USA Today: Better tests find record concussions among US troops

The Law Offices of Ian Mattoch was forwarded the below article by a California neuropsychologist who serves as an expert in many of our cases involving persons that have suffered a traumatic brain injury as the result of someone else’s negligence.

By Gregg Zoroya, USA TODAY
Improved battlefield diagnosis has led to a record number of concussions detected among U.S. troops fighting in Afghanistan
and Iraq last year, with an average of 16 inflicted each day last spring, according to newly released Pentagon figures.

For the full article, click on the following link:
http://www.usatoday.com/news/military/story/2012-04-12/brain-injuries-concussions-US-military-troops/54185894/1

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Federal TBI Program Info Alert: Head Impact Exposure in Youth Football

The Law Offices of Ian Mattoch is a personal injury law firm with offices throughout the State of Hawaii specializing in the representation of persons that have suffered traumatic brain injury, spinal cord injury, or catastrophic injuries as a result of someone else’s negligence. As a member of the Federal TBI Program Listserv, we were sent an abstract of a recent study of interest published in the journal Annals of Biomedical Engineering investigated head impact exposure in youth football:

Title: Head Impact Exposure in Youth Football
Authors: Ray W. Daniel, Steven Rowson, and Stefan M. Duma, Center for Injury Biomechanics, Virginia Tech-Wake Forest University
Abstract: The head impact exposure for athletes involved in football at the college and high school levels has been well documented; however, the head impact exposure of the youth  population involved with football has yet to be investigated, despite its dramatically larger population. The objective of this study was to investigate the head impact exposure in youth football. Impacts were monitored using a custom 12 accelerometer array equipped inside the helmets of seven players aged 7–8 years old during each game and practice for an entire season. A total of 748 impacts were collected from the 7 participating players during the season, with an average of 107 impacts per player. Linear accelerations ranged from 10 to 100 g, and the rotational accelerations ranged from 52 to 7694 rad/s2. The majority of the high level impacts occurred during practices, with 29 of the 38 impacts above 40 g occurring in practices.  Although less frequent, youth football can produce high head accelerations in the range of concussion causing impacts measured in adults. In order to minimize these most severe head impacts, youth football practices should be modified to eliminate high impact drills that do not replicate the game situations.

Click here to read the full text of this article: http://www.springerlink.com/content/r1w055654612u47j/fulltext.pdf


TBISERV is the listserv for the Federal TBI Program. TBISERV is moderated by the Federal TBI Program’s Technical Assistance Center.  To search the TBISERV archives, visit: https://list.nih.gov/archives/tbiserv.html

 

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Action Alert: Help with Co-Sponsors for TBI Act

On March 21, Rep. Bill Pascrell, Jr. (D-NJ) and Todd Platts (R-PA) introduced H.R. 4238, the Brain Injury Act of 2012, to reauthorize programs established by the TBI Act of 1996, as amended. The
National Association of State Head Injury Administrators is asking NASHIA members and advocates to assist in obtaining co-sponsors for the bill.  Sample letters below can be emailed to your representative.  To find your representative’s e-mail go to www.congress.org and enter your zip code. You may also call and ask for the health or disability staffer to ask for support.

For further assistance go to the NASHIA website (www.nashia.org)
to the Public Policy page under Key Issues and Get Involved web pages. Should you have any questions, please do not hesitate to contact Susan Vaughn, Director of Public Policy, at publicpolicy@nashia.org.

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Neuropathology of mTBI: relationship to neuroimaging findings

Erin D. Bigler & William L. Maxwell
Springer Science+Business Media, LLC 2012
Published online March 21, 2012

Neuroimaging identified abnormalities associated with traumatic brain injury (TBI) are but gross indicators that reflect underlying trauma-induced neuropathology at the cellular level. This review examines how cellular pathology relates to neuroimaging findings with the objective of more closely relating how neuroimaging findings reveal underlying neuropathology. Throughout this review an attempt will be made to relate what is directly known from post-mortem microscopic and gross anatomical studies of TBI of all severity levels to the types of lesions and abnormalities observed in contemporary neuroimaging of TBI, with an emphasis on mild traumatic brain injury (mTBI).

