstract
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Nonrandomized studies of rehabilitation for traumatic brain injury: can they determine effectiveness? Author(s): Powell JM, Temkin NR, Machamer JE, Dikmen SS. Source: Archives of Physical Medicine and Rehabilitation. 2002 September; 83(9): 1235-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12235603&dopt=Abstract
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Novel therapies in development for the treatment of traumatic brain injury. Author(s): Vink R, Nimmo AJ.
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Source: Expert Opinion on Investigational Drugs. 2002 October; 11(10): 1375-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12387701&dopt=Abstract ·
Olfactory function after mild traumatic brain injury. Author(s): De Kruijk JR, Leffers P, Menheere PP, Meerhoff S, Rutten J, Twijnstra A. Source: Brain Injury : [bi]. 2003 January; 17(1): 73-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12519649&dopt=Abstract
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Optimal temperature for the management of severe traumatic brain injury: effect of hypothermia on intracranial pressure, systemic and intracranial hemodynamics, and metabolism. Author(s): Tokutomi T, Morimoto K, Miyagi T, Yamaguchi S, Ishikawa K, Shigemori M. Source: Neurosurgery. 2003 January; 52(1): 102-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12493106&dopt=Abstract
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Outcome after mild traumatic brain injury: an examination of recruitment bias. Author(s): McCullagh S, Feinstein A. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2003 January; 74(1): 39-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12486264&dopt=Abstract
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Outcome after traumatic brain injury improved by an organized secondary insult program and standardized neurointensive care. Author(s): Elf K, Nilsson P, Enblad P. Source: Critical Care Medicine. 2002 September; 30(9): 2129-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12352052&dopt=Abstract
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Outcome of prolonged coma following severe traumatic brain injury. Author(s): Lippert-GrUner M, Wedekind C, Klug N. Source: Brain Injury : [bi]. 2003 January; 17(1): 49-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12519647&dopt=Abstract
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Outcomes and costs of acute treatment of traumatic brain injury. Author(s): McGarry LJ, Thompson D, Millham FH, Cowell L, Snyder PJ, Lenderking WR, Weinstein MC. Source: The Journal of Trauma. 2002 December; 53(6): 1152-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12478043&dopt=Abstract
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Parental stress and burden following traumatic brain injury amongst children and adolescents. Author(s): Hawley CA, Ward AB, Magnay AR, Long J. Source: Brain Injury : [bi]. 2003 January; 17(1): 1-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12519644&dopt=Abstract
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Pediatric traumatic brain injury and procedural memory. Author(s): Ward H, Shum D, Wallace G, Boon J. Source: J Clin Exp Neuropsychol. 2002 June; 24(4): 458-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12187459&dopt=Abstract
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Performance on measures of executive function following pediatric traumatic brain injury. Author(s): Slomine BS, Gerring JP, Grados MA, Vasa R, Brady KD, Christensen JR, Denckla MB. Source: Brain Injury : [bi]. 2002 September; 16(9): 759-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12217202&dopt=Abstract
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Positive end-expiratory pressure alters intracranial and cerebral perfusion pressure in severe traumatic brain injury. Author(s): Huynh T, Messer M, Sing RF, Miles W, Jacobs DG, Thomason MH. Source: The Journal of Trauma. 2002 September; 53(3): 488-92; Discussion 492-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12352486&dopt=Abstract
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Practice parameter: Antiepileptic drug prophylaxis in severe traumatic brain injury: Report of the Quality Standards Subcommittee of the American Academy of Neurology. Author(s): Chang BS, Lowenstein DH.
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Source: Neurology. 2003 January 14; 60(1): 10-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12525711&dopt=Abstract ·
Predicting recovery in patients suffering from traumatic brain injury by using admission variables and physiological data: a comparison between decision tree analysis and logistic regression. Author(s): Andrews PJ, Sleeman DH, Statham PF, McQuatt A, Corruble V, Jones PA, Howells TP, Macmillan CS. Source: Journal of Neurosurgery. 2002 August; 97(2): 326-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12186460&dopt=Abstract
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Prediction of employment status following traumatic brain injury using a behavioural measure of frontal lobe functioning. Author(s): Simpson A, Schmitter-Edgecombe M. Source: Brain Injury : [bi]. 2002 December; 16(12): 1075-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12487722&dopt=Abstract
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Prediction of post-traumatic complaints after mild traumatic brain injury: early symptoms and biochemical markers. Author(s): De Kruijk JR, Leffers P, Menheere PP, Meerhoff S, Rutten J, Twijnstra A. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2002 December; 73(6): 727-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12438478&dopt=Abstract
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Predictors of caregiver burden following traumatic brain injury. Author(s): Nabors N, Seacat J, Rosenthal M. Source: Brain Injury : [bi]. 2002 December; 16(12): 1039-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12487718&dopt=Abstract
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Predictors of driving outcome after traumatic brain injury. Author(s): Coleman RD, Rapport LJ, Ergh TC, Hanks RA, Ricker JH, Millis SR.
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Source: Archives of Physical Medicine and Rehabilitation. 2002 October; 83(10): 1415-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12370878&dopt=Abstract ·
Progesterone protects against necrotic damage and behavioral abnormalities caused by traumatic brain injury. Author(s): Shear DA, Galani R, Hoffman SW, Stein DG. Source: Experimental Neurology. 2002 November; 178(1): 59-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12460608&dopt=Abstract
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Protective effects of the 5-HT(1A) receptor agonist 8-hydroxy-2-(di-npropylamino)tetralin against traumatic brain injury-induced cognitive deficits and neuropathology in adult male rats. Author(s): Kline AE, Yu J, Massucci JL, Zafonte RD, Dixon CE. Source: Neuroscience Letters. 2002 November 29; 333(3): 179-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12429377&dopt=Abstract
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Psychiatric effects of traumatic brain injury events in Cambodian survivors of mass violence. Author(s): Mollica RF, Henderson DC, Tor S. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2002 October; 181: 339-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12356662&dopt=Abstract
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Quality of life in children with traumatic brain injury - basic issues, assessment, and recommendations. Author(s): Ravens-Sieberer U, Patrick PD. Source: Restorative Neurology and Neuroscience. 2002; 20(3,4): 151-159. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12454363&dopt=Abstract
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Vocabulary Builder Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]
Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Amnesia: Lack or loss of memory; inability to remember past experiences. [EU]
Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anesthesiology: A specialty concerned with the study of anesthetics and anesthesia. [NIH] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antiepileptic: An agent that combats epilepsy. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Apathy: Lack of feeling or emotion; indifference. [EU] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Bilateral: Having two sides, or pertaining to both sides. [EU] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances,
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including fluids, between the blood and tissue fluid; called also vas capillare. [EU]
Caspases: A family of intracellular cysteine endopeptidases. They play a key role in inflammation and mammalian apoptosis. They are specific for aspartic acid at the P1 position. They are divided into two classes based on the lengths of their N-terminal prodomains. Caspases-1,-2,-4,-5,-8, and -10 have long prodomains and -3,-6,-7,-9 have short prodomains. EC 3.4.22.-. [NIH]
Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Contusion: A bruise; an injury of a part without a break in the skin. [EU] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Diffusion: The process of becoming diffused, or widely spread; the spontaneous movement of molecules or other particles in solution, owing to their random thermal motion, to reach a uniform concentration throughout the solvent, a process requiring no addition of energy to the system. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Endothelium: The layer of epithelial cells that lines the cavities of the heart and of the blood and lymph vessels, and the serous cavities of the body, originating from the mesoderm. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal
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tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Extracellular: Outside a cell or cells. [EU] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Hematoma: tissue. [NIH]
An extravasation of blood localized in an organ, space, or
Hemodilution: Reduction of blood viscosity usually by the addition of cell free solutions. Used clinically l) in states of impaired microcirculation, 2) for replacement of intraoperative blood loss without homologous blood transfusion, and 3) in cardiopulmonary bypass and hypothermia. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Hyperthermia: Abnormally high body temperature, especially that induced for therapeutic purposes. [EU] Hyperventilation: A state in which there is an increased amount of air entering the pulmonary alveoli (increased alveolar ventilation), resulting in reduction of carbon dioxide tension and eventually leading to alkalosis. [EU] Hypotension: Abnormally low blood pressure; seen in shock but not necessarily indicative of it. [EU]
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Hypothermia: A low body temperature, as that due to exposure in cold weather or a state of low temperature of the body induced as a means of decreasing metabolism of tissues and thereby the need for oxygen, as used in various surgical procedures, especially on the heart, or in an excised organ being preserved for transplantation. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Microdialysis: A technique for measuring extracellular concentrations of substances in tissues, usually in vivo, by means of a small probe equipped with a semipermeable membrane. Substances may also be introduced into the extracellular space through the membrane. [NIH] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neonatal: Pertaining to the first four weeks after birth. [EU] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurosciences: The scientific disciplines concerned with the embryology, anatomy, physiology, biochemistry, pharmacology, etc., of the nervous sytem. [NIH]
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Paradoxical: Occurring at variance with the normal rule. [EU] Paresis: Slight or incomplete paralysis. [EU] Perfusion: 1. The act of pouring over or through, especially the passage of a fluid through the vessels of a specific organ. 2. A liquid poured over or through an organ or tissue. [EU] Perivascular: Situated around a vessel. [EU] Peroxidase: A hemeprotein from leukocytes. Deficiency of this enzyme leads to a hereditary disorder coupled with disseminated moniliasis. It catalyzes the conversion of a donor and peroxide to an oxidized donor and water. EC 1.11.1.7. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of YEASTS. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Prophylaxis: The prevention of disease; preventive treatment. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Receptor: 1. A molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. A sensory nerve terminal that responds to stimuli of various kinds. [EU] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU]
Saline: Salty; of the nature of a salt; containing a salt or salts. [EU]
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Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH] Serum: 1. The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. Blood serum; the clear liquid that separates from blood on clotting. 3. Immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU]
Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU]
Spirometry: Measurement of volume of air inhaled or exhaled by the lung. [NIH]
Systemic: Pertaining to or affecting the body as a whole. [EU] Tibia: The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the FIBULA laterally, the TALUS distally, and the FEMUR proximally. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Traumatology: The branch of surgery which deals with wounds and disability from injuries. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU]
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CHAPTER 5. PATENTS ON TRAUMATIC BRAIN INJURY Overview You can learn about innovations relating to traumatic brain injury by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.23 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with traumatic brain injury within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with traumatic brain injury. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
23Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Traumatic Brain Injury By performing a patent search focusing on traumatic brain injury, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on traumatic brain injury: ·
Methods of treating traumatic brain injury by vagus nerve stimulation Inventor(s): Naritoku; Dean K. (Springfield, IL), Jensen; Robert A. (Carbondale, IL), Browning; Ronald A. (Carbondale, IL), Clark; Kevin B. (Murphysboro, IL), Smith; Douglas C. (Carbondale, IL), Terry, Jr.; Reese S. (Houston, TX) Assignee(s): Board of Trustees of Southern Illinois University (Springfield, IL) Patent Number: 6,104,956 Date filed: May 30, 1997 Abstract: Methods of modulating brain neural plasticity, improving memory and learning, improving recovery from traumatic brain injury, preventing epilepsy, treating memory disorders and chronic memory impairment, and treating persistent impairment of consciousness in humans and animals by vagus nerve stimulation are provided. These methods comprise selecting an appropriate human or animal subject and applying to the subject's vagus nerve an electrical stimulation signal having parameter values effective in modulating the electrical activity of the vagus nerve in a manner so as to modulate the activity of preselected portions of the brain. Excerpt(s): The present invention relates to methods and apparatus for modulating neural plasticity in the nervous system. Neural plasticity includes phenomena such as memory and learning consolidation processes, as well as recovery of function following traumatic brain injury. The methods of the present invention are directed to modulating neural plasticity, improving memory and learning consolidation processes, cognitive processing, and motor and perceptual skills in both
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normal subjects and subjects suffering from chronic memory impairment, alleviating symptoms and improving outcome in subjects suffering from traumatic brain injury, preventing the development of epilepsy in subjects prone to developing this condition, and treating persistent impairment of consciousness. These methods employ electrical stimulation of the vagus nerve in human or animal subjects via application of modulating electrical signals to the vagus nerve by use of a neurostimulating device. ... Vagus nerve stimulation has been shown to cause activation of several parts of the brain that are specifically involved in cognitive processing, memory, learning, sensory and motor processing, and affects regions of the brain that are prone to developing epilepsy or which regulate the development of epilepsy (Naritoku et al. (1995) In Ashley et al., Eds., Traumatic Brain Injury Rehabilitation, CRC Press, Boca Raton, pp. 43-65). These studies demonstrate that vagus nerve stimulation activates the amygdala and cingulate cortex, which are involved in learning and cognitive processing. Such stimulation also activates several thalamic nuclei which serve relay functions. In addition, it activates several sensory nuclei, including the auditory, visual, and somatic sensory systems. Finally, vagus nerve stimulation activates monoaminergic nuclei, especially the locus ceruleus and A5 groups, which provide norepinephrine to the brain. Monoamines are crucial for both learning and memory, and for preventing the development of epilepsy (Jobe et al. (1981) Biochem. Pharmacol. 30:3137-3144). ... Noradrenergic systems are also known to modulate memory consolidation and amygdaloid complex activity (cf. McGaugh (1989) Annual Review of Neuroscience 12:255-287); however, Holdefer et al. ((1987) Brain Research 417:108-117) demonstrated that locus coeruleusmaintained discharge does not correlate with the memory modulation produced by peripherally-injected 4-OH amphetamine, D-amphetamine, or epinephrine. Although the locus coeruleus receives indirect vagal input, it also receives serotonergic projections from the dorsal raphe nucleus. Consequently, dorsal raphe nucleus activity might suppress the responsiveness of locus coeruleus neurons to autonomic stimulation, thereby increasing serotonergic control over the amygdaloid complex and other brain areas during the memory consolidation period. This hypothesis is supported directly by studies of Naritoku et al.((1995) In Ashley et al., Eds., Traumatic Brain Injury Rehabilitation, CRC Press, Boca Raton, pp. 43-65), which demonstrated activation of the locus ceruleus and A5 nuclei, which are noradrenergic neurons. Preliminary evidence of Krahl et al. ((1994) Society for Neuroscience Abstracts 20:1453) also indicates that cells found in the dorsal locus coeruleus respond differentially to those found in either the ventral locus coeruleus or subcoeruleus following vagus nerve stimulation.
