How Is Traumatic Brain Injury Initially Treated
The primary focus of emergency care is to stabilize the individual by ensuring the brain gets sufficient oxygen, controlling blood and brain pressure, and preventing further injury or complications.
For moderate to severe brain injury surgery may be needed, especially if there is intracranial pressure or bleeding that causes swollen tissue to push up against the skull. Surgery is performed to relieve intracranial pressure by removing blood clots, placing an external ventricular drain, or removing a section of the skull to allow the brain to swell without injury to its delicate tissues, or repairing skull fractures to help reduce further damage to the brain. Types of TBI that most often require surgery are subarachnoid hemorrhages, hematomas, or penetrating traumatic brain injuries.
Steroids are another type of treatment that may be used to reduce swelling in TBIs like diffuse axonal injuries . Diffuse axonal injuries result in microscopic tears that can be hard to detect on an MRI. DAIs are one of the most severe types of TBI.
Communicating With Coma Patients
Determining if a coma patient is conscious seems easy, right? Yet the error rate for detecting consciousness is 30-40%, says Joseph Giacino, PhD, program director and principal investigator for the Spaulding-Harvard Traumatic Brain Injury Model System.
Over the past 15 years, Giacino and his team have used functional magnetic resonance imaging to determine consciousness. A person with a coma is put in a scanner and instructed to perform a mental task, such as thinking of the word truck. When they do, the language areas of their brain light up. The same thing happens for motor function if you ask someone to think about raising their right hand.
You might have a patient with no evidence of conscious behavior, no speech, no movement, nothing, says Giacino, lead author of the coma recovery scale-revised, which helps diagnose, assess, and treat coma patients. But then you put them in the scanner and say, I want you to imagine walking around the rooms of your house, I want you to imagine playing tennis, I want you to imagine saying the word truck, and then we look for these functional signatures in the brain. We know now that between 15 and 30% of people who dont show behavioral signs of conscious awareness actually perform these tasks in a scanner. Thats a big deal.
TBIMS members also must conduct research and participate in at least one collaborative study with others in the system. Research topics include:
No Effective Treatment To
TBI can lead to motor deficits and chronic disability and currently there are no effective drugs to treat these deficits.
Researchers are increasingly focused on using somatic stem cells to restore lost function. Stem cells can differentiate or proliferate into different types of cells and are thought to promote repair and regeneration of tissues or organs damaged due to illness or injury.
The study included 61 patients with TBI with an average age of 34 years . The mean time from injury was about 8 years and Glasgow Outcome Scale Extended ranged from 3-6.
A total of 46 participants were randomly assigned to receive the stem cell therapy and 15 a sham procedure. In the treatment group, there were three different doses of cells .
The treatment involved an investigational regenerative cell medicine comprised of bone marrow-derived mesenchymal stem cells . The allogeneic cells came from a male donor.
For the 20-minute procedure, a neurosurgeon drilled a tiny hole in the skull and, guided by MRI, injected the stem cells into the area of the lesion.
Patients receiving a surgical sham procedure were brought to the operating room, anesthetized, and had a hole drilled into their head over the area of their lesion. However, the surgeon only went halfway through the skull bone.
Participants were instructed to do specific physiotherapy exercises at home every morning and afternoon for the first 6 months of the study.
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A Vulnerable Brain Region
Traumatic brain injuries, which range from a mild concussion to a severe injury, can be the result of a fall, sports injury, gunshot injury, blow to the head, explosion, or domestic violence. Often, soldiers returning from war also suffer head injuries, which commonly lead to the development of epilepsy. Traumatic brain injury affects 69 million people around the world annually, and is the leading cause of death in children and a major source of disability in adults.
These injuries are frequent and can happen to anyone, says Paz, who is also an associate professor of neurology at UC San Francisco and a member of the Kavli Institute for Fundamental Neuroscience. The goal of our study was to understand how the brain changes after traumatic brain injuries and how those changes can lead to chronic problems, such as the development of epilepsy, sleep disruption, and difficulty with sensory processing.