However, it is impossible to discuss the neuropathology of mTBI without discussing what occurs with more severe injury and viewing pathological changes on some continuum from the mildest to the most severe. Historical milestones in understanding the neuropathology of mTBI are reviewed along with implications for future directions in the examination of neuroimaging and neuropathological correlates of TBI.

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NASHIA: Washington Weekly Update

Hawaii’s personal injury attorney Ian Mattoch shares National Association of State Head Injury Administrators (NASHIA)’s Washington Weekly post in celebrating March as Brain Injury Awareness Month.  This update was prepared by Susan L. Vaughn, Director of Public Policy, publicpolicy@nashia.org:

HHS Appoints Members to National Advisory Council on Alcohol Abuse
The U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius recently appointed four new members to the National Advisory Council on Alcohol Abuse and Alcoholism of the National Institute on Alcohol Abuse and Alcoholism (NIAAA).  The council advises the Secretary, the Director of the National Institutes of Health and the director of NIAAA on program and policy matters, offers recommendations on research conducted at NIAAA, and reviews applications for grants and cooperative agreements.

SAMHSA Is Accepting Applications for Offender Reentry Program Grants
The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications for Offender Reentry grants.
The purpose of this program is to expand and/or enhance substance abuse treatment and related recovery and reentry  services to sentenced adult offenders returning to the community from incarceration for criminal offenses.  SAMHSA expects that up to $13.8 miilion will be available for up to 12 grants of up to $400,000 per grant annually, over the three year grant period. Domestic public and private nonprofit entities are eligible to apply. Applications for No. TI-12-003 are available by calling SAMHSA’s Information Line at 1-877-SAMHSA7 [TDD: 1 800-487-4889] or by downloading the application at http://www.samhsa.gov/grants/index.aspx. The due date is May 1, 2012.

CMS Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents
The Centers for Medicare & Medicaid Services (CMS) Medicare-Medicaid Coordination Office (MMCO), the Center for Medicare and Medicaid Innovation (Innovation Center), and the Center
for Medicaid and CHIP Services (CMCS) issued an Informational Bulletin to inform States about a new CMS opportunity, the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents (“Initiative”). The Initiative will focus on beneficiaries who are eligible for both Medicare and Medicaid (often known as “dual eligibles” or Medicare-Medicaid enrollees). Organizations interested in applying to participate in this Initiative must submit a proposal to CMS by June 14, 2012. CMS is requiring interested organizations to submit a non-binding Notice of Intent to Apply by April 30, 2012. The Request for Applications is available by searching for CFDA 93.621 at: www.grants.gov. CMS will host a webinar to discuss the Initiative. More information will be available at: https://www.cms.gov/medicare-medicaid-coordination/09_ReducingAvoidableHospitalizationsAmongNursingFacilityResidents.asp#TopOfPage

CMS Issues Final Rule on Medicaid Eligibility and ACA
On March 16, 2012, CMS released its eligibility and enrollment final rule to assist States in implementing the Affordable Care Act (ACA) Medicaid coverage expansion. The rule includes certain changes and clarifications to ease transitions between Medicaid and Exchange coverage and help patients avoid gaps in coverage. Under
the ACA, millions of uninsured Americans will gain access to affordable coverage through Affordable Insurance Exchanges and improvements in Medicaid and the Children’s Health Insurance Program (CHIP). These programs will use consistent standards and systems to seamlessly and efficiently meet  consumers’ healthcare needs, improve quality, and lower costs. To see the rule go to: http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/REG-03-16-12.pdf.