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Web site: http://www.delphion.com/details?pn=US06104956__ ·
Method of treatment of traumatic brain injury Inventor(s): Scheiner; Stuart L. (East Brunswick, NJ) Assignee(s): Forest Laboratories, Inc. (New York, NY) Patent Number: 5,527,822 Date filed: December 29, 1993 Abstract: A method of treatment of a mammal, including humans, suffering from traumatic brain injury, which comprises administering to the sufferer a therapeutically effective amount of a butyrolactone derivative. Excerpt(s): It is widely accepted that severe traumatic brain injuries (TBI) initiate a cascade of events that lead to dramatic elevation of intracranial pressure (ICP) and dysfunction of cerebrovascular regulatory mechanisms essential for survival. Indeed, ischemic brain injury is seen universally in those patients who die following severe TBI. Intracranial hypertension (IH) following traumatic brain injury is associated with direct effects on cerebral perfusion which may be responsible for secondary ischemia. The contributions of both post-traumatic cerebral edema and alteration in cerebral blood volume to ICP appear to vary based on the length of time after the primary mechanical insult. This combination of vasomotor dysfunction and abnormalities in vascular permeability is characteristic of acute inflammation. ... U.S. Pat. No. 4,883,813 proposes the use of certain butyrolactone derivatives for treatment of inflammation in mammals, such as acute inflammation. However, none of the prior art has proposed the use of compounds (I) to (V) for the treatment of traumatic brain injury. As is known, the treatment of traumatic brain injury with steroidal or non-steroidal antiinflammatory drugs is not likely to be successful due to a number of factors, including the inability of conventional anti-inflammatory agents to cross the blood-brain barrier. It was therefor unexpected that the butyrolactone derivatives used in the present invention would be useful in the treatment of traumatic brain injury. ... It is presently preferred to administer compounds (I) to (V) parenterally, such as intravenously, in a bolus, so as to obtain the most rapid delivery of the active agent to the brain. A suitable daily dosage for obtaining attenuation of the effects of traumatic brain injury is from about 10 to about 1000 mg/kg body weight, although the optimum dosage of the compound (I) to (V) will be determined by the physician taking into account the age, weight and general health of the subject. The daily dosage may also be administered
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in one or several treatments over a period of time, such as by way of single or multiple doses per day or from sustained release compositions. Web site: http://www.delphion.com/details?pn=US05527822__
Patent Applications on Traumatic Brain Injury As of December 2000, U.S. patent applications are open to public viewing.24 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to traumatic brain injury: ·
Pharmaceutical combinations for the treatment of stroke and traumatic brain injury Inventor(s): Chenard, Bertrand L. ; (Waterford, CT), Menniti, Frank S. ; (Mystic, CT), Saltarelli, Mario D. ; (Mystic, CT) Correspondence: PFIZER INC; 150 EAST 42ND STREET; 5TH FLOOR STOP 49; NEW YORK; NY; 10017-5612; US Patent Application Number: 20020045656 Date filed: September 6, 2001 Abstract: This invention relates to methods of treating traumatic brain injury (TBI) or hypoxic or ischemic stroke, comprising administering to a patient in need of such treatment an NR2B subtype selective N-methyl-Daspartate (NMDA) receptor antagonist in combination with either: (a) a neutrophil inhibitory factor (NIF); (b) a sodium channel antagonist; (c) a nitric oxide synthase (NOS) inhibitor; (d) a glycine site antagonist; (e) a potassium channel opener; (f) an AMPA/kainate receptor antagonist; (g) a calcium channel antagonist; (h) a GABA-A receptor modulator (e.g., a GABA-A receptor agonist); or (i) an antiinflammatory agent. Excerpt(s): This invention relates to methods of treating traumatic brain injury (TBI), ischemic stroke, or hypoxic brain injury, comprising administering to a patient in need of such treatment an NR2B subtype selective N-methyl-D-aspartate (NMDA) receptor antagonist in combination with one or more other compounds that protect neurons from toxic insult, inhibit the inflammatory reaction after brain damage or promote cerebral reperfusion. ... More specifically, this invention relates to methods of treating traumatic brain injury (TBI) or hypoxic or ischemic
24
This has been a common practice outside the United States prior to December 2000.
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stroke, comprising administering to a patient in need of such treatment an NR2B subtype selective N-methyl-D-aspartate (NMDA) receptor antagonist in combination with either: (a) a neutrophil inhibitory factor (NIF); (b) a sodium channel antagonist; (c) a nitric oxide synthase (NOS) inhibitor; (d) a glycine site antagonist; (e) a potassium channel opener; (f) an AMPA/kainate receptor antagonist; (g) a calcium channel antagonist; (h) a GABA-A receptor modulator (e.g., a GABA-A receptor agonist); (i) an antiinflammatory agent; or (j) a matrix metalloprotease (MMP) inhibitor. ... The present invention relates to the additional therapeutic benefits that may be gained by treating traumatic brain injury, stroke, or hypoxic brain injury with an NR2B subtype selective NMDA receptor antagonist in combination with other types of compounds. These include compounds that protect neurons from toxic insult, inhibit the inflammatory reaction after brain damage and/or promote cerebral reperfusion. Although NMDA receptor-mediated toxicity is a principal cause of the neuronal dysfunction and death that occurs after CNS insult, additional mechanisms also participate. By reducing the pathological consequences of these additional mechanisms, the overall benefit of the therapeutic intervention may be increased. Furthermore, inhibiting multiple pathological processes may provide an unexpected synergistic benefit over and above that which may be achievable alone with the use of an NMDA receptor antagonist. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Method of treating traumatic brain injury and other neuronal disorders Inventor(s): Hamm, Robert ; (Crozier, VA), Deford, S. Michelle ; (Richmond, VA), Shiotani, Tadashi ; (Tokyo, JP) Correspondence: OBLON SPIVAK MCCLELLAND MAIER & NEUSTADT PC; FOURTH FLOOR; 1755 JEFFERSON DAVIS HIGHWAY; ARLINGTON; VA; 22202; US Patent Application Number: 20010041734 Date filed: June 22, 2001 Abstract: A method for treatment of neuronal disorders and traumatic brain injury is provided which involves timely administration to a subject in need thereof of an effective amount of nefiracetam. Excerpt(s): Traumatic brain injury, as well as neuronal disorders with common pathological features, such as stroke and epilepsy, can have devastating effects on a person, both short-term and long-term. Traumatic brain injury is often associated with cerebral concussion. ... Traumatic brain injury is known to be a biphasic process. The first phase,
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the excitatory phase, occurs immediately upon injury. During this phase there is great neuronal excitation due to the trauma. Following the excitatory phase is the recovery phase, during which the neuronal excitation has abated and the job of repair has begun. Most often with traumatic brain injury, the excitatory phase is associated with increased intracranial pressure (ICP), with fluctuations of ICP over several days or more. Patients in the excitatory phase must typically be cared for in the intensive care unit of a hospital. Once the ICP has been stabilized and the patient can be removed from intensive care, the patient is typically entering into the recovery phase. ... Traumatic brain injury produces an acute neuronal depolarization and an extensive release of neurotransmitters. The resulting excessive receptor activation may produce abnormal neurotransmitter-receptor interactions which contribute to the pathophysiology associated with experimental traumatic brain injury. Both the cholinergic and glutamatergic receptor systems have been documented to play a prominent role in the receptormediated pathophysiology of traumatic brain injury. Prior attempts to treat traumatic brain injury have focused on administration of antagonists of these cholinergic or glutamatergic receptors (such as the AMPA-glutamate receptor, wherein AMPA represents .alpha.-amino-3hydroxy-5-methyl-4-isoxazole propionic acid) as early as possible after the occurrence of the injury. (See Hamm et al, Cognitive Brain Research, 1, 223-226 (1993) and Lyeth et al, Brain Research, 452, 39-48 (1988)). The goal of these studies was to add the antagonist during the excitatory phase of the injury process during the period of high receptor activity in an attempt to minimize the damage occurring to the neuronal tissue. Unfortunately, such attempts were not successful. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with traumatic brain injury, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “traumatic brain injury” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on traumatic brain injury. You can also use this procedure to
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view pending patent applications concerning traumatic brain injury. Simply go to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH] Biphasic: Having two phases; having both a sporophytic and a gametophytic phase in the life cycle. [EU] Cholinergic: Resembling acetylcholine in pharmacological stimulated by or releasing acetylcholine or a related compound. [EU]
action;
Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU] Neutrophil: Having an affinity for neutral dyes. [EU] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising
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from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]
Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Vagal: Pertaining to the vagus nerve. [EU] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU]
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CHAPTER 6. BOOKS ON TRAUMATIC BRAIN INJURY Overview This chapter provides bibliographic book references relating to traumatic brain injury. You have many options to locate books on traumatic brain injury. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on traumatic brain injury include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “traumatic brain injury” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on traumatic brain injury:
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Mild Traumatic Brain Injury: A Therapy and Resource Manual Source: San Diego, CA: Singular Publishing Group, Inc. 1998. 260 p. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 2386777. Fax (800) 774-8398 or (619) 238-6789. E-mail:
[email protected]. Website: www.singpub.com. PRICE: $49.95 plus shipping and handling. ISBN: 1565938275. Summary: This book is a therapy and reference manual created in response to the unique needs of adolescents and adults who have sustained mild to moderate traumatic brain injuries (MTBI). The authors focus on providing practical suggestions for developing individualized therapy tasks to promote a client's successful return to the demands of the home, school, or work environment. Nine chapters cover the diversified roles of the speech language pathologist, the assessment of MTBI, treatment options (including establishing a positive therapeutic relationship), treating complex attention impairments, treating functional and prospective memory impairments, treating word retrieval and thought formulation impairments, treating information processing impairments (auditory and visual), treating executive functioning impairments, and therapy documentation, transition, and discharge. Each chapter includes therapy tasks, home practice tasks, and suggestions for families (including patient and family handouts). The text concludes with a reference list and subject index. 26 references.
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Clinical Management of Communication Problems in Adults with Traumatic Brain Injury Source: Frederick, MD: Aspen Publishers, Inc. 1991. 181 p. Contact: Available from Aspen Publishers, Inc. 7201 McKinney Circle, P.O. Box 990, Frederick, MD 21704. (800) 638-8437 or (301) 417-7500. Fax (301) 695-7931. Website: www.aspenpublishers.com. PRICE: $52.00 plus shipping and handling. ISBN: 0834202794. Summary: This book describes a practical, functional, and proven approach to help maximize the potential of individuals with traumatic brain injuries (TBI). The authors do not address specific management of aphasia, dysarthria, and dysphagia, but rather focus on the cognitive linguistic problems that are unique to the TBI population. The book offers six chapters that cover cognitive-linguistic problems associated with TBI, including neuropathology and models of cognition and communication; a classification system for cognitive, linguistics, speech, and swallowing disorders in the adult with TBI; a framework for clinical management; the evaluation of communication problems in the adult with TBI; treatment
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of communication problems, including sensory stimulation, attention, orientation, perception, pragmatics, semantics, memory, and higher level cognitive processes; and family-based treatment, including managing the grief process. Each chapter includes references and the book concludes with a subject index. ·
Coping with Mild Traumatic Brain Injury Source: Garden City Park, NY: Avery Publishing Group, Inc. 1998. 352 p. Contact: Available from Avery Publishing Group, Inc. 120 Old Broadway, Garden City Park, NY 11040. (800) 548-5757. PRICE: $14.95 (retail price); bulk rates available. ISBN: 0895297914. Summary: This book presents a guide to coping with mild traumatic brain injury (MTBI), a problem resulting from car accidents, falls, sports injuries, work-related accidents, and physical assault. The authors note that MTBI is commonly misdiagnosed because the symptoms are unpredictable and can be mistaken for those of many other conditions. The authors first review how the brain works and how it can be injured, the procedures used to diagnose brain injury, and the different treatments available. They then examine the most common physical, mental, and psychological symptoms of brain injury, explaining why each occurs and what can be done about it, and offering practical suggestions for coping with the problem. Also covered are financial, insurance, and family issues; the rehabilitation process; and eventual outcomes. Most of the chapters deal with one particular aftereffect of MTBI and provide a real-life story, an explanation of why the symptom or problem occurs, information about treatment, and practical suggestions for coping with the problem. Chapters cover specific problems including fatigue, headaches, dizziness, problems with sexuality, vision problems, hearing problems, sensory and metabolic disturbances, muscular and motor problems, and seizures. Other problems relate to attention and concentration, memory, reasoning and understanding, speech and language, academic performance, moods and behaviors, psychiatric disorders, and grieving. The book concludes with an extensive resource section that provides additional guidance and sources of support.
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Pediatric Traumatic Brain Injury: Proactive Intervention Source: San Diego, CA: Singular Publishing Group, Inc. 1994. 281 p. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 2386777. Fax (800) 774-8398 or (619) 238-6789. E-mail:
[email protected].
