Tag Archives: traumatic brain injuries

Johns Hopkins study: Education mitigates the effects of brain injury

24 Apr

Education Portal defines illiteracy in the article, Illiteracy: The Downfall of American Society.

Most people think of literacy as a simple question of being able to read. But while a young child who can work her way through a basic picture book is considered to have age-appropriate literacy levels, an adult who can only read at the most fundamental level is still functionally illiterate.
The world requires that adults not only be able to read and understand basic texts, but also be able to function in the workplace, pay bills, understand legal and financial documents and navigate technology – not to mention the advanced reading comprehension skills required to pursue postsecondary education and the opportunities that come with it.
As a result, when we talk about the effects of illiteracy on society, we’re talking primarily about what happens when you have a large number of adults whose literacy skills are too low to perform normal, day-to-day tasks. However, it is worth keeping in mind that childhood illiteracy is, of course, directly correlated to adult illiteracy. http://education-portal.com/articles/Illiteracy_The_Downfall_of_American_Society.html

The key concept is the individual cannot adequately function in the society in which they live. That means that tasks necessary to provide a satisfactory life are difficult because they cannot read and/or comprehend what they read.
Research is taking the concept of literacy a step farther with the concept of cognitive reserve.

Jon Hamilton of NPR reported in the article, Education May Help Insulate The Brain Against Traumatic Injury:

A little education goes a long way toward ensuring you’ll recover from a serious traumatic brain injury. In fact, people with lots of education are seven times more likely than high school dropouts to have no measurable disability a year later.
“It’s a very dramatic difference,” says Eric Schneider, an epidemiologist at Johns Hopkins and the lead author of a new study. The finding suggests that people with more education have brains that are better able to “find ways around the damage” caused by an injury, he says.
The study looked at the medical records of 769 adults who suffered traumatic brain injuries serious enough to require an inpatient hospital stay and rehabilitation. A year after the injury, just 10 percent of people who didn’t finish high school had no disability, compared with 39 percent of people with enough years of education to have received a college degree. People with advanced degrees did even better.
One reason for the difference may be something known as “cognitive reserve” in the brain, Schneider says. The concept is a bit like physical fitness, he says, which can help a person recover from a physical injury. Similarly, a person with a lot of cognitive reserve may be better equipped to recover from a brain injury…
For several decades, studies have shown that people with more education, and presumably more cognitive reserve, are less likely to develop the memory and thinking problems of Alzheimer’s disease. The new study suggests the benefits of education and cognitive reserve extend to brain damage caused by injury rather than disease.
There’s no guaranteed way to increase your cognitive reserve, Schneider says. But there are hints that staying physically and socially active helps, and that “pursuing lifelong learning may be beneficial,” he says.
One limitation of the study is that it relied on a standard disability rating scale, which relies on measures such as a person’s ability to return to work. That could have meant that a college graduate returning to an office job was less likely to be declared disabled than, “a roofer with balance issues,” Schneider says. He adds that even people with a disability rating of zero may still have mental or physical problems caused by their brain injury. http://www.npr.org/blogs/health/2014/04/23/306228476/education-may-help-insulate-the-brain-against-traumatic-injury

Citation:

