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New app designed to help survivors of traumatic brain injury recognize and regulate emotions

Indiana University School of Medicine, May 8, 2018

A new app developed by an Indiana University School of Medicine faculty member is designed to help survivors of traumatic brain injuries recognize and regulate their emotions— skills that are critical to maintaining relationships and quality of life but that are often compromised in patients who have endured head traumas.

The app, called My Emotional Compass, is the result of years of research led by Dawn M. Neumann, PhD, associate professor of physical medicine and rehabilitation at IU School of Medicine and research director at the Rehabilitation Hospital of Indiana. It is available on the Apple App Store and the Google Play Store.

Patients with TBI frequently experience damage to regions of the brain and neural networks involved with processing emotions. As a result, many survivors have trouble identifying, labeling and expressing their emotions, a condition known as alexithymia. For example, patients may be unable to articulate that receiving a surprise gift made them feel happy and appreciative, or that being passed over for a promotion left them feeling frustrated and ashamed.

As many as 60 percent of individuals with moderate to severe TBI experience alexithymia, making it challenging to display empathy and respond in a socially appropriate manner in personal and professional relationships. Patients with mild TBI also experience this challenge.

There are no standard, evidenced-based interventions to treat these issues. The app and related research studies led by Neumann aim to begin filling this gap. My Emotional Compass is specifically designed to address alexithymia by helping patients interpret and put words to their own feelings.

“We need to re-teach individuals who have experienced a traumatic brain injury about emotions and give them an emotional vocabulary,” Neumann said. “It might sound simplistic, but the very act of labeling an emotion can help control it.”

In addition to problems with recognizing and labeling personal emotions, many patients with TBI also have difficulty recognizing others’ emotions, interpreting tone of voice, reading facial and physical cues, and responding empathetically to these cues. “You can’t understand what it means that someone else is feeling sad or angry if you don’t recognize those emotions in yourself,” Neumann said.

Because there is an association between recognizing self-emotions and recognizing and responding to others’ emotions, there is a possibility treatments aimed at reducing alexithymia may also improve these other related skills as well.

The app takes users through a series of questions and helps them identify how they are feeling in response to certain scenarios. For example, a user is asked to think of a situation that occurred earlier in the day, then to identify if the experience was pleasant or unpleasant, and to further refine the emotional response in terms of level of emotional charge. (Did the event elicit a strong, moderate or mild emotional arousal?) This ultimately guides the individual to understand the nuances between feelings of anxiety, fear, disgust or anger, for instance.

The app is based on a pilot study led by Neumann at the Rehabilitation Hospital of Indiana that employed the same techniques. It involved patients who, on average, had experienced a traumatic brain injury at least eight years prior. They underwent eight, one-hour emotional awareness training sessions with a research therapist. The results were promising. “We have patients who benefitted tremendously, and the benefits were lasting,” Neumann said.

After the trial, patients were given a laminated piece of paper that reinforced what they learned and served as their Emotional Compass. Neumann sought to make the tool available to a broader audience in a user-friendly format. She selected CreateAbility Concepts, Inc. to help develop the app because of the company’s understanding of this population. It helped transfer Neumann’s manual compass into a highly interactive app through an elaborate series of interviews and mock-ups.

CreateAbility Concepts licensed Neumann’s work through the IU Innovation and Commercialization Office, which protects, markets and licenses intellectual property developed at Indiana University so it can be commercialized by industry.

“This license agreement is a perfect marriage of Dawn Neumann’s outstanding content and CreateAbility Concept’s superior technical know-how,” said David Wilhite, director at ICO. “We are glad to license this intellectual property to an Indiana-based company to bring it to the market.”

Patients are encouraged to use My Emotional Compass in collaboration with a clinician, such as a psychologist or speech language pathologist.

“The inability to recognize and interpret emotions puts a significant strain on relationships and impedes a person’s quality of life, but it is a problem that is often overlooked as clinicians focus on immediate and long-term physical complications of the injury,” Neumann said. “My hope is that this app continues to shine a light on the importance of treating alexithymia and other related conditions and empowers patients by giving them access to an effective, easy-to-use tool.”

