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~ THERAPY BLOG ~

  • Blood Test for Concussions

    Blood Test for Concussion?

    S100B is a serum protein that is thought to aid in the functioning of neurons early in life, and it is present only in the brain. In studies over the past several years, the S100B protein has been found to be transiently increased in the bloodstream after mild TBI (Dash et al, 2010), suggesting that the blood brain barrier can be compromised in traumatic brain injury, including concussion.  It has been evaluated in six clinical trials with over 2000 participants and demonstrated 98% sensitivity in diagnosis of mild TBI. 

    The blood–brain barrier (BBB) is a separation of circulating blood from cerebral spinal fluid in the central nervous system (CNS).  It is semi-permeable, allowing some materials to cross, but preventing others from crossing.  The blood–brain barrier protects the brain from many common bacterial infections, antibodies, poisons and certain drugs.

    When the S100B protein becomes present in the bloodstream, the body may react to it as a foreign invader and release auto-antibodies to attack it. The antibodies can then leak into the brain through the weakened blood-brain barrier where they are thought to attack brain tissue. In one recent study, four out of 27 football players who had pre- and in-season blood tests showed signs of an autoimmune response to elevated S100B levels.

    In the future, testing for the presence of the S100B protein following suspected concussion may be one way to rapidly confirm injury. In 2010, the U.S. Army announced that 34 patients had been accurately diagnosed with traumatic brain injury via a blood test for other proteins (SBDP145 and SBDP120) that seep through the blood-brain barrier after damage. The Army data focused on mild to severe injury, so ongoing S100B studies might help create blood testing technology to detect mild brain trauma quickly and perhaps for as little as $40. S100B blood tests are already used outside of sports, and as a standard procedure in a few emergency rooms in Germany for diagnosing brain trauma.

  • New Concussion Guidelines

    New Concussion Guidelines Released
    The American Academy of Neurology released a report on Monday, March 19, 2013 stating that it had revised its guidelines for handling concussions to emphasize treating athletes case by case rather than according to a predetermined scale.
    “We’ve moved away from the concussion grading systems we first established in 1997 and are now recommending that concussion and return to play be assessed in each athlete individually,” said Christopher C. Giza, a doctor at the David Geffen School of Medicine and Mattel Children’s Hospital at U.C.L.A. and one of the lead authors of the new guidelines. “There is no set timeline for safe return to play.”
    Concussions, Giza and other authors of the report said, are clinical diagnoses. “Symptom checklists, the Standardized Assessment of Concussion (SAC), neuropsychological testing (paper-and-pencil and computerized) and the Balance Error Scoring System may be helpful tools in diagnosing and managing concussions but should not be used alone for making a diagnosis.”
    They also reported that there are more than a million sports-related concussions annually in the US, and that the risk of concussion was greatest in football and rugby, followed by hockey and soccer. For young women and girls, the risk was greatest in soccer and basketball.
    Signs and symptoms of a concussion are complex and variable, and any athlete suspected of having a concussion should be thoroughly evaluated by a qualified medical professional. The AAN guidelines recommend that athletes suspected of having a concussion should be immediately removed from play.
    “If in doubt, sit it out,” said Dr. Jeffrey S. Kutcher, a physician at the University of Michigan Medical School in Ann Arbor and a member of the academy. “You only get one brain; treat it well.”

  • Video illustrating and explaining physiology of Mild Traumatic Brain Injuries

    Brainline.org is was a fantastic website with information for people with TBI, family members and professionals. In the 14 min. video sited below, the physiology and anatomy of what happens to the brain during a mild traumatic brain injury is beautifully illustrated and explained.

    Video Illustration of Physiology of MTBI
  • Hillary Clinton’s Concussion and Double Vision

    Hillary Clinton’s Concussion and Double Vision

    Difficulty with vision is often an overlooked symptom following a brain injury, concussion, stroke, or any kind of acquired brain injury.

    Recently, Hillary Clinton fell after she fainted and suffered a concussion. During the course of her medical care following the concussion, a blood clot was also found in a vein that runs between the skull and the brain, behind her right ear. You may have heard reports that Mrs. Clinton was doing well and suffered no neurological damage. However, you may have also seen the reports where she wore glasses with Fresnel prism (a prism in the form of adhesive plastic placed on the lenses) due to double vision. This is most likely an issue resulting from her concussion and neurological insult.

    A lot of people who have suffered an acquired brain injury notice changes in their vision. If a person, like Mrs. Clinton suffers from double vision (diplopia), everyday tasks can become very difficult. Thankfully, there is help available. An optometrist knowledgeable in vision rehabilitation and the effects of an acquired brain injury on vision can provide a thorough eye examination, diagnose the problems, and provide or prescribe treatment. Treatment may include one or more of the following: glasses with prism, exercises for your eyes, and/or surgery. Prism can be ground into the lens or an adhesive (Fresnel) prism placed on your glasses such as what Mrs. Clinton was seen using. The prism can shift the image to help align the 2 images seen from each eye. Another type of treatment, and often performed concurrently, involves eye exercises to teach the person’s eyes how to work together again. Much like a person who suffers from hemiplegia following a stroke would participate in therapy to regain movement and control of their affected limbs, a person can participate in vision therapy to improve eye teaming skills. Surgery may also be recommended to better align the eyes.
    Hopefully, Mrs. Clinton will continue to improve and resolve her diplopia. In the meantime, hopefully more awareness will be brought to visual dysfunction and treatment options following an acquired brain injury and concussion such as Mrs. Clinton’s.

    For more information on Fresnel prisms, vision therapy, and symptoms following an acquired brain injury please visit the Neuro Optometric Rehabilitation Association website (nora.cc)

    To find out more about how prisms can help diplopia visit: http://www.glassescrafter.com/information/prism-in-eyeglasses.html



  • 10 Suggestions of how to Communicate to someone with Aphasia

    When someone you know has suffered a stroke and has aphasia (a communication deficit), you may not know how to communicate to them.

    Although strokes affect different parts of the brain and can cause different types of aphasia, here are some basic tips on how to talk to that person.

    After you get their attention:

    • Minimize or eliminate distractions in the environment when you are trying to talk to them.
    • Simplify how you are saying things without talking down to the person.
    • Slow down your rate of speech.
    • Sometimes asking questions that can be answered by yes and no can be helpful but at other times, the person with aphasia may say yes but really mean no or vice versa.
    • Use various modes of communication (writing, drawing, gestures, etc.) when speaking to them.
    • Encourage them to also use various modes to communicate such as gestures, writing, drawing, or to describe the word they are trying to say. 
    • Give them time to respond before you repeat information. 
    • Avoid speaking for the person and ask permission before you do so.  
    • Praise attempts to speak and don't be critical of their errors.
    • Use your imagination to try to figure out what they are trying to say. 

    For more tips go to the National Aphasia Association.

  • 9 Things NOT to Say to Someone with a Brain Injury

       Brain injury is confusing to people who don’t have one. It’s natural to want to say something, to voice an opinion or offer advice, even when we don’t understand.

    And when you care for a loved one with a brain injury, it’s easy to get burnt out and say things out of frustration.
    Here are a few things you might find yourself saying that are probably not helpful:

      >> Brain Line Resource

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