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Website: www.singpub.com. PRICE: $42.50 plus shipping and handling. ISBN: 1565931688. Summary: This book is designed for professionals from a variety of disciplines who are challenged daily by children and adolescents with traumatic brain injury (TBI). The authors explain their philosophy for planning and implementing programming for this group of youngsters. The book is divided into four major parts: Part I provides an overview of TBI in the pediatric population; Part II describes how to use problemsolving techniques to conduct functional assessments; Part III suggests treatment approaches based on a proactive, problem-solving approach; and, using a case study, Part IV illustrates this approach to intervention. Each chapter begins with an introduction and list of objectives for the reader and ends with several summary guidelines and a reference list. A brief subject index concludes the volume. ·
Children with traumatic brain injury: A parent's guide Source: Bethesda, MD: Woodbine House. 2001. 482 pp. Contact: Available from Woodbine House, 6510 Bells Mill Road, Bethesda, MD 20817. Telephone: (800) 843-7323 or (301) 897-3570 / fax: (301) 897- 5838 / e-mail:
[email protected] / Web site: http://www.woodbinehouse.com. $17.95; plus shipping and handling. Summary: This book is written for parents of children who have suffered traumatic brain injury (TBI) to help them navigate the medical and educational systems and to find additional information and support for the family and the child. Chapter topics include defining TBI; rehabilitation and medical concerns; coping as a family; helping the child adjust; how TBI affects learning and thinking, speech and language, and behavior; strategies for managing behavior; the educational needs of children with TBI; and legal issues for families. An appendix provides scales used to assess patients with TBI. The book also contains a glossary, reading list, resource guide, notes, and an index.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to traumatic brain injury (sorted
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alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
Communication Disorders Following Traumatic Brain Injury: Management of Cognitive, Language, and Motor Impairments by David R. Beukelman, Kathryn M. Yorkston (Editor); January 1991; 089079295X; http://www.amazon.com/exec/obidos/tg/detail//089079295X/icongroupinterna
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Communication Disorders Following Traumatic Brain Injury; June 1990; ISBN: 0316092517; http://www.amazon.com/exec/obidos/tg/detail//0316092517/icongroupinterna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “traumatic brain injury” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:25 ·
Assistive technology in traumatic brain injury vocational rehabilitation. Author: C. Gerald Warren; Robert T. Fraser and David C. Clemmons, editors; Year: 1991; Orlando, FL: PMD Press, c1991. ISBN: 1878205072 http://www.amazon.com/exec/obidos/ASIN/1878205072/icongroupin terna
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Clinical management of communication problems in adults with traumatic brain injury. Author: Anita S. Halper, Leora R. Cherney, Trudy K. Miller; Year: 1991. ISBN: 0834202794
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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http://www.amazon.com/exec/obidos/ASIN/0834202794/icongroupin terna ·
Cognitive rehabilitation for persons with traumatic brain injury: a functional approach. Author: edited by Jeffrey S. Kreutzer and Paul H. Wehman; Year: 1991; Baltimore: P.H. Brookes, c1991. ISBN: 1557660719 http://www.amazon.com/exec/obidos/ASIN/1557660719/icongroupin terna
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Cognitive-communication disorders following traumatic brain injury: a practical guide. Author: Jane Freund ... [et al.]; Year: 1994; Tuscon, Ariz.: Communication Skill Builders, c1994. ISBN: 0884501639 http://www.amazon.com/exec/obidos/ASIN/0884501639/icongroupin terna
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Communication disorders following traumatic brain injury: management of cognitive, language, and motor impairments. Author: edited by David R. Beukelman, Kathryn M. Yorkston; Year: 1991; Austin, Tex.: Pro-Ed, c1991. ISBN: 089079295X http://www.amazon.com/exec/obidos/ASIN/089079295X/icongroupi nterna
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Community integration following traumatic brain injury. Author: edited by Jeffrey S. Kreutzer and Paul Wehman; Year: 1990; Baltimore: Brookes, c1990. ISBN: 155766045X http://www.amazon.com/exec/obidos/ASIN/155766045X/icongroupi nterna
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Development and implementation of the New South Wales Brain Injury Rehabilitation Program. Author: prepared by Mid Western Brain Injury Rehabilitation Program; Year: 1999; [Bathhurst, NSW]: Midwestern Brain InjuryRehabilitation Program [1999]. ISBN: 0731388550
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Dynamic cognitive and behavioral changes during the rehabilitation process of traumatic brain injury. Author: Zeev Groswasser, Max J. Stern; Year: 1989; Lynn, MA, USA: New Medico Healthcare System, [1989]
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Family support programs and rehabilitation: a cognitive-behavioral approach to traumatic brain injury. Author: Louise Margaret Smith and Hamish P.D. Godfrey; Year: 1995; New York: Plenum Press, c1995. ISBN: 0306449323 http://www.amazon.com/exec/obidos/ASIN/0306449323/icongroupin terna
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Medical rehabilitation of traumatic brain injury. Author: edited by Lawrence J. Horn, Nathan D. Zasler; Year: 1996; Philadelphia: Hanley & Belfus; St. Louis: North American and worldwide sales and distribution, Mosby, c1996. ISBN: 1560530707
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http://www.amazon.com/exec/obidos/ASIN/1560530707/icongroupin terna ·
Neurobehavioural sequelae of traumatic brain injury. Author: edited by R. Ll. Wood; Year: 1990; New York: Taylor & Francis, 1990. ISBN: 0850668174 http://www.amazon.com/exec/obidos/ASIN/0850668174/icongroupin terna
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Neuropsychiatry of traumatic brain injury. Author: edited by Jonathan M. Silver, Stuart C. Yudofsky, and Robert E. Hales; Year: 1994; Washington, DC: American Psychiatric Press, c1994. ISBN: 0880485388 http://www.amazon.com/exec/obidos/ASIN/0880485388/icongroupin terna
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Occupational therapy approaches to traumatic brain injury. Author: Jerry A. Johnson, editor; Laura H. Krefting, guest editor; Year: 1990; New York: Haworth Press, c1990. ISBN: 1560240644 http://www.amazon.com/exec/obidos/ASIN/1560240644/icongroupin terna
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Recovery after traumatic brain injury. Author: edited by B.P. Uzzell and Henry H. Stonnington; Year: 1996; Mahwah, N.J.: Lawrence Erlbaum Associates, 1996. ISBN: 0805818235 http://www.amazon.com/exec/obidos/ASIN/0805818235/icongroupin terna
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Rehabilitation of a child with a traumatic brain injury. Author: edited by Robert A. Hock; Year: 1984; Springfield, Ill., U.S.A.: Thomas, c1984. ISBN: 0398048967 http://www.amazon.com/exec/obidos/ASIN/0398048967/icongroupin terna
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Rehabilitation of the adult and child with traumatic brain injury. Author: [edited by] Mitchell Rosenthal, Michael R. Bond, J. Douglas Miller; Ernest R. Griffith, co-ordinating editor; foreword by Bryan Jennett; Year: 1990; Philadelphia: Davis, c1990. ISBN: 0803676263 http://www.amazon.com/exec/obidos/ASIN/0803676263/icongroupin terna
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Report of the Working Party on the Management of Traumatic Brain Injury. Author: Medical Disability Society. Working Party on the Management of Traumatic Brain Injury; Year: 1988; [London?]: Published by the Development Trust for the Young Disabled on behalf of the Medical Disability Society, 1988.
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Returning the individual with traumatic brain injury to the community: an overview of programs and services in Israel. Author: editors, Shlomo Katz, Victor Florian; Year: 1990; Durham, NH (University
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of New Hampshire, Durham 03824-3577): International Exchange of Experts and Information in Rehabilitation, [1990] ·
Traumatic brain injury: clinical, social, and rehabilitational aspects. Author: edited by B.G. Deelman, R.J. Saan, A.H. van Zomeren; Year: 1990; Amsterdam: Swets; Zeitlinger, c1990. ISBN: 9026510829 http://www.amazon.com/exec/obidos/ASIN/9026510829/icongroupin terna
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Traumatic brain injury: mechanisms of damage, assessment, intervention, and outcome. Author: edited by Erin D. Bigler; Year: 1990; Austin, Tex.: Pro-Ed, c1990. ISBN: 0890792011 http://www.amazon.com/exec/obidos/ASIN/0890792011/icongroupin terna
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Traumatic brain injury and neuropsychological impairment: sensorimotor, cognitive, emotional, and adaptive problems of children and adults. Author: Rolland S. Parker; with an appendix by Arthur Greenspan; Year: 1990; New York: Springer-Verlag, c1990. ISBN: 0387972390 http://www.amazon.com/exec/obidos/ASIN/0387972390/icongroupin terna
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Traumatic brain injury and vocational rehabilitation. Author: edited by David W. Corthell; Year: 1990; Menomonie, Wis.: Research and Training Center, Stout Vocational Rehabilitation Institute, School of Education and Human Services, University of Wisconsin--Stout, c1990.
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Traumatic brain injury in children and adolescents: a sourcebook for teachers and other school personnel. Author: Mary P. Mira, Bonnie Foster Tucker, Janet Siantz Tyler; Year: 1992; Austin, Tex.: Pro-Ed, c1992. ISBN: 0890795312 http://www.amazon.com/exec/obidos/ASIN/0890795312/icongroupin terna
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Traumatic brain injury rehabilitation for speech-language pathologists. Author: Rita J. Gillis; with contributions by Jeffrey N. Pierce, Monica McHenry; Year: 1996; Boston: Butterworth-Heinemann, c1996. ISBN: 0750696508 http://www.amazon.com/exec/obidos/ASIN/0750696508/icongroupin terna
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Traumatic brain injury vocational rehabilitation: job placement models. Author: Robert T. Fraser, Brian McMahon, Paul Wehman; Robert T. Fraser and David C. Clemmons, editors; Year: 1991; Orlando, FL: PMD Press, c1991. ISBN: 1878205226 http://www.amazon.com/exec/obidos/ASIN/1878205226/icongroupin terna
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Traumatic brain injury. Author: editor, Paul Bach-y-Rita; Year: 1989; New York, N.Y.: Demos, c1989. ISBN: 0939957183 http://www.amazon.com/exec/obidos/ASIN/0939957183/icongroupin terna
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Traumatic brain injury. Author: Ralph M. Reitan, Deborah Wolfson; Year: 1986; Tucson, Ariz.: Neuropsychology Press, c1986. ISBN: 0934515069 http://www.amazon.com/exec/obidos/ASIN/0934515069/icongroupin terna
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Traumatic brain injury. Author: Practice Division, the American Occupational Therapy Association, Inc; Year: 1989; Rockville, MD: The Association, [1989]
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Vocational rehabilitation for persons with traumatic brain injury. Author: edited by Paul Wehman, Jeffrey S. Kreutzer; Year: 1990; Rockville, Md.: Aspen Publishers, 1990. ISBN: 0834201356 http://www.amazon.com/exec/obidos/ASIN/0834201356/icongroupin terna
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Vocational rehabilitation of clients with traumatic brain injury. Author: Sixth Regional Information Utilization Institute, March 26-28, 1985, Philadelphia, Pennsylvania; the George Washington University Regional Rehabilitation Continuing Education Program and; Year: 1985; [Washington, D.C. (2025 Eye St., N.W., Ste. 624, Washington 20052): George Washington University, Regional Rehabilitation Continuing Education Program, 1985?]
Chapters on Traumatic Brain Injury Frequently, traumatic brain injury will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with traumatic brain injury, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and traumatic brain injury using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “traumatic brain injury” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on traumatic brain injury:
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AAC and Traumatic Brain Injury: Influence of Cognition on System Design and Use Source: in Beukelman, D.R.; Yorkston, K.M.; Reichle, J., eds. Augmentative and Alternative Communication for Adults with Acquired Neurologic Disorders. Baltimore, MD: Paul H. Brookes Publishing Co. 2000. p. 271-304. Contact: Available from Paul H. Brookes Publishing Co. P.O. Box 10624, Baltimore, MD 21285. (800) 638-3775. Fax (410) 337-8539. Website: www.brookespublishing.com. PRICE: $42.00 plus shipping and handling. ISBN: 1557664730. Summary: The loss of speech in adulthood due to acquired neurologic disorders causes a person to confront enormous life changes. This chapter on the use of augmentative and alternative communication (AAC) strategies for people with traumatic brain injury (TBI) is from a textbook that explores the challenges these adults face during their transition, whether gradual or immediate, from speaking to using AAC. People with a TBI may experience such severe neurogenic communication disorders that they are unable to meet their communication needs through natural speech alone. Many people use AAC systems sometime during the recovery process. In this chapter, the authors review the neuropathology of TBI, discuss the cognitive impairments and behavior issues that are commonly associated with TBI, present a theoretical framework that assists in the rehabilitation of people with TBI using AAC systems, and discuss the influence of cognition on the selection, design, and use of AAC systems. The authors discuss different types of AAC systems, assessing and remediating impairments, functional limitations, factors to consider in the configuration of AAC display, and symbol use and message formulation. The authors conclude by noting that AAC devices are getting smaller and more powerful, and they perform a variety of functions. Speech language pathologists and other rehabilitation professionals are increasingly aware of the benefits of AAC for people with TBI and are incorporating AAC into treatment plans for individuals at all stages of recovery. 2 tables. 70 references.
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Assessment of Mild-to-Moderate Traumatic Brain Injury Source: in Green, B.S.; Sevens, K.M.; Wolfe, T.D.W. Mild Traumatic Brain Injury: A Therapy and Resource Manual. San Diego, CA: Singular Publishing Group, Inc. 1998. p. 19-60. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 2386777. Fax (800) 774-8398 or (619) 238-6789. E-mail:
[email protected].
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Website: www.singpub.com. PRICE: $49.95 plus shipping and handling. ISBN: 1565938275. Summary: This chapter is from a therapy and reference manual created in response to the unique needs of adolescents and adults who have sustained mild to moderate traumatic brain injuries (MTBI). The authors focus on providing practical suggestions for developing individualized therapy tasks to promote a client's successful return to the demands of the home, school, or work environment. This chapter addresses the assessment of MTBI. Topics include neuropsychological evaluation and assessment considerations, the importance of an integrated assessment, test administration, complex attention, memory skills, verbal communication skills, written communication skills, verbal information processing skills, written information processing skills, executive functioning skills, reasoning skills, and mathematical skills. A final section covers preparing the cognitive language evaluation report, including analyzing test scores, interpreting supplemental information, and sharing assessment results. The chapter concludes with extensive appendices, including client interview questionnaires, sample evaluation segments, vocational recommendations, and publisher and purchasing information for standardized tests. 10 references. ·
Traumatic Brain Injury: Every Parent's Fear Source: in DeFeo, A.B., ed. Parent Articles 2. San Antonio, TX: Communication Skill Builders. 1995. p. 179-180. Contact: Available from Communication Skill Builders. Customer Service, 555 Academic Court, San Antonio, TX 78204-2498. (800) 211-8378; Fax (800) 232-1223. PRICE: $55.00 plus shipping and handling. Order Number 076-163-0732. Summary: In this fact sheet, from a communication skills book for parents, a parent of a child with a traumatic brain injury (TBI) discusses the emotions and psychological factors that may affect the parents of children with TBI. Topics covered include the author's family's story, coping immediately after the trauma occurs, later recovery, speech and language re-development, psychosocial concerns as the child progresses, the role of speech language therapy, dealing with the rehabilitation and insurance communities, and the need for parents to find their own support network. The author encourages parents to educate themselves, to draw on other parents for support, and to act as their child's advocate.
