News

 

My Tech Tools for TBI

 

By Alexander Rostron, August 25, 2020

 
After my traumatic brain injury (TBI), I suffered from a large drop in mental capacity.  I could not remain focused for even moderate lengths of time and forgot the majority of the content that I had just consumed.  

Not only that, whenever I attempted focused work, I was so mentally and physically tired after doing something as simple as reading that I needed to take a nap.  The limited runs of mental stamina prompted me to explore different tools and systems for assistance.

Below are three apps I find useful:

Notability App (iOS, Mac)

I use Notability to write notes (handwritten and typed), take photos and record audio from class and during medical appointments.  My favorite feature is the ability to capture audio while handwriting notes and highlighting key terms with the Apple Pencil.  

While reviewing my class notes to study for a test, I realized that the audio recorded more information than I was able to put down during the lecture.  For example, a professor gives an example of the definition they had just explained.  I was only able to write out the definition, before the professor started on a different part of the lesson.  The audio recording left me more information than my writing speed could handle.

Google Calendar

I use Google Calendar to track the scheduled appointments I have.  My favorite part of that utility is the option of adding details to each event, such as the address, a notification to remind me an hour before, and a space for a custom description.  Here is where I list important details about what needs to be brought and prepared for the appointment.  I have used it to track things I need to bring and do before each appointment.

Forest Pomodoro Timer (iOS, Mac)

I use Forest to practice the Pomodoro technique for working on tasks that take intense focus, while giving scheduled breaks for a mental recovery.  It is a timer that stops if you use your phone.  This is to practice only studying for a set amount of time, with an alert after as a reminder to physically get up from where I’m studying and take a very short break.  Studies have shown that after 25 minutes of intense mental focus, human ability to retain information gets severely diminished.  This is a tool I consistently use when I am completing a task with a lot of paperwork and takes a lot of time and mental energy, such as writing essays or personal record-keeping.

These 3 tools act as such a critical part of my life post-TBI.  The Notability app catches all of the information that I cannot record at the time of, and helps support my memories with the tools it gives to type, write, and emphasize certain information.  The Google Calendar system helps give me a clear layout of the events in the week ahead of me and contains a place for each small and important detail.  The Forest app helps me pace myself through large blocks of work with small checkpoint breaks to ensure that I don’t drain my mental battery and a chance to reflect about what info I had just absorbed.

These are the systems that assist me with the mental stamina and memory recall struggles specific to my traumatic brain injury. If you have tools that you would like to add to this list, I would love to hear about what you have used to support your life post-TBI. If you would like to hear more about one of these tools please let me know.  If you have any comments, questions, or feedback please feel free to reach out to me at arroston@gmail.com.

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Alcohol and Brain Injury

After a TBI or Stroke the brain can become more sensitive to the effects of alcohol. This can cause cognitive problems that impact memory, mobility, and speech. It can also cause someone to feel fatigued and unwell. What can be expected after your recovery?

 

By Fred at Spindpals.com, July 18, 2020

 

Whether we’re on holiday abroad or enjoying the Christmas festivities, an alcoholic drink tends to not be too far from reach for many of us.

But after a brain injury, the body’s tolerance to alcohol is greatly reduced, and many survivors find that they are no longer able to enjoy alcohol in the same way as they did before their injury. The reduced tolerance to alcohol means that many effects of brain injury are exacerbated after drinking, such as memory problems, mobility issues, speech and fatigue.

Remember you should always discuss with your medical practitioner your particular condition to understand what the impact would be on yourself. Never take alcohol without their approval and guidance.

AUTHOR: “It is clear that there is an uneasy relationship between alcohol and brain injury. Survivors are often faced with the challenge of balancing a desire to enjoy the social life they had before they sustained their injury with the acceptance that alcohol now affects them in a different way.”

We asked brain injury survivors to tell us about how their relationship with alcohol has changed.

For some, the enjoyment of drinking is simply outweighed by the effects caused.

“I don’t drink anymore,” said Louise Fry. “I couldn’t drink to start with because of meds, but now? It just hits me too hard.”

Janet Creamer agreed: “Drinking is now a no-no. Just one alcoholic drink does awful things to my brain. It feels like I’ve drunk way too much and I get that spaced out feeling.”

Others, like Giles Philip Hudson, have found that being advised by doctors to no longer drink has actually been a blessing in disguise.

AUTHOR: “After sustaining my brain injury and spending over four months in hospital, doctors advised me not to drink alcohol. During this time I found I no longer needed to drink alcohol to make me feel good or enjoy myself. I certainly don’t need the headaches it causes.”
 

Enjoy a drink at home with family and friends

Naturally, many people want to continue to be able to enjoy a drink every now and then, particularly at social gatherings. But what if going to the bar is too daunting a prospect?

Home drinking is increasingly popular For some, staying in allows them to enjoy a drink without some of the challenges of being in a busy, crowded and noisy pub or bar.

“Since my disability I do not feel comfortable going into a bar as I may find it hard to use the restrooms,” said one member of the community, “so my drinking is done in my home.”

Patricia Nugent on Facebook agreed: “We tend to drink at home so it is easier and less stressful to moderate intake,” she said.

If you are choosing to drink at home, it’s important you monitor your intake carefully.
Here’s some useful advice for home drinkers:

    1. Keep track of how many units you’re consuming
    2. Use smaller glasses
    3. Use proper spirit measures to avoid inadvertently pouring yourself a double or triple measure
    4. Eat as you drink
    5. Invest in a good bottle stop to make that bottle of wine last longer

Out and about

For others, however, a good night out is still a must! If that’s the case, then planning ahead can be the key to the success of the evening.

“I don’t go out much, once every two months,” said Michelle Richardson. “But it’s lovely to have some drinks and let my hair down and forget how challenging recovery is for a while.

AUTHOR: “I do have to prepare for a night out by having an afternoon snooze.”

