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Medical practitioner Conferences

Posted: November 21, 2017 at 10:32 am

The purpose behind this message is to welcome you at the upcoming “May 21-22, 2018 Osaka, Japan” which will be held on May 11-12, 2018 at Osaka, Japan.

This gathering manages the one of a kind technique for Medicine and its inventive procedures. The conference is a two-day event, comprised of Keynote Presentations, Poster, Oral talks, Symposia, Workshop, Scientific meetings and Exhibitions in the field of Medicine and Surgery, for an Exhibitions and workshops.
Sessions at the conference are designed to cover a broad spectrum of subjects in oncology and you are free to choose one and inform us at your convenience.
Physicians Meet 2018 Emphasizes on:
General Physicians Meet, Surgical Nursing, Cardiology and Vascular Surgery, Psychology and Psychiatric disorders, Dental, Oral and Maxillofacial Surgery, Gastroenterology and Hepatology, Pediatric Nephrology, Neurology and Brain disorders, Oncology, Ophthalmology and Vision Science etc.

For more details Visit:
Looking forward for your reply
Thanks and regards
Alicia Fernando
Program Manager
Medical practitioner Conferences
+1-6508894686 ext 6059, 6060
Conferenceseries LLC
Kemp House, 152 City Road,
London EC1V 2NX, UK.
E-mail: [email protected]

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New Advancement in Induced Pluripotent Stem Cell Research

Posted: October 17, 2017 at 3:29 pm

A recent change in how well we understand stem cells may make it easier for scientists and researchers to gather stem cells for use in scientific research as well as medical application. A new study was released in the research publication, Cell, which was performed by representatives from the University of California San Francisco.

One of the issues which hinder the use of stem cells as a more widespread treatment or field of research is that researchers and patients have a bottleneck of available healthy stem cell lines which can be used for research. Researchers hope that this new discovery will allow future scientific discoveries and applications in the areas of creating new and healthy tissue for patients with kidney failure or any other form of organ tissue failure. The future of medical therapy lies with Stem Cell Research, but many other forms of treatment, including Hormone Replacement Therapy, are already in practice today.

Researchers have discovered that it is possible to essentially “flip a switch” in an adult cell, reverting it back to the preliminary state at which cells existed in one of the earliest stages of development—the embryonic stem cell. Medical researchers hypothesize that Stem Cell treatments could be used for a variety of medical health issues which plague the world today, including kidney failure, liver disease, and Type-1 and Type-2 Diabetes.

Use of Embryonic Stem Cells Contentious

There is an ethical issue in Stem Cell Research today. Many Pro-Life Advocates are vociferously against the use of Embryonic Stem Cells harvested from procedures such as fertility treatments designed for conception. They believe that the use of embryonic stem cells harvested from donors and couples looking to conceive is unethical.

Using current research, it may be possible to bypass this ethical quandary completely by using adult cells and converting them into embryonic stem cells. Furthermore, because these stem cells are genetic derivatives of the patient from which the adult cells were harvested, this potentially paves the way for patient-specific medical treatments using stem cells.

After adult cells have been converted back into Embryonic Stem Cells, it will be possible to convert them into any possible cell that the patient needs or would benefit from.

Hijacking the Blueprint of the Cell Allows Scientists to Revert Adult Cells to their Earliest State

Researchers have increased the capacity to produce Embryonic Stem Cells by identifying previously unrecognized biochemical processes which tell human cells how to develop. In essence, researchers have discovered how the body blueprints cells, and can change the blueprints so that a new cell is made.

By utilizing these newly recognized pathways, it is possible to create new stem cells more quickly than ever before. One of the researchers explains the implications of this research. Dr. Miguel Ramalho-Santos is an associate professor of obstetrics, medicine, and cancer research at the University of California San Francisco. Dr. Ramalho-Santos is also a member of the Broad Center of Regenerative Medicine and Stem Cell Research.