To do so, Paz and her team recorded the activity of different cells and circuits in the brain of mice after brain injury. The researchers monitored the mice continually and wirelessly, meaning the mice could go about their normal activities without being disrupted.
We collected so much data, from the time of injury and over the next several months, that it actually crashed our computers, says Paz. But it was important to capture all the different stages of sleep and wakefulness to get the whole picture.
New Treatments For Traumatic Brain Injuries
Traumatic brain injuries can occur as a result of a slip and fall, car accident, assault or sports injury. There is no âcure allâ for TBIs but doctors and researchers conduct many studies in the hopes of finding successful treatments for TBIs.
According to a recent article posted on PsyPost, controlled application of what is called vacuum pressure seems to be a promising way to limit tissue damage from TBI. The results of the study were published in the August issue of the journal, Neurosurgery.
The technology, known as mechanical tissue resuscitation appeared to Result in smaller injuries and better recovery. Mechanical resuscitation is when vacuum pressure is applied to the area of injury.
The researchers are not sure how vacuum pressure to reduces the loss of brain tissue and reducing hemorrhaging and state it requires further investigation. They wondered if mechanical tissue resuscitation promotes increased blood flow to the tissue and helps to remove waste.
Another recent study published on Nature Communications found that immune cells can help protect brain cells after traumatic brain injury. The study, emanating from the Cleveland Clinicâs Lerner Researcher Institute explained that microglia, a type of immune cells provide a helpful role in recovery.
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Bone Marrow Stromal Cells
Neuronal tissue has limited capacity to repair after injury. Cellular therapies using neural stem/progenitor cells are promising approaches for the treatment of brain injury. However, the clinical use of embryonic stem cells or fetal tissues is limited by ethical considerations and other scientific problems. Thus, MSCs could represent an alternative source of stem cells for cell replacement therapies. MSCs are mesoderm-derived cells, primarily resident in adult bone marrow. MSCs can give rise to neuronal cells as well as many tissue-specific cell phenotypes .
MSCs spontaneously express certain neuronal phenotype markers in culture, in the absence of specialized induction reagents . When cultured in neural stem cell culture conditions, 8% of MSCs are able to generate neurospheres. These MSC-derived neurospheres express characteristic NSC antigens and are capable of self-renewal and multi-lineage differentiation into neurons, astrocytes and oligodendrocytes. When these MSC-derived neurospheres are co-cultured with primary astrocytes, they differentiate into neurons, forming dendrites, axonal processes and synapses as well as firing tetrodotoxin-sensitive action potentials . Nestin-positive MSCs can differentiate in vitro into excitable neuron-like cells. MSC-derived neuron-like cells exhibit several electrophysiological key properties classically devoted to neurons, including firing of action potentials .
Drug Repurposing In The Treatment Of Traumatic Brain Injury
- 1Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
- 2University of Miami Miller School of Medicine, Miami, FL, United States
- 3Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- 4Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
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Sports And Recreation Head Injury Prevention Tips
- For specific sports, 100 percent of the time, buy and use helmets or protective headgear approved by the American Society for Testing and Materials .
- Supervise younger children at all times.
- Do not allow younger children to use sporting equipment or play sports unsuitable for their age.
- Avoid the use of playgrounds with hard surfaces.
- Follow all rules and warning signs at water parks, swimming pools and public beaches.
- Do not dive in water less than 12 feet deep or in above-ground pools. Check the depth and check for debris in the water before diving.
- Wear appropriate clothing for the sport.
- Do not wear any clothing that can interfere with your vision.
- Do not participate in sports when you are ill or very tired.
- Obey all traffic signals, and be aware of drivers when cycling or skateboarding.
- Avoid uneven or unpaved surfaces when cycling, skateboarding or in-line skating.