Functional recovery after moderate/severe traumatic brain injury
A role for cognitive reserve?
1. Eric B. Schneider, PhD,
2. Sandeepa Sur, MSc, MHS,
3. Vanessa Raymont, MBChB, MSc, MRCPsych,
4. Josh Duckworth, MD,
5. Robert G. Kowalski, MBBCh, MS,
6. David T. Efron, MD,
7. Xuan Hui, MD, ScM,
8. Shalini Selvarajah, MD, MPH,
9. Hali L. Hambridge, ScM and
10. Robert D. Stevens, MD
+SHOW AFFILIATIONS
| + SHOW FULL DISCLOSURES
1. From the Center for Surgical Trials and Outcomes Research, Department of Surgery (E.B.S., D.T.E., X.H., S. Selvarajah, H.L.H.), Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine (R.G.K., R.D.S.), and Departments of Neurology (R.D.S.) and Neurosurgery (R.D.S.), Johns Hopkins School of Medicine, Baltimore, MD; Tulane Center for Aging (S. Sur), Tulane University School of Medicine, New Orleans, LA; Department of Radiology (V.R., J.D., R.D.S.), Johns Hopkins University, Baltimore, MD; and Centre for Mental Health (V.R.), Department of Medicine, Imperial College London, UK.
1. Correspondence to Dr. Schneider: eschnei1@jhmi.edu
+ AUTHOR DISCLOSURES: ERIC B. SCHNEIDER, PHD
+ AUTHOR DISCLOSURES: SANDEEPA SUR, MSC, MHS
+ AUTHOR DISCLOSURES: VANESSA RAYMONT, MBCHB, MSC, MRCPSYCH
+ AUTHOR DISCLOSURES: JOSH DUCKWORTH, MD
+ AUTHOR DISCLOSURES: ROBERT G. KOWALSKI, MBBCH, MS
+ AUTHOR DISCLOSURES: DAVID T. EFRON, MD
+ AUTHOR DISCLOSURES: XUAN HUI, MD, SCM
+ AUTHOR DISCLOSURES: SHALINI SELVARAJAH, MD, MPH
+ AUTHOR DISCLOSURES: HALI L. HAMBRIDGE, SCM
+ AUTHOR DISCLOSURES: ROBERT D. STEVENS, MD
1. Published online before print April 23, 2014, doi: 10.1212/WNL.0000000000000379 Neurology 10.1212/WNL.0000000000000379
» Abstract
Full Text (PDF)
1. Also available:
2. Accompanying Comment
Abstract
Objective: To evaluate the hypothesis that educational attainment, a marker of cognitive reserve, is a predictor of disability-free recovery (DFR) after moderate to severe traumatic brain injury (TBI).
Methods: Retrospective study of the TBI Model Systems Database, a prospective multicenter cohort funded by the National Institute on Disability and Rehabilitation Research. Patients were included if they were admitted for rehabilitation after moderate to severe TBI, were aged 23 years or older, and had at least 1 year of follow-up. The main outcome measure was DFR 1 year postinjury, defined as a Disability Rating Scale score of zero.
Results: Of 769 patients included, 214 (27.8%) achieved DFR at 1 year. In total, 185 patients (24.1%) had <12 years of education, while 390 (50.7%) and 194 patients (25.2%) had 12 to 15 years and ≥16 years of education, respectively. DFR was achieved by 18 patients (9.7%) with <12 years, 120 (30.8%) with 12 to 15 years, and 76 (39.2%) with ≥16 years of education (p < 0.001). In a logistic regression model controlling for age, sex, and injury- and rehabilitation-specific factors, duration of education of ≥12 years was independently associated with DFR (odds ratio 4.74, 95% confidence interval 2.70–8.32 for 12–15 years; odds ratio 7.24, 95% confidence interval 3.96–13.23 for ≥16 years).
Conclusion: Educational attainment was a robust independent predictor of 1-year DFR even when adjusting for other prognostic factors. A dose-response relationship was noted, with longer educational exposure associated with increased odds of DFR. This suggests that cognitive reserve could be a factor driving neural adaptation during recovery from TBI.
Received July 18, 2013.
Accepted in final form January 21, 2014.
© 2014 American Academy of Neurology

Cognitive reserve is the key concept in interpreting this study.

Molly Edmonds wrote in the How Stuff Works article, Can you delay dementia?

But don’t get downhearted; even if you didn’t go for that Ph.D., you can still start challenging the brain at any age to build up cognitive reserve. Software and video games meant to challenge the brain have begun popping up on the market, though scientists warn that these tools don’t have much science behind them [sources: Belluck, Larson]. You don’t even have to get that high-tech. In one study, participants who worked a crossword puzzle four days of the week had a 47 percent lower risk of dementia than those who did a crossword once a week . Mental activities like playing chess and other board games, learning a foreign language, volunteering, reading and playing a musical instrument all keep the brain humming. Finding a friend to do some of these activities with is also a bonus — in a study that examined over 1,000 people, those with a limited social network were 60 percent more likely to have dementia after a three-year period .
For a real-life example of how cognitive reserve can delay dementia, look no further than the 678 Catholic Sisters of Notre Dame, of Mankato, Minn. These nuns’ cognitive states were studied for years as doctors tried to learn more about dementia, and doctors conducted postmortem exams on the women’s brains. In one examination, doctors found that some of the nuns who had signs of Alzheimer’s disease in the brain hadn’t demonstrated a lack of cognitive function while still alive. The doctors did notice that the blood vessels in the brain were in exceptionally good shape, however, meaning that even as Alzheimer’s started to appear, the brain found a way to work around the challenges [sources: Whitehouse, Tan]. That’s not to say that cognitive reserve can delay dementia forever — if the women had lived longer, they may have developed dementia eventually.
Your brain depends on a regular flow of blood, so another way to keep those cerebral blood vessels working well is good old-fashioned exercise. Read on to find out what other physical activities can help your brain. http://health.howstuffworks.com/mental-health/dementia/delay-dementia1.htm

Just as one must exercise their body to stay healthy, they must also exercise their brain.