He explains that these stem cell discoveries have the ability to alter the way that the medical sciences can take advantage of stem cells with regard to both cancer research and regenerative medicine. Dr. Ramalho-Santos was the lead researcher for this study, and the research was largely funded by the Director of the National Institutes of Health New Innovator Award, granted to promising young researchers which are leading highly innovative and promising medical research studies.

Dr. Ramalho-Santos’ research builds off of earlier research which discovered that it was possible to take adult cells and turn them back into embryonic stem cells. These stem cells don’t have any inherent aging processes, and they can be turned into any other kind of tissue. In the process of this conversion, the adult cells lose all of their unique characteristics, leaving them in an ultimately immature and malleable state.

This earlier research was conducted by researchers from UC San Francisco in partnership with Dr. Shinya Yamanaka from Kyoto University and Gladstone Institutes. These entities all gained a piece of the Nobel Prize in Physiology or Medicine from their part in the study.

Pluripotent Stem Cells vs. Embryonic Stem Cells

Thus far, we’ve described these cells as Embryonic Stem Cells, but in fact, the more accurate term for these cells are Induced Pluripotent Stem Cells (IPS). These cells are biologically and functionally similar to Embryonic Stem Cells, but have a different name because they are sourced from adult cells. The difference between Induced Pluripotent Stem Cells and Embryonic Stem Cells is that Induced Pluripotent Stem Cells do seem to retain some of the characteristics of their previous state, which appears to limit their ability to convert into any other type of cell. This new research identifies new pathways by which it may be possible to increase the number of cells that an individual IPS Cell can turn into, perhaps allowing them to convert into any other kind of human cell.

Induced Pluripotent Stem Cells are not explicitly considered an alternative to Embryonic Stem Cells, but are considered a different approach to produce similar cells. If researchers fully uncover the mechanisms of how to reprogram these cells, it will lower many barriers to stem cell research and the availability of stem cell treatments.

As of today, researchers have figured out how to make these Induced Pluripotent Stem Cells, but the percentage of adult cells which are reverted successfully is quite low, and frequently, these cells still show some aspects of specialization, which limits their use.

How Do Scientists Make Stem Cells From Adult Cells?

There are genes within every cell which have the ability to induce pluripotency, reverting the cell to an earlier stage of specialization. The initial stage of this process is the result of activating Yamanaka Factors, specific genes that initiate this reversion process.

As of today, this process of de-maturation is not completely understood, and researchers realized from the start that the cells they created were not truly identical to Embryonic Stem Cells, because they still showed signs of their former lives, which often prevented them from being successfully reprogrammed.

The new research conducted by Dr. Ramalho-Santos appears to increase our knowledge regarding how these cells work, and how to program them more effectively. Dr. Ramalho-Santos and his team discovered more genes associated with these programming/reprogramming processes, and by manipulating them, they have increased the viability and range of particular stem cells.

It appears that these genetic impulses are constantly at play to maintain the structure and function of a cell, and that by systematically removing these safeguards, it is possible to increase the ability to alter these cells.

This research increases researchers’ ability to produce these stem cells, by increasing the ability of medical scientists to produce adequate numbers of stem cells, while also increasing the range of potential treatment options by more effectively inducing the total pluripotency which is available in Embryonic Stem Cells. This research may also help scientists treat certain forms of cancer which are the result of malfunctions of these genes.

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New Stem Cell Cancer Treatment on the Horizon?

Posted: at 2:51 pm

Stem Cell Research is an amazing field right now, and promises to be a powerful and potent tool to help us live longer and healthier lives. Just last month, for example, Stem Cell Therapy was used to restore sight in patients with severe retinal deterioration, allowing them to see clearer than they had in years, or even decades.

Now, there is another form of Stem Cell Treatment on the horizon—this one of a very different form. Stem Cells have now been used as a mechanism to deliver medical treatment designed to eliminate cancer cells, even in hard to reach places. One issue with current cancer treatments is that, treatments that are effective at treating tumors on the surface of the brain cannot be performed safely when the tumor is deeper within the brain’s tissues.

Stem Cells have the fantastic ability to transform into any other kind of cell within the human body, given the appropriate stimulation. As of today, most of these cells come from Embryonic Lines, but researchers are learning how to backwards engineer cells in the human body, reverting them back to their embryonic state. These cells are known as Induced Pluripotent Stem Cells.