If you do want to enjoy a night out on the town with friends, here are some more top tips:

    ▪ Don’t drink on an empty stomach and check your medication allows you to drink
    ▪ Make sure your friends know about your brain injury, lowered alcohol tolerance levels, and any other issues such as an intolerance to noise
    ▪ Drink water between alcoholic drinks and avoid getting into rounds

Alcohol-free alternatives

Of course, not drinking alcohol doesn’t mean you can’t still go out to pubs and bars.

“My husband has been told he can’t drink alcohol,” said Amanda Hopkins. “So, as he is a real ale drinker, we made a pact to still go to country location but to just check out ‘alcohol-free’ ales and to become connoisseurs of the growing ‘alcohol-free’ ranges that are now appearing from many microbreweries.

“It won’t be quite the same but we hope it will be a bit of fun tasting them.”

AUTHOR: Kathy M agreed: “I sometimes have a non-alcoholic beer shandy so I feel like I am having a pint and I’ve discovered things like elderflower cordial with soda. There’s nothing wrong with ordering a fancy coffee or mocktail either.”

Drinking alcohol after Stroke

    ▪ Drinking too much alcohol contributes to a number of risk factors for stroke, including high blood pressure.
    ▪ Alcohol can interfere with the medicine you take to reduce stroke risk.
    ▪ Your doctor can advise when it is safe for you to start drinking alcohol again and how much alcohol it is safe for you to drink.
    ▪ Healthy men and women should have no more than two standard drinks a day, and no more than four standard drinks on any one occasion.

Alcohol and stroke risk

Drinking too much alcohol contributes to a number of risk factors for stroke. If you have already had a stroke or transient ischaemic attack (TIA), you can help reduce your risk by only drinking a safe amount.

High blood pressure is the biggest risk factor for stroke, and drinking too much raises your blood pressure. Atrial fibrillation, which is a type of irregular heartbeat, can be triggered by too much alcohol.

Diabetes and being overweight also increase your risk of having a stroke. Both of are linked to alcohol consumption.

Alcoholic drinks are also high in calories with little nutritional value. Reducing the amount you drink will support you to maintain a healthy weight.

Hemorrhagic stroke and alcohol

A hemorrhagic stroke is caused by a break in the wall of a blood vessel in the brain. If you have had a hemorrhagic stroke, you must not drink alcohol for at least three weeks after your stroke. Ask your doctor when it is safe to start drinking alcohol again.

Drinking alcohol and your medication

Alcohol could interfere with the medicine you take particularly, blood-thinning medicine such as Warfarin. Discuss with your doctor about whether it is safe to drink alcohol while taking any medicines.

Consuming alcohol safely if your doctor clears you to

The Guidelines for Alcohol Consumption gives advice about safe amounts of alcohol.

AUTHOR: Remember, the Guidelines are for healthy people. Talk to your doctor about whether it is safe for you to drink at all, and whether the amounts in the Guidelines are safe for you.

The Guidelines state that healthy men and women should have no more than two standard drinks on any day and if you go out, no more than four standard drinks on any one occasion.

    ▪ For spirits with 40 % ABV, a standard drink is 30 mls (1.5 fl oz)
    ▪ A 285 ml (10 fl oz) glass of 3.5% ABV beer is about 1 standard drink.
    ▪ 100 ml (3.5 fl oz) of wine or champagne is approximately one standard drink, however this varies between types. Keep in mind most glasses of wine served in restaurants and bars are more than 100 ml (3.5 fl oz).
    ▪ Always check the label on the bottle to find out how many standard drinks you are having.
    If you find you are tempted to go over your safe limits learn strategies to help you keep to them.

Strategies to reduce your drinking

Write down how many drinks you have to see how much and how often you drink.
If you find that you are drinking more than is safe, try these tips:

    ▪ Drink water when you are thirsty rather than alcohol.
    ▪ Sip your drink slowly. Put down the glass after each mouthful.
    ▪ At social occasions, make every second drink a non-alcoholic beverage. Choose something like a sparkling water rather than a sugary drink.
    ▪ Try low-alcohol alternatives such as light beer.
    ▪ Opt out of ‘shouts’. Drink at your own pace. If you cannot avoid buying a round, get yourself a non-alcoholic drink.
    ▪ Avoid salty snacks such as potato chips or peanuts. These make you thirsty and more inclined to drink quickly.
    ▪ Set goals such as not drinking alone and have at least two days without alcohol each week.
    ▪ Do not drink on an empty stomach. A full stomach slows the absorption of alcohol

Brain Injury affects different people in different ways. There is no one size fits all. For some, their relationship with alcohol will be over. For others, a moderate consumption can be tolerated. Complete your recovery and then discuss with your medical practitioner your options. Do not make any decisions without consulting them first.

This post is shared from the Stroke Association AU and Headway UK websites
 
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Computer Vision Syndrome

 

Caring for Your Vision with So Much Screen-Time!

Avoid “Computer Vision Syndrome”

By Carl Hillier, OD FCOVD

 
Most of us are engaged in “screen time” more than ever before—using Zoom/Skype/FaceTime as a tele-therapy platform. For many, this can be very successful, but also potentially very visually stressful.

We recommend the following guidelines to help minimize the following problems associated with excess screen-time—collectively known as “Computer Vision Syndrome”:

  • Cognitive Fatigue
  • Visual Fatigue/Eye Strain
  • Dry Eye Symptoms
  • Blurred Distance Vision
  • Headache
  • Neck and Shoulder Pain
  • Poor-Quality Sleep

 

Things to do to alleviate the symptoms above:

  • Take scheduled breaks from screen time at least every 30 minutes, walking away from the computer for at least 2 minutes.
  • During these 2 minutes, stand or sit in a very relaxed way and rotate your body without moving your feet—try to look behind you one way, then back to the other way as far as you are able.
  • Check each eye individually during these 2-minute breaks to ensure you are not losing distance vision from either eye.
  • Acquire optical quality lenses that deflect the harmful blue light that emanates from screens. Your optometrist can get the proper protective lenses for you.
  • Research-proven nutritional supplementation solutions:
    • Lutein (10 mg), Zeaxanthin (2 mg) and Mesozeaxanthin (10 mg)—to improve visual performance, sleep quality and decrease adverse physical symptoms
    • Omega-3—Minimum EPA: 400 mg; Minimum DHA: 960 mg
  • Stop screen time 2 hours before going to sleep.
  • Get outside as much as possible!