Real Warriors Campaign Launches New Campaign
During the past quarter, the Real Warriors Campaign developed new tools and resources designed specifically to keep active duty service members, veterans, National Guardsmen, reservists and military families informed of available resources for psychological health care and support. The Real Warriors Campaign launched a new video profile of Navy Chaplain (Lt. Cmdr.) Steve Dundas. During Chaplain Dundas’ deployment to Iraq, he experienced combat first-hand while providing support to service members. He
returned home feeling depressed, angry and disconnected from his faith, but with the support of his command, he received care for PTSD and learned tools and tips for coping with invisible wounds. Watch Chaplain Dundas’ video at  www.realwarriors.net/multimedia/profiles/dundas.php.  The
Campaign is offering a new weekly Podcast Series, “Real Warriors, Real Advice”, in which warriors, veterans and military families highlight the importance of seeking care for invisible wounds and offer tools and tips on building and maintaining psychological resilience. You can access and download episodes from the campaign website (www.realwarriors.net/podcasts) or subscribe to receive the weekly updates automatically.

AAPD Is Accepting Applications for Youth Transitions Fellowship
The American Association of People with Disabilities (AAPD), in coordination with The HSC Foundation, is now accepting applications for the 2012-2013 Youth Transitions Fellow. The Youth Transitions Fellow will gain exposure to youth programs serving people with disabilities and will have the opportunity to facilitate collaboration among internship, fellowship, and apprenticeship programs based in the Greater Washington, DC area. This paid fellowship position at AAPD is ideal for a recent college graduate with a disability who is looking to jump start a career and help peers transition to the workplace. The fellowship will start in May, 2012 and continue for 12 months. For more information or to apply, visit: http://www.aapd.com/what-powers-us/work-at-aapd.html. The deadline is April 30th, 2012.

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CDC is making noise about TBI – Once a Silent Epidemic

Attorney Ian Mattoch and the Law Offices of Ian Mattoch in Hawaii
is passing along a recent post by CDC Injury Center.  As the closing of Brain Injury Awareness Month activities, the below are links to stories of three individuals who are helping to Give a Voice to Brain Injury:

The CDC is asking for you to share your story.

Post your story on the HeadsUp Facebook Page. Visit the Heads
Up Film Festival
to share a video and add to the national
conversation on brain injury. Read others’ posts and view others’ videos to learn about facing daily challenges, achieving successes, seeking support, or finding rehabilitation services. Together, we can make some noise about TBI – a once ‘Silent Epidemic.’

Learn more about Traumatic Brain Injury.

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Neurology: White matter integrity related to functional working memory networks in TBI

Neurology, March, 2012 published the following article:

White matter integrity related to functional working memory networks in traumatic brain injury
E.M. Palacios, MSc; R. Sala-Llonch, MSc; C. Junque, PhD; T. Roig, PhD; J.M. Tormos, MD, PhD; N. Bargallo, MD, PhD; P. Vendrell, PhD;
ABSTRACT
Objective: This study explores the functional and structural patterns of connectivity underlying working memory impairment after severe traumatic axonal injury.

Methods: We performed an fMRI n-back task and acquired diffusion tensor images (DTI) in a group of 19 chronic-stage patients with severe traumatic brain injury (TBI) and evidence of traumatic axonal injury and 19 matched healthy controls. We performed image analyses with FSL software and fMRI data were analyzed using probabilistic independent component analysis. Fractional anisotropy (FA) maps from DTI images were analyzed with FMRIB’s Diffusion Toolbox.

Results: We identified working memory and default mode networks. Global FA values correlated with both networks and FA whole-brain analysis revealed correlations in several tracts associated with the functional activation. Furthermore, working
memory performance in the patient group correlated with the functional activation patterns and with the FA values of the associative fasciculi.

Conclusion:
Combining structural and functional neuroimaging data, we were able to describe structural white matter changes related to functional network alterations and to lower performance
in working memory in chronic TBI. Neurology® 2012;78:852–860

 

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Funding Opportunity from CDC’s Injury Center on TBI

Federal TBI Program Listserv announced the following two funding opportunities from CDC’s Injury Center on Traumatic Brain Injury:

Characterizing the Short and Long Term Consequences of Traumatic Brain Injury among Children in the United States:
http://www.grants.gov/search/search.do;jsessionid=yP9gPfKBgQXN8nFT0vT25ngvnqtJHDlMjhN7gpbGLJ5fTGhX1WLc!-916096435?oppId=147334&mode=VIEW