How Does This Stem Cell Cancer Treatment Work?

Using genetic engineering, it is possible to create stem cells that are designed to release a chemical known as Pseudomonas Exotoxin, which has the ability to destroy certain tumor cells in the human brain.

What is Pseudomonas Exotoxin?

Pseudomonas Exotoxin is a compound that is naturally released by a form of bacteria known as Pseudomonas Aeruginosa. This chemical is toxic to brain tumor cells because it prevents polypeptides from growing longer, essentially preventing the polypeptides from growing and reproducing. When used in a specific manner, this toxin has the ability to destroy cancerous and malignant tissue without negatively impacting healthy tissue. In addition to its potential as a cancer treatment, there is also evidence that the therapy could be used for the treatment of Hepatitis B.

PE and Similar Toxins Have been Used Therapeutically in the Past

As of now, this chemical, which we will refer to for the rest of the article as PE, has been used as a cancer treatment before, but there are major limitations regarding the use of PE for particular cancers, not because of the risks of the treatment, but because of the lack of an effective method to deliver the medication to where it is needed.

For example, similar chemicals have been highly effective in the treatment of a large number of blood cancers, but haven’t been nearly as effective in larger, more inaccessible tumors. The chemicals break down or become metabolized before they can fully do their job.

How do Stem Cells Increase the Effectiveness of PE Cancer Treatment

Right now, PE has to be created in a laboratory before it is administered, which is not very effective for these embedded cancers. By using Stem Cells as an intermediary, it is possible to deliver the medication to deeper areas of the brain more effectively, theoretically highly increasing the efficacy of the treatment.

The leader of this Stem Cell Research is Harvard researcher Dr. Khalis Shah. His goal was to find an effective means to treat these deep brain tumors which are not easily treated by methods available today. In utilizing Stem Cells, Dr. Shah has potentially found a means by which the stem cells can constantly deliver this Cancer Toxin to the tumor area. The cells remain active and are fed by the body, which allows them to provide a steady stream of treatment that is impossible to provide via any other known method.

This research is still in its early stages, and has not yet reached human trials, but in mice, the PE Toxin worked exactly as hypothesized and was able to starve out tumors by preventing them from replicating effectively.

Perhaps this might seem a bit less complicated than it actually is. One of the major hurdles that had to be overcome was that this Toxin would normally be strong enough to kill the cell that hosted it. In order for the Stem Cells to release the cancer, they had to be able to withstand the effects of PE, themselves. Using genetic engineering, Dr. Shah and his associates were able to create a cell that is capable of both producing and withstanding the effects of the toxin.

Stem Cell delivered medical therapy is a 21st century form of medical treatment that researchers are just beginning to learn how to effectively utilize. Essentially, this treatment takes a stem cell and converts it into a unique symbiotic tool capable of feeding off of the host for energy in order to perform a potentially life-saving function. It’s really quite fascinating.

How Does PE Not Damage or Kill Brain Cells Indiscriminately?

You might be concerned about the idea of a patient having a toxin injected into the brain to cure a disease. It sounds almost like a dangerous, tribal, homeopathic remedy. In reality, the researchers have been able to harness the destructive power of the toxin and re-engineer it so that it directly targets cancer cells while having limited negative effects on healthy, non-cancerous tissue.

The toxin does its damage after it has been absorbed by a cell. By retooling the toxin so that it does not readily absorb into healthy cells, the dangers associated with having such a potentially dangerous toxin in the brain are seriously and significantly mitigated.

Beyond that, Dr. Shah and his associates have been able to take steps to effectively “turn off” PE while it is inside the host stem cell, and only activates when it has entered the cancerous tissue. Dr. Shah explains that, although this research has only been conducted in animal subjects, there is no known reason why the effectiveness and safety of the treatment would not be applicable to human patients.

