In part one of this series on Traumatic Brain Injury yesterday we discussed the enormous problem and the widespread nature of TBI’s. Today we look into the revolutionary protocols that are being used that have been getting results for people suffering from these types of injuries.
The American Congress of Rehabilitation Medicine and other groups have established criteria to define levels of TBI as mild, moderate, or severe. These levels are based on medical symptoms at the time of injury. Approximately 80% of reported TBI’s are mild, with the remainder split between moderate and severe. One of the most confusing aspects of TBI is that the level of injury at the time of the TBI only partially predicts the long-term outcome for any particular person.
At times there are cases of remarkable recovery after the extended loss of consciousness (coma) as reported by the press. Other times, individuals with TBI defined as ‘mild’ based on initial physical symptoms, face major challenges from cognitive, mood and personality changes. Additionally, terminology such as mild TBI, concussion and minor head injury, have been used interchangeably over the years, creating confusion. Most professional groups generally define mild TBI as having a disruption of or loss of consciousness less than 30 minutes, moderate TBI with loss of consciousness over 30 minutes up to 24 hours, and severe TBI as loss of consciousness over 24 hours. Mild TBI may also be diagnosed when a person has disruption of brain function characterized by loss of memory for events immediately before or after the accident, any alteration of mental state at the time (e.g. dazed, confused, disoriented) and any focal neurologic ‘deficits’ (e.g. balance word retrieval) that may be transient — but, the severity of injury is not the best indicator of prognosis.
A Constellation of Issues
The constellation of problems that may continue after mild TBI is called post-concussive syndrome or disorder (PCS or PCD). These are a multitude of symptoms caused or worsened by TBI and persisting after three months (most mild TBI symptoms usually clear within three months). Hallmark PCS/PCD features include but are not limited to a history of head trauma that has caused a significant cerebral concussion, manifestations of concussion that include loss of consciousness, post-traumatic amnesia, and less commonly, post-traumatic onset of seizures, evidence of difficulty in attention (concentrating, shifting focus of attention, performing simultaneous cognitive tasks).
The brain is a complex organ that operates as a delicate and remarkable electrochemical system, where chemical messengers move between cells called neurons. Through the chemical changes that occur, patterns of electrical activity are formed, creating our thoughts, feelings, and actions. This brain electrical activity is what the neurological tests called the electroencephalogram (EEG) measures, a test often used in the diagnosis of seizures.
100 Billion Neurons at Work
The typical human brain is a 3-lb universe with 100 billion neurons, each of which has the potential to connect to thousands of other neurons, passing their information through electrochemical messengers. Much of the ‘thinking’ part of the brain that performs our highest intellectual functions is in the outer layer of the tissue known as the grey matter. Underneath this grey matter is the white matter, cellular information superhighways that speed transmission of information in the brain by having a fatty insulation covering (myelin), similar to the electrical insulation covering wires. The insulated projections from neuron cell bodies that relay electrochemical impulses are called axons, and together bundles of axons forms tracks. These white matter tracks vary in thickness, and are often finer than a human hair, making them vulnerable to injury.
The brain is viewed not only in terms of grey or white matter but also by the functions of various regions or lobes. The frontal lobe is the most vulnerable, and oversees the executive duties of life, allowing us to be successful, independent, and able to adjust our changing world and life demands. The rearmost part of the frontal lobe is responsible for movement, taking our intentions and sending out the motor plan so that we can reach, jump and run. On each side of the brain just above the ear area rests the temporal lobes. They are also very vulnerable to TBI, and injury in this region is associated with higher risk for seizure and subsequently, psychological problems. The temporal lobes are critical in learning and memory, as well as understanding language and sequencing. Above the temporal lobes and further back in the brain are the parietal lobes.
The parietal lobes control, pull together and comprehend our experience of the sensory world. Parietal lobes play a critical role in touch sensation, spatial abilities as well as academic skills. Surprisingly our vision happens in the occipital lobe in the very back of the head. Injury to this region of the brain may cause cortical blindness, where the eyes work perfectly well, but the occipital lobe cannot process the images.
iSynchony: A New Treatment
There is no cure for TBI. Thus the importance of optimal care is paramount every step of the way. However, there is a new kid on the block dealing with and getting results for traumatic brain injury. It’s called iSynchrony. This novel application of currently existing technology is showing significant efficacy in treating mild and moderate TBI, concussion and post-concussion syndrome.
Individualized Transcranial Magnetic Stimulation, iTMS, can within 1 to 2 months of therapy, relieve many of the symptoms of mild to moderate traumatic brain injury/concussion. Particular improvement is usually noticed in areas of focus, concentration and executive function. This can easily make the difference between keeping a job and losing a job, graduating college or dropping out of college. Also, patients find their symptoms of anxiety and insomnia, which often occur with TBI, diminish rapidly.
A 10-day trial course is always the first step on the bridge to recovery. If the 10-day trial fails to improve the symptoms of the condition, one stops and doesn’t invest in the remaining 20 to 40 daily sessions of iTMS. Also, iTMS and hyperbaric high-oxygen chambers have been tested as co-therapies with one another, with potentially exciting results. We await more clinical results on the combination. In the meantime, iTMS is fast developing a track record of dramatic results for mild to moderate TBI, concussion and post-concussion syndrome and is without a doubt worth a try for anyone suffering from a TBI and its many life-altering symptoms.
Tomorrow our third and final part of the series focusing on veterans and athletes here on Liberty Nation.
Lorraine C. Silvetz, MSW is Director of iSynchrony based in Oakton, VA and Executive Director of Global Stress Initiative a program for the treatment of veterans and their families launched in 2010 under the auspices of the International Committee Against Mental Illness (ICAMI) which is led by Robert Cancro, MD, Chairman Emeritus of NYU Langone's Department of Psychiatry.
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