- Perform regular safety checks of sports fields, playgrounds and equipment.
- Discard and replace damaged sporting equipment or protective gear
- Never slide head-first when stealing a base.
Why Might I Need Rehab After Traumatic Brain Injury
Rehab may help:
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Improve your ability to function at home and in your community
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Help treat the mental and physical problems caused by TBI
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Provide social and emotional support
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Help you adapt to changes as they occur during your recovery
Rehab can also help prevent complications of TBI such as:
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Blood clots
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Pressure ulcers, also called bedsores
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Breathing problems and pneumonia
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A drop in blood pressure when you move around
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Muscle weakness and muscle spasm
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Bowel and bladder problems
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Reproductive and sexual function problems
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Animal Care And Ethical Statement
Forty-five male Wistar rats were purchased from the Animal Center of Mashhad University of Medical Sciences. They received humane care in compliance with the guidelines of the ethics of laboratory animals care and the international norms and standards for conducting medical research. Animals were kept under a 12 h light/dark cycle in 3070% humidity and constant temperature environment with ad libitum access to food and water. To eliminate the anxiety from human contact, the rats underwent adaptation exercises before performing behavioral tests. Also, some of the experiments were performed by an investigator who was blinded to the experimental groups to avoid any possible biases.
Path To A Potential Treatment
In addition to chronic inflammation, Paz and her team also uncovered abnormal brain activity in the mice with traumatic brain injury.
First, the researchers noticed disruptions in sleep spindles, which are normal brain rhythms that occur during sleep. These are important for memory consolidation, among other things. The scientists also found epileptic spikes, or abnormal fluctuations in brain activity. These spikes can be disruptive to cognition and normal behavior, and are also indicative of a greater susceptibility to seizures.
The scientists observed that the anti-C1q antibody treatment not only helped restore the sleep spindles, but also prevented the development of epileptic activities.
Overall, our study indicates that targeting the C1q molecule after injury could avoid some of the most devastating, long-term consequences of traumatic brain injury, says Holden. We hope this could eventually lead to the development of treatments for traumatic brain injury.
Researchers in the Paz Lab, including Irene Lew , are working to better understand what happens in the brain after injury.
Annexons anti-C1q inhibitors are designed to treat multiple autoimmune and neurological disorders, and are already being examined in clinical trials, including for an autoimmune disorder known as Guillain-Barré syndrome, where the drug has been shown to be safe in humans.
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Stem Cells Restore Lost Function In Traumatic Brain Injury
Pauline Anderson
Stem cell therapy improves motor impairment and is safe and well tolerated in patients with traumatic brain injury , results from a phase 2 trial indicate.
Dr Peter McAllister
“We proved for the first time that we can affect outcomes in moderately to severely disabled patients with TBI using stem cells,” study investigator Peter McAllister, MD, co-founder and medical director of the New England Center for Neurology and Headache, Stamford, Connecticut, told Medscape Medical News.
“I think the potential of regenerative medicine was always out there, but we are now getting to the point where we’re living up to that potential,” said McAllister, who is also an associate professor of neurology at Yale University School of Medicine in New Haven.
The findings were presented at the American Academy of Neurology 2022 Annual Meeting.
Assessment Of The Lesion Volume
To evaluate the lesion volume, a series of coronal sections were cut and collected at 100 m intervals . After that, the sections were air-dried at room temperature and stained with hematoxylineosin . The images were captured by a light microscope and analyzed by Image J software. The lesion volume was estimated by the following equation:
D is the distance between sections and A is the area of the cavity in the relevant section.
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What To Know About The Effects Of Tbi
Little can be done to reverse initial brain damage caused by trauma according to the National Institute of Neurological Disorders and Stroke. But health care professionals will work to stabilize patients and try to prevent further harm. The severity of long-term effects depends on the seriousness of the injury, location of the injury, the number of previous brain injuries, and the age and general health of a patient.