In this treatment, surgeons remove as much of the tumor as possible from the brain, and insert the engineered Stem Cells submerged in a sterile gel in the area where the tumor was removed or partially still exists. Researchers found that, when they used this treatment on laboratory rats, they could tell through imaging and analysis that the modified PE toxin effectively killed the cancer cells, and that this cancer treatment effectively lengthened the life of the rat, as compared to control subjects.

What’s the Next Step?

Of course, cancer treatment is far more complex than a single treatment, no matter how effective that treatment may be. Because human cancer treatment is a comprehensive therapy approach, the end goal of this research is to create a form of therapy in which the method used in animal subjects is combined with other existing approaches, increasing and maximizing the effectiveness of the comprehensive treatment.

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Spinal cord injury – Diagnosis and treatment – Mayo Clinic

Posted: December 16, 2017 at 7:43 pm


In the emergency room, a doctor may be able to rule out a spinal cord injury by careful inspection and examination, testing for sensory function and movement, and by asking some questions about the accident.

But if the injured person complains of neck pain, isn’t fully awake, or has obvious signs of weakness or neurological injury, emergency diagnostic tests may be needed.

These tests may include:

A few days after injury, when some of the swelling may have subsided, your doctor will conduct a more comprehensive neurological exam to determine the level and completeness of your injury. This involves testing your muscle strength and your ability to sense light touch and pinprick sensations.

Unfortunately, there’s no way to reverse damage to the spinal cord. But researchers are continually working on new treatments, including prostheses and medications that may promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury.

In the meantime, spinal cord injury treatment focuses on preventing further injury and empowering people with a spinal cord injury to return to an active and productive life.

Urgent medical attention is critical to minimize the effects of any head or neck trauma. Therefore, treatment for a spinal cord injury often begins at the scene of the accident.

Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they’ll use to transport you to the hospital.

In the emergency room, doctors focus on:

If you do have a spinal cord injury, you’ll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury.

After the initial injury or the condition stabilizes, doctors turn their attention to preventing secondary problems that may arise, such as deconditioning, muscle contractures, pressure ulcers, bowel and bladder issues, respiratory infections, and blood clots.

The length of your hospitalization depends on your condition and the medical issues you’re facing. Once you’re well enough to participate in therapies and treatment, you may transfer to a rehabilitation facility.

Rehabilitation team members will begin to work with you while you’re in the early stages of recovery. Your team may include a physical therapist, an occupational therapist, a rehabilitation nurse, a rehabilitation psychologist, a social worker, a dietitian, a recreation therapist, and a doctor who specializes in physical medicine (physiatrist) or spinal cord injuries.

During the initial stages of rehabilitation, therapists usually emphasize maintenance and strengthening of existing muscle function, redeveloping fine motor skills and learning adaptive techniques to accomplish day-to-day tasks.

You’ll be educated on the effects of a spinal cord injury and how to prevent complications, and you’ll be given advice on rebuilding your life and increasing your quality of life and independence.

You’ll be taught many new skills, and you’ll use equipment and technologies that can help you live on your own as much as possible. You’ll be encouraged to resume your favorite hobbies, participate in social and fitness activities, and return to school or the workplace.

Medications may be used to manage some of the effects of spinal cord injury. These include medications to control pain and muscle spasticity, as well as medications that can improve bladder control, bowel control and sexual functioning.

Inventive medical devices can help people with a spinal cord injury become more independent and more mobile. Some devices may also restore function. These include:

Your doctor may not be able to give you a prognosis right away. Recovery, if it occurs, typically starts a week to six months after an injury. The fastest rate of recovery is often seen in the first six months, but some people experience small improvements for up to one to two years.

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

An accident that results in paralysis is a life-changing event. Suddenly having a disability can be frightening and confusing, and adapting is no easy task. You may wonder how your spinal cord injury will affect your everyday activities, job, relationships and long-term happiness.

Recovery from such an event takes time, but many people who are paralyzed progress to lead productive and fulfilling lives. It’s essential to stay motivated and get the support you need.

If you’re newly injured, you and your family will likely experience a period of mourning and grief. Although the grieving process is different for everyone, it’s common to experience denial or disbelief, followed by sadness, anger, bargaining and, finally, acceptance.

