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Jack Sisson's TBI Blog

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We all know by now that Traumatic Brain Injury is the signature wound of the Iraq War. Explosions that would have killed soldiers in previous wars are now less often fatal, due to the improved protective qualities of military helmets. What happens, however, is that the brain is knocked around inside the skull, as the head forcibly hits the helmet during the explosion. The result is less fatalities, but more brain injuries. According to the Defense Department, more than 134,000 service men and women suffered traumatic brain injuries from 2003 through 2009. The military has planned clinical trials using pure oxygen in a pressurized chamber to determine if the technique can help brain-injury sufferers heal.

From The Associated Press:
The U.S. military plans clinical trials next year to see whether breathing pure oxygen in a pressurized chamber might help thousands of Iraq and Afghanistan war veterans suffering from traumatic brain injuries.

About 300 service members with mild to moderate damage will participate in the trials of hyperbaric oxygen therapy to help determine whether it can help them heal, or at least ease the headaches, mood swings or other symptoms linked to brain injury.

Some will spend a total of 40 hours over 10 weeks breathing pure oxygen in a hyperbaric chamber, where the atmospheric pressure is increased to a level similar to what they would experience about 20 feet under water.

According to the Defense Department, more than 134,000 service men and women suffered traumatic brain injuries from 2003 through 2009.

Read the story here.

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One of Jack's concerns is the frequency of traumatic brain injuries in prisons and their affect on inmates in a prison environment. A few years ago, it would be almost impossible to find literature on this topic, but thanks to the growing body of knowledge about TBI, and its movement into the public consciousness (primarily due to the Iraq War), information on TBI is easier to find than ever before. To be sure, TBI and the Criminal Justice System is lagging somewhat behind other areas in terms of information available, but the field is steadily growing (as is TBI and the Homeless population).

The following is from the National Disability Rights Network:

Increasingly, large numbers of persons with mental illness, cognitive disabilities and/or physical disabilities are coming into contact with the adult correctional system. It is estimated that as many as 50 percent of prisoners have a mental illness or other type of disability. Jails and prisons have become the “new asylums” -- a costly response to mental health care.

From arrest through every phase of the criminal justice system, persons with disabilities encounter a system not designed to handle large numbers of persons with disabilities. Lack of access to community mental health treatment and other public services often results in people with disabilities being arrested and booked in jails where adequate treatment is unlikely. When competency is an issue, delays in transporting such individuals for treatment are commonplace. Those who are convicted and confined in penal facilities tend to serve longer sentences than others convicted of similar crimes, and prison conditions are harsher due to their disabilities.

Persons with disabilities often encounter an absence of justice in a system not designed to handle a large number of persons with disabilities.

Why are inmates with TBI or some form of mental illness not hospitalized in a state hospital? Why are they going to prison in ever increasing numbers?

A few years ago, Frontline produced an in-depth look at Ohio's prison system, and why it houses so many mentally ill individuals. Although this program focuses on mental illness, who's to say whether some of the prisoners filmed had also suffered a TBI. But mental illness or TBI, the sheer wrongness of incarcerating sufferers with either condition is obvious.

The opening sentences of the Frontline introduction:
Fewer than 55,000 Americans currently receive treatment in psychiatric hospitals. Meanwhile, almost 10 times that number -- nearly 500,000 -- mentally ill men and women are serving time in U.S. jails and prisons. As sheriffs and prison wardens become the unexpected and often ill-equipped caretakers of this burgeoning population, they raise a troubling new concern: Have America's jails and prisons become its new asylums?
You can watch the entire show here. Please let us know what you think. We'll be writing more about TBI and prisons this year.

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The C.D.C. has begun funding studies of TBI's in prisons, another of Jack's interests. He has long believed that all prisoners should get a neuro-psych evaluation as part of their exit routine before being released. The prison environment is ripe for TBI's, and it's also probable that a fair percentage of inmates had a TBI long before being sentenced. (Remember that one of Jack's doctors, Jonathan H. Pincus, in his 2002 book (Base Instincts: What Makes Killers Kill?) theorized, "It is the interaction of childhood abuse with neurologic disturbances and psychiatric illnesses that explains murder.") TBI's fall under the classification of neurologic disturbances, and it makes sense to study their prevalence in the prison population.