Field Triage of Traumatic Brain Injury in Older Adults Taking Anticoagulants or Platelet Inhibitors:

http://www.grants.gov/search/search.do;jsessionid=yP9gPfKBgQXN8nFT0vT25ngvnqtJHDlMjhN7gpbGLJ5fTGhX1WLc!-916096435?oppId=146913&mode=VIEW

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NASHIA Washington Update: SPECIAL EDITION

The National Association of State Head Injury Administrators (NASHIA) release a special edition of Washington Update, prepared by Susan L. Vaughn, NASHIA’s Director of Public Policy. The following was highlighted:

Last week, NASHIA members were well represented  in Washington, D.C. !  William A.B. Ditto, Chair of the Public Policy Committee, testified on behalf of the TBI Act reauthorization on Monday.   On Wednesday, a press conference was held announcing the introduction
of the TBI reauthorization bill, in addition to the Congressional Brain Injury Awareness Day events also held that day.  Through Rebeccah Wolfkiel’s efforts,  NASHIA was actively involved in the planning of the Fair, briefing and reception, as well as a sponsor.

CBITF Holds Awareness Day Activities
The Rayburn House Office Building Foyer was packed last week with exhibitors, including NASHIA,
promoting TBI awareness during the annual Awareness Day Fair sponsored by the Congressional Brain Injury Task Force. Above, right, Rebeccah (Becky) Wolfkiel, NASHIA Government Relations, visits with college students supporting concussion legislation during the Fair.
Following the Press Conference regarding reauthorization, the CBITF sponsored a briefing, “The Impact of Traumatic Brain Injury: Anytime, Anyone, Any Age”, featuring an array of panelists including individuals with TBI, researchers and representatives of the Centers for Disease Control and Prevention, the National Intitute of Neurological Disorders and Stroke, and Department of Veterans Administration. Bill Ditto moderated the session.

Happy 20th Birthday
— National Center for Injury
Prevention and Control!

During the CBITF Reception, Rep. Pascrell noted that this year is the 20th anniversary of the
National Center for Injury Prevention and Control. Staff were on hand to help celebrate!
CDC’s National Center for Injury Prevention and Control (Injury Center) is committed to saving lives and protecting our nation from injuries and violence. The Injury Center is the only U.S. federal agency that deals exclusively with injury and violence prevention in non-occupational settings. It leads a coordinated public health approach to tackling this critical health and safety issue. The Center’s work is guided by the belief that everyone should have access to the best information and resources to help them live life to its fullest potential.

 

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Check out Medxpress: Brain Wiring a No-Brainer?

Brain wiring a no-brainer? Scans reveal
astonishingly simple 3D grid structure.

March 29, 2012 in Neuroscience
Curvature in this DSI image of a whole human brain turns out to be folding of 2-D sheets of parallel neuronal fibers that cross paths at right angles. This picture came from the new
Connectom scanner. Credit: Van Wedeen, M.D., Martinos Center and Dept. of
Radiology, Massachusetts General Hospital and Harvard University Medical School

The brain appears to be wired more like the checkerboard streets of New York City than the curvy lanes of Columbia, Md., suggests a new brain imaging study. The
most detailed images, to date, reveal a pervasive 3D grid structure with no diagonals, say scientists funded by the National Institutes of Health.

“Far from being just a tangle of wires, the brain’s connections turn out to be more like
ribbon cables — folding 2D sheets of parallel neuronal fibers that cross paths at right angles, like the warp and weft of a fabric,” explained Van Wedeen, M.D., of Massachusetts General Hospital (MGH), A.A. Martinos Center for Biomedical Imaging and the Harvard Medical School. “This grid structure is continuous and consistent at all scales and across humans and other primate species.”

Wedeen and colleagues report new evidence of the brain’s elegant simplicity March 30, 2012 in the journal Science. The study was funded, in part, by the NIH’s National Institute of Mental Health (NIMH), the Human Connectome Project of the NIH Blueprint for Neuroscience Research, and other NIH components.