If you would like more advice on how to establish a strong visual foundation for the demands of online learning, just let us know. We can provide activities for you to do off-line that will help you maintain good vision while you are on-line!

Carl G. Hillier, OD FCOVD
Melissa C. Hillier, OD FCOVD
San Diego Center For Vision Care
SanDiegoCenterForVisionCare.com

CLICK HERE to download the original article
 


Ayn al Asad Air Base in western Iraq after an Iranian missile attack on Jan. 8. The number of service members experiencing symptoms associated with brain injuries has since topped 100. Photo Credit…Sergey Ponomarev for The New York Times

 

Brain Injuries Are Common in Battle.
The Military Has No Reliable Test for Them.

Traumatic brain injury is a signature wound of the wars in Iraq and Afghanistan. But the military still has no objective way of diagnosing it in the field.

By Dave Philipps and Thomas Gibbons-Neff for nytimes.com, February 15, 2020

 
U.S. troops at Ayn al Asad Air Base in western Iraq hunkered down in concrete bunkers last month as Iranian missile strikes rocked the runway, destroying guard towers, hangars and buildings used to fly drones.
When the dust settled, President Trump and military officials declared that no one had been killed or wounded during the attack. That would soon change.

A week after the blast, Defense Department officials acknowledged that 11 service members had tested positive for traumatic brain injury, or TBI, and had been evacuated to Kuwait and Germany for more screening. Two weeks after the blast, the Pentagon announced that 34 service members were experiencing symptoms associated with brain injuries, and that an additional seven had been evacuated. By the end of January the number of potential brain injuries had climbed to 50. This week it grew to 109.

The Defense Department says the numbers are driven by an abundance of caution. It noted that 70 percent of those who tested positive for a TBI had since returned to duty. But experts in the brain injury field said the delayed response and confusion were primarily caused by a problem both the military and civilian world have struggled with for more than a decade: There is no reliable way to determine who has a brain injury and who does not.

Top military leaders have for years called traumatic brain injury one of the signature wounds of the wars in Iraq and Afghanistan; at the height of the Iraq war in 2008, they started pouring hundreds of millions of dollars into research on detection and treatment. But the military still has no objective tool for diagnosing brain injury in the field. Instead, medical personnel continue to use a paper questionnaire that relies on answers from patients — patients who may have reasons to hide or exaggerate symptoms, or who may be too shaken to answer questions accurately.

The military has long struggled with how to address so-called invisible war wounds, including traumatic brain injury and post-traumatic stress disorder. Despite big investments in research that have yielded advances in the laboratory, troops on the ground are still being assessed with the same blunt tools that have been in use for generations.

The problem is not unique to the military. Civilian doctors struggle to accurately assess brain injuries, and still rely on a process that grades the severity of a head injury in part by asking patients a series of questions: Did they black out? Do they have memory problems or dizziness? Are they experiencing irritability or difficulty concentrating?

“It’s bad, bad, bad. You would never diagnose a heart attack or even a broken bone that way,” said Dr. Jeff Bazarian a professor of emergency medicine at the University of Rochester Medical Center. “And yet we are doing it for an injury to the most complex organ in the body. Here’s how crazy it gets: You are relying on people to report what happened. But the part of the brain most often affected by a traumatic brain injury is memory. We get a lot of false positives and false negatives.”

Without a good diagnosis, he said, doctors often don’t know whether a patient has a minor concussion that might require a day’s rest, or a life-threatening brain bleed, let alone potential long-term effects like depression and personality disorder.

At Ayn al Asad, personnel used the same paper questionnaires that field medics used in remote infantry platoons in 2010. Aaron Hepps, who was a Navy corpsman in a Marines infantry company in Afghanistan at that time, said it did not work well then for lesser cases, and the injuries of many Marines may have been missed. During and after his deployment, he counted brain injuries in roughly 350 Marines — about a third of the battalion.

After the January missile attack, Maj. Robert Hales, one of the top medical providers at the air base, said that the initial tests were “a good start,” but that it took numerous screenings and awareness among the troops to realize that repeated exposure to blast waves during the hourlong missile strikes had affected dozens.

Traumatic brain injuries are among the most common injuries of the wars in Iraq and Afghanistan, in part because armor to protect from bullet and shrapnel wounds has gotten better, but they offer little protection from the shock waves of explosions. More than 350,000 brain injuries have been reported in the military since 2001.

The concrete bunkers scattered around bases like Ain al Assad protect from flying shrapnel and debris, but the small quarters can amplify shock waves and lead to head trauma.

The blasts on Jan. 8, one military official said, were hundreds of times more powerful than the rocket and mortar attacks regularly aimed at U.S. bases, causing at least one concrete wall to collapse atop a bunker with people inside.

Capt. Geoff Hansen was in a Humvee at Ayn al Asad when the first missile hit, blowing open a door. Then a second missile hit.

“That kind of blew me back in,” he said. “Blew debris in my face so I went and sat back down a little confused.”

A tangle of factors make diagnosing head injuries in the military particularly tricky, experts say. Some troops try to hide symptoms so they can stay on duty, or avoid being perceived as weak. Others may play up or even invent symptoms that can make them eligible for the Purple Heart medal or valuable veteran’s education and medical benefits.