The grieving process is a common, healthy part of your recovery. It’s natural and important to grieve the loss of the way you were. But it’s also necessary to set new goals and find a way to move forward with your life.

You’ll probably have concerns about how your injury will affect your lifestyle, your financial situation and your relationships. Grieving and emotional stress are normal and common.

However, if your grief and sadness are affecting your care, causing you to isolate yourself from others, or prompting you to abuse alcohol or other drugs, you may want to consider talking to a social worker, psychologist or psychiatrist. Or you might find a support group of people with spinal cord injuries helpful.

Talking with others who understand what you’re going through can be encouraging, and members of the group may have good advice on adapting areas of your home or work space to better accommodate your current needs. Ask your doctor or rehabilitation specialist if there are any support groups in your area.

One of the best ways to regain control of your life is to educate yourself about your injury and your options for reclaiming an independent life. A range of driving equipment and vehicle modifications is available today.

The same is true of home modification products. Ramps, wider doors, special sinks, grab bars and easy-to-turn doorknobs make it possible for you to live more autonomously.

Because the costs of a spinal cord injury can be overwhelming, you may want to find out if you’re eligible for economic assistance or support services from the state or federal government or from charitable organizations. Your rehabilitation team can help you identify resources in your area.

Your friends and family may respond to your disability in different ways. Some may be uncomfortable and unsure if they’re saying or doing the right thing.

Being educated about your spinal cord injury and willing to educate others is helpful. Children are naturally curious and sometimes adjust rather quickly if their questions are answered in a clear, straightforward way. Adults also can benefit from learning the facts.

Explain the effects of your injury and what your family and friends can do to help. At the same time, don’t hesitate to tell friends and loved ones when they’re helping too much. Although it may be uncomfortable at first, talking about your injury often strengthens your relationships with family and friends.

Your spinal cord injury may affect your body’s response to sexual stimuli. However, you’re a sexual being with sexual desires. A fulfilling emotional and physical relationship is possible but requires communication, experimentation and patience.

A professional counselor can help you and your partner communicate your needs and feelings. Your doctor can provide the medical information you need regarding sexual health. You can have a satisfying future complete with intimacy and sexual pleasure.

By nature, a spinal cord injury has a sudden impact on your life and the lives of those closest to you. When you first hear your diagnosis, you may start making a mental list of all of the things you can’t do anymore. However, as you learn more about your injury and your treatment options, you may be surprised by all you can do.

Thanks to new technologies, treatments and devices, people with spinal cord injuries play basketball and participate in track meets. They paint and take photographs. They get married, have and raise children, and have rewarding jobs.

Today, advances in stem cell research and nerve cell regeneration give hope for a greater recovery for people with spinal cord injuries. At the same time, new treatments are being investigated for people with long-standing spinal cord injuries.

No one knows when new treatments will be available, but you can remain hopeful about the future of spinal cord research while living your life to the fullest today.

Traumatic spinal cord injuries are emergencies, and the person who’s injured may not be able to participate in his or her care in the beginning.

A number of specialists will be involved in stabilizing the condition, including a doctor who specializes in nervous system disorders (neurologist) and a surgeon who specializes in spinal cord injuries and other nervous system problems (neurosurgeon), among others.

A doctor who specializes in spinal cord injuries will lead your rehabilitation team, which will include a variety of specialists.

If you have a possible spinal cord injury or you accompany someone who’s had a spinal cord injury and can’t provide the necessary information, here are some things you can do to facilitate care.

For a spinal cord injury, some basic questions to ask the doctor include:

Don’t hesitate to ask any other questions you have.

Your doctor is likely to ask questions, including:

Dec. 16, 2017

Read more from the original source:
Spinal cord injury – Diagnosis and treatment – Mayo Clinic

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Traumatic Spinal Cord Injury Treatment & Rehab …

Posted: at 7:43 pm

Treatment of spinal cord injury may involve medication, and surgery, and always requires physical therapy. Spinal cord injury may be due to either traumatic or non-traumatic causes. Non-traumatic causes of spinal cord injury occur over time and include arthritis, cancer, infection, blood vessels problems, bleeding, and inflammation.