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Traumatic Brain Injury Source: in Vinson, B.P. Essentials for Speech-Language Pathologists. San Diego, CA: Singular Publishing Group. 2001. p. 397-407. Contact: Available from Thomson Learning Group. P.O. Box 6904, Florence, KY 41022. (800) 842-3636. Fax (606) 647-5963. Website: www.singpub.com. PRICE: $49.95 plus shipping and handling. ISBN: 0769300715. Summary: Traumatic brain injury (TBI) is often referred to as a closed head injury and is typically classified as mild, moderate, or severe. The Individuals With Disabilities Education Act (IDEA) calls for the reintegration of children with TBI into the classroom, and teachers report that language disabilities are the factors that cause the greatest interference with success in school. This chapter on TBI is from a textbook that is designed to help new professionals with the transition to clinical practice in speech language pathology. The author first defines TBI, then reports the types of injuries that may be involved, the underlying complications, the effects (initial effects, acute recovery period, and residual effects), and pediatric versus adult aphasia (impairment of language comprehension). The author then discusses assessment considerations (including specific assessment instruments) and treatment strategies. The author concludes by emphasizing the importance of following children with TBI closely throughout their academic careers to monitor possible residual deficits that may play a role in a child's educational and social progress. In addition, the speech language pathologist should track the patient's progress and maintenance of skills once the client has been discharged from active therapy. Cognitive and communicative demands will increase as the client explores reentering different social and vocational aspects of life, and the need for additional therapy may become apparent. 3 tables.
Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to traumatic brain injury have been published that consolidate information across various sources. These too might be useful in gaining access to additional guidance on traumatic brain injury. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:26 You will need to limit your search to “Directories” and traumatic brain injury using the “Detailed Search” option. Go directly to the following hyperlink:
26
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Directory of Speech-Language Pathology Assessment Instruments Source: Rockville, MD: American Speech-Language-Hearing Association (ASHA). 1996. 402 p. Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 897-0157. Website: www.asha.org. PRICE: $30.00 plus shipping and handling. Item Number 0111968. Summary: This directory provides speech-language pathologists with a comprehensive reference on assessment tools used to evaluate the speech and language abilities of individuals across the life span. Assessment instruments are categorized according to areas of practice in speechlanguage pathology. Screening instruments are included with other tests in each category. Tests are categorized in the following areas: spoken language assessment, written language assessment, cognitive communication assessment (including dementia and traumatic brain injury), articulation and phonology assessment, fluency assessment, voice assessment, swallowing and oral motor assessment, test batteries, related tests, and developmental scales. For each assessment instrument, the directory provides title, authors, year (most recent revision), source (companies that sell the test; the publisher is listed first, then others in alphabetical order), age range, administration time in minutes, availability in other languages, availability of computerized scoring, a brief description, reference to review of the instrument in an ASHA publication, and the date the entry was reviewed or updated by the publisher. The directory concludes with a list of the titles of all tests within each category, an alphabetized list of the titles of all test materials, and an alphabetized listing of publishers with addresses and telephone numbers.
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Brain Connections: Your Source Guide to Information on Brain Diseases and Disorders. 5th ed Source: New York, NY: Dana Alliance for Brain Initiatives. 2000. 49 p. Contact: Available from Dana Press. Charles A. Dana Foundation, 745 Fifth Avenue, Suite 700, New York, NY 10151. Fax (212) 593-7623. Website: www.dana.org. PRICE: Single copy free.
http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by”. For publication date, select “All Years”, select language and the format option “Directory”. By making these selections and typing in “traumatic brain injury” (or synonyms) into the “For these words:” box, you will only receive results on directories dealing with traumatic brain injury. You should check back periodically with this database as it is updated every three months.
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Summary: This guide lists organizations that assist people with a brainrelated disorder or disease as well as those organizations that assist caregivers and health care providers in these areas. The guide lists more than 275 organizations alphabetically by disease or disorder. Listings of particular relevance to communication disorders include: acoustic neuroma, aphasia, ataxia, attention deficit hyperactivity disorder, autism, deafness and hearing loss, disability and rehabilitation, dizziness, dyslexia, dystonia, head injury, learning disabilities, neurofibromatosis, smell and taste (chemosensory) disorders, spasmodic dysphonia, stuttering, tinnitus, Tourette syndrome, and vestibular disorders. Emphasis is placed on organizations that have a national focus, however, many of these groups sponsor local chapters or affiliates and make referrals to local medical professionals and organizations. For each organization listed, the guide notes mailing address, telephone numbers, e-mail and web sites; also provided are symbols which indicate that the organization offers support groups, referrals to doctors, referrals to other sources of information, regional chapters, availability of literature, availability of speakers, and volunteer opportunities. The guide also describes the publishing body, the Dana Alliance for Brain Initiatives, and provides a list of ways in which readers can support and further brain research.
General Home References In addition to references for traumatic brain injury, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Adams & Victor’s Principles Of Neurology by Maurice Victor, et al; Hardcover - 1692 pages; 7th edition (December 19, 2000), McGraw-Hill Professional Publishing; ISBN: 0070674973; http://www.amazon.com/exec/obidos/ASIN/0070674973/icongroupinterna · Clinical Neuroanatomy Made Ridiculously Simple (MedMaster Series, 2000 Edition) by Stephen Goldberg; Paperback: 97 pages; 2nd edition (February 15, 2000), Medmaster; ISBN: 0940780461; http://www.amazon.com/exec/obidos/ASIN/0940780461/icongroupinterna · It’s Not a Tumor!: The Patient’s Guide to Common Neurological Problems by Robert Wiedemeyer; Paperback: (January 1996), Boxweed Pub; ISBN: 0964740796; http://www.amazon.com/exec/obidos/ASIN/0964740796/icongroupinterna
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· Neurology for the Non-Neurologist by William J. Weiner (Editor), Christopher G. Goetz (Editor); Paperback (May 1999), Lippincott, Williams & Wilkins Publishers; ISBN: 0781717078; http://www.amazon.com/exec/obidos/ASIN/0781717078/icongroupinterna
Vocabulary Builder Ataxia: Failure of muscular coordination; irregularity of muscular action. [EU]
Neuroanatomy: Study of the anatomy of the nervous system as a specialty or discipline. [NIH] Semantics: The relationships between symbols and their meanings. [NIH] Spasmodic: Of the nature of a spasm. [EU] Tinnitus: A noise in the ears, as ringing, buzzing, roaring, clicking, etc. Such sounds may at times be heard by others than the patient. [EU]
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CHAPTER 7. MULTIMEDIA ON TRAUMATIC BRAIN INJURY Overview Information on traumatic brain injury can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on traumatic brain injury. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on traumatic brain injury is the Combined Health Information Database. You will need to limit your search to “video recording” and “traumatic brain injury” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “traumatic brain injury” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on traumatic brain injury:
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Socially Co-Constructed Narratives: Facilitation of Thought Organization, Episodic Memory, and Discourse Organization Source: Tucson, AZ: National Center for Neurogenic Communication Disorders, University of Arizona. 1998. (videocassette). Contact: National Center for Neurogenic Communication Disorders, University of Arizona. P.O. Box 210071, Tucson, AZ 85721-0071. (521) 621-1472. Fax (520) 621-2226. PRICE: $40.00. Order number TR-42. Summary: This videocassette program is one in a series of Telerounds Continuing Education from the National Center for Neurogenic Communication Disorders at the University of Arizona (funded partly by NIDCD). This program describes the impact of a communication partner's interaction style and approach on the resulting communication. The video notes that when the communication partners of a person with language disability use an interactive style that is elaborative and collaborative, they contribute to the individual's development or redevelopment of thought organization, language organization, and episodic memory. The program reviews a videotaped interaction between a father and young son (age almost 4 years), then discusses the theoretical concepts of knowledge structure and internal scripts. The video states that parents with a positive facilitative style of interaction participate with their children in constructing organized descriptions of events, rather then demanding performance from them. In effect, these parents are teaching their children how to think and how to organize their thoughts. The program lists competencies for collaboration (collaborative intent, cognitive support, emotional support, and positive style of questions) and elaboration (topics, organization, and explanation). The program concludes with a case study of a child with language disability from traumatic brain injury (TBI). The program shows the parent-child interaction and communication styles before and after speech language therapy. The program concludes by answering questions phoned in by the teleconference audience and by providing information about joining Centernet, the online forum run by the Center.
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Speech Production Disorders Following Traumatic Brain Injury Source: Tucson, AZ: National Center for Neurogenic Communication Disorders. 1993. (videocassette and handout). Contact: Available from National Center for Neurogenic Communication Disorders. Telerounds Coordinator, Building 71, Room 500, University of Arizona, Tucson, AZ 85721. (520) 621-1819 or (520) 621-1472. PRICE: $25.00.
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Summary: In this telerounds program, speech production disorders and neural lesions are described for a group of individuals with traumatic brain injury (TBI). The neural lesions are interpreted in terms of their possible relations to the speech disorders and the proposed neural mechanisms of speech production. The program also discusses the associated research and clinical implications. The handout provided with the videotape includes an abstract, a list of objectives, a brief outline of the program, a reference list, and an evaluation form for viewers to complete and return. 31 references. (AA-M).
Bibliography: Multimedia on Traumatic Brain Injury The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in traumatic brain injury (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on traumatic brain injury. For more information, follow the hyperlink indicated: ·
Acute care of patients with head injuries. Source: AREN; Year: 1995; Format: Videorecording; Carrollton, TX: Westcott Communications, [1995]
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Advancements in traumatic brain injury. Source: a presentation of Films for the Humanities & Sciences; ITV, Information Television Network; Year: 1997; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1997.
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Assessing brain function. Source: produced by the Department of Neurological Surgery, University of Washington, School of Medicine and Region X Rehabilitation Consortium in Traumatic Brain Injury Vocational Rehabilitation; Year: 1990; Format: Videorecording; [Seattle, Wash.]: University of Washington, c1990.
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Brain: effects of childhood trauma. Source: [presented by] Linkletter Films for Magna Systems, Inc; Year: 2002; Format: Videorecording; Barrington, IL: Magna Systems, c2002.
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Brain: vital and protected; Brain injury and intracranial pressure. Source: Trainex Corporation; Year: 1978; Format: Filmstrip; Garden Grove, Calif.: Trainex, c1978.
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Counseling techniques for brain injured clients with language difficulties. Source: produced by the Department of Neurological Surgery, University of Washington, School of Medicine and Region X Rehabilitation Consortium in Traumatic Brain Injury; Year: 1991; Format: Videorecording; Seattle, Wash.: University of Washington, c1991.
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Helping the patient with brain injury to learn: self-feeding as a place to begin. Source: produced by the Drucker Brain Injury Center of Moss Rehabilitation Hospital; Year: 1987; Format: Videorecording; Philadelphia, PA: The Hospital, c1987.
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Managing thinking and behavioural problems after brain injury. Source: [presented by] G.F. Strong Rehabilitation Centre, in cooperation with Biomedical Communications, Special Projects Division, University of British Columbia; Year: 1987; Format: Videorecording; Vancouver, B.C.: The Centre, c1987.
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Neurological emergencies in head trauma. Source: Paul M. Katz; Year: 1992; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1992.
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Patterns of brain injury: on rounds in neurology. Source: Trainex Corporation; Year: 1978; Format: Filmstrip; Garden Grove, Calif.: Trainex, c1978.
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Pediatric head injury. Year: 1985; Format: Videorecording; Sacramento, Calif.: Head Trauma Support Project, c1985.
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Programming the dysfunctional brain: discover options for the treatment of cerebral palsy & traumatic brain injury. Source: Successful Images, Inc. & Institute of Human Development, Inc; Year: 2000; Format: Videorecording; Ft. Lauderdale, FL: Successful Images, c2000.
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Speech production disorders following traumatic brain injury. Source: the National Center for Neurogenic Communication Disorders; [with the cooperation of] Veterans Health Administration, Office of Academic Affairs [and] Long Beach Regional Med; Year: 1993; Format: Videorecording; [Tuscon, Ariz.]: Arizona Board of Regents, c1993.
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Traumatic brain injury: facilitating return-to-work. Source: [a jointly sponsored production of School of Education, the University of Wisconsin Milwaukee, Paul M. Deutsch Press, Inc., Brian T. McMahon Publications, Inc.; a production of Telev; Year: 1991; Format: Videorecording; [Milwaukee]: School of Education, University of Wisconsin Milwaukee, c1991.
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Traumatic brain injury. Year: 1985; Format: Videorecording; Sacramento, Calif.: Head Trauma Support Project, c1985.
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Traumatic brain injury in the United States: a report to Congress. Source: prepared by Division of Acute Care, Rehabilitation Research, and
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Disability Prevention, National Center for Injury Prevention and Control, Centers for Disease Contr; Year: 1999; Format: Electronic resource; [Atlanta, Ga.]: Centers for Disease Control and Prevention, [1999] ·
Traumatic brain injury overview. Year: 1985; Format: Videorecording; Sacramento, Calif.: Head Trauma Support Project, c1985.