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Canadian study: Teens who have suffered a concussion at higher risk for bullying and suicide

16 Apr

Kids Health has some great information about concussions at their site:

What Is a Concussion and What Causes It?
The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. When a person gets a head injury, the brain can move around inside the skull and even bang against it. This can lead to bruising of the brain, tearing of blood vessels, and injury to the nerves. When this happens, a person can get a concussion — a temporary loss of normal brain function.
Most people with concussions recover just fine with appropriate treatment. But it’s important to take proper steps if you suspect a concussion because it can be serious.
Concussions and other brain injuries are fairly common. About every 21 seconds, someone in the United States has a serious brain injury. One of the most common reasons people get concussions is through a sports injury. High-contact sports such as football, boxing, and hockey pose a higher risk of head injury, even with the use of protective headgear.
People can also get concussions from falls, car accidents, bike and blading mishaps, and physical violence, such as fighting. Guys are more likely to get concussions than girls. However, in certain sports, like soccer, girls have a higher potential for concussion.
http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_
https://drwilda.com/2012/03/06/dont-ignore-concussions/
See, Update: Don’t ignore concussions https://drwilda.com/2012/05/20/update-dont-ignore-concussions/

Bryan Toporek reported in the Education Week article, Once-Concussed Teenagers Found to Be at Higher Risk for Bullying, Suicide:

Teenagers who have suffered a traumatic brain injury such as a concussion are twice as likely to be bullied and roughly three times as likely to attempt suicide compared to those who haven’t, according to a new study published online today in the open-access journal PLOS ONE.
The study drew upon data from the 2011 Ontario Student Drug Use and Health Survey, which contains responses from nearly 9,300 students between grades 7 and 12 in 181 publicly funded schools across Ontario. Questions about traumatic brain injuries were added to the OSDUHS for the first time in 2011 and were answered by a subsample of 4,816 students.
The teenagers were asked whether they had ever suffered a head injury that resulted in them being unconscious for at least five minutes or required at least one night’s stay in a hospital. Just under 20 percent of the students involved in the study had suffered at least one head injury that met either of those qualifications….
http://blogs.edweek.org/edweek/schooled_in_sports/2014/04/once-concussed_teenagers_found_to_be_at_higher_risk_for_bullying_suicide.html

Citation:

Research Article
Suicidality, Bullying and Other Conduct and Mental Health Correlates of Traumatic Brain Injury in Adolescents
Gabriela Ilie mail,
Robert E. Mann,
Angela Boak,
Edward M. Adlaf,
Hayley Hamilton,
Mark Asbridge,
Jürgen Rehm,
Michael D. Cusimano
Published: April 15, 2014
•DOI: 10.1371/journal.pone.0094936

