Making Headway Brain Injury Alliance of Utah 5280 So. Commerce Drive E-190 * Murray, UT 84107 * 801-716-4993 * 800-281-8442 * www.biau.org Making Headway Distributed Three Times Each Year
Issue II Summer 2012
OUR NAME HAS CHANGED, BUT NOT OUR SERVICE, PASSION OR COMMITMENT On June 4, 2012, the Board of Directors of the Brain Injury Association of Utah voted to end its affiliation with the Brain Injury Association of America. This decision reflect our organization’s desire to continue its mission to enhance the quality of life and bring the promise of a better tomorrow for all people affected by brain injury. Our mission stays the same. Our name, however, is changing. As of July 1, 2012, we will be known as the Brain Injury Alliance of Utah. What changes for you? Nothing. Our staff, programs, services, events and partnerships all remain the same. You will notice a new logo and color scheme, but the quality of service, attention to detail and passion for those living with brain injury which we have exhibited for almost 25 years, remain the same. If you have any questions, please, feel free to give us a call at 800-281-8442 or 801-716-4993. There will be someone here who can provide information. Our organization will continue providing services and programs that will help individuals with brain injuries and their family members who live with this everyday of their life. Last year we received 3,928 calls on our information help-line. We provided support, information and resources to individuals with brain injuries, family members and to the professional community. Our Association sent out 197 information packets through mail, and electronically. Over IN THIS ISSUE 10,726 pieces of literature were handed out at Health Fairs, ConferBoard of Directors…………………………Page 2 ences, and BIAU events. Brain Injury Awareness Night…….…...….Page 3 We have expanded our New Stem Cell Found in the Brain……..…Page 3 website with great Gauging Seizures’ Severity………………..Page 4 information, resources, Donations & Support………………….…...Page 5 and links to help Blood-Barrier Building Blocks Forged From Human Stem Cells…………………………Page 5 individuals to maneuNeuroExpressions Art Show...……..……...Page 7 ver through our site. As Sports Related Concussions……….………Page 8 of December 31, 2011, Community Shares of Utah………………..Page 9 there were 20,036 new UCLA Researchers—Phineas Gage’s Brain….……………………………………Page 12 visitors to our website, with a total of 267,457 hits. The number of hits to our site is generated by software that tracks all first-time visitors,
pages viewed, and topics viewed, along with the number of total hits by all categories. Our Legal and Medical Brain Injury Seminar, the 5K Run Walk & Roll event, and our Family & Professionals Conference were accessible online with the opportunity to register for these events from our website. As we move forward we will increase the service to the community through our Being HeadSmart, Hispanic/Latino, and Veterans Outreach Programs. Our Being HeadSmart program was formed to educate children from kindergarten through the sixth-grade, their families and the community about brain injury and prevention. The reason for the emphasis on this group is in part the staggering number of children who have sustained a brain injury. It is the most frequent cause of disability and death among children and adolescents in the United States; each year, more than onemillion children sustain brain injuries ranging from mild to severe. Not only are the children affected by a brain injury, their families are as well. Thus, our goal is to create an awareness of brain injury among children, families and the community. We hope to do that by (1). Empowering children and parents to obtain and consistently use the safety equipment (i.e. Helmets) that will protect them from suffering a brain injury, (2). Helping to create school programs which will reinforce our prevention and awareness message (e.g. bike rodeos, safety fairs, and/or brain injury awareness poster campaign), and (3). Increase public awareness and encourage safety through in-service meetings, support groups, and health/safety fairs throughout Utah. The Hispanic/Latino Outreach Program was formed in response to the rapidly increasing Latino population in Utah, the Brain Injury Alliance of Utah has created this outreach program to reach the Hispanic residents. Latinos suffer more TBIs per capita than any other ethnic group in the United States and due to language and cultural barriers, oftentimes they do not receive adequate treatment following such injuries. We present materials brochures, fact sheets, fliers and personal stories at the Mexican Consulate of Salt Lake City. There we instruct caregivers, family, friends and individuals with brain injuries to seek proper medical attention. We are also developing relationships with the local Hispanic media outlets in an effort to spread the word. Continued on Page 9