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If you've read this blog much at all, you already know that Jack believes that TBI is a contributing factor to homelessness. He's just not sure how much it contributes because there have been no studies done to check this. One of Jack's ongoing efforts has been to initiate a study to test a sample homeless population for TBI. He is still hopeful that his contacts at Harvard University will bring this plan to fruition.

Jack is a longtime admirer of Mel Eby, the Director of Tallahassee's homeless facility, The Shelter, for more than 20 years. Here's a video that was filmed for Mel's 20th anniversary.

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According to the BBC News, "Failure to control type 2 diabetes may have a long-term impact on the brain, research has suggested."

Severe hypoglycaemic episodes - hypos - occur when blood sugar levels drop dangerously low. A University of Edinburgh team found they may lead to poorer memory and diminished brain power. The study, based on 1,066 people with type 2 diabetes aged between 60 and 75, was presented at a conference of the charity Diabetes UK.

The volunteers completed seven tests assessing mental abilities such as memory, logic and concentration. The 113 people who had previously experienced severe hypos scored lower than the rest of the group. They performed poorly in tests of their general mental ability, and vocabulary.

Lead researcher Dr Jackie Price said: "Either hypos lead to cognitive decline, or cognitive decline makes it more difficult for people to manage their diabetes, which in turn causes more hypos.

"A third explanation could be that a third unidentified factor is causing both the hypos and the cognitive decline."
We will continue tracking this research. Because diabetes affects so many people, a direct correlation between it and brain function has staggering implications:
Diabetes now affects nearly 24 million people in the United States, an increase of more than 3 million in approximately two years, according to new 2007 prevalence data estimates released today by the Centers for Disease Control and Prevention (CDC). This means that nearly 8 percent of the U.S. population has diabetes.

In addition to the 24 million with diabetes, another 57 million people are estimated to have pre-diabetes, a condition that puts people at increased risk for diabetes. Among people with diabetes, those who do not know they have the disease decreased from 30 percent to 25 percent over a two-year period.
Read BBC article.

Read more on diabetes.

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From ScienceDaily (Apr. 2, 2009)
A blood test that can help predict the seriousness of a head injury and detect the status of the blood-brain barrier is a step closer to reality, according to two recently published studies involving University of Rochester Medical Center researchers.

News stories about tragic head injuries – from the death of actress Natasha Richardson to brain-injured Iraq war soldiers and young athletes – certainly underscore the need for a simpler, faster, accurate screening tool, said brain injury expert Jeffrey Bazarian, M.D., M.P.H., associate professor of Emergency Medicine, Neurology and Neurosurgery at URMC, and a co-author on both studies.

The S-100B blood test recently cleared a significant hurdle when a panel of national experts, including Bazarian, agreed for the first time that it could be a useful tool for patients with a mild injury, allowing them to safely avoid a CT scan.

Previous studies have shown the S-100B serum protein biomarker to increase rapidly after an injury. If measured within four hours of the injury, the S-100B test accurately predicts which head injury patients will have a traumatic abnormality such as hemorrhage or skull fracture on a head CT scan. It takes about 20 minutes to get results and could spare many patients unnecessary radiation exposure.

Physicians at six Emergency Departments in upstate New York, including the ED at Strong Memorial Hospital in Rochester, this year will continue to study the accuracy of the test among 1,500 patients. Scientists plan to use the data to apply for U.S. Food and Drug Administration approval.
Read article.

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From the Tallahassee Democrat:
Unemployment, incarceration and divorce can all be experienced by those suffering from traumatic brain injury.
To address this, the state Department of Health recently developed a five-year plan to help people suffering from these and other problems resulting from TBI.

The plan was created as a way to enhance the traumatic brain injury system of care currently in existence and to increase advocacy, education and funding.
We'll try to get a copy of the five-year-plan and let you know more about it when we do.
Thom DeLilla, bureau chief of the Florida Department of Health Brain and Spinal Cord Injury Program, said a lack of knowledge about the injury is another important issue that needs to be solved by the five-year plan.

"Generally most people are not aware of TBI, the consequences of brain injury or resources available throughout the state," DeLilla said.
Well, Jack has been saying that since the mid 1980s. In fact, there were little or no resources available when Jack had his TBI. Although increased awareness and treatment options are what Jack's been fighting for these many years, it's a bittersweet victory that positive change, however delayed, is now in sight.