In the case of traumatic spinal cord injury due to an accident, immediate, comprehensive trauma care is crucial for both survival and long-term outcome. A competent trauma team can do much to minimize the spread of damage from a spinal cord injury. The long-term prognosis for a spinal cord injury depends on the nature and location of the injury, as well as the quality of care received.

If emergency medical personnel suspect you have sustained a spinal injury, they will do everything possible to prevent further injury. While medics work to stabilize your heart rate, breathing, and blood pressure, your head and neck will be put into a special brace to prevent movement and additional injury. You will be put on stiff back board to prevent injury while you are being loaded in the ambulance and taken to the hospital.

Once at the trauma center, doctors will continue to work to make sure that you are stabilized and that no further injury will occur. You will continue to be immobilized while undergoing tests such as CAT scans and MRIs; these imaging tests will help the doctors determine the extent of your injury.

In cases of severe injury to the neck area of the spinal cord, respiratory problems may occur. Doctors may need to help you breathe by giving you oxygen through a tube inserted down your throat; this process is called intubation.

Spinal cord injuries have a tendency to worsen after the initial injury. Blood pressure and blood flow may drop dramatically immediately after the injury or may remain fairly normal in the first few hours only to drop dramatically within a day or so. As blood pressure drops and blow flow decreases, inflammation sets in and nerve cells at a distance from the injury begin to die. Researchers still do not understand all of the reasons why the injury spreads in this way, but a corticosteroid drug first used for spinal cord injuries in the early 1990s may help reduce the extent of the spread.

Doctors may give you this powerful corticosteroid, methylprednisolone (Medrol). When given within eight hours of the initial injury, methylprednisolone has been known to prevent further damage and to promote recovery in some people. Methylprednisolone reduces nerve damage and decreases inflammation around the injury. The use of methylprednisolone is controversial. It can cause serious side effects and some doctors believe it provides little benefit; however, other doctors are convinced that the drug is worth the risks and should be used to in most spinal cord injuries.

During the first few hours and days after a traumatic spinal cord injury, doctors may need to operate remove foreign objects, bone fragments, fractured vertebrae or herniated disks that are compressing the spine (decompressive surgery). Sometimes surgery is necessary to stabilize the spine; however, the precise time to perform emergency surgery is controversial. Some doctors believe that the sooner such an operation is performed, the greater chance a patient has of full recovery. Other doctors are convinced that surgery should be postponed for several days, so that the patients condition will be more stable.

The debate over when to perform surgery is yet to be settled, but in 2008 a comprehensive study seemed to indicate that earlier invention is better. According to the Surgical Treatment of Acute Spinal Cord Injury Study (STASCIS) 24% of people who underwent decompressive surgery within a day of their initial injury showed significant improvement when measured by the American Spinal Injury Association (ASIA) scale. The condition of these patients improved by two grades or better on this scale. While doctors are encouraged by the studys results, it is still too early for a definitive decision on these results. More research must be done.

In the meanwhile, patients and their families desiring early intervention should understand that such a procedure is not advisable for all spinal cord injuries. If you have had a severe spinal cord injury, but experienced no problems with your heart, blood pressure, breathing, and other vital functions, you may be eligible for early intervention. Unfortunately, many people who sustain a spinal cord injury have complications which delay surgery; they frequently have other injuries beside the spinal cord injury.

There are also other surgical procedures which may help you later in your road to recovering as much function as possible. Tendon transfer surgery can sometimes help people with a spinal cord injury gain more control of their arms and hands. A nonessential muscle which still has nerve function can be transferred to a place in the shoulders or arms to assist in motor function. Naturally, tendon transfer surgery is utilized only for people in relatively good health; it requires a period of being immobile for a length of time prior to the surgery, which can cause you to temporarily lose muscle gains you have made. Tendon transfer surgery will not be considered until at least a year after the initial injury.