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Board of Directors Executive Board President……Antonietta Anna Russo, Ph.D. Past President ....Teresa Such-Neibar, D.O. Vice Presidents … Elizabeth Cardell, OTR/L Edward Havas, Esq Miette Murphy, MS, CCC,SLP Treasurer……………Kristopher Smith Pauline Fontaine Secretary……Tony J. Washington, BS, CWDP
Board Members Bret W. Hortin, CLU, CHFC, CASL Cheryl Hostetter, MS, SLP Julie McCauley, MSW Robert B. Sykes, Esq. Michael A. Worel Advisory Board Erin D. Bigler, Ph.D. Elaine Clark, Ph.D. Sam Goldstein, Ph.D. Reuel McPhie, MBA, MPH, FACHCA Elaine Pollock, B.A. John Speed, MBBS
Calendar of Events August 9th Brain Injury Awareness Night Ogden Raptors Lindquist Field, Ogden, Utah October 13th Family & Professionals Conference South Towne Expo Center Sandy, Utah
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New Stem Cell Found in the Brain Researchers at Lund University in Sweden have discovered a new stem cell in the adult brain. These cells can proliferate and form several different cell types - most importantly, they can form new brain cells. Scientists hope to take advantage of the finding to develop methods to heal and repair disease and injury in the brain. Analyzing brain tissue from biopsies, the researchers for the first time found stem cells located around small blood vessels in the brain. The cell’s specific function is still unclear, but its plastic properties suggest great potential. “A similar cell type has been identified in several other organs where it can promote regeneration of muscle, bone, cartilage and adipose tissue,” said Patrik Brundin, M.D., Ph.D., Jay Van Andel Endowed Chair in Parkinson's Research at Van Andel Research Institute (VARI), Head of the Neuronal Survival Unit at Lund University and senior author of the study. In other organs, researchers have shown clear evidence that these types of cells contribute to repair and wound healing. Scientists suggest that the curative properties may also apply to the brain. The next step is to try to control and enhance stem cell self-healing properties with the aim of carrying out targeted therapies to a specific area of the brain. “Our findings show that the cell capacity is much larger than we originally thought, and that these cells are very versatile,” said Gesine Paul-Visse, Ph.D., Associate Professor of Neuroscience at Lund University and the study’s primary author. “Most interesting is their ability to form neuronal cells, but they can also be developed for other cell types. The results contribute to better understanding of how brain cell plasticity works and opens up new opportunities to exploit these very features.” The study, published in the journal PLoS ONE, is of interest to a broad spectrum of brain research. Future possible therapeutic targets range from neurodegenerative diseases to stroke. “We hope that our findings may lead to a new and better understanding of the brain's own repair mechanisms,” said Dr. Paul-Visse. “Ultimately the goal is to strengthen these mechanisms and develop new treatments that can repair the diseased brain.”
Printed with permission from Children’s Neurobiological Solutions April 19, 2012 Source: Van Andel Institute
In Recognition of Our New & Renewing Members April 1 - June 30, 2012
Jill Bingham Brain-Behavior Associates, P.C. Susan B. Denney Sue & David Dewey Jean Jackson Elizabeth Kattman Jon Moore Herm Olsen, Esq. Todd & Jodie Palmer Elaine Pollock Constance Schoon Shea & Shea Attorney At Law Sue Smith Leann Turner
Corporate Members Country Life Care Center Dewsnup King & Olsen Robert DeBry & Associates Gridley Ward & Vandyke, P.C. Intelligis, LLC Law Office of Brian Kelm Learning Services Corp. Phoenix Services Corp. University of Utah Rehabilitation Center USU Center for People with Disabilities Why Become A Member? The Brain Injury Alliance of Utah’s (BIAU) primary purpose is to provide support for individuals with brain injuries and their families. The BIAU serves the community through efforts that include advocacy, educational programs and the promotion of research and training. Throughout our years of service, the BIAU has embarked on an aggressive agenda to improve the quality of life for those suffering from a brain injury, along with the needs of their families. As a member you will receive and/or support the following: 3-issues of Brain Injury Alliance of Utah, Inc. newsletter Requested educational material Announcements of upcoming educational conferences and/or events Emotional support through our Helpline and/or support groups Legislative efforts Promotion of injury prevention Voting privileges at BIAU annual meeting To become a member contact us at: 801-716-4993 or 800-281-8442 or on the website:
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Gauging Seizures' Severity April 26, 2012 Source: Massachusetts Institute of Technology