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From The Frederick News Post
(Originally published March 31, 2009)

In July 1995, Jean Berube's father, a professor at Old Dominion University, was involved in a car accident. Soon after, he appeared completely recovered from relatively minor injuries.

"It was months later, in October, when he started slurring his words and showed symptoms that looked like he was having a stroke," Berube said. "My mother knew something was wrong."

Rushed to Virginia Beach General Hospital, Berube's father underwent emergency brain surgery. A subdural hematoma, as a result of brain injury, after weeks of slow, undetected bleeding, suddenly reached a critical mass.

"It took months, but my dad got better and eventually went back to work," she said. "In the end, he was fortunate."

The event changed her life.

A lawyer and legislative assistant working on health care issues, among others, on Capitol Hill for former Virginia congressman Owen Pickett, Berube returned home to Virginia briefly to take care of her family. She, of course, became very interested in what had happened to her dad, and in the nature of brain injury itself.

In 1997, she left Pickett's office to become director of public policy and government relations for the Brain Injury Association in Alexandria. Since, Berube, who now lives in Frederick , has been an independent consultant and lobbyist for a variety of brain injury organizations, including the International Brain Injury Association and the National Brain Injury Research, Treatment and Training Foundation.

Today she's recognized as a leading lobbyist specializing in work on behalf of nonprofits providing research and care in the traumatic brain injury field. She works with everyone from Dr. Rick Hunt, director for injury response at the Center for Disease Control, to Col. Michael Jaffe, M.D., the national director of the Defense and Veterans Brain Injury Center, to leaders of health care reform and the Wounded Warriors Project, to congressmen such as Rep. Bill Pascrell Jr., a leading advocate for brain injury research, and Frederick Rep. Roscoe Bartlett, who joined the Congressional Brain Injury Task Force last summer.

March is Brain Injury Awareness Month and the all-day fair March 25 featured presentations on mild traumatic brain injuries from the battlefield to the football field, a congressional briefing and reception. The next day an all-day seminar included panels on the costs of brain injury from the National Center for Injury Prevention and Control, health care reform and preventing disparity in civilian, military and veterans health care.

National Guard troops, for example, Berube said, once their tour of duty is done, often visit civilian doctors unfamiliar with diagnosing and treating issues such as mild traumatic brain injury.

Even before actress Natasha Richardson died earlier this month after initially rejecting medical attention following a seemingly minor fall while skiing, traumatic brain injury research and care has been receiving more attention in recent years because of the wars in Iraq and Afghanistan.

Continue reading the article.

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It's been a busy few weeks. We usually write about embryonic stem cells on the Beginning of Human Life blog, but since the research could benefit those suffering from traumatic brain injuries, I'm including those news items here as well. First, a recap on the embryonic stem cell issue:

The Moral Imperative to Relieve Suffering: Embryonic Stem Cell Research

There have been many moral objections raised to embryonic stem cell research. But as President Obama prepares to sign an executive order to repeal his predecessor's ban on federal funding for such scientific inquiry, we should also ask what the moral imperatives are to do this research. In addition, are there moral insights that can help us develop guidelines for the research?

Restrictions on federal funding of embryonic stem cell research have retarded scientific investigation that could well yield important medical advances. Devastating diseases such as Alzheimer's, Parkinson's, diabetes, heart disease, and spinal cord injury may see treatments emerge that can relieve enormous suffering and promote healing. There is a clear moral imperative, shared across many religions, to relieve suffering and promote healing. This is a strong ground on which to base religious arguments for the research.

The religious objections arise specifically in relationship to embryonic stem cell research. The religious controversy is rooted in the belief that the fertilized egg, even while not implanted in a woman's uterus, is still spiritually complete "life" and as such sacrosanct.

Read the article in The Washington Post.


President Obama Reverses Bush's Stem Cell Research Ban
WASHINGTON
– President Obama reversed a Bush administration order and vowed Monday to "vigorously support" stem cell research that scientists hope will lead to cures for deadly ailments like diabetes and Parkinson's disease.

"We will bring the change that so many scientists and researchers, doctors and innovators, patients and loved ones have hoped for and fought for these past eight years. We will lift the ban on federal funding for promising embryonic stem cell research," Obama said to cheers at the White House.

Fulfilling a campaign pledge, Obama signed an executive order ending President Bush’s ban on federal funding for embryonic stem cell research.