Objective
Our knowledge on the adverse correlates of traumatic brain injuries (TBI), including non-hospitalized cases, among adolescents is limited to case studies. We report lifetime TBI and adverse mental health and conduct behaviours associated with TBI among adolescents from a population-based sample in Ontario.
Method and Findings
Data were derived from 4,685 surveys administered to adolescents in grades 7 through 12 as part of the 2011 population-based cross-sectional Ontario Student Drug Use and Health Survey (OSDUHS). Lifetime TBI was defined as head injury that resulted in being unconscious for at least 5 minutes or being retained in the hospital for at least one night, and was reported by 19.5% (95%CI:17.3,21.9) of students. When holding constant sex, grade, and complex sample design, students with TBI had significantly greater odds of reporting elevated psychological distress (AOR = 1.52), attempting suicide (AOR = 3.39), seeking counselling through a crisis help-line (AOR = 2.10), and being prescribed medication for anxiety, depression, or both (AOR = 2.45). Moreover, students with TBI had higher odds of being victimized through bullying at school (AOR = 1.70), being cyber-bullied (AOR = 2.05), and being threatened with a weapon at school (AOR = 2.90), compared with students who did not report TBI. Students with TBI also had higher odds of victimizing others and engaging in numerous violent as well as nonviolent conduct behaviours.
Conclusions
Significant associations between TBI and adverse internalizing and externalizing behaviours were found in this large population-based study of adolescents. Those who reported lifetime TBI were at a high risk for experiencing mental and physical health harms in the past year than peers who never had a head injury. Primary physicians should be vigilant and screen for potential mental heath and behavioural harms in adolescent patients with TBI. Efforts to prevent TBI during adolescence and intervene at an early stage may reduce injuries and comorbid problems in this age group…. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0094936
Here is the press release from St. Michael’s Hospital:
Teenagers who have had a concussion also have higher rates of suicide attempts, being bullied and high-risk behavior, study finds
Toronto, April 15, 2014
Teenagers who have suffered a traumatic brain injury such as a concussion are at “significantly greater odds” of attempting suicide, being bullied and engaging in a variety of high risk behaviours, a new study has found.
They are also more likely to become bullies themselves, to have sought counselling through a crisis help-line or to have been prescribed medication for anxiety, depression or both, said Dr. Gabriela Ilie, lead author of the study and a post-doctoral fellow at St. Michael’s Hospital.
They have higher odds of damaging property, breaking and entering, taking a car without permission, selling marijuana or hashish, running away from home, setting a fire, getting into a fight at school or carrying or being threatened by a weapon, she said in a paper published today in the journal PLOS ONE.
Dr. Ilie said the study provides the first population-based evidence demonstrating the extent of the association between TBI and poor mental health outcomes among adolescents.
“These results show that preventable brain injuries and mental health and behavioural problems among teens continue to remain a blind spot in our culture,” Dr. Ilie said. “These kids are falling through the cracks.”
The data used in the study was from the 2011 Ontario Student Drug Use and Health Survey developed by the Centre for Addiction and Mental Health. The survey, one of the longest ongoing school surveys in the world, contains responses from almost 9,000 students from Grades 7-12 in publicly funded schools across Ontario. The OSDUHS began as a drug use survey, but is now a broader study of adolescent health and well-being. Questions about traumatic brain injury were added to the survey for the first time in 2011.
“We know from a previous study based on OSDUHS data that as many as 20 per cent of adolescents in Ontario said they have experienced a traumatic brain injury in their lifetime,” said Dr. Robert Mann, senior scientist at CAMH and director of the OSDUHS. “The relationship between TBI and mental health issues is concerning and calls for greater focus on prevention and further research on this issue.”
Dr. Ilie said the teenage years are already a turbulent time for some, as they try to figure out who they are and what they want to be. Since a TBI can exacerbate mental health and behavioural issues, she said primary physicians, schools, parents and coaches need to be vigilant in monitoring adolescents with TBI.
In addition, she said many TBI experienced by youth occur during sports and recreational pursuits, and are largely preventable through use of helmets and the elimination of body checking in hockey.
The study found that adolescents who had suffered a TBI sometime in their life had twice the odds of being bullied at school or via the Internet and almost three times the odds of attempting suicide or being threatened at school with a weapon compared to those without a TBI.
This research was funded by a Canadian Institute of Health Research Team Grant in Traumatic Brain Injury and Violence and by the Ontario Neurotrauma Foundation. Additional funding was obtained from a grant from AUTO21, a member of the Networks of Centres of Excellence program that is administered and funded by the Natural Sciences and Engineering Research Council, the Social Sciences and Humanities Research Council, in partnership with Industry Canada, and ongoing funding support from the Ontario Ministry of Health and Long-Term Care.
About St. Michael’s Hospital
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.
Media contacts
For more information, or to arrange an interview with Dr. Sievenpiper, contact:
Leslie Shepherd
Manager, Media Strategy
416-864-6094
shepherdl@smh.ca
About CAMH
The Centre for Addiction and Mental Health (CAMH) is Canada’s largest mental health and addiction teaching hospital, as well as one of the world’s leading research centres in its field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please visit http://www.camh.ca.
For more information on OSDUHS or to interview Dr. Mann, please contact:
Kate Richards
Media Relations
Centre for Addiction and Mental Health (CAMH)
Office: 416 535 8501 x36015
Mobile: 416 427 7743
kate.richards@camh.ca
http://www.camh.ca

The Sports Concussion Institute has some great information about concussions http://www.concussiontreatment.com/concussionfacts.html

People must take concussions very seriously.

Resources:

Concussions
http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_

Concussion http://www.emedicinehealth.com/concussion/article_em.htm

Concussion – Overview http://www.webmd.com/brain/tc/traumatic-brain-injury-concussion-overview

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