In this week's issue of the journal Neurology, researchers at MIT and two Boston hospitals provide early evidence that a simple, unobtrusive wrist sensor could gauge the severity of epileptic seizures as accurately as electroencephalograms (EEGs) do — but without the ungainly scalp electrodes and electrical leads. The device could make it possible to collect clinically useful data from epilepsy patients as they go about their daily lives, rather than requiring them to come to the hospital for observation. And if early results are borne out, it could even alert patients when their seizures are severe enough that they need to seek immediate medical attention. Rosalind Picard, a professor of media arts and sciences at MIT, and her group originally designed the sensors to gauge the emotional states of children with autism, whose outward behavior can be at odds with what they're feeling. The sensor measures the electrical conductance of the skin, an indicator of the state of the sympathetic nervous system, which controls the human fight-or-flight response. In a study conducted at Children's Hospital Boston, the research team — Picard, her student Ming-Zher Poh, neurologist Tobias Loddenkemper and four colleagues from MIT, Children's Hospital and Brigham and Women's Hospital — discovered that the higher a patient's skin conductance during a seizure, the longer it took for the patient's brain to resume the neural oscillations known as brain waves, which EEG measures. At least one clinical study has shown a correlation between the duration of brain-wave suppression after seizures and the incidence of sudden unexplained death in epilepsy (SUDEP), a condition that claims thousands of lives each year in the United States alone. With SUDEP, death can occur hours after a seizure. Currently, patients might use a range of criteria to determine whether a seizure is severe enough to warrant immediate medical attention. One of them is duration. But during the study at Children's Hospital, Picard says, "what we found was that this severity measure had nothing to do with the length of the seizure." Ultimately, data from wrist sensors could provide crucial information to patients deciding whether to roll over and go back to sleep or get to the emergency room. Surprising signals The realization that the wrist sensors might be of use in treating epilepsy was something of a fluke. "We'd been working with kids on the autism spectrum, and I didn't realize, but a lot of them have seizures," Picard says. In reviewing data from their autism studies, Picard and her group found that seizures were sometimes preceded by huge spikes in skin conductance. It seemed that their sensors might actually be able to predict the onset of seizures. At the time, several MIT students were working in Picard's lab
through MIT's Undergraduate Research Opportunities Program (UROP); one of them happened to be the daughter of Joseph Madsen, director of the Epilepsy Surgery Program at Children's Hospital. "I decided it was time to meet my UROP's dad," Picard says. In a project that would serve as the basis of Poh's doctoral dissertation, Madsen agreed to let the MIT researchers test the sensors on patients with severe epilepsy, who were in the hospital for as much as a week of constant EEG monitoring. Poh and Picard considered several off-the-shelf sensors for the project, but "at the time, there was nothing we could buy that did what we needed," Picard says. "Finally, we just built our own." "It's a big challenge to make a device robust enough to withstand long hours of recording," Poh says. "We were recording days or weeks in a row." In early versions of the sensors, some fairly common gestures could produce false signals. Eliminating the sensors' susceptibility to such sources of noise was largely a process of trial and error, Picard says. Blending in
Additionally, Poh says, "I put a lot of thought into how to make it really comfortable and as nonintrusive as possible. So I packaged it all into typical sweatbands." Since the patients in the study were children, "I allowed them to choose their favorite character on their wristband — for example, Superman, or Dora the Explorer, whatever they like," Poh says. "To them, they were wearing a wristband. But there was a lot of complicated sensing going on inside the wristband." Indeed, Picard says, the researchers actually lost five of their homemade sensors because hospital cleaning staff saw what they thought were ratty sweatbands lying around recently vacated rooms and simply threw them out. Picard is continuing to investigate the possibility that initially intrigued her — that the devices could predict seizures. In the meantime, however, her collaborators at Children's Hospital are conducting a study that will follow up on the one reported in Neurology, and a similar study is beginning at Brigham and Women's Hospital. Rather than sweatbands with TV and comic-book characters, however, the new studies will use sensors produced by Affectiva, a company that Picard started in order to commercialize her lab's work.
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In Appreciation of Those Who Support The BIAU April 1, 2012 — June 30, 2012
Gold Bar $5,000 & Over Dewsnup King & Olsen
Gold Nugget $2,500 & Over Country Life Care Center Robert DeBry & Associates Law Office of Brian Kelm University of Utah Rehab Center
Gold Ring $1,000 & Over Intellegis, LLC Learning Services Corp. Phoenix Services Corp.