Read the article in U.S. News & World Report.


Some Catholics Disappointed in Obama

He garnered the majority of Catholic votes in the 2008 election, but a number of Catholic groups now say President Obama is showing a complete lack of regard for their beliefs.

They count his decisions to lift restrictions on abortion and stem cell research among the most offensive.

"As far as the Catholic church goes, there's no bigger priority for Catholics than human dignity and human life," said Cathy Ruse, senior fellow at the Family Research Council said. "And the Obama administration has just been an assault on those values again and again in just two months."

But some American Catholics support the president, saying his policies are consistent with their "mainstream" beliefs.

"President Obama has already reached out and won the Catholic vote," Jon O'Brien, president of Catholics for Choice, said.

"That's what happened in the last election in spite of the very loud voices of some extreme uber-Catholics who really want to paint this black and white picture -- to engage us in this endless culture war," he said.

O'Brien, whose group supports access to contraception and abortion, said Obama presented Catholic voters with a social justice agenda they can support.

Read the article at FoxNews.com.


Majority of Americans Likely Support Stem Cell Decision
Fifty-two percent support easing Bush-era restrictions or lifting restrictions entirely
WASHINGTON, D.C. -- A majority of Americans likely support President Barack Obama's executive order Monday doing away with the rules on federal funding of embryonic stem cell research that were in place under the Bush administration. In a Gallup Poll conducted last month, 38% of Americans said they support easing those restrictions and another 14% said they favor no restrictions at all. About 4 in 10 Americans favor keeping the Bush restrictions or eliminating federal funding altogether.

Read more about the poll and what the country's really thinking at Gallup.com.


Then traumatic brain injury was all over the news this week for a sad story. The lovely, talented actress Natasha Richardson, married to actor Liam Neeson and the daughter of Oscar-winning actress Vanessa Redgrave, fell on a beginner's ski slope in Canada, felt and acted fine after the accident, began having headaches about an hour later, lapsed into a coma, her brain ceased to function, she was removed from life support and died within hours. Broadway, Hollywood, and the rest of the country were shocked. She was so talented. She was so beautiful. By all accounts, she was so funny, and loving, and giving. She was only 45. How could a simple fall in which she ran into nothing or no one cause her to die?
Richardson Died From Clot That Compressed Brain Natasha Richardson, the British actress who fell during a ski lesson on Monday and later in the day lapsed into a coma, died of a large blood clot compressing her brain, New York City's medical examiner said yesterday.The bleeding that led to the clot was caused by "blunt impact to the head," according to the official report, which also labeled the death an accident.

The formal name for the condition is "epidural hematoma." It is usually the result of bleeding from arteries torn when the skull is struck hard, often on the temple where the bone is thinnest.

Arterial hemorrhage inside the skull is a potential catastrophe. Each heartbeat pumps blood under high pressure into a confined space, compressing the brain tissue.

"It is the most feared, treatable problem in neurosurgery," said Gail Rosseau, chief of surgery at the Neurologic and Orthopedic Hospital of Chicago. "These are the patients who 'talk and die.'"

Read the article in The Washington Post.

Then the accident dissection and second-guessing starts. I know it's important to understand why she died, but it just feels like it would be a little more decent to wait until after her funeral. Anyhow:

Natasha Richardson Refused to Wear Helmet
Natasha Richardson chose not to wear an inexpensive ski helmet which could have saved her life.

According to "The Sun," the actress who died after falling during a ski lesson at a Canadian resort, turned down resort staff recommendations that she wear the head protection.

Read the article at ArkansasMatters.com


After Wake, Some Wonder If Helicopter Could Have Saved Richardson

A day before Natasha Richardson's scheduled funeral, some are wondering if a medical helicopter might have been able to save the actress, who passed away Wednesday at age 45 after falling on a Quebec ski slope. The province of Quebec lacks a medical helicopter system, often used in the US and other parts of Canada, to airlift stricken patients to major trauma centers. Montreal's top head trauma doctor told The Associated Press that may have played a role in Richardson's death.

"It's impossible for me to comment specifically about her case, but what I could say is ... driving to Mont Tremblant from the city (Montreal) is a 2 1/2-hour trip, and the closest trauma center is in the city. Our system isn't set up for traumas and doesn't match what's available in other Canadian cities, let alone in the States," Tarek Razek, director of trauma services for the McGill University Health Centre, which represents six of Montreal's hospitals, told the AP.