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Traumatic brain injury vocational rehabilitation series. Source: produced by the Department of Neurological Surgery, University of Washington, School of Medicine and Region X Rehabilitation Consortium in Traumatic Brain Injury Vocational Rehabil; Year: 1991; Format: Videorecording; Seattle, Wash.: University of Washington, c1990-c1991.
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Who are they now? : Understanding traumatic brain injury. Year: 1993; Format: Videorecording; Chicago: Rehabilitation Institute of Chicago, [1993]
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CHAPTER 8. PERIODICALS AND NEWS ON TRAUMATIC BRAIN INJURY Overview Keeping up on the news relating to traumatic brain injury can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on traumatic brain injury. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover traumatic brain injury beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on traumatic brain injury is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “traumatic brain injury” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased.
Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to traumatic brain injury. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “traumatic brain injury” (or synonyms). The following was recently listed in this archive for traumatic brain injury: ·
Disorders Similar In Children With And Without Traumatic Brain Injury In Outpatient Psych Setting Source: Reuters Medical News Date: February 27, 1997 http://www.reuters.gov/archive/1997/02/27/professional/links/19970 227clin006.html
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Hypothermia After Traumatic Brain Injury Improves Outcome Source: Reuters Medical News Date: February 20, 1997 http://www.reuters.gov/archive/1997/02/20/professional/links/19970 220clin004.html
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Botulinum Toxin Improves Upper Extremity Spasticity In Traumatic Brain Injury Patients Source: Reuters Medical News Date: October 31, 1996 http://www.reuters.gov/archive/1996/10/31/professional/links/19961 031clin006.html
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can
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be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name. Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “traumatic brain injury” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “traumatic brain injury” (or synonyms). If you know the name of a company that is relevant to traumatic brain injury, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “traumatic brain injury” (or synonyms).
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Newsletters on Traumatic Brain Injury Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “traumatic brain injury.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “traumatic brain injury” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above: ·
Family Survival Project Update [Newsletter] Source: San Francisco, CA: Family Survival Project. [4 p. average]. Contact: Available from Family Survival Project. 425 Bush Street, Suite 500, San Francisco, CA 94108. (415) 434-3388. Summary: This newsletter is directed to those who have sustained traumatic brain injury and illness and their families and friends. It covers regional and national news and happenings in the chapter's area. Articles are mainly concerned with legislative advocacy for those with brain injury or illness. Each issue may contain a question-and-answer section on legal matters, a list of recommended reading, and a column entitled 'Clearinghouse,' providing information on hotlines, seminars, and community service organizations.
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.”
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By making these selections, and typing in “traumatic brain injury” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on traumatic brain injury: ·
Memory and Disability: What Is Memory? Source: Wellspring Currents. [Newsletter] Number 1: 1-3, 5, 7. Summer 1991. Contact: Available from Wellspring Currents. 179 West Washington, Suite 360, Chicago, IL. 60602. (312) 201-9696. PRICE: Call for price information. Summary: Memory impairment is a common complaint of patients who have psychological problems such as depression or those who have primary neurologic disorders such as Alzheimer's disease, Parkinson's disease, and traumatic brain injury. This newsletter article discusses what is currently understood about how normal memory operates and the influence of aging on memory. Also discussed are the validity, use, and misuse of memory and mental status tests in guardianship and residential placement of memory impaired individuals.
Academic Periodicals covering Traumatic Brain Injury Academic periodicals can be a highly technical yet valuable source of information on traumatic brain injury. We have compiled the following list of periodicals known to publish articles relating to traumatic brain injury and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on traumatic brain injury published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The
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following is a sample of periodicals which publish articles on traumatic brain injury: ·
Acta Neurochirurgica. (Acta Neurochir (Wien)) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ac ta+Neurochirurgica&dispmax=20&dispstart=0
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Brain Research. (Brain Res) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Br ain+Research&dispmax=20&dispstart=0
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Critical Care Medicine. (Crit Care Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Cr itical+Care+Medicine&dispmax=20&dispstart=0
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Current Opinion in Neurology. (Curr Opin Neurol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Cu rrent+Opinion+in+Neurology&dispmax=20&dispstart=0
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Experimental Neurology. (Exp Neurol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ex perimental+Neurology&dispmax=20&dispstart=0
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Journal of Neurosurgery. (J Neurosurg) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Neurosurgery&dispmax=20&dispstart=0
·
Journal of Rehabilitation Research and Development. (J Rehabil Res Dev) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Rehabilitation+Research+and+Development&dispmax=20&dis pstart=0
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Muscle & Nerve. (Muscle Nerve) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=M uscle+&+Nerve&dispmax=20&dispstart=0
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Neuroscience Letters. (Neurosci Lett) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ne uroscience+Letters&dispmax=20&dispstart=0
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·
The Journal of Clinical Psychiatry. (J Clin Psychiatry) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Clinical+Psychiatry&dispmax=20&dispstart=0
Vocabulary Builder Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU]
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CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.27 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:28 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
·
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 28 See http://www.nlm.nih.gov/databases/databases.html. 27
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·
Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat traumatic brain injury, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and traumatic brain injury using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “traumatic brain injury” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with traumatic brain injury. The following is a sample result:
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·
Recovery from traumatic brain injury in children Source: Arlington, VA: National Center for Education in Maternal and Child Health. 1997. 8 pp. Contact: Available from Librarian, National Center for Education in Maternal and Child Health, 2000 15th Street, North, Suite 701, Arlington, VA 22201-2617. Telephone: (703) 524-7802 / fax: (703) 524-9335 / e-mail:
[email protected] / Web site: http://www.ncemch.org. Photocopy available at no charge; also available from the Web site at no charge. Summary: This report summarizes a Maternal and Child Health funded project presented at a seminar July 16, 1997. This project examines the impact of pediatric moderate-to-severe traumatic brain damage on families and whether the child's recovery is influenced by the family environment. The report ends with reaction to the project and discussion and a publication list. [Funded by the Maternal and Child Health Bureau].
·
Rehabilitation for Traumatic Brain Injury in Children and Adolescents Source: Rockville, MD: Agency for Healthcare Research and Quality (AHRQ), Department of Health and Human Services. September 1999. 120 p. Contact: Available from Agency for Healthcare Research and Quality (AHRQ). P.O. Box 8547, Silver Spring, MD 20907-8547. (800) 358-9295. Website: www.ahrq.gov. PRICE: Single copy free. AHCPR Publication Number 00-E001. Summary: This report focuses on the results of a systematic review of the literature about child and adolescent traumatic brain injury (TBI). With the assistance of technical experts, key questions were formulated in five areas: the effectiveness of early, intensive rehabilitation; referral of children with TBI to special education; the effectiveness of special education for children with TBI; the effect of developmental phase on prediction and outcome; and the effect of support for families. Patient populations, interventions, and outcome measures were defined, and literature was compiled and categorized from seven databases: medical, educational, and psychological. The initial search strategy yielded 1,464 abstracts of potentially relevant studies; of these, 356 articles were relevant to one of the five research questions. No randomized controlled trials and very few comparative studies were found that addressed the key research questions. One study suggests that the early introduction of physiatry during the acute care phase of treatment aids in detecting musculoskeletal trauma that may otherwise be missed. No literature was found that accurately documents rates of referral for children with TBI to
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special services. A large body of literature documents the utility of patients' developmental information in predicting deficits and outcomes. Correlational studies associate family support with better family functioning. This report reviews the findings of the literature review and includes discussions and recommendations for future research. Appendices list the technical expert panels, key questions, search strategies, categorization and code system for bibliography, and an evidence table template. The report concludes with the bibliography of the studies reviewed. 2 figures. 4 tables. 563 references. ·
Traumatic brain injury in the United States: Assessing outcomes in children: Summary and recommendations from the Expert Working Group, Atlanta, GA, October 26-27, 2000 Source: [Atlanta, GA]: National Center for Injury Prevention and Control. [2001]. 50 pp. Contact: Available from HRSA Information Center, 2070 Chain Bridge Road, Suite 450, Vienna, VA 22182-2536. Telephone: (888) ASK-HRSA or (877) 474-4772 TTY / fax: (703) 821-2098 / e-mail:
[email protected] / Web site: http://www.ask.hrsa.gov. Summary: This report is intended for researchers, public health professional including those from state health departments, and advocates interested in furthering research on outcomes of traumatic brain injury (TBI) in children. This report summarizes the comments, suggestions, and recommendations of a working group convened by the Centers for Disease Control and Prevention (CDC) on assessment of TBI outcomes in children and youth. Meeting participants identified (1) key research topics and variables to measure in assessing longer-term outcomes; (2) reviewed conceptual models of disability that could provide a framework for designing appropriate studies of TBI outcomes; (3) discussed the advantages and shortcomings for assessing these outcomes; and (4) described the challenges in designing and implementing studies on TBI and recommended ways to address those challenges. The appendices include an overview of available outcome assessments; presentation slides; surveillance data from South Carolina; resources to guide selection of research topics; and an overview of TBI surveillance activities funded by the CDC.
·
Funding traumatic brain injury services Source: Denver, CO: National Conference of State Legislatures. 2001. 33 pp.
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Contact: Available from National Conference of State Legislatures, 1560 Broadway, Suite 700, Denver, CO 80202. Telephone: (303) 830-2200 or (303) 830-2054 book order line / fax: (303) 863-8003 / e-mail:
[email protected] / Web site: http://www.ncsl.org. $15.00, plus shipping and handling. Summary: This brief offers an overview of traumatic brain injury (TBI) and its effect on individuals and society, particularly in the need for and use of a variety of health and assistive services. It is designed to serve as a guide for states to identify resources and funding streams to help address the range of associated issues. Topics discussed include defining TBI; outlining legislative concerns; determining how prevalent TBI is in the United States in relation to other chronic illnesses and conditions; and identifying legislation and funding sources covering TBI. The appendix contains state-by-state information about federal and state spending on TBI, data collected in a study conducted by the Brain Injury Association of America Inc. in 1999. Statistical information is presented in charts, graphs, and tables throughout the report. [Funded by the Maternal and Child Health Bureau]. ·
TBI: Traumatic Brain Injury State Demonstration Grant Program: Project abstracts, FY__ Source: Silver Spring, MD: TBI Technical Assistance Center. 1998. annual. Contact: Available from TBI Technical Assistance Center, 8737 Colesville Road, Suite 950, Silver Spring, MD 20910. Telephone: (301) 650-8080 / fax: (301) 650-8045. Summary: This report begins with background information on the Traumatic Brain Injury State Demonstration Grant Program. Part II of the report is a tabular state-by-state summary of objectives. Part III contains project abstracts for planning grants and implementation grants, each section arranged alphabetically by state name. Part IV is the grantee contact list. [Funded by the Maternal and Child Health Bureau].
·
Traumatic brain injury in Massachusetts: Incidence and prevention Source: Boston, MA: Injury Prevention and Control Program, Massachusetts Department of Public Health. 1994. 44 pp. Contact: Available from Cindy Rodgers, Massachusetts Department of Public Health, Injury Prevention and Control Program, 250 Washington Street, Fourth Floor, Boston, MA 02108-4619. Telephone: (617) 624-5070 / fax: (617) 624-5075 / e-mail:
[email protected]. Available at no charge.
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Summary: This report describes the extent of traumatic brain injury in Massachusetts, including the frequency of brain injury by cause, and estimates the lifetime costs of health care and lost earnings. Clinical patterns of these injuries, sample cases from one emergency department, and prevention strategies targeted at the three leading causes of brain injuries: motor vehicles, falls and firearms, are also described. ·
What legislators need to know about traumatic brain injury Source: Denver, CO: National Conference of State Legislatures. 1993. 52 pp. Contact: Available from Book Order Department, National Conference of State Legislatures, 1560 Broadway, Suite 700, Denver, CO 80202-5140. Telephone: (303) 830-2200 / fax: (303) 863-8003. $10.00. Summary: This report addressed to state legislators reviews the public policy aspects of traumatic brain injury, including the services such patients require; what federal assistance is available; what private insurance coverage applies; how states finance and deliver services to people with traumatic brain injuries; and how long-term care is handled. There is also a resources list of organizations that work in this area.
The NLM Gateway29 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.30 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.31 To use the NLM Gateway, simply go to the search site at Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 31 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other 29 30
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http://gateway.nlm.nih.gov/gw/Cmd. Type “traumatic brain injury” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category.
Results Summary Category Items Found Journal Articles 355308 Books / Periodicals / Audio Visual 2595 Consumer Health 294 Meeting Abstracts 2575 Other Collections 96 Total 360868
HSTAT32 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.33 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.34 Simply search by “traumatic brain injury” (or synonyms) at the following Web site: http://text.nlm.nih.gov. established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 32 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 33 The HSTAT URL is http://hstat.nlm.nih.gov/. 34 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.
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Coffee Break: Tutorials for Biologists35 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.36 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.37 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
·
MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical
35 Adapted
from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 37 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 36
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literature, and to explore relevant Web http://www.med.virginia.edu/~wmd4n/medweaver.html. ·
sites;
see
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see http://www.lexical.com/Metaphrase.html.
The Genome Project and Traumatic Brain Injury With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to traumatic brain injury. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).38 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/omim/searchomim.html to search the database. Type “traumatic brain injury” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for traumatic brain injury: 38 Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
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·
Apolipoprotein E Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?107741
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Tumor Necrosis Factor Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?191160
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Tumor Necrosis Factor Receptor Subfamily, Member 1b; Tnfrsf1b Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?191191
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Tumor Necrosis Factor Receptor Superfamily, Member 1a Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?191190
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
·
Nervous System: Mind and body. Examples: Alzheimer disease, Amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, Fragile X syndrome, Friedreich’s ataxia, Huntington disease, NiemannPick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, Spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html
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·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html Entrez
Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
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Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
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Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
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Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
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PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
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OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
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Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
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Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
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ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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·
NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genom e, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “traumatic brain injury” (or synonyms) and click “Go.”