Gold Chip $500 & Over Community Shares of Utah Yellow Cab
Gold Coin $100 - $249 over Elizabeth Cardell Pauline Fontaine Kathryn Ferguson Charles Gerrard Sam Goldstein Edward Havas Cheryl Hostetter Colin King Alan Mortensen Miette Murphy Karen Pace Antonietta Russo True Loyal Connections Michael Worel
Blood-Brain Barrier Building Blocks Forged From Human Stem Cells The blood-brain barrier -- the filter that governs what can and cannot come into contact with the mammalian brain -- is a marvel of nature. It effectively separates circulating blood from the fluid that bathes the brain, and it keeps out bacteria, viruses and other agents that could damage it. But the barrier can be disrupted by disease, stroke and multiple sclerosis, for example, and also is a big challenge for medicine, as it can be difficult or impossible to get therapeutic molecules through the barrier to treat neurological disorders. Now, however, the blood-brain barrier may be poised to give up some of its secrets as researchers at the University of WisconsinMadison have created in the laboratory dish the cells that make up the brain's protective barrier. Writing in the June 24, 2012 edition of the journal Nature Biotechnology, the Wisconsin researchers describe transforming stem cells into endothelial cells with blood-brain barrier qualities. Access to the specialized cells "has the potential to streamline drug discovery for neurological disease," says Eric Shusta, a UW-Madison professor of chemical and biological engineering and one of the senior authors of the new study. "You can look at tens of thousands of drug candidates and just ask the question if they have a chance to get into the brain. There is broad interest from the pharmaceutical industry." The blood-brain barrier depends on the unique qualities of endothelial cells, the cells that make up the lining of blood vessels. Continued on Page 15
Disclaimer All information provided in official Brain Injury Association of Utah’s (BIAU) publications is provided for information purposes only and does not constitute a legal contract between the BIAU and any person or entity unless otherwise specified. BIAU does not support or endorse any resource, links or information within this publication but provides it for readers to view information that may be useful or cutting edge.
Friends of BIAU Lisa Barnes Paul Barnes Sue & David Dewey Entertainment Express #1, LLC Leta Greene Cheri Hughes Sarah E. Johnson Eleanor Mayhew Mike Robinson Constance Schoon Cindy Wilmshurst
Memoriam Genny & Thomas Vaughn— In Memory of Brad Nicol
Volunteers We would like to thank the many volunteers who give of their time and energy to support the mission of the BIAU. Without them this organization would not exist. Only with your help can we continue to expand public awareness, enact legislative change, and serve the people whose lives are forever changed by the physical, cognitive, social and financial consequences of this devastating injury.
Please make your tax-deductible contribution to the Brain Injury Association of Utah
For all of your Self Administered Service needs.
We offer the experience of a large company and the personalized service of a local company. Visit our website: www.morningstarfs.com Or contact us:
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NeuroExpressions Art Show
The Brain Injury Alliance of Utah would like to thank everyone who attended our 2nd Annual NeuroExpressions Art Show on April 13th . In one year this event has grown from 29 pieces of art submitted, and 50 individuals attending . This year 70 pieces of art were submitted and 125 individuals attended the 2nd Annual NeuroExpressions Art Show. We especially want to thank each artist who graciously donated their artwork for this event. We would also like to thank Kim & Valerie for making this a special evening. Great Job. Information will be posted on our website at www.biau.org regarding our 3rd Annual NeuroExpressions Art Show.