Read the article at ABC News.
And then there's this final disgusting note:
Anti-gay church plans protest of Richardson funeral
MILLBROOK — Members of the Topeka, Kan.-based baptist church said they are coming to Millbrook Sunday to protest Natasha Richardson's funeral.

On it's Web site, Westboro Baptist Church said it plans to protest at St. Joseph's Church because Richardson supported research for a cure for AIDS. The small Kansas church has protested schools, colleges, churches, funerals and other venues.

The Westboro Baptist Church, founded in 1955 by the Rev. James Phelps, describes itself as an old-school Baptist church.

In April 2004, nine members of the church came to New Paltz to protest the same-sex marriages officials were conducting. They were met by hundreds of New Paltz-area residents who came out in support of the same-sex ceremonies and to oppose the Kansas group that held banners and shouted slogans with homosexual slurs.

Nearly 100 police officers from New Paltz, state police, Ulster County Sheriff's Department, Town of Lloyd and the Town of Ulster provided security at the event. No incidents were reported.

On Friday, local police said they are preparing for traffic and crowds Sunday, based on reports Richardson will be buried in a private ceremony near the family's Town of Washington home.

Read the article in the Poughkeepsie Journal.

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Concussions confer tremendous brain damage," reports CNN. That's the latest finding from the Center for the Study of Traumatic Encephalopathy (CSTE), at the Boston University School of Medicine. From a Boston University press release:
Leading medical experts at the Center for the Study of Traumatic Encephalopathy (CSTE) at Boston University School of Medicine (BUSM) reported today that nine-year NFL veteran, former Tampa Bay Buccaneer Tom McHale was suffering from chronic traumatic encephalopathy (CTE), a degenerative brain disease caused by head trauma, when he died in 2008 at the age of 45. In addition, the CSTE has discovered early evidence of CTE in the youngest case to date, a recently deceased 18-year-old boy who suffered multiple concussions in high school football.
Jack has argued for many years that concussions were more serious than popular opinion made them out to be. In fact, he was concerned enough to found a study at his prep school alma mater that administers neuropsychiatric tests to every incoming athlete. This serves as the baseline for future tests. Then, if a student athlete suffers a head injury, a subsequent test could presumably measure the extent, if any, of brain damage.
The discovery of the initial stages of CTE in an 18-year-old should move the discussion of football's concussion crisis toward youth football. The identity of the 18-year-old will not be revealed at the family's request. According to Cantu who wrote the first return-to-play guidelines, "Our efforts to educate athletes, coaches, and parents on the need to identify and rest concussions have only been moderately successful because people have been willing to look the other way when a child suffers a concussion. I hope the discovery of CTE in a child creates the urgency this issue needs. It is morally and ethically wrong to allow our children to voluntarily suffer this kind of brain trauma without taking the simple educational steps needed to protect them."
By the way, Jack doesn't limit his concerns to athletes. He thinks everyone should be tested as part of routine medical care.

According to the results of the study:
McHale, a Cornell University graduate, former restaurateur, husband and father of three boys, is the sixth former NFL player to be diagnosed post-mortem with CTE since 2002. CTE, a progressive neurodegenerative disease caused by repetitive trauma to the brain, is characterized by the build-up of a toxic protein called tau in the form of neurofibrillary tangles (NFTs) and neuropil threads (NTs) throughout the brain. The abnormal protein initially impairs the normal functioning of the brain and eventually kills brain cells. Early on, CTE sufferers may display clinical symptoms such as memory impairment, emotional instability, erratic behavior, depression and problems with impulse control. However, CTE eventually progresses to full-blown dementia. McHale died due to a drug overdose after a multi-year battle with addiction. Expert consensus is that drug abuse of any kind would never cause the neuropathological findings of CTE seen in McHale.
We encourage you to read the entire press release.