And sometimes commanders suspect troops with legitimate injuries of malingering and force them to return to duty. Pentagon officials said privately this week that some of the injuries from the Jan. 8 incident had probably been exaggerated. Mr. Trump seemed to dismiss the injuries at a news conference in Davos, Switzerland, last month. “I heard they had headaches,” he said. “I don’t consider them very serious injuries relative to other injuries I have seen.”

In the early years of the war in Iraq, troops with concussions were often given little medical treatment and were not eligible for the Purple Heart. It was only after clearly wounded troops began complaining of poor treatment that Congress got involved and military leaders began pressing for better diagnostic technology.

Damir Janigro, who directed cerebrovascular research at the Cleveland Clinic for more than a decade, said relying on the questionnaire makes accurate diagnosing extremely difficult.

“You have the problem of the cheaters, and the problem of the ones who don’t want to be counted,” he said. “But you have a third problem, which is that even if people are being completely honest, you still don’t know who is really injured.”

In civilian emergency rooms, the uncertainty leads doctors to approve unnecessary CT scans, which can detect bleeding and other damage to the brain, but are expensive and expose patients to radiation. At the same time doctors miss other patients who may need care. In a war zone, bad calls can endanger lives, as troops are either needlessly airlifted or kept in the field when they cannot think straight.

Mr. Janigro is at work on a possible solution. He and his team have developed a test that uses proteins found in a patient’s saliva to diagnose brain injuries. Other groups are developing a blood test.

Both tests work on a similar principle. When the brain is hit by a blast wave or a blow to the head, brain cells are stretched and damaged. Those cells then dispose of the damaged parts, which are composed of distinctive proteins. Abnormal levels of those proteins are dumped into the bloodstream, where for several hours they can be detected in both the blood and saliva. Both tests, and another test being developed that measures electrical activity in the brain, were funded in part by federal grants, and have shown strong results in clinical trials. Researchers say they could be approved for use by the F.D.A. in the next few years.

The saliva test being developed by Mr. Janigro will look a bit like an over-the-counter pregnancy test. Patients with suspected brain injuries would put sensors in their mouths, and within minutes get a message that says that their brain protein levels are normal, or that they should see a doctor.

But the new generation of testing tools may fall short, said Dr. Gerald Grant, a professor of neurosurgery at Stanford University and a former Air Force lieutenant colonel who frequently treated head injuries while deployed to Iraq in 2005.

Even sophisticated devices had trouble picking up injuries from roadside bombs, he said.

“You’d get kids coming in with blast injuries,” he said, “and they clearly had symptoms, but the CT scans would be negative.”

He was part of an earlier effort to find a definitive blood test, which he said in an interview was “the holy grail.” But progress was slow. The grail was never found, he said, and the tests currently being developed are helpful for triaging cases, but too vague to be revolutionary.

“Battlefield injuries are complex,” he said. “We still haven’t found the magic biomarker.”

CLICK HERE to go to the original article
 

 

What’s the difference between all the different head scans (X-Ray, CT, MRI, MRA, PET scan)? And what do they show in the head?

Michael S. Tehrani, M.D.Follow Founder & CEO at MedWell Medical

 
Ever wonder what’s the difference between all the different head scans (xray, CT, MRI, MRA, PET scan) and what they show in the head. Well wonder no more. The Dr. T easy to understand version…

X-Ray: shows bone/skull only. Does not show the brain. Best used to detect if there are bone fractures.

CT: a quick test. Shows brain but detail not great. Shows if any larger bleed, stroke, lesions, or masses.

MRI: a long test. Shows brain and detail is great. Shows smaller bleeds, stroke, lesions, or masses.

MRA:
shows the flow of blood in the vasculature system of the brain. If there is vessel narrowing or blockage this test would show it.

PET scan: shows how active different parts of the brain is. An active brain uses sugar as energy and pet scan detects how much sugar is being used by lighting up and turning different colors. The more sugar being used the more that area will light up and be different in colors. Cancer cells use the most sugar so cancer cells light up the most. PET scan is used to see if there are cancer cells. (Cancer cells replicate at a very fast and uncontrolled rate hence use a lot of sugar to allow that replication hence why they light up so much).

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High school injury reports analyzed by InvestigateWest and Pamplin Media show that girls are twice as likely to get concussions as boys in Oregon. Girls in the 13U age group, pictured above, are the youngest allowed to use headers.
 

The Concussion Gap: Head injuries in girls soccer are an ‘Unpublicized Epidemic’

Lee van der Voo, InvestigateWest, photos by David Ball / Pamplin Media Group

 
When it comes to concussion in sports, all eyes are on football, or so it seems. But it’s not just football that causes a high number of head injuries among young athletes.

Another culprit? Girls soccer.

National research has found girls are more likely to suffer a concussion than boys in any sport. In 2017, researchers at Northwestern University generated national headlines when they found concussion rates among young female soccer players were nearly as high as concussion rates for boys playing football — and roughly triple the rate of concussions in boys soccer.

In Oregon, injury reports from public high schools analyzed by InvestigateWest and Pamplin Media Group mirrored that trend, showing soccer concussions were second to those from football between 2015 and 2017. What’s more, at the schools that included the gender of injured athletes, there were nearly twice as many reports of possible concussions for girls playing soccer than boys in the sport.

The rate of concussions in girls soccer worries local experts like Jim Chesnutt, a doctor in sports medicine at Oregon Health & Science University, who says those injuries are not widely recognized, even as concussion rates rise for girls playing soccer.

“In a lot of ways, it’s a growing epidemic for young girls that I think has gone unpublicized,” said Chesnutt, co-director of the Oregon Concussion Awareness and Management Program and a member of the Governor’s Task Force on Traumatic Brain Injury.

More exposure, more injury

It’s understandable that much of the youth concussion conversation centers on football, given the physical contact that is visibly — and audibly — evident on every play, as well as the large rosters and the lengthy lists of players who are injured.