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Management of Sports-Related Concussions Model Local Education Agency Concussion and Head Injury Policy Medical management of sports-related concussion continues to evolve. Recently, there has been a significant amount of new research regarding sports-related concussions in high school athletes. Model Local Education Agency (LEA) has established this protocol to provide education about concussion for coaches, school personnel, parents, and students. LEAs include local boards of education, local charter boards, as well as miscellaneous special programs. This protocol outlines procedures for staff to follow in managing concussions, and outlines school policy as it pertains to return to play issues following a concussion. LEA seeks to provide a safe return to activity for all students following any injury, but particularly after a concussion. In order to effectively and consistently manage these injuries, procedures have been developed to aid in insuring that concussed students are identified, treated and referred appropriately, receive appropriate follow-up medical care during the school day and are fully recovered prior to returning to activity. County or State Health Department employees and Physical Education specialists shall review this protocol annually. Any changes or modifications will be reviewed and given to athletic department staff, including coaches and other appropriate school personnel in writing. All appropriate staff shall attend a yearly in-service meeting in which procedures for managing sporting event-related
concussions are discussed. Local education agencies should note that the Utah State Board of Education passed R277-614 on august 6, 2011. the Rule directs LEAs to develop a policy using this, the USOE/ Risk Management’s model policy, to provide training to appropriate personnel, to provide notice to parents of the LEA’s policy, to post a copy of the LEA’s policy, and to use model parent acknowledgement and permission forms. Recognition of Concussion What is a concussion? A concussion is type of traumatic brain injury that interferes with normal function of the brain. It occurs when the brain is rocked back and forth or twisted inside the skull as a result of a blow to the head or body. What may appear to be only a mild jolt or blow to the head or body can result in a concussion. A concussion can occur even if a player or student in an activity is not knocked out or loses consciousness. (NFHS “Suggested Guidelines for Management of Concussion in Sports.”) Common signs and symptoms of sports-related concussion Signs (observed by others) Student appears dazed or stunned Confusion Continues on Page 10
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Our Veterans Outreach Program was designed because of the rate of blast-related concussions, mild traumatic brain injury, or MTBI is so high the Brain Injury Alliance of Utah is collaborating with the Veterans Affairs Hospital of Salt Lake City and other local agencies to: Educate service members and veterans alike, of the resources available to rehabilitate these invisible scars and to transition to civilian-life. Educate the Institutions of Higher Education in Utah and better inform them of the available re sources and appropriate services. Present information at local health fairs, supportgroups, in-service trainings, conferences, work shops, etc. to spread awareness of this silent epidemic. Be a voice among the crowd for those who served their country. We are excited about the future of the Brain Injury Alliance of Utah (BIAU). There will be changes of names, logos, literature, but our desire, passion, and commitment to the brain injury population will never change. We will continue to serve those who are in need. If you have any questions about our new name or look please contact us at 800-281-8442 or 801-716-4993.
MISSION Community Shares/Utah brings hope, comfort and help to those in need. Our mission consists of human, animal, and environmental services. We unite a remarkable and varied group of nonprofits. These agencies receive training, education, and financial resources that enable them to reach their goals and programs each year. Community Shares/Utah recommends and encourages Utahn’s to “designate.” This is accomplished by selecting the agency and the amount of their contribution on the pledge form provided by their company. The member agency always receives the designated contribution. All money collected remains in Utah. For more information visit our website. http://www.communitysharesutah.org
The Brain Injury Alliance of Utah is a proud member of Community Shares/Utah
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Forgets plays Unsure about game, score, opponent Moves clumsily (altered coordination) Balance Problems Personality change Responds slowly to questions Forgets events prior to hit Forgets events after the hit Loss of consciousness (any duration)
Symptoms (reported by student):
Headache Fatigue Nausea or vomiting Double vision, blurry vision Sensitive to light or noise Feels sluggish Feels “foggy” Problems concentrating Problems remembering
These signs and symptoms following a witnessed or suspected blow to the head or body are indicative of probable concussion. Any student who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the contest, game, or practice and shall not return to play until cleared by an appropriate health care professional.
Management and Referral Guidelines for All Staff 1. The following situations indicate a medical emergency and require activation of the Emergency Medical System: Any student with a witnessed loss of consciousness (LOC) of any duration should be spine boarded and transported immediately to nearest emergency department via emergency vehicle. Any student who has symptoms of a concussion, and who is not stable i.e., condition is worsening), is to be transported immediately to the nearest emergency department via emergency vehicle. A student who exhibits any of the following symptoms should be transported immediately to the nearest emergency department, via emergency vehicle. Deterioration of neurological function Decreasing level of consciousness Decrease or irregularity in respirations Any signs or symptoms of associated injuries, spine or skull fracture, or bleeding Mental status changes: lethargy, difficulty maintaining arousal, confusion or Seizure activity 2. a student who is symptomatic but stable, may be transported by his or her parents. The parents should be advised to contact the student’s primary care provider, or seek care at the nearest emergency department, on the day of the injury. Continue on Page 11
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will pick the student up at the event for transport. (see Section II)
Guidelines and Procedures for Coaches and Teachers Supervising Contests and Games: Recognize * Remove * Refer Recognize concussion 1. All educators and agents of the LEA should become familiar with the signs and symptoms of concussion that are described above. 2. Educators and agents of LEAs shall have appropriate training about recognizing and responding to traumatic head injuries, consistent with the employees’ responsibilities for supervising student & athletes. Remove from activity Any student who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the sporting event and shall not return to play until cleared by an appropriate health care professional. When in doubt, sit ‘em out Refer the athlete/student for medical evaluation 1.