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We've talked a great deal on this blog about how tragic it is that it's taken a horrible war to increase public awareness of traumatic brain injury (TBI). The Iraq War has sent hundreds of our military home with TBI's, numbers high enough that traumatic brain injury has been dubbed "the signature wound" of the war. We are, of course, glad that more and more people now know about TBI and its devastating effects on its victims, their families and caregivers. But it is profoundly sad that this knowledge has come with such a painful price. Here's another article that would not have been written if we were not at war in Iraq:
One of the increasing problems that some soldiers returning from Iraq are having to deal with are brain injuries. We’ve heard a lot in the news about their having post-traumatic stress disorder, but an increasing number of soldiers are also having problems associated with traumatic brain injury. Soldiers hurt on the battlefields are not the only people who can sustain brain injuries, but their increasing numbers are creating an increased awareness of TBIs.

A TBI also can be caused by an automobile accident, a fall, physical abuse, a sports accident, an aneurysm, carbon monoxide poisoning, a stroke, substance abuse or birth defects. An estimated 1.5 million Americans suffer a brain injury each year, and this number far exceeds the number of people who have multiple sclerosis, spinal cord injuries, HIV/AIDS and breast cancer combined. As a matter of fact, there are approximately 5.3 million people who are living with some type of disability that has been caused by a brain injury.

When a person has a TBI, he/she can have physical, cognitive, emotional, psychological, functional, behavioral and/or social changes present - and each person has different symptoms with varying degrees of severity. Because of the complexity of the brain, and the many different aspects of an individual’s physical and behavioral wellness that are affected.
Continue reading.

 
From the Navy Times, Kelly Kennedy - Staff writer, Friday Feb 22, 2008:
After months of military officials and medical personnel lamenting the lack of an immediate, unequivocal, physical proof of mild traumatic brain injury, an anesthesiologist thinks he has found a solution.

And it may be as simple as two sensors and a BlackBerry.

Dr. Richard Dutton heads up trauma anesthesiology at the R. Adams Cowley Shock Trauma Center at the University of Maryland and sees about 4,000 people a year who doctors believe have a brain injury. But without a CT scan or an MRI, it’s hard to immediately tell for sure — especially if, as is the case in most trauma situations, doctors are also worried about broken bones, ruptured organs or heavy bleeding. And about 3,000 of those cases are mild TBI, which doesn’t show up on a scan.

So Dutton and a team of engineers decided to see if they could use sonar to “listen” for differences in healthy brains and injured brains. They used a headband with sensors to pick up the sound transmitted through the brain with sonar and then analyzed the data fed back into a computer. The Air Force paid for the research.

-----

Doctors typically can’t see mild TBI, even with a scan. But they know it’s important not to send a service member back out on patrol with a mild TBI because injuries caused by mild TBI are cumulative; even a slight second head injury can cause death for someone with an already damaged brain, and no one wants to go on patrol with someone whose vision is blurry or who has short-term memory loss.

When Dutton and the engineers tried out their equipment on people they believed to have mild TBIs, they found turbulent blood flow — or irregular bandwidths — on the Brain Acoustic Monitor.

“You hit your head, your BAM becomes abnormal,” Dutton said. “We think we may have an objective marker for brain injury. This is pretty exciting stuff.”

And it’s completely portable, which could be good news for troops in Iraq and Afghanistan. In Iraq, there’s one CT scan — in Balad — and no MRI machine. Medics don’t have access to the heavy, expensive equipment.

Read the entire article. This could be a huge diagnostic breakthrough for TBI's.

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Years ago, I remember, I read some quotation to the effect that "just because somebody's handicapped doesn't mean he can't be a jerk."

I myself am hearing-impaired, and understood exactly what the quotation meant: the handicapped, or the disabled, or the special-needs individual, or whatever polite term you want to use -- all such people are people first, and handicapped second. They have the same kinds of neuroses that other people have; the same things (plus a whole lot more) make them angry; and so on. They can be just really difficult to live with.

Ditto, those who live with them. Being a caretaker doesn't somehow magically endow you with superhuman powers of forgiveness, patience, generosity. It doesn't require you to be a saint, and it won't make you one.

Graphic evidence of the clash of human failings -- exaggerated by a disability -- comes from Jacqueline L'Heureux's article, "Do We Have to Crash Our Marriage, Too?" from the Fall 2007 issue of The Challenge, a print publication of the Brain Injury Association of America (BIAA). BIA has graciously permitted us to post a copy of that article (599KB PDF) here on sossisson.com. The article begins:
I never saw the truck coming, stopped on a freeway under a knock-your-eye-out blue sky. My back would freeze for months from the monster grille I never felt mount our car.