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By John Prybys, LAS VEGAS REVIEW-JOURNAL (August 22, 2016) — Randy Dexter and Captain are more than just dog owner and dog. That’s obvious from the way Captain looks for Dexter whenever the Army veteran leaves the room, and the way the Lab mix’s demeanor slips instantly from playful to dead serious once he’s wearing the jacket that denotes his status as a service animal.

Dexter is a retired U.S. Army staff sergeant who did two tours of duty in Iraq. He was diagnosed with both post-traumatic stress disorder and a mild traumatic brain injury, and the story of Dexter and Captain is featured in a new awareness campaign urging veterans and military service people to seek help for traumatic brain injury if they need it.

The campaign, “A Head for the Future,” is sponsored by the Defense and Veterans Brain Injury Center. In his video, Dexter shares the struggles he has experienced coping with his injuries and the reluctance he felt at first to seek help for it.

But, he says, “I was lucky, because when I was in the Army and had my head injury, I was kind of forced to get help.”

Dexter, 34, is a graduate of Green Valley High School who served in the Army for 11 years and had two tours of duty in Iraq. In 2005, Dexter, a combat medic, and his squad were hit by an IED, prompting a long, and continuing, struggle with post-traumatic stress disorder.

Then, after returning home and while still being treated for PTSD and training soldiers bound for Iraq and Afghanistan, Dexter suffered a brain injury during a recreational football game. He’s not sure, even now, what happened. All he knows is that he lost the memory of about 24 hours’ time and, even, of going to the game at all.

X-rays and imaging studies revealed no skull fractures or apparent injuries. But, afterward, Dexter experienced a worsening of already existing problems with his memory, concentration and equilibrium, and began to suffer migraines and severe, debilitating headaches that eventually compounded his PTSD and caused severe depression.

Dr. Scott Livingston, director of education for the Defense and Veterans Brain Injury Center in Silver Springs, Maryland, says symptoms of PTSD and brain injury often can overlap, making diagnosis a challenge. And when a brain injury does occur, he says, it often presents with no obvious symptoms that can be detected by X-ray or imaging scans.

In such cases, the problem likely is “more of a microscopic type of injury within the brain,” Livingston says.

Most civilians probably assume that brain injuries among service people are caused mostly by blasts and blunt-force trauma to the head. Yet, Livingston says, most are caused by motor vehicle collisions, training-related accidents, falls and sports and recreational activities.

Whatever the cause, military personnel are reluctant to report an injury or seek care for it. The current campaign is designed to raise awareness of brain injuries among service people, promote ways to prevent it when possible, and encourage men and women to report it and get it checked out, Livingston says.

“It’s well-known in scientific literature that the earlier someone reports a mild traumatic brain injury and goes to seek help, the better the chances are for better and more complete recovery,” he says.

During his treatment, Dexter participated in a program that paired injured veterans with service dogs. His experience with a dog named Ricochet was so good that he later welcomed the chance to be paired with Captain.

Dexter and Captain are a great team. Dexter says the dog can detect impending anxiety attacks even before he does, and that the dog can serve as a physical shield and protector in such public places as big-box retail stores, which can be particularly unnerving places for those with PTSD.

The true test of Captain’s effectiveness is that the dog has allowed Dexter to significantly reduce the medications he has to take. Today, it would be difficult for someone who doesn’t know the back story to detect Dexter’s struggles with traumatic brain injury, and it was his own previous interest in speaking out publicly about his conditions that led to his participation in the new awareness campaign.

Dexter now attends UNLV, where he’s majoring in communication studies and Spanish. He has been active on the debate teams, will be a peer adviser for other veterans, and hopes to kick off a music show on the university’s HD/internet radio station.

Dexter hopes his video and his story will help to persuade other veterans and active service people to seek out help for PTSD and brain injury. That can be difficult, he notes, because the standard soldier’s stance is that, whatever is happening, “you just deal with it, and that’s true across the whole military culture.”

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