the agent of the LEA is responsible for notifying the student’s parent (s) of the injury. a. Contact the parent(s) to inform a parent of the injury. Depending on the injury, either an emergency vehicle will transport or parent(s)
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b. A medical evaluation is required before returning to play. In the event that a student’s parent(s) cannot be reached, and the student is able to be sent home (rather than directly to MD) The LEA’s agent should insure that the student will be with a responsible individual, who is capable of monitoring the student and understanding the home care instructions, before allowing the student to go home. The LEA agent should continue efforts to reach a parent. If there is any question about the status of the student, or if the student cannot be monitored appropriately, the student should be referred to an Emergency Department for evaluation. An LEA’s agent should accompany the student and remain with the student until a parent arrives. The LEA’s agent shall provide for supervision of other students for whom he or she is responsible when accompanying the injured student. Continued on Page 13
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UCLA Researchers Map Damaged Connections In Phineas Gage's Brain May 16, 2012 Source: University of California - Los Angeles
Poor Phineas Gage. In 1848, the supervisor for the Rutland and Burlington Railroad in Vermont was using a 13pound, 3-foot-7-inch rod to pack blasting powder into a rock when he triggered an explosion that drove the rod through his left cheek and out of the top of his head. As reported at the time, the rod was later found, "smeared with blood and brains." Miraculously, Gage lived, becoming the most famous case in the history of neuroscience — not only because he survived a horrific accident that led to the destruction of much of his left frontal lobe but also because of the injury's reported effects on his personality and behavior, which were said to be profound. Gage went from being an affable 25year-old to one that was fitful, irreverent and profane. His friends and acquaintances said he was "no longer Gage." Over the years, various scientists have studied and argued about the exact location and degree of damage to Gage's cerebral cortex and the impact it had on his personality. Now, for the first time, researchers at UCLA, using brain-imaging data that was lost to science for a decade, have broadened the examination of Gage to look at the damage to the white matter "pathways" that connect various regions of the brain. Reporting in the May 16 issue of the journal PLoS ONE, Jack Van Horn, a UCLA assistant professor of neurology, and colleagues note that while approximately 4 percent of the cerebral cortex was intersected by the rod's passage, more than 10 percent of Gage's total white matter was damaged. The passage of the tamping iron caused widespread damage to the white matter connections throughout Gage's brain, which likely was a major contributor to the behavioral changes he experienced. Because white matter and its myelin sheath — the fatty coating around the nerve fibers that form the basic wiring of the brain — connect the billions of neurons that allow us to reason and remember, the research not only adds to the lore of Phineas Gage but may eventually lead to a better understanding of multiple brain disorders that are caused in part by similar damage to these connections. What we found was a significant loss of white matter connecting the left frontal regions and the rest of the brain," said Van Horn, who is a member of UCLA's Laboratory of Neuro Imaging (LONI). "We suggest that the disruption of the brain's 'network' considerably compromised it. This may have had an even greater Impact on Mr. Gage than the damage to the cortex alone in terms of his purported personality change." LONI is part of an ambitious joint effort with Massachusetts General Hospital and the National Institutes of Health to document the trillions of microscopic links between every one of the brain's 100 billion neurons — the so-called "connectome." And because mapping the brain's physical wiring eventually will lead to answers about what causes
mental conditions that may be linked to the breakdown of these connections, it was appropriate, as well as historically interesting, to take a new look at the damage to Gage's brain. Since Gage's 189-year-old skull, which is on display in the Warren Anatomical Museum at Harvard Medical School, is now fragile and unlikely to again be subjected to medical imaging, the researchers had to track down the last known imaging data, from 2001, which had been lost due to various circumstances at Brigham and Women's Hospital, a teaching affiliate of Harvard, for some 10 years. The authors were able to recover the computed tomographic data files and managed to reconstruct the scans, which revealed the highest-quality resolution available for modeling Gage's skull. Next, they utilized advanced computational methods to model and determine the exact trajectory of the tamping iron that shot through his skull. Finally, because the original brain tissue was, of course, long gone, the researchers used modern-day brain images of males that matched Gage's age and (right) handedness, then used software to position a composite of these 110 images into Gage's virtual