I want that day back, to live repeatedly, like the characters in "Our Town" -- every part of it right until the crash. Not because it was special, but because it was so ordinary, effortless -- as no day has been since. I want to start with rising early, clear-minded and happy to make breakfast for my son, who hardly ever touches it, then joke quietly, scruff his hair and send him off to school. I want to say the same thing I have said as he leaves every day since preschool (and his three brothers before him). "Remember, no matter what happens out there, you are loved." He waves me off, smiling at the silly ritual that he is too old for on this day his mother changes forever.

After that day, I was in rehab most of the rest of his high school in another city. His father swung from being angry to coldly withdrawn in response to my traumatic brain injury (TBI), seizure disorder, and chronic pain from my injuries. Rubble continued to rise under the truck long after that Indian summer evening. The debris eventually included my clinical practice as a Ph.D. family therapist, my life's work treating post-traumatic stress disorder (PTSD) patients and their families, a center I founded and directed, my university teaching, and the necessary, but wrenching dissolution of my 33-year marriage.
Think non-TBI'd family relationships are harrowing? Wait till you read the rest of L'Heureux's story.

Note, though, that the piece is not unrelievedly grim. L'Heureux concludes with some helpful tips, among them these:
If You Have a TBI and Your Marriage Is in Trouble:
  • Find a therapist -- it's okay if it takes several tries before you find a fit.
  • In the first 24 months post-injury, advocating for yourself in your marriage, or even using sessions well in therapy, is difficult. You will have problems processing and retrieving information, assessing your own experience, using judgment and finding energy. If your spouse is angry, and the therapist does not monitor the stimulation in the room, you can be "cooked" easily. The most important thing is to ask for help from others. Ask for help in all tasks. Things will get better.
  • Many changes happen in the first two years after the injury and sometimes after that. Don't try to judge how things will be in your marriage by how things are now. Your brain is still healing (and body, if physical injuries are present). You may not be stable on medications due to the changes. If you have PTSD symptoms, get help. It is highly treatable. Look up EMDR [certified clinicians] on the web. Ask if they work in stages, starting with grounding and stabilization.
  • If you are working with a couples' therapist who has no brain injury experience and your therapy is not progressing, call your state brain injury association for mental health providers who work with brain-injured patients.
  • When you call, ask the therapist to send intake forms before the visit. Write things down between sessions as you think of them. Speak up as soon as you get lost in the processing part of couples' sessions -- it's too important. If you need a short break, that's okay, too.

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This morning I found an interesting site, Spot-On.com, which is, according to the site's About Us page, "a web-based syndication service offering a range of independent, intelligent and insightful looks at politics and current events." One post, by admitted liberal writer Christopher Brauchli, definitely merits sharing with our readers:
In his last State of the Union message, Mr. Bush received great applause when he said: "Our military families also sacrifice for America. . . . We have a responsibility to provide for them. So I ask you to join me in expanding their access to child care. . . and allowing our troops to transfer their unused education benefits to their spouses or children. Our military families serve our nation, they inspire our nation, and tonight our nation honors them." One week later he submitted his 2009 budget and dissed the veterans. No funds were included for transferring education benefits.

In submitting his $1.3 trillion budget he forgot to include the benefit that would cost between $1 billion and $2 billion dollars. That was not the end of ignoring the needs of veterans. According to a release from the Brain Injury Association of America, for the third year in a row, Mr. Bush has proposed the complete elimination of the Federal traumatic Brain Injury Program. The program "provides grants to state agencies and [other organizations] to improve access to health and other services for individuals with traumatic brain injury and their families." Susan Connors, president and CEO of the Brain Injury Association of America described the omission as "deeply disappointing" and went on to say that "President Bush just doesn't get it." Those two examples are not the only ones in which veterans who have withstood the onslaught from the enemy in Iraq have to defend themselves from the onslaught of the wolf in the White House parading in sheep's clothing.
Visit Spot-On.com to read the complete post.

Just the kind of duplicitous doublespeak we've come to associate with this administration, but it's especially troubling when those being hurt by it are our returning military, for heaven's sake, as well as some of our most vulnerable citizens. It's a disgraceful situation that should get tons of press, but I wonder how many of the Republican Party's faithful are even aware that the country's vets are being treated this way. My guess is not many. As I've said before, "Support our Troops" takes more than a magnet slapped on the rear of your SUV.

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Losing the Physical Self

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