But if you compare girls soccer with football, and only look at the high school participation and injury data, “you’re missing a gigantic part of the picture,” according to Michael Koester, a doctor of sports medicine at the Slocum Center in Eugene. He directs its sports concussion program and serves as the chair of the Sports Medicine Advisory Committee for the National Federation of State High School Associations.

Koester notes that high school boys play eight to 10 football games per season, and typically play other sports in the off-season.

Girls, however, play 15 to 20 soccer games in a high school season, but when that season ends, they may play another 80-plus games throughout the winter, spring and summer with club teams, said Koester, who, like Chesnutt, is a medical adviser to the Oregon Schools Activities Association.

“If we’re looking at injury risk by athletic exposure,” which is one practice or game, a standard in evaluating risk, Koester said, female soccer players probably are playing five if not 10 times more practices and games than football players.

And Koester doesn’t see the trend ending.

“The thought used to be that this was all revolving around, ‘Wow! They want to get their kid a scholarship,’ ” he said. “Now it’s kind of gotten to the point where there’s so much single-sport participation that we see kids that are specializing in sport early, just so they’ll be able to make their high school team.”

Single-sport athletes are more prone to injury in any sport. According to a study by scientists at the University of Wisconsin, high school athletes who specialized in just one sport at an early age were twice as likely to suffer injuries to their lower extremities.

“We see a lot of overuse injury among girls playing soccer,” Koester said. “We see a lot of ACL injury among girls playing soccer. It’s a well-known problem.”

Aggressive play

Another factor is the evolution of sports.

Angella Bond is an athletic trainer for Tuality Sports Medicine and works on the sidelines with athletes at Hillsboro schools. Anecdotally, she said, all athletes push to be bigger, faster and stronger. Soccer is no exception, nor are girls.

As athletes develop, they take bigger hits at higher speeds, and competitive games build on their momentum. As competition grows in girls soccer, the sport is trending to be more aggressive, she said.

“Unfortunately, I think that happens with girls sports,” she said. “Arms fly a little bit more.”

Chesnutt agreed. “I think over the years, soccer has become more physical,” he said. “And I think the physical contact and the aggressive nature of that physical contact is more associated with concussions.”

According to the American Academy of Pediatrics, soccer — unlike football, ice hockey and lacrosse — is not a “collision sport.” But it is a “contact sport” because athletes “routinely make contact with each other or inanimate objects.”

Header balls, though often singled out as a source of concussions, are not necessarily to blame.

The force created when a soccer ball meets a head can rattle a brain, but data increasingly points to other factors when competitors vie for a ball in the air.

According to a study by The Research Institute at Nationwide Children’s Hospital, while headers accounted for 27 percent of concussions, it was knocks with other players on aerial play — including head-to-head contact and arms and elbows to the head — and contact with the ground that accounted for 70 percent of those concussions in girls soccer, suggesting aggressive play is a factor in most concussions involving headers.

Why girls?

But why are girls more prone to concussions than boys while playing soccer? The prevailing theories focus on their weaker neck-muscle development, weaker body strength (needed to stabilize the neck and head during aerial play), and more frequent contact with the ground. A year ago, a study in the Journal of the American Osteopathic Association found that female high school soccer players took twice as long as male players to recover.

It’s also possible that girls don’t benefit as much from early treatment. A recent study published by the American Academy of Pediatrics found that girls are five times more likely than boys to stay on the pitch and play through a head injury.

And the soccer community has been slow to recognize the hard hits its girls are taking. Instead, soccer is at the forefront of the cultural empowerment of girls.

Local experts concerned about concussion risk note that sports, including girls soccer, have plenty of benefits. Just being physically active is good for kids, and sports like soccer help establish lifelong fitness habits, teach team-building skills, and promote character development and assertiveness.

“The worry is that the take-home message is that (girls soccer) is healthy and fantastic and nothing can be bad about it,” said Koester, who says an opposite negative message, equally extreme, is more often associated with boys playing football.

Greater awareness needed

Concussion education and awareness in girls soccer is paramount, according to local experts such as Chesnutt.

“I think the way to decrease it is to really analyze how we can modify the amount of body contact that goes on in soccer to limit the dangerous aggressive behavior that is associated with concussion,” he said.

Unlike youth football, a sport that’s adjusting to new information about concussions all the time, soccer has largely failed to address new information about concussions, Chesnutt said.

Football, for example, has reduced head-to-head helmet play, limited full-contact practices and games, and zeroed in on the specialty teams with the highest concussion rates.

“Football has really done, I think, an exceptional job of identifying some areas where there have been some definite higher incidents and some problems,” said Chesnutt, who lectures nationally about youth concussions. “As a group of coaches, leagues, parents and referees, they’ve all looked at it and come up with some solutions that have decreased concussion rates. And I think it’s time for soccer to do the same thing.”

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Top 10 Volunteer Opportunities in San Diego in 2019

September 25, 2019, by Mary at greatnonprofits.org

 
Want to volunteer or intern at a great San Diego nonprofit? Whether you’re new to the city and want to learn about its charities, trying to change up your routine with some local charity work, or just want to volunteer or intern at a neighborhood nonprofit, everyone knows that the best way to find the right place for you is from the people who’ve been there!

Here’s a list of volunteers’ and interns’ favorite San Diego charities. Every nonprofit on this list has earned an overall score of 4 or greater out of 5 on GreatNonprofits.org. If your favorite San Diego nonprofit or volunteer gig is missing, find it on GreatNonprofits.org, write a positive review, and show your co-volunteers how to start adding reviews and get it on the list!

Mayan Families
We just returned after 10 days working with Mayan Families. I, along with my daughter and nephew, have been volunteering with this great nonprofit for the past four years. The focus of our volunteering has been to raise money for the purpose of installing stoves for indigenous families living around Lake Atitlán. The beauty of this particular program, and most of the programs run by Mayan Families, is the direct and immediate impact they have on the recipients. We love the fact that we see where the money we raised is going and that we literally have a hand in helping change the lives of people who truly need the help.