skull, the assumption being that Gage's anatomy would have been similar. Van Horn found that nearly 11 percent of Gage's white matter was damaged, along with 4 percent of the cortex. "Our work illustrates that while cortical damage was restricted to the left frontal lobe, the passage of the tamping iron resulted in the widespread interruption of white matter connectivity throughout his brain, so it likely was a major contributor to the behavioral changes he experienced," Van Horn said. "Connections were lost between the left frontal, left temporal and right frontal cortices and the left limbic structures of the brain, which likely had considerable impact on his executive as well as his emotional functions." And while Gage's personality changed, he eventually was able to travel and find employment as a stagecoach driver for several years in South America. Ultimately, he died in San Francisco, 12 years after the accident. Van Horn noted a modern parallel. "The extensive loss of white matter connectivity, affecting both hemispheres, plus the direct damage by the rod, which was limited to the left cerebral hemisphere, is not unlike modern patients who have suffered a traumatic brain injury," he said. "And it is analogous to certain forms of degenerative diseases, such as Alzheimer's disease or frontal temporal dementia, in which neural pathways in the frontal lobes are degraded, which is known to result in profound behavioral changes." Van Horn noted that the quantification of the changes to Gage's brain's pathways might well provide important insights for clinical assessment and outcome-monitoring in modern-day brain trauma patients. Printed with permission from Children’s Neurobiological Solutions
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Students with suspected head injuries should not be permitted to drive home. 3. LEA agents should seek assistance from the host site certified athletic trainer (ATC) or team Return to Play (RTP) Procedures After Concussion 1. Return to activity and play is a medical decision. The student must meet all of the following criteria in order to progress to activity: a. Asymptomatic at rest and with exertion (including mental exertion in school) and b. Have written clearance from the student’s primary care provider or concussion specialist (student must be cleared for progression to activity by a physician other than an Emergency Room physician, if diagnosed with a concussion). 2. Once the above criteria are met, the student will be progressed back to full activity following the step-wise process detailed below. (This progression must be closely supervised by an LEA agent. If your school does not have an athletic trainer, then the coach must have a very specific plan to follow as directed by the athletes physician). 3. Progression is individualized, and will be determined on a case-by-case basis. Factors that may affect the rate of progression include: previous who has had an extended duration of symptoms, Or one who is participating in a collision or contact
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history of concussion, duration and type of symptoms, age of the student, and sport/activity in which the student participates. An athlete/student with a prior history of concussion, one sport may be progressed more slowly. 4. Stepwise progression as described below: Step 1. Complete cognitive rest. This may include staying home from school or limiting school hours (and studying) for several days. Activities requiring concentration and attention may worsen symptoms and delay recovery. Step 2. Return to school full-time Step 3. Light exercise. This step cannot begin until the student is no longer having concussion symptoms and is cleared by a physician for further activity. At this point the athlete may begin walking or riding an exercise bike. No weight lifting. Step 4. Running in the gym or on the field. No helmet or other equipment. Step 5. Non-contact training drills in full equipment. Weight training can begin. Step 6. Full contact practice or training. Step 7. Play in game. Must be cleared by physician before returning to play.  The student should spend 1 to 2 days at each step before advancing to the next. If post concussion symptoms occur at any step, student must Continued on Page 14
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Rehab Without Walls
stop the activity and the treating physician must be contacted. Depending upon the specific type and severity of the symptoms, the student may be told to rest for 24 hours and then resume activity at a level one step below where he or she was at when the symptoms occurred. This resumption of activity could be considerably simplified for a student injured during recess compared to a student injured at a game or formal practice. Potential Problem Areas While current Utah law designates that a student may be returned to play by “an appropriate health care provider” it is the prerogative of each LEA to designate the credentials of the providers from whom they will accept clearance. This is a very important decision and should be made after careful consideration by the athletic director, principal, superintendent, teacher (elementary), and parent(s). The school district’s liability carrier may also be consulted. For students injured during formal competitions, serious consideration must also be given as to what the school will do in the case where an athlete is clearly still having concussion symptoms, yet given return to play clearance by a health care provider. A formal policy should be developed which designates a specific individual (preferably an expert in the field of concussion management-typically a physician or neuropsychologist) who shall evaluate the athlete and make the final decision regarding return to play. Taken from the BIAU Family & Professionals Conference October 2011 Adopted by the Utah State Board of Education through the 2011 legislative H.B 204 Protection of Athletes with Head Injuries