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database39 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html, you can also search across syndromes using an alphabetical index. Search by keywords at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database40 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 40 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 39
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knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “traumatic brain injury” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to nonprofessionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in traumatic brain injury (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · The Behavioral Neurology of White Matter by Christopher M. Filley; Paperback - 279 pages; 1st edition (September 15, 2001), Oxford University Press; ISBN: 019513561X; http://www.amazon.com/exec/obidos/ASIN/019513561X/icongroupintern a · The Cerebellum and Its Disorders by Mario-Ubaldo Manto, Massimo Pandolfo; Hardcover - 1st edition (January 2002), Cambridge University Press; ISBN: 0521771560; http://www.amazon.com/exec/obidos/ASIN/0521771560/icongroupinterna · Clinical Neurology by David A. Greenberg, et al; Paperback - 390 pages; 5th edition (February 9, 2002), Appleton & Lange; ISBN: 0071375430; http://www.amazon.com/exec/obidos/ASIN/0071375430/icongroupinterna · Clinical Neurology for Psychiatrists by David M. Kaufman; Hardcover 670 pages, 5th edition (January 15, 2001), W. B. Saunders Co.; ISBN: 0721689957; http://www.amazon.com/exec/obidos/ASIN/0721689957/icongroupinterna · Comprehensive Neurology by Roger N. Rosenberg (Editor), David E. Pleasure (Editor); 1280 pages, 2nd edition (April 1998), Wiley-Liss; ISBN: 0471169587; http://www.amazon.com/exec/obidos/ASIN/0471169587/icongroupinterna
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· Emergent and Urgent Neurology by William J. Weiner (Editor), Lisa M. Shulman (Editor); Hardcover - 571 pages; 2nd edition (January 15, 1999), Lippincott, Williams & Wilkins Publishers; ISBN: 0397518579; http://www.amazon.com/exec/obidos/ASIN/0397518579/icongroupinterna · Neurology in Clinical Practice: Volume I: Principles of Diagnosis and Management, Volume II: The Neurological Disorders (2-Volume Set, Includes a 12-Month Subscription to the Online Edition) by W. G. Bradley, et al; Hardcover - 2413 pages, 3rd edition, Vol 1-2 (January 15, 2000), Butterworth-Heinemann; ISBN: 0750699736; http://www.amazon.com/exec/obidos/ASIN/0750699736/icongroupinterna · Neuroscience: Exploring the Brain by Mark F. Bear, et al; Hardcover - 855 pages, 2nd edition (January 15, 2001), Lippincott, Williams & Wilkins Publishers; ISBN: 0683305964; http://www.amazon.com/exec/obidos/ASIN/0683305964/icongroupinterna · Office Practice of Neurology by Martain A. Samuels, Steven F. Feske; Hardcover, Churchill Livingstone; ISBN: 0443065578; http://www.amazon.com/exec/obidos/ASIN/0443065578/icongroupinterna · Patient-Based Approaches to Cognitive Neuroscience by Martha J. Farah (Editor), Todd E. Feinberg (Editor); Paperback - 425 pages (April 3, 2000), MIT Press; ISBN: 0262561239; http://www.amazon.com/exec/obidos/ASIN/0262561239/icongroupinterna · Principles of Neural Science by Eric R. Kandel (Editor), et al; Hardcover 1414 pages, 4th edition (January 5, 2000), McGraw-Hill Professional Publishing; ISBN: 0838577016; http://www.amazon.com/exec/obidos/ASIN/0838577016/icongroupinterna · Review Manual for Neurology in Clinical Practice by Karl E. Misulis, et al; Paperback, Butterworth-Heinemann Medical; ISBN: 0750671920; http://www.amazon.com/exec/obidos/ASIN/0750671920/icongroupinterna
Vocabulary Builder Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH]
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CHAPTER 10. DISSERTATIONS ON TRAUMATIC BRAIN INJURY Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to traumatic brain injury. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Traumatic Brain Injury ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to traumatic brain injury. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with traumatic brain injury: ·
A Heuristic Study Using an Evolutionary Perspective of the Experience of Adolescents Adapting to the Head Injury of a Parent by Pryce, Nancy Lorraine, Ph.D from University of South Carolina, 1995, 304 pages http://wwwlib.umi.com/dissertations/fullcit/9611246
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·
A Study of the Components Associated with the School Reentry Process for Students with Traumatic Brain Injury by Klomes, Jeannine Marie, EDD from Northern Illinois University, 1995, 237 pages http://wwwlib.umi.com/dissertations/fullcit/9614886
·
An Initial Exploration Through the Use of the Genogram of the Premorbid Functioning of Families with a Person with a Head Injury by Norwood, Whitney, Psy.D from Rutgers, the State University of New Jersey, G.S.A.P.P., 1992, 445 pages http://wwwlib.umi.com/dissertations/fullcit/9320765
·
Assessments of the Educational Needs and Services for Adolescents with Traumatic Brain Injury: the Parents' View by Moulton, Lynn Rozelle; Ph.D from the University of Texas at Austin, 2001, 242 pages http://wwwlib.umi.com/dissertations/fullcit/3008400
·
Biomechanics of Traumatic Brain Injury in the Infant by Prange, Michael Thomas; Ph.D from University of Pennsylvania, 2002, 186 pages http://wwwlib.umi.com/dissertations/fullcit/3043942
·
Caregiver Coping Resources and the Care of a Relative with Traumatic Brain Injury (home Care) by Caperton, Rebecca Clendenin, Ph.D from Memphis State University, 1993, 122 pages http://wwwlib.umi.com/dissertations/fullcit/9402977
·
Children's Social Competence Six Months Following Traumatic Brain Injury by Nassau, Jack Howard, Ph.D from Case Western Reserve University, 1996, 101 pages http://wwwlib.umi.com/dissertations/fullcit/9720439
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Cognitive Processing Theory: a Basis for Instruction for Adolescents with Traumatic Brain Injury (reading Comprehension) by Wright, Carol Lynn, Ph.D from University of Florida, 1995, 226 pages http://wwwlib.umi.com/dissertations/fullcit/9618789
·
Comparison of Autonomy in Families with and without Traumatically Brain-injured Adolescents (traumatic Brain Injury) by Bragg, Russell Merle, Ph.D from University of Washington, 1990, 99 pages http://wwwlib.umi.com/dissertations/fullcit/9104203
Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to traumatic brain injury is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access
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the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
Vocabulary Builder Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH]
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PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with traumatic brain injury and related conditions.
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APPENDIX A. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to traumatic brain injury. Finally, at the conclusion of this chapter, we will provide a list of readings on traumatic brain injury from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?41 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 41
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?42 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
42
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include qi gong, reiki and therapeutic touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.43
43
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative or Complementary Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Traumatic Brain Injury Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for traumatic brain injury. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to traumatic brain injury and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “traumatic brain injury” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to traumatic brain injury: ·
Auditory stimulation effect on a comatose survivor of traumatic brain injury. Author(s): Jones R, Hux K, Morton-Anderson KA, Knepper L.
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Source: Archives of Physical Medicine and Rehabilitation. 1994 February; 75(2): 164-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8311672&dopt=Abstract ·
Biochemical and physiological parameters of recovery in acute severe head injury: responses to multisensory stimulation. Author(s): Johnson DA, Roethig-Johnston K, Richards D. Source: Brain Injury : [bi]. 1993 November-December; 7(6): 491-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7903180&dopt=Abstract
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Cognitive brain potentials in a three-stimulus auditory "oddball" task after closed head injury. Author(s): Rugg MD, Pickles CD, Potter DD, Doyle MC, Pentland B, Roberts RC. Source: Neuropsychologia. 1993 April; 31(4): 373-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8502373&dopt=Abstract
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Combined motor disturbances following severe traumatic brain injury: an integrative long-term treatment approach.Author(s): Keren O, Reznik J, Groswasser Z. Source: Brain Injury : [bi]. 2001 July; 15(7): 633-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11429091&dopt=Abstract
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Curative effect of wilsonii injecta on severe head injury. Author(s): Chen L, Zeng F, Yang L, Chai J, Li K, Lu M, Kuang Y. Source: Chinese Journal of Traumatology = Chung-Hua Ch'uang Shang Tsa Chih / Chinese Medical Association. 2002 April; 5(2): 82-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11904068&dopt=Abstract
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Dietary supplement creatine protects against traumatic brain injury. Author(s): Sullivan PG, Geiger JD, Mattson MP, Scheff SW. Source: Annals of Neurology. 2000 November; 48(5): 723-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11079535&dopt=Abstract
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EEG operant conditioning (biofeedback) and traumatic brain injury. Author(s): Thatcher RW.
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Source: Clin Electroencephalogr. 2000 January; 31(1): 38-44. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10638351&dopt=Abstract ·
Effect of training frequency on face-name recall by adults with traumatic brain injury. Author(s): Hux K, Manasse N, Wright S, Snell J. Source: Brain Injury : [bi]. 2000 October; 14(10): 907-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11076136&dopt=Abstract
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Effects of auditory stimuli on intracranial pressure and cerebral perfusion pressure in traumatic brain injury. Author(s): Schinner KM, Chisholm AH, Grap MJ, Siva P, Hallinan M, LaVoice-Hawkins AM. Source: J Neurosci Nurs. 1995 December; 27(6): 348-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8770779&dopt=Abstract
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Evaluation of a specific balance and coordination programme for individuals with a traumatic brain injury. Author(s): Dault MC, Dugas C. Source: Brain Injury : [bi]. 2002 March; 16(3): 231-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11908477&dopt=Abstract
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Evidence that synaptically-released zinc contributes to neuronal injury after traumatic brain injury. Author(s): Suh SW, Chen JW, Motamedi M, Bell B, Listiak K, Pons NF, Danscher G, Frederickson CJ. Source: Brain Research. 2000 January 10; 852(2): 268-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10678752&dopt=Abstract
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Fast vigilance decrement in closed head injury patients as reflected by the mismatch negativity (MMN). Author(s): Kaipio ML, Novitski N, Tervaniemi M, Alho K, Ohman J, Salonen O, Naatanen R. Source: Neuroreport. 2001 May 25; 12(7): 1517-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11388440&dopt=Abstract
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Flexyx Neurotherapy System in the treatment of traumatic brain injury: an initial evaluation. Author(s): Schoenberger NE, Shif SC, Esty ML, Ochs L, Matheis RJ. Source: The Journal of Head Trauma Rehabilitation. 2001 June; 16(3): 26074. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11346448&dopt=Abstract
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Ginkgo biloba: applications in traumatic brain injury. Author(s): Elovic EP, Zafonte RD. Source: The Journal of Head Trauma Rehabilitation. 2001 December; 16(6): 603-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11732975&dopt=Abstract
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Group psychotherapy for persons with traumatic brain injury: management of frustration and substance abuse. Author(s): Delmonico RL, Hanley-Peterson P, Englander J. Source: The Journal of Head Trauma Rehabilitation. 1998 December; 13(6): 10-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9885315&dopt=Abstract
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Homeopathic treatment of mild traumatic brain injury: A randomized, double-blind, placebo-controlled clinical trial. Author(s): Chapman EH, Weintraub RJ, Milburn MA, Pirozzi TO, Woo E. Source: The Journal of Head Trauma Rehabilitation. 1999 December; 14(6): 521-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10671699&dopt=Abstract
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Hypnosis and attention deficits after closed head injury. Author(s): Laidlaw TM. Source: Int J Clin Exp Hypn. 1993 April; 41(2): 97-111. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8468107&dopt=Abstract
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Hypomania induced by herbal and pharmaceutical psychotropic medicines following mild traumatic brain injury. Author(s): Spinella M, Eaton LA. Source: Brain Injury : [bi]. 2002 April; 16(4): 359-67.
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http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11953006&dopt=Abstract ·
Improving outcome after traumatic brain injury--progress and challenges. Author(s): Gentleman D. Source: British Medical Bulletin. 1999; 55(4): 910-26. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10746339&dopt=Abstract
·
Lateralized effects of migraine and ANS seizures after closed head injury. Author(s): Leisman G. Source: The International Journal of Neuroscience. 1990 September; 54(12): 63-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2265966&dopt=Abstract
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Mental imagery, human memory, and the effects of closed head injury. Author(s): Richardson JT. Source: Br J Soc Clin Psychol. 1979 September; 18(3): 319-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=519141&dopt=Abstract
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Microtubule-associated protein 2 levels decrease in hippocampus following traumatic brain injury. Author(s): Taft WC, Yang K, Dixon CE, Hayes RL. Source: Journal of Neurotrauma. 1992 Fall; 9(3): 281-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1474611&dopt=Abstract
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Neuropsychiatric Aspects of Traumatic Brain Injury. Author(s): Arciniegas DB, Topkoff J, Silver JM. Source: Curr Treat Options Neurol. 2000 March; 2(2): 169-186. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11096746&dopt=Abstract
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Outpatient management and outcome in relation to work in traumatic brain injury patients. Author(s): Christensen AL. Source: Scand J Rehabil Med Suppl. 1992; 26: 34-42.