“We continue to be impressed with Mayan Families’ dedication to its motto to ‘Educate, Feed, Shelter, Feed’ these wonderful people around Lake Atitlán.” –David Kujan

Sepsis Alliance
“As a small nonprofit, they do a tremendous job of spreading awareness about sepsis and as a result have reached millions of people to educate them about the signs and symptoms of this condition, albeit with their limited staff and budget.

“I feel confident in asking others for donations for this organization, as I have seen firsthand that they use their funds very effectively.” –Lynn S1

Labrador Rescuers
“Lab Rescue goes over and above to help match the right family with the right lab.

They have a great foster program that provides information about the traits of the labs to help find the right fit. We can improve our program by increasing the number of people helping to promote intake, fostering, adoptions, and fundraising.” –mobileUser381273

San Diego Dance Theatre
“The Dance Fierce program has served as an incredible creative outlet for students from all backgrounds and has united these students through the art of dance. Students who participate in this program are more well-rounded, expressive, and balanced. They pride themselves on their hard work and are more motivated every day through their experiences.” –Mmctighe

San Diego Brain Injury Foundation
“I ended up doing one of my internships at SDBIF. Never have I seen so few accomplish so much for so many on so little resources.

I can only imagine how much more dynamic and influential in helping those with brain injuries, myself included, this organization could be if they had additional funding. The ‘F’ signifying foundation should be changed to ‘Family’—as this organization helps us all to feel this way during very trying times that can last for years.” –Michael Murphy

College Area Pregnancy Services
“During the almost 14 years that I volunteered at CAPS as a counselor I witnessed firsthand the impact this place has on every client who comes in. Women from all ages come burdened with fear, confusion, and uncertainty. Volunteers and staff at CAPS are able to provide a safe, nonjudgmental place for these women where they find not only help and resources, but also a caring and personal environment. A comment I most often heard after a counseling appointment was ‘This place is so nice, I felt comfortable and welcomed here.’

“CAPS will be forever in my heart, and love to tell others about it.” –Ana_39

The League of Amazing Programmers
“The League has done an incredible job exposing young people to the vast world of computers in a way that is fun and interactive!

As a volunteer, I have seen kids develop confidence and problem-solving prowess before my very eyes, all while developing skills they will use for the rest of their lives!” –Mike D3

Mind Treasures
“I’ve had the privilege of volunteering with this wonderful organization for many years. Their program is changing the lives of the children one student and school at the time. Children are becoming aware of their hidden potentials and learning how to use these resources in their personal, family, and community finances.” –MT Volunteer 1

The Seany Foundation
“The passion that you see from those involved in this foundation is infectious. From the founders, board members, organizers, and volunteers you see an intense commitment to carry on the fight for whom this foundation is in honor of, Sean Robins. The rapidly accelerating success in awareness and donations is a testament to their effectiveness as an organization and their tremendous potential.” –Keenan 27

Voice of the Bride Ministries
“Voice of the Bride is a beautiful expression of community love and hard work. I’m constantly amazed at how far they manage to stretch each dollar and how many people they touch—be it by feeding families, helping community, or simply being a force of goodness in an area. They truly love the poor and give to the needy.” –FreckldFlower

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New Rules to Protect Your Kid’s Noggin

May 25, 2019, Parents Magazine

 
Children bonk their head all the time when they’re wrestling with siblings, playing soccer, and just being clumsy-and it’s easy to worry that a bump could turn into something bigger. After all, more than 800,000 kids in the U.S. get a concussion every year. For the first time, the Centers for Disease Control and Prevention has released specific “return to learn” and “return to play” guidelines for head injuries, based on 25 years of research. One doctor shares the big takeaways.

ALWAYS take any injury beyond a light head bump seiously. A concussion occurs when a bump, blow, or jolt to the head or a hit to the body makes the brain bounce or twist in the skull. This creates chemical changes and can sometimes damage brain cells. “If your child complains of a headache or dizziness, is nauseous or vomiting, appears dazed, or sleeps more or less than usual, it’s time to get a doctor’s evaluation,” says Dennis Cardone, D.O., associate professor of orthopedic surgery and pediatrics and co-director of the NYU Langone Concussion Center. Even toddlers can get a concussion from a tumble, so look for changes in their behavior such as not wanting to nurse or eat or losing interest in toys.

If diagnosed with a concussion, your child will need menlal rest, says Dr. Cardone. That means taking a break from all activities for two to three days, and after that, starting with light aerobic activity. He may need to attend school for only half the day or do little to no homework (he won’t mind this rule!). However, he shouldn’t return to any sports or strenuous activities that have a high risk of falling or contact (think: field hockey, gymnastics, climbing a tree) until he’s been cleared by his doctor, which should be within a few weeks.

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Brainline Holiday Article Picture
 

15 Tips for Surviving — AND Enjoying — the Holidays with Brain Injury

By BrainLine

Flashing lights. Crowded stores. Loud family gatherings. The holiday season should be joyful, but it can often be overwhelming to someone who is living with brain injury.

If you are living with TBI, share these tips with your friends and family. If someone you love is living with TBI, the tips below can help you plan to make the holiday season happier and more relaxed for all of your friends and family.

These great ideas came from members of BrainLine’s wonderful online community.