Phone: 801-264-0213 Fax: 801-264-0219 261 East 4500 South Salt Lake City, UT 84107
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In many parts of the body, the endothelial cells that line capillaries are spaced so that substances can pass through. But in the capillaries that lead to the brain, the endothelial cells nestle in tight formation, creating a semipermeable barrier that allows some substances -- essential nutrients and metabolites -- access to the brain while keeping others -- pathogens and harmful chemicals -locked out. The cells described in the new Wisconsin study, which was led by Ethan S. Lippmann, now a postdoctoral fellow at the Wisconsin Institute for Discovery, and Samira M. Azarin, now a postdoctoral fellow at Northwestern University, exhibit both the active and passive regulatory qualities of those cells that make up the capillaries of the intact brain. The research team coaxed both embryonic and induced pluripotent stem cells to form the endothelial cells of the blood-brain barrier. The use of induced cells, which can come from patients with specific neurological conditions, may be especially important for modeling disorders that compromise the blood-brain barrier. What's more, because the cells can be mass produced, they could be used to devise high-throughput screens for molecules that may have therapeutic value for neurological conditions or to identify existing drugs that may have neurotoxic qualities.
"The nice thing about deriving endothelial cells from induced pluripotent stem cells is that you can make disease-specific models of brain tissue that incorporate the blood-brain barrier," explains Sean Palecek, a UW-Madison professor of chemical and biological engineering and a senior author of the new report. "The cells you create will carry the genetic information of the condition you want to study." The generation of the specialized blood-brain barrier endothelial cells, the Wisconsin researchers note, has never been done with stem cells. In addition to the potential applications to screen drugs and model pathologies of the bloodbrain barrier, they may also provide a novel window for developmental biologists who are interested in how the barrier comes together and co-develops with the brain. "Neurons develop at the same time as the endothelial cells," Shusta says, noting that, in development, the cells secrete chemical cues that help determine organ specificity. "We don't know what all those factors are," Lippmann says. "But with this model, we can go back and look." Identifying all of the molecular factors at play as blank slate stem cells differentiate to become specialized endothelial cells could one day have clinical significance to treat stroke or tamp down the ability of brain tumors to recruit blood vessels needed to sustain cancer. June 24, 2012 Source: University of Wisconsin-Madison
Country Life Care Center Opening in the Fall of 2012
Rarely does anything of good and reliable quality just happen. Country Life Care Center represents the years of training and experience of its founders and staff. These individuals have brought together refined procedures, care planning and an environment they know, from experience, works well in the care of persons recovering from catastrophic injury or illness. Country Life Care Center is offering care services for those who have experienced catastrophic injury or illness. These individuals commonly receive care that includes ventilators, tracheostomy, intravenous, enteral tube feeding and other forms of complex care support. Country Life will provide long to life term care programs for children, adolescents and adults. Some of the standard care programs will include services for: Traumatic Brain Injury Spinal Cord Injury Neuro-motor Disorders
Ventilator Dependency
Complex Wound Care
Stroke
The facility was carefully designed to include elements that promote the comfort and service access needed by this unique program of care. Due to the age range of those we will care for, planning family involvement has been a critical factor in design. Family is a guiding influence in establishing privacy and community opportunities for gathering within the facility. Planning for family involvement is a very fortunate result in the development of Country Life Care. The space for in room care equipment, on unit community space, family gathering areas and outdoor access are simply designed into Country Life from the ground up. Country Life Care Center is located at the 13747 S Redwood Road in Riverton Utah (corner of Bangerter & Redwood). For additional information please call us at (801) 491-0682
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www.biau.org
801-716-4993
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