“Getting a high resolution wiring diagram of our brains is a landmark in human
neuroanatomy,” said NIMH Director Thomas R. Insel, M.D. “This new technology may
reveal individual differences in brain connections that could aid diagnosis and treatment of brain disorders.”

Knowledge gained from the study helped shape design specifications for the most powerful brain scanner of its kind, which was installed at MGH’s Martinos Center last fall. The new Connectom diffusion magnetic resonance imaging (MRI) scanner can visualize the networks of crisscrossing fibers – by which different parts of the brain communicate with each other – in 10-fold higher detail than conventional scanners, said
Wedeen.


This detail from a DSI scan shows a fabric-like 3-D grid structure of connections in monkey brain. Credit: Van Wedeen, M.D., Martinos Center and Dept. of
Radiology, Massachusetts General Hospital and Harvard University Medical School.

“This one-of-a-kind instrument is bringing into sharper focus an astonishingly simple architecture that makes sense in light of how the brain grows,” he explained. “The wiring of the mature brain appears to mirror three primal pathways established in embryonic
development.”

As the brain gets wired up in early development, its connections form along perpendicular pathways, running horizontally, vertically and transversely. This grid structure appears to guide connectivity like lane markers on a highway, which would limit options for growing nerve fibers to change direction during development. If they can turn in just four directions: left, right, up or down, this may enforce a more efficient, orderly way for the fibers to find their proper connections – and for the structure to adapt through evolution, suggest the researchers.

Obtaining detailed images of these pathways in human brain has long eluded researchers, in part, because the human cortex, or outer mantle, develops many folds, nooks and crannies that obscure the structure of its connections. Although studies using chemical tracers in neural tracts of animal brains yielded hints of a grid structure, such invasive techniques could not be used in humans.

Wedeen’s team is part of a Human Connectome Project Harvard/MGH-UCLA consortium that is optimizing MRI technology to more accurately to image the pathways. In diffusion imaging, the scanner detects movement of water inside the fibers to reveal their locations. A high resolution technique called diffusion spectrum imaging (DSI)
makes it possible to see the different orientations of multiple fibers that cross at a single location – the key to seeing the grid structure.

In the current study, researchers performed DSI scans on postmortem brains of four
types of monkeys – rhesus, owl, marmoset and galago – and in living humans. They
saw the same 2D sheet structure containing parallel fibers crossing paths everywhere in all of the brains – even in local path neighborhoods. The grid structure of cortex pathways was continuous with those of lower brain structures, including memory and emotion centers. The more complex human and rhesus brains showed more differentiation between pathways than simpler species.

Among immediate implications, the findings suggest a simplifying framework for
understanding the brain’s structure, pathways and connectivity.

The technology used in the current study was able to see only about 25 percent of
the grid structure in human brain. It was only apparent in large central circuitry, not in outlying areas where the folding obscures it. But lessons learned were incorporated into the design of the newly installed Connectom scanner, which can see 75 percent of it, according to Wedeen.

Much as a telescope with a larger mirror or lens provides a clearer image, the new scanner markedly boosts resolving power by magnifying magnetic fields with magnetically stronger copper coils, called gradients. Gradients make it possible to vary the magnetic field and get a precise fix on locations in the brain. The Connectom
scanner’s gradients are seven times stronger than those of conventional scanners. Scans that would have previously taken hours – and, thus would have been impractical with living human subjects – can now be performed in minutes.

“Before, we had just driving directions. Now, we have a map showing how all the highways and byways are interconnected,” said Wedeen. “Brain wiring is not like the wiring in your basement, where it just needs to connect the right endpoints. Rather, the
grid is the language of the brain and wiring and re-wiring work by modifying it.”

More information: Wedeen VJ, Rosene DL, Ruopeng W, Guangping D,
Mortazavi F, Hagmann P, Kass JH, Tseng W-YI. The Geometric Structure of the Brain Fiber Pathways: A Continuous Orthogonal Grid. March 30, 2012 Science.

Provided by National Institutes of Health

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