  1. Identify — in advance, if possible — a quiet place to go at gatherings if you are feeling overwhelmed. This gives you a chance to take a break and lets your loved ones stay involved in the festivities.
  2. Avoid crowded stores and order gifts online instead.
  3. If you are shopping in stores, remember to make a list in advance and plan your trips on weekdays — either early in the morning or late at night when there are fewer crowds.
  4. Wear a cap with a brim or lightly tinted sunglasses to minimize the glare of bright lights in stores or flashing lights on a tree.
  5. Wear noise-reducing headphones or earbuds. These are also great gift ideas for loved ones with TBI if they don’t already have them.
  6. Ask a friend to go with you to stores or holiday parties. They can help you navigate crowds and anxiety-producing situations.
  7. Plan in advance as much as possible. And ask your hosts what their plans are so you aren’t surprised by anything.
  8. Volunteer to help with the holiday activities that you enjoy the most and are least stressful for you.
  9. Remember to ask for help and accept help if it is offered to you.
  10. Ask someone you trust to help you with a budget to avoid overspending on gifts.
  11. Take a nap if you need a break.
  12. Remember that it’s okay to skip the big parties and plan to celebrate in a way that makes you comfortable and happy.
  13. Check in advance to see if fireworks are part of outdoor celebrations — and skip them if they make you uncomfortable.
  14. If flashing lights bother you, ask your friends and family to turn off the flashing feature on Christmas tree lights or other decorations when you visit their homes.
  15. You can let your host know in advance that you may need to leave early. It will help you feel comfortable if you need to get home or to a quiet place and it can also help avoid any hurt feelings.

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Libby and Tom Bates // CBS News

A brain disease best known for impacting football players who suffered concussions is now being found in soldiers

By Sharyn Alfonsi, September 16, 2018, CBS News

Until a few years ago, NFL players who struggled with severe depression, bouts of rage and memory loss in their retirement were often told they were just having a hard time adjusting to life away from the game. Doctors have since learned these changes can be symptoms of the degenerative brain disease CTE – chronic traumatic encephalopathy, caused by blows to the head.

As we first reported in January, CTE isn’t just affecting athletes, but also showing up in our nation’s heroes. Since 9/11 over 300,000 soldiers have returned home with brain injuries. Researchers fear the impact of CTE could cripple a generation of warriors.

When Joy Kieffer buried her 34-year old son this past summer, it was the end of a long goodbye.

Kieffer’s son, Sgt. Kevin Ash, enlisted in the Army Reserves at the age of 18. Over three deployments, he was exposed to 12 combat blasts, many of them roadside bombs. He returned home in 2012 a different man.

Joy Kieffer: His whole personality had changed. I thought it was exposure to all of the things that he had seen, and he had just become harder. You know, but he was — he was not happy.

Sharyn Alfonsi: So at this point, you’re thinking this decline, this change in my child is just that he’s been in war and he’s seen too much.

Joy Kieffer: Right.

Sharyn Alfonsi: Did he tell you about blasts that he experienced during that time?

Joy Kieffer: Uh-huh.

Sharyn Alfonsi: What did he–tell you?

Joy Kieffer: That they shook him. And he was having blackouts. And — it frightened him.

Ash withdrew from family and friends. He was angry. Depressed. Doctors prescribed therapy and medication, but his health began to decline quickly. By his 34th birthday, Sgt. Kevin Ash was unable to speak, walk or eat on his own.

Sharyn Alfonsi: Looking back on it now, was there anything you feel like he could’ve done?

Joy Kieffer: Uh-uh.

Sharyn Alfonsi: Because?

Joy Kieffer: Because it was– it– it was his brain. The thing I didn’t know was that his brain was continuing to die. I mean, before he went into the service he said, “you know, I could come back with no legs, or no arms, or even blind, or I could be shot, I could die,” but nobody ever said that he could lose his mind one day at a time.

His final wish was to serve his country one last time by donating his brain to science — a gesture he thought would bring better understanding to the invisible wounds of war.

Joy reached out to the VA-Boston University-Concussion Legacy Foundation Brain Bank where neuropathologist Dr. Ann McKee is leading the charge in researching head trauma and the degenerative brain disease CTE.

McKee has spent fourteen years looking at the postmortem brains of hundreds of athletes who suffered concussions while playing their sport.

Last summer, her findings shook the football world when she discovered CTE in the brains of 110 out of 111 deceased NFL players — raising serious concerns for those in the game today.

And when Dr. McKee autopsied Patriots tight-end Aaron Hernandez who killed himself after being convicted of murder, she found the most severe case of CTE ever, in someone under 30.

Now she’s seeing similar patterns in deceased veterans who experienced a different kind of head trauma — combat blasts. Of the 125 veterans’ brains Dr. Mckee’s examined, 74 had CTE.

Sharyn Alfonsi: I can understand a football player who keeps, you know, hitting his head, and having impact and concussions. But how is it that a combat veteran, who maybe just experienced a blast, has the same type of injury?

Dr. Ann McKee: This blast injury causes a tremendous sort of– ricochet or– or– a whiplash injury to the brain inside the skull and that’s what gives rise to the same changes that we see in football players, as in military veterans.

Blast trauma was first recognized back in World War I. Known as ‘shell shock,’ poorly protected soldiers often died immediately or went on to suffer physical and psychological symptoms. Today, sophisticated armor allows more soldiers to walk away from an explosion but exposure can still damage the brain — an injury that can worsen over time.

Dr. Ann McKee: It’s not a new injury. But what’s been really stumping us, I think, as– as physicians is it’s not easily detectable, right? It’s– you’ve got a lot of psychiatric symptoms– and you can’t see it very well on images of the brain and so it didn’t occur to us. And I think that’s been the gap, really, that this has been what everyone calls an invisible injury.

Dr. Ann McKee: This is the world’s largest CTE brain bank.

The only foolproof way to diagnose CTE is by testing a post-mortem brain.

Sharyn Alfonsi: So these are full of hundreds of brains…

Dr. Ann McKee: Hundreds of brains, thousands really…

Researchers carefully dissect sections of the brain where they look for changes in the folds of the frontal lobes – an area responsible for memory, judgement, emotions, impulse control and personality.

Dr. Ann McKee: Do you see there’s a tiny little hole there? That is an abnormality. And it’s a clear abnormality.

Sharyn Alfonsi: And what would that affect?

Dr. Ann McKee: Well, it’s part of the memory circuit. You can see that clear hole there that shouldn’t be there. It’s connecting the important memory regions of the brain with other regions. So that is a sign of CTE.