Pioneering New Treatment Leads To Improved Recovery From Brain Trauma In Mice
- Date:
- Babraham Institute
- Summary:
- Researchers have designed a targeted therapeutic treatment that restricts brain inflammation. The effectiveness of this approach in improving outcomes was demonstrated following brain injury, stroke or multiple sclerosis in mice. The system increases the number of regulatory T cells, mediators of the immune system’s anti-inflammatory response, in the brain. By boosting the number of T regulatory cells in the brain, the researchers were able to prevent the death of brain tissue in mice following injury and the mice performed better in cognitive tests. The treatment has a high potential for use in patients with traumatic brain injury, with few alternatives currently available to prevent harmful neuroinflammation.
A therapeutic method for harnessing the body’s immune system to protect against brain damage is published today by researchers from the Babraham Institute’s Immunology research programme. The collaboration between Professor Adrian Liston and Professor Matthew Holt has produced a targeted delivery system for boosting the numbers of specialised anti-inflammatory immune cells specifically within the brain to restrict brain inflammation and damage. Their brain-specific delivery system protected against brain cell death following brain injury, stroke and in a model of multiple sclerosis. The research is published today in the journal Nature Immunology.
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Which Treatments Are Safe And Effective To Reduce Intracranial Pressure Following Severe Traumatic Brain Injury
General Head Injury Prevention Tips
- Wear a seatbelt every time you drive or ride in a motor vehicle.
- Never drive while under the influence of drugs, alcohol or ride as a passenger with anyone who is under the influence.
- Keep firearms unloaded in a locked cabinet or safe, and store ammunition in a separate, secure location.
- Remove hazards in the home that may contribute to falls. Secure rugs and loose electrical cords, put away toys, use safety gates and install window guards. Install grab bars and handrails if you are frail or elderly.
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Advancing Understanding Of Transportation Options
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This Stage II randomized, controlled, longitudinal trial seeks to assess the acceptability, feasibility, and effects of a driving decision aid use among geriatric patients and providers. This multi-site trial will test the driving decision aid in improving decision making and quality and determine its effects on specific subpopulations of older drivers . The overarching hypotheses are that the DDA will help older adults make high-quality decisions, which will mitigate the negative psychosocial impacts of driving reduction, and that optimal DDA use will target certain populations and settings.
La Jolla, California
Understanding Treatments For Traumatic Brain Injury Survivors
Treatments for traumatic brain injury depend on various factors including the severity and location of the injury. Your medical team will first assess and diagnose a TBI in order to provide proper treatment. For moderate to severe injuries, emergency care such as surgery, may be needed. In milder cases, doctors may prescribe medication or suggest getting sufficient rest for the brain to heal.
After stabilization, TBI survivors may experience a variety of secondary effects. To treat these effects, survivors must engage in rehabilitation to activate neuroplasticity through massed practice of therapeutic exercises. Gamified neurorehabilitation devices, like FitMi and MusicGlove, are also great ways to stay engaged and get more repetitions while having fun in between therapy sessions.
We hope this article helped you understand treatments for traumatic brain injury and the importance of rehabilitation thereafter. With enough practice and consistency over time, you can restore function and maximize independence.
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Treatments For Traumatic Brain Injury: What They Are & How It Works
Andrea Reinkensmeyer, OTR/L Flint Rehab
There are a variety of treatments for traumatic brain injury that can help survivors boost recovery. However, treatment depends on many factors, such as the severity and location of the injury. Medical teams first assess the injury using a test or evaluation to determine the type of TBI and provide the necessary treatments, which may include surgery, medication, and/or rest.
After initial treatment, survivors may sustain lasting secondary effects of traumatic brain injury. To treat these effects, survivors engage in rehabilitation therapy to strengthen and restore functions that may have been affected.
This article will discuss how treatments for traumatic brain injury are determined, the brains ability to repair itself, and the most effective rehabilitation exercises to help improve function and promote recovery.