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http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1488639&dopt=Abstract ·
Peer support in the community: initial findings of a mentoring program for individuals with traumatic brain injury and their families. Author(s): Hibbard MR, Cantor J, Charatz H, Rosenthal R, Ashman T, Gundersen N, Ireland-Knight L, Gordon W, Avner J, Gartner A. Source: The Journal of Head Trauma Rehabilitation. 2002 April; 17(2): 112-31. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11909510&dopt=Abstract
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Postconcussional disorder following mild to moderate traumatic brain injury: anxiety, depression, and social support as risk factors and comorbidities. Author(s): McCauley SR, Boake C, Levin HS, Contant CF, Song JX. Source: J Clin Exp Neuropsychol. 2001 December; 23(6): 792-808. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11910545&dopt=Abstract
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Problems and coping strategies of individuals with traumatic brain injury and their spouses. Author(s): Willer BS, Allen KM, Liss M, Zicht MS. Source: Archives of Physical Medicine and Rehabilitation. 1991 June; 72(7): 460-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2059116&dopt=Abstract
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Psychophysiological responses in closed head injury. Author(s): Levine MJ, Gueramy M, Friedrich D. Source: Brain Injury : [bi]. 1987 October-December; 1(2): 171-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3454680&dopt=Abstract
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Real-time continuous visual biofeedback in the treatment of speech breathing disorders following childhood traumatic brain injury: report of one case. Author(s): Murdoch BE, Pitt G, Theodoros DG, Ward EC. Source: Pediatric Rehabilitation. 1999 January-March; 3(1): 5-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10367289&dopt=Abstract
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Rehabilitation after traumatic brain injury in adults. Author(s): Mazaux JM, Richer E. Source: Disability and Rehabilitation. 1998 December; 20(12): 435-47. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9883393&dopt=Abstract
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Rehabilitation of a person with severe traumatic brain injury. Author(s): Burke D, Alexander K, Baxter M, Baker F, Connell K, Diggles S, Feldman K, Horny A, Kokinos M, Moloney D, Withers J. Source: Brain Injury : [bi]. 2000 May; 14(5): 463-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10834341&dopt=Abstract
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Social competence and head injury: a practical approach. Author(s): McGann W, Werven G, Douglas MM. Source: Brain Injury : [bi]. 1997 September; 11(9): 621-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9376830&dopt=Abstract
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Stress as a diagnostic challenge for postconcussive symptoms: sequelae of mild traumatic brain injury or physiological stress response. Author(s): Hanna-Pladdy B, Berry ZM, Bennett T, Phillips HL, Gouvier WD. Source: The Clinical Neuropsychologist. 2001 August; 15(3): 289-304. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11778766&dopt=Abstract
·
The effects of closed head injury upon intrusions and confusions in free recall. Author(s): Richardson JT. Source: Cortex. 1984 September; 20(3): 413-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6488817&dopt=Abstract
·
The magnitude and correlates of alcohol and drug use before traumatic brain injury. Author(s): Bombardier CH, Rimmele CT, Zintel H. Source: Archives of Physical Medicine and Rehabilitation. 2002 December; 83(12): 1765-73.
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http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12474184&dopt=Abstract ·
Tinnitus after head injury: evidence from otoacoustic emissions. Author(s): Ceranic BJ, Prasher DK, Raglan E, Luxon LM. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1998 October; 65(4): 523-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9771778&dopt=Abstract
·
Transient evoked and distortion product otoacoustic emissions in traumatic brain injury. Author(s): Cevette MJ, Bielek D. Source: Journal of the American Academy of Audiology. 1995 May; 6(3): 225-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7620199&dopt=Abstract
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Traumatic brain injury. State of the state. Author(s): Hooper SR, Callahan B. Source: N C Med J. 2001 November-December; 62(6): 336-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11729461&dopt=Abstract
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Use of AA and NA in the treatment of chemical dependencies of traumatic brain injury survivors. Author(s): Kramer TH, Hoisington D. Source: Brain Injury : [bi]. 1992 January-February; 6(1): 81-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1739857&dopt=Abstract
·
Zinc supplementation is associated with improved neurologic recovery rate and visceral protein levels of patients with severe closed head injury. Author(s): Young B, Ott L, Kasarskis E, Rapp R, Moles K, Dempsey RJ, Tibbs PA, Kryscio R, McClain C. Source: Journal of Neurotrauma. 1996 January; 13(1): 25-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8714860&dopt=Abstract
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Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to Traumatic Brain Injury; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Brain Inflammation, Meningitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Me ningitiscc.html
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Brain Inflammation, Viral Encephalitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Enc ephalitisViralcc.html Edema Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ede macc.html Encephalitis, Viral Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Enc ephalitisViralcc.html Epilepsy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Seiz ureDisorderscc.html Meningitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Me ningitiscc.html Seizure Disorders Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Seiz ureDisorderscc.html
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Vertigo Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Vertigo.htm Water Retention Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ede macc.html ·
Herbs and Supplements Horse Chestnut Alternative names: Aesculus hippocastanum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Horse_Chestnut.htm
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Alternative and Complementary Treatment in Neurologic Illness by Michael I. Weintraub (Editor); Paperback - 288 pages (March 23, 2001), Churchill Livingstone; ISBN: 0443065586; http://www.amazon.com/exec/obidos/ASIN/0443065586/icongroupinterna · Radical Healing: Integrating the World’s Great Therapeutic Traditions to Create a New Transformative Medicine by Rudolph Ballentine, M.D., Linda Funk (Illustrator); Paperback - 612 pages; Reprint edition (March 14, 2000), Three Rivers Press; ISBN: 0609804847; http://www.amazon.com/exec/obidos/ASIN/0609804847/icongroupinterna
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· The Review of Natural Products by Facts and Comparisons (Editor); CdRom edition (January 2002), Facts & Comparisons; ISBN: 1574391453; http://www.amazon.com/exec/obidos/ASIN/1574391453/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Center for Complementary and Alternative Medicine Clearinghouse National Institutes of Health P. O. Box 8218 Silver Spring, MD 20907-8218
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Anterograde: Moving or extending forward; called also antegrade. [EU] Creatine: An amino acid that occurs in vertebrate tissues and in urine. In muscle tissue, creatine generally occurs as phosphocreatine. Creatine is excreted as creatinine in the urine. [NIH] Encephalitis: Inflammation of the brain. [EU] Psychotropic: Exerting an effect upon the mind; capable of modifying mental activity; usually applied to drugs that effect the mental state. [EU] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Visceral: (From viscus a viscus) pertaining to a viscus. [EU]
Researching Nutrition 209
APPENDIX B. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with traumatic brain injury. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with traumatic brain injury may be given different recommendations. Some recommendations may be directly related to traumatic brain injury, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of traumatic brain injury. We will then show you how to find studies dedicated specifically to nutrition and traumatic brain injury.
Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet:
210 Traumatic Brain Injury
·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
·
Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
·
Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs.
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Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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·
Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
·
Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
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·
Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:44 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
·
DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
44
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
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·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge.
What Are Dietary Supplements?45 Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”46 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.47 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 46 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 47 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 45
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symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected]
Finding Studies on Traumatic Brain Injury The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.48 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
48
Researching Nutrition 215
Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “traumatic brain injury” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following information is typical of that found when using the “Full IBIDS Database” when searching using “traumatic brain injury” (or a synonym): ·
Altered cellular metabolism following traumatic brain injury: a magnetic resonance spectroscopy study. Author(s): Department of Biochemistry, University of Oxford, United Kingdom.
[email protected] Source: Garnett, M R Corkill, R G Blamire, A M Rajagopalan, B Manners, D N Young, J D Styles, P Cadoux Hudson, T A J-Neurotrauma. 2001 March; 18(3): 231-40 0897-7151
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Diet manipulation to resume regular food consumption for an adult with traumatic brain injury. Author(s): Rehabilitation Services, Anderson Memorial Hospital, South Carolina 29621. Source: Yuen, H K Hartwick, J A Am-J-Occup-Ther. 1992 October; 46(10): 943-5 0272-9490
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&pag e=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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·
The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to Traumatic Brain Injury; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
Food and Diet Sprains and Strains Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Sprains_Strains.ht m Wound Healing Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Wound_Healing.h tm
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Akathisia: 1. A condition of motor restlessness in which there is a feeling of muscular quivering, an urge to move about constantly, and an inability to sit still, a common extrapyramidal side effect of neuroleptic drugs. 2. An inability to sit down because of intense anxiety at the thought of doing so. [EU]
Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bromocriptine: A semisynthetic ergot alkaloid that is a dopamine D2 agonist. It suppresses prolactin secretion and is used to treat amenorrhea, galactorrhea, and female infertility, and has been proposed for Parkinson disease. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH]
218 Traumatic Brain Injury
Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Thermoregulation: Heat regulation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
Finding Medical Libraries 219
APPENDIX C. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.49
49
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):50 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
50
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 221
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
·
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
·
California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
·
California: University of California, Davis. Health Sciences Libraries
·
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
·
California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
·
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
·
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
·
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
·
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
·
Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
·
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
·
Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
·
Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
·
Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
222 Traumatic Brain Injury
·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
·
Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
·
Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
·
Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
·
Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
·
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
·
Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
·
Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
·
Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
·
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
·
Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
·
Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
·
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
·
Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
·
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
·
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 223
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
·
Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
·
Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
·
Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
·
Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
·
Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
·
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
·
Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
·
Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
·
Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
·
Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
·
Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
·
Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
·
Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
224 Traumatic Brain Injury
·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
·
National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
·
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
·
Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
·
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld /
·
New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
·
New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
·
New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
·
New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
·
New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
·
New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
·
New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
·
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
·
Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 225
·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
·
Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
·
Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
·
Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
·
Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
·
Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
·
Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
·
Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
·
South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
·
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
·
Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
·
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
·
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
Online Glossaries 227
APPENDIX D. YOUR RIGHTS AND INSURANCE Overview Any patient with traumatic brain injury faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.51 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·
Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.
51Adapted
from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.
228 Traumatic Brain Injury
·
Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.
·
Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.
·
Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.
Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·
Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.
·
Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.
·
Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health
Online Glossaries 229
plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·
Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.
Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·
Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.
·
Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.
·
Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.
·
Discuss all current treatments a consumer may be undergoing.
·
Discuss all risks, nontreatment.
·
Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
230 Traumatic Brain Injury
·
Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.
·
Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should: ·
Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.
·
Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.
Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·
Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable
Online Glossaries 231
healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.52
Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”53 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·
Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan’s internal complaint and appeal processes to address your concerns.
·
Avoid knowingly spreading disease.
52 To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 53 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1.
232 Traumatic Brain Injury
·
Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.
·
Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
·
Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
·
Make a good-faith effort to meet financial obligations.
·
Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.54 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.55 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
54 More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 55 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html.
Online Glossaries 233
3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.
234 Traumatic Brain Injury
7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful
Online Glossaries 235
contact information on how to find more in-depth information about Medicaid.56
Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·
You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: ·
You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts: ·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp. 56
236 Traumatic Brain Injury
Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The
Online Glossaries 237
phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.
Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and
·
A monthly income that is below certain limits.
For more information, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.
NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.57 NORD programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their 57
Adapted from NORD: http://www.rarediseases.org.
238 Traumatic Brain Injury
prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.
Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:58 ·
Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html
·
Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html
·
HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html
·
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
·
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
·
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
·
Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html
·
Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html
·
Veteran’s Health, Persian Gulf War, Gulf War Syndrome, Agent Orange: http://www.nlm.nih.gov/medlineplus/veteranshealth.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html. 58
Online Glossaries 239
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
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On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia is available at the following Web address: http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to traumatic brain injury and keep them on file. The NIH, in particular, suggests that patients with traumatic brain injury visit the following Web sites in the ADAM Medical Encyclopedia:
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·
Basic Guidelines for Traumatic Brain Injury Head injury Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000028.htm
·
Signs & Symptoms for Traumatic Brain Injury Altered level of consciousness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Blurry Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003029.htm Cessation of breathing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003069.htm Comatose Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Confusion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003205.htm Convulsions Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm Discouraged Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003213.htm Drowsiness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003208.htm
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Drowsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003208.htm Headache Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003024.htm Lethargy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Loss of consciousness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Restlessness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003212.htm Slurred speech Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003204.htm Stiff neck Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003261.htm Swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm Vomit Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm ·
Diagnostics and Tests for Traumatic Brain Injury
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Heart rate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003399.htm ·
Background Topics for Traumatic Brain Injury Analgesics Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002123.htm Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Choking Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000047.htm Fracture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000001.htm Neck injury Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000029.htm Safety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001931.htm Spinal injury Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000029.htm Unconscious Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000022.htm Wound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000043.htm
Online Glossaries 243
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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TRAUMATIC BRAIN INJURY GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. ACTH: Adrenocorticotropic hormone. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]
Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Akathisia: 1. A condition of motor restlessness in which there is a feeling of muscular quivering, an urge to move about constantly, and an inability to sit still, a common extrapyramidal side effect of neuroleptic drugs. 2. An inability to sit down because of intense anxiety at the thought of doing so. [EU]
Amnesia: Lack or loss of memory; inability to remember past experiences. [EU]
Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anesthesiology: A specialty concerned with the study of anesthetics and anesthesia. [NIH] Anterograde: Moving or extending forward; called also antegrade. [EU]
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Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antiepileptic: An agent that combats epilepsy. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Apathy: Lack of feeling or emotion; indifference. [EU] Aphasia: Defect or loss of the power of expression by speech, writing, or signs, or of comprehending spoken or written language, due to injury or disease of the brain centres. [EU] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Aspiration: The act of inhaling. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Ataxia: Failure of muscular coordination; irregularity of muscular action. [EU]
Audiology: The study of hearing and hearing impairment. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Autonomic: Self-controlling; functionally independent. [EU] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms:
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round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bilateral: Having two sides, or pertaining to both sides. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biphasic: Having two phases; having both a sporophytic and a gametophytic phase in the life cycle. [EU] Bromocriptine: A semisynthetic ergot alkaloid that is a dopamine D2 agonist. It suppresses prolactin secretion and is used to treat amenorrhea, galactorrhea, and female infertility, and has been proposed for Parkinson disease. [NIH] Calpain: Cysteine proteinase found in many tissues. Hydrolyzes a variety of endogenous proteins including neuropeptides, cytoskeletal proteins, proteins from smooth muscle, cardiac muscle, liver, platelets and erythrocytes. Two subclasses having high and low calcium sensitivity are known. Removes Z-discs and M-lines from myofibrils. Activates phosphorylase kinase and cyclic nucleotide-independent protein kinase. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU]
Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Caspases: A family of intracellular cysteine endopeptidases. They play a key role in inflammation and mammalian apoptosis. They are specific for aspartic acid at the P1 position. They are divided into two classes based on the lengths of their N-terminal prodomains. Caspases-1,-2,-4,-5,-8, and -10 have long prodomains and -3,-6,-7,-9 have short prodomains. EC 3.4.22.-. [NIH]
Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH]
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Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]
Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Cholinergic: Resembling acetylcholine in pharmacological stimulated by or releasing acetylcholine or a related compound. [EU]
action;
Chronic: Persisting over a long period of time. [EU] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. in surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Comatose: Pertaining to or affected with coma. [EU] Contusion: A bruise; an injury of a part without a break in the skin. [EU] Convulsion: A violent involuntary contraction or series of contractions of the voluntary muscles. [EU] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Creatine: An amino acid that occurs in vertebrate tissues and in urine. In muscle tissue, creatine generally occurs as phosphocreatine. Creatine is excreted as creatinine in the urine. [NIH] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU]
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Diffusion: The process of becoming diffused, or widely spread; the spontaneous movement of molecules or other particles in solution, owing to their random thermal motion, to reach a uniform concentration throughout the solvent, a process requiring no addition of energy to the system. [EU] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dysarthria: Imperfect articulation of speech due to disturbances of muscular control which result from damage to the central or peripheral nervous system. [EU] Dysphagia: Difficulty in swallowing. [EU] Dystonia: Disordered tonicity of muscle. [EU] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Encephalitis: Inflammation of the brain. [EU] Endothelium: The layer of epithelial cells that lines the cavities of the heart and of the blood and lymph vessels, and the serous cavities of the body, originating from the mesoderm. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the
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primary ingredient in alcoholic beverages. [NIH] Extracellular: Outside a cell or cells. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gestures: Movement of a part of the body for the purpose of communication. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Hematoma: tissue. [NIH]
An extravasation of blood localized in an organ, space, or
Hemodilution: Reduction of blood viscosity usually by the addition of cell free solutions. Used clinically l) in states of impaired microcirculation, 2) for replacement of intraoperative blood loss without homologous blood transfusion, and 3) in cardiopulmonary bypass and hypothermia. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for
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its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Hyperthermia: Abnormally high body temperature, especially that induced for therapeutic purposes. [EU] Hyperventilation: A state in which there is an increased amount of air entering the pulmonary alveoli (increased alveolar ventilation), resulting in reduction of carbon dioxide tension and eventually leading to alkalosis. [EU] Hypotension: Abnormally low blood pressure; seen in shock but not necessarily indicative of it. [EU] Hypothermia: A low body temperature, as that due to exposure in cold weather or a state of low temperature of the body induced as a means of decreasing metabolism of tissues and thereby the need for oxygen, as used in various surgical procedures, especially on the heart, or in an excised organ being preserved for transplantation. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Leprosy:
A chronic granulomatous infection caused by Mycobacterium
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leprae. The granulomatous lesions are manifested in the skin, the mucous membranes, and the peripheral nerves. Two polar or principal types are lepromatous and tuberculoid. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] LH: A small glycoprotein hormone secreted by the anterior pituitary. LH plays an important role in controlling ovulation and in controlling secretion of hormones by the ovaries and testes. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lobe: A more or less well-defined portion of any organ, especially of the brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective tissue, and by their shape. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Methylphenidate: A central nervous system stimulant used most commonly in the treatment of attention-deficit disorders in children and for narcolepsy. Its mechanisms appear to be similar to those of dextroamphetamine. [NIH] Microdialysis: A technique for measuring extracellular concentrations of substances in tissues, usually in vivo, by means of a small probe equipped with a semipermeable membrane. Substances may also be introduced into the extracellular space through the membrane. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neonatal: Pertaining to the first four weeks after birth. [EU]
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Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuroanatomy: Study of the anatomy of the nervous system as a specialty or discipline. [NIH] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the NERVOUS SYSTEM. [NIH] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neuropsychology: A branch of psychology which investigates the correlation between experience or behavior and the basic neurophysiological processes. The term neuropsychology stresses the dominant role of the nervous system. It is a more narrowly defined field than physiological psychology or psychophysiology. [NIH] Neurosciences: The scientific disciplines concerned with the embryology, anatomy, physiology, biochemistry, pharmacology, etc., of the nervous sytem. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrophil: Having an affinity for neutral dyes. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH]
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Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Paradoxical: Occurring at variance with the normal rule. [EU] Paraplegia: Paralysis of the legs and lower part of the body. [EU] Paresis: Slight or incomplete paralysis. [EU] Perfusion: 1. The act of pouring over or through, especially the passage of a fluid through the vessels of a specific organ. 2. A liquid poured over or through an organ or tissue. [EU] Perivascular: Situated around a vessel. [EU] Peroxidase: A hemeprotein from leukocytes. Deficiency of this enzyme leads to a hereditary disorder coupled with disseminated moniliasis. It catalyzes the conversion of a donor and peroxide to an oxidized donor and water. EC 1.11.1.7. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH]
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Prophylaxis: The prevention of disease; preventive treatment. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Psychotropic: Exerting an effect upon the mind; capable of modifying mental activity; usually applied to drugs that effect the mental state. [EU] Pulmonary: Pertaining to the lungs. [EU] Quadriplegia: Severe or complete loss of motor function in all four limbs which may result from brain diseases; spinal cord diseases; peripheral nervous system diseases; neuromuscular diseases; or rarely muscular diseases. The locked-in syndrome is characterized by quadriplegia in combination with cranial muscle paralysis. Consciousness is spared and the only retained voluntary motor activity may be limited eye movements. This condition is usually caused by a lesion in the upper brain stem which injures the descending cortico-spinal and cortico-bulbar tracts. [NIH] Receptor: 1. A molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. A sensory nerve terminal that responds to stimuli of various kinds. [EU] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU]
Retrograde: 1. Moving backward or against the usual direction of flow. 2.
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Degenerating, deteriorating, or catabolic. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Saline: Salty; of the nature of a salt; containing a salt or salts. [EU] Schizophrenia: A severe emotional disorder of psychotic depth characteristically marked by a retreat from reality with delusion formation, hallucinations, emotional disharmony, and regressive behavior. [NIH] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Semantics: The relationships between symbols and their meanings. [NIH] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH] Serum: 1. The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. Blood serum; the clear liquid that separates from blood on clotting. 3. Immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU]
Socialization: The training or molding of an individual through various relationships, educational agencies, and social controls, which enables him to become a member of a particular society. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so
Glossary 257
that the muscles are stiff and the movements awkward. 3. a person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU]
Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spirometry: Measurement of volume of air inhaled or exhaled by the lung. [NIH]
Stabilization: The creation of a stable state. [EU] Subacute: Somewhat acute; between acute and chronic. [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]
Systemic: Pertaining to or affecting the body as a whole. [EU] Tendinitis: Inflammation of tendons and of tendon-muscle attachments. [EU] Thermoregulation: Heat regulation. [EU] Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tibia: The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. [NIH] Tinnitus: A noise in the ears, as ringing, buzzing, roaring, clicking, etc. Such sounds may at times be heard by others than the patient. [EU] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU]
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Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Traumatology: The branch of surgery which deals with wounds and disability from injuries. [NIH] Vagal: Pertaining to the vagus nerve. [EU] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Visceral: (From viscus a viscus) pertaining to a viscus. [EU] Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins
Glossary 259
Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna ·
Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupintern a
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
·
Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
·
Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupintern a
·
Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co,
260 Traumatic Brain Injury
ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
Index 261
INDEX A Adolescence ................................122, 245 Agonist.................121, 133, 134, 217, 247 Amnesia.................................................85 Amphetamine ......................................131 Amygdala.............................131, 136, 245 Anatomical.............................................88 Antibody.........................................47, 252 Antidepressant.......................................95 Antioxidant...........................................101 Anxiety...........................15, 201, 217, 245 Apathy .................................................107 Aphasia....................39, 70, 140, 150, 152 Arginine ...................................92, 97, 102 Arteries ............................91, 97, 122, 246 Arterioles ...............................91, 122, 247 Aspiration...............................................41 Assay.....................................................94 Ataxia...........................................152, 179 Auditory .........................81, 131, 140, 198 Autonomic......................15, 131, 136, 254 Axons.....................................................16 B Bacteria .................48, 167, 210, 257, 258 Bilateral..................................................85 Biochemical .........................................120 Biomechanics ......................................186 Biphasic ...............................................134 C Calpain ..................................................99 Capsules..............................................213 Carbohydrate.......................124, 212, 250 Caspases.......................................94, 116 Cerebrospinal ..............................106, 114 Cerebrovascular ............................37, 132 Cholesterol ..................................210, 212 Choline ..................................................17 Cholinergic...........................................135 Chronic .......15, 48, 50, 90, 111, 130, 131, 174, 228, 251, 257 Coagulation .........................................114 Cognition .......11, 16, 18, 30, 84, 140, 148 Comatose ............................................196 Consciousness .......46, 85, 126, 130, 131, 240, 241, 245, 248, 255 Contusion ....................4, 86, 98, 101, 102 Cortex ......46, 76, 98, 123, 131, 248, 249, 254 Cortical ....31, 48, 90, 91, 93, 98, 101, 256 Creatine ...............................197, 207, 248 Cues ......................................................16
Cysteine ................................................ 99 D Degenerative ................................ 38, 211 Dementia....................................... 33, 151 Depolarization ..................................... 135 Deprivation............................................ 99 Diarrhea .............................................. 210 Dizziness..................... 141, 152, 207, 258 Dorsal............................................ 30, 131 Dysarthria................ 39, 80, 112, 114, 140 Dysphagia ..................................... 40, 140 Dystonia ........................................ 40, 152 Dystrophy...................................... 40, 179 E Edema........................................... 89, 132 Empiric .................................................. 20 Endothelium .......................................... 97 Enzyme ......... 94, 123, 126, 249, 254, 255 Estradiol .............................................. 103 Ethanol................................................ 113 Extracellular .. 88, 111, 124, 125, 250, 252 Extraction ............................................ 102 F Fatigue ............................ 31, 45, 141, 246 Femur.................................................... 93 Firearms........................................ 13, 175 G Gastrointestinal ....... 15, 46, 123, 249, 250 Genotype .................................... 126, 254 Gestures ............................................... 40 Glucose........................... 89, 99, 124, 250 Glycine .......................... 47, 133, 134, 253 H Hematoma ........................................ 4, 86 Hemodilution ......................................... 97 Hemodynamics ................................... 118 Homeostasis ......................................... 89 Hypertension............................... 113, 132 Hyperthermia ...................................... 115 Hyperventilation .................................. 111 Hypotension .......................................... 97 Hypothermia................ 106, 118, 124, 250 Hypoxia ................................... 97, 99, 101 I Idiopathic............................... 81, 124, 251 Immunohistochemistry.......................... 93 Induction ............................................... 94 Inflammation ......... 48, 123, 132, 247, 256 Infusion ................................................. 92 Intravenous ........................................... 93
262 Traumatic Brain Injury
Ischemia .94, 99, 100, 101, 102, 132, 137, 255 L lesion ...................................................255 Lesion ..............................................31, 62 Lipid .......................................46, 101, 248 Lobe...................15, 27, 85, 120, 136, 245 M Mediator.................................................99 Methylphenidate ....................................67 Microdialysis ..........................................90 Mobility ..............................41, 55, 82, 116 Modulator.....................................133, 134 Molecular ....... 94, 98, 126, 167, 170, 177, 178, 255, 258 N Necrosis.................................99, 137, 255 Neonatal ..............................................101 Neural .....15, 16, 17, 18, 89, 98, 100, 101, 130, 157, 211 Neurology ............................................158 Neuromuscular ......................................40 Neuronal ...88, 89, 93, 94, 96, 98, 99, 101, 108, 134, 198, 217, 253 Neurons ....16, 17, 47, 88, 89, 98, 99, 131, 133, 217, 253 Neuropeptides ...............46, 217, 247, 253 Neurophysiology..........................136, 248 Neuropsychology...........................47, 253 Neurotransmitter.....17, 47, 135, 136, 250, 253, 254 Neutrophil ....................................133, 134 Niacin...................................................210 Norepinephrine ......................47, 131, 253 O Osteoporosis .........................................13 Overdose .............................................211 P Paradoxical............................................86 Paraplegia .............................................50 Paresis.................................................110 Perivascular...........................................97 Peroxidase...........................................101 Pharmacologic...........................11, 30, 94 Phenotype ...................................126, 254 Postnatal..............................................101 Potassium..........88, 92, 97, 133, 134, 212 Prevalence...................12, 13, 26, 82, 107 Progesterone ...................................68, 92 Prophylaxis ..........................................119 Psychiatric .................24, 69, 70, 106, 141 Psychiatry ..............................................30 Psychotherapy...............................19, 199 Psychotropic ........................................199 Pulmonary .....................15, 124, 250, 251
Q Quadriplegia ........................... 50, 62, 255 R Receptor ............... 99, 103, 121, 133, 135 Reperfusion......................... 133, 137, 255 Resuscitation ...................................... 113 Riboflavin ............................................ 210 S Saline .................................. 113, 125, 251 Sclerosis ............. 40, 50, 70, 85, 179, 180 Secretion... 46, 69, 76, 217, 247, 252, 256 Seizures ...... 15, 38, 48, 67, 85, 96, 141, 200, 256 Selenium ............................................. 212 Semantics ........................................... 141 Sertraline............................................... 96 Serum ................................... 92, 127, 256 Skull .................................................. 4, 85 Socialization.................................... 23, 52 Spastic .................................. 80, 127, 257 Spasticity..................................... 127, 257 Spectrum............................................... 13 Spirometry............................................. 81 Stabilization........................................... 30 Subacute............................................... 21 Synergistic .......................................... 134 Systemic ............................. 118, 124, 250 T Tendinitis............................................... 50 Thermoregulation................................ 210 Thrombolytic ............................... 137, 257 Thyroxine ............................................ 211 Tibia ...................................................... 93 Tinnitus ............................................... 152 Tomography.......................... 25, 105, 108 Tone...................................... 91, 167, 257 Topical .................... 56, 62, 124, 249, 257 Toxicity.......................................... 98, 134 Translating ............................................ 31 Transplantation ....... 17, 93, 116, 125, 251 V Vagal................................................... 131 Vasomotor........................................... 132 Vegetative ............................................. 27 Veins ..................................... 91, 127, 258 Ventral................................................. 131 Venules ................................. 91, 122, 247 Vertigo......................................... 207, 258 Vestibular ...................................... 30, 152 Viruses .................................................. 98 Visceral ............................................... 203 W Walkers ................................................. 13 X Xerostomia............................................ 87
Index 263
264 Traumatic Brain Injury
Index 265
266 Traumatic Brain Injury