Thin slivers of the affected areas are then stained and viewed microscopically. It’s in these final stages where a diagnosis becomes clear as in the case of Sgt. Kevin Ash.

Sharyn Alfonsi: So this is Sergeant Ash’s brain?

Dr. Ann McKee: Right. This is– four sections of his brain. And what you can see is– these lesions. The, and those lesions are CTE And they’re in very characteristic parts of the brain. They’re at the bottom of the crevice. That’s a unique feature of CTE.

Sharyn Alfonsi: And in a healthy brain, you wouldn’t see any of those kind of brown spots?

Dr. Ann McKee: No, no, it would be completely clear. And then when you look microscopically, you can see that the tau, which is staining brown and is inside nerve cells is surrounding these little vessels.

Sharyn Alfonsi: And explain, what is the tau?

Dr. Ann McKee: So tau is a protein that’s normally in the nerve cell. It helps with structure and after trauma, it starts clumping up as a toxin inside the nerve cell. And over time, and even years, gradually that nerve cell dies.

Dr. Lee Goldstein has been building on Dr. McKee’s work with testing on mice.

Inside his Boston University lab, Dr. Goldstein built a 27-foot blast tube where a mouse – and in this demonstration, a model – is exposed to an explosion equivalent to the IEDs used in Iraq and Afghanistan.

Dr. Lee Goldstein: When it reaches about 25 this thing is going to go.

Dr. Goldstein’s model shows what’s going on inside the brain during a blast. The brightly colored waves illustrate stress on the soft tissues of the brain as it ricochets back and forth within the skull.

Dr. Lee Goldstein: What we see after these blast exposures, the animals actually look fine. Which is shocking to us. So they come out of what is a near lethal blast exposure, just like our military service men and women do. And they appear to be fine. But what we know is that that brain is not the same after that exposure as it was microseconds before. And if there is a subsequent exposure, that change will be accelerated. And ultimately, this triggers a neurodegenerative disease. And, in fact, we can see that really after even one of these exposures.

Sharyn Alfonsi: The Department of Defense estimates hundreds of thousands of soldiers have experienced a blast like this. What does that tell you?

Dr. Lee Goldstein: This is a disease and a problem that we’re going to be dealing with for decades. And it’s a huge public health problem. It’s a huge problem for the Veterans Administration. It’s a huge moral responsibility for all of us.

A responsibility owed to soldiers like 34-year-old Sgt. Tom Bates.

Sgt. Tom Bates: We were struck with a large IED. It was a total devastation strike.

Bates miraculously walked away from a mangled humvee — one of four IED blasts he survived during deployments in Iraq and Afghanistan.

Sharyn Alfonsi: Do you remember feeling the impact in your body?

Sgt. Tom Bates: Yes. Yeah.

Sharyn Alfonsi: What does that feel like?

Sgt. Tom Bates: Just basically like getting hit by a train.

Sharyn Alfonsi: And you were put back on the frontlines.

Sgt. Tom Bates: Yes.

Sharyn Alfonsi: And that was it?

Sgt. Tom Bates: Uh-huh

When Bates returned home in 2009, his wife Libby immediately saw a dramatic change.

Libby Bates: I thought, “Something is not absolutely right here. Something’s going on. For him to just lay there and to sob and be so sad. You know, what do you do for that? How do I– how do I help him? He would look at me and say, “If it wasn’t for you, I would end it all right now.” You know, I mean, like, what do you– what do you do– and what do you say to somebody who says that? You know I love this man so much. And —

Sharyn Alfonsi: You’re going to the VA, you’re getting help, but did you feel like you weren’t getting answers?

Sgt. Tom Bates: Yes.

Sharyn Alfonsi: And so you took it into your own hands and started researching?

Sgt. Tom Bates: I knew the way everything had gone and how quick a lot of my neurological issues had progressed that something was wrong. And I just– I wanted answers for it.

That led him to New York’s Mount Sinai Hospital where neurologist Dr. Sam Gandy is trying to move beyond diagnosing CTE only in the dead by using scans that test for the disease in the living.

Dr. Sam Gandy: By having this during life, this now gives us for the first time the possibility of estimating the true prevalence of the disease. It’s important to estimate prevalence so that people can have some sense of what the risk is.

In the past year, 50 veterans and athletes have been tested for the disease here. Tom Bates asked to be a part of it.

That radioactive tracer – known as t807 – clings to those dead clusters of protein known as tau, which are typical markers of the disease.

Through the course of a 20 minute PET scan, high resolution images are taken of the brain and then combined with MRI results to get a 360 degree picture of whether there are potential signs of CTE.

Scan results confirmed what Tom and Libby had long suspected.

On the right, we see a normal brain scan with no signs of CTE next to Tom’s brain where tau deposits, possible markers of CTE, are bright orange.

Dr. Sam Gandy: Here these could be responsible for some of the anxiety and depression he’s suffered and we’re concerned it will progress.

Sgt. Tom Bates: My hope is that this study becomes more prominent, and gets to more veterans, and stuff like that so we can actually get, like, a reflection of what population might actually have this.

There is no cure for CTE.

Dr. Gandy hopes his trial will lead to drug therapies so he can offer some relief to patients like Tom.

Dr. Ann McKee believes some people may be at higher risk of getting the disease than others.

While examining NFL star Aaron Hernandez’s brain she identified a genetic bio-marker she believes may have predisposed him to CTE.

A discovery that could have far-reaching implications on the football field and battlefield.

Sharyn Alfonsi: Do you think you will ever be your old self again?

Sgt. Tom Bates: I don’t ever see me being my old self again. I think it’s just too far gone.

Sharyn Alfonsi: So what’s your hope then?

Sgt. Tom Bates: Just to not become worse than I am now.

Since our story first aired, over 100 veterans have contacted Dr. Gandy to enroll in ongoing trials to identify whether they are living with CTE. And more than 300 have reached out to Dr. Mckee about donating their brains to research.

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