Adjusting to a spinal cord injury is difficult because all physical aspects of your body are affected. You may lose control of your bladder and/or your bowels and you may experience urinary tract infections. You may experience pressure sores from being in one position for long time. You are at greatly increased risk of blood clots in your limbs and lungs (deep vein thrombosis and pulmonary embolism). Lung and breathing problems are common. You may experience spastic muscles. You are also at risk for a dangerous condition called autonomic dysreflexia and at risk of experiencing a new injury because you lack sensation in your limbs. Although these conditions are very disheartening, they are not insurmountable; your rehabilitation team will help you learn to manage each problem.

The extent of bladder control problems depends on the extent of your injury. In the hospital your bladder function will likely be managed with a catheter which stays in place. A catheter is a thin tube inserted into the bladder; the tube empties into a bag. Later you may benefit from intermittent catherization. You or a caregiver will insert a catheter at regular intervals, so that your bladder may empty completely; intermittent catheterization is less likely to lead to an infection, than leaving the catheter in around the clock. Emptying your bladder on schedule and careful monitoring can help you avoid urinary tract infections; if you do develop an infection, early intervention with antibiotics can help clear it.

A spinal cord injury can cause either a lack of bowel control or constipation. A high fiber diet and medications can help manage bowel function. Your rehabilitation team will help you device a schedule to help regulate bowel elimination.

Pressure sores are a real problem for people with spinal cord injury; they can become seriously infected if left untreated. Because you must sit or lay in the same position for a long period of time, your skin can break down; since you may have little or no sensation in the affected area, you may not realize that there is a problem. Pressure sores can be prevented by regularly changing position. Once you are stable, in the hospital and rehabilitation center, you will be routinely turned through the night, generally at intervals of two hours; this not only helps eliminate pressure sores, it also prevents fluid from accumulating in one area of your body and it helps protect the lungs from pneumonia. You will be turned or repositioned in the day time as well while you are immobile. Once at you will be reminded to change positions frequently, either on your own or with the help of a caregiver.

Staying immobile for long periods of time also slows blood circulation and can cause clots to form. Clots may develop deep within the vein of a muscle (deep vein thrombosis) and these can cause an artery in the lungs to be blocked (pulmonary embolism). Both conditions are extremely risk and can cause death.

You may be given medications to thin your blood and improve your circulation. Some people benefit from inflatable pumps which are placed on the legs to increase circulation and prevent fluid build. Special support stockings can help as well.

Spinal cord injuries can weaken the abdominal and chest muscles; sometimes movement of these muscles is completely impaired. If your diaphragm muscles (chest muscles used to breath with) are completely paralyzed you will be intubated and you may have to stay on a ventilator for a period of time; some people can learn to consciously breath and can thus stay off the ventilator for periods of time.

Even if your breathing is not directly impaired, you are still at greater risk of pneumonia. You will be given respiratory exercises and medications to help prevent lung infections and improve your lung function.

You may experience muscles spasms and your arms and legs may jump. This is relatively rare and unfortunately it is not an indication that you are regaining sensation or movement in these areas. These involuntary movements occur because some of your nerves have become more sensitive, yet your damaged spinal cord will not allow the brain to interpret and regulate their signals.

If your spinal cord was injured above the middle of the chest, you can be subject to autonomic dysreflexia, a dangerous, sometimes fatal problem. Pain or irritation below your injury may send a signal which cannot reach the brain. The interrupted signal causes a reflex which constricts your blood vessels; the blood pressure may rise while the heart rate drops, leading to a stroke or a seizure. Even a simple problem such as a full bladder or irritating clothes may trigger such a signal; eliminating the source of irritation can help relieve the problem. Sometimes a change of position will help.

Because you may not be able to feel pain or other stimuli on some areas of your body it is possible to injure yourself without realizing it. People with spinal cord injuries may experience severe burns or cuts without realizing it. Extra vigilance on your part and on your caregivers part can help eliminate this danger. Be on the lookout for cuts or sores that may require medical treatment.

When you have a spinal cord injury you are sometimes able to feel pain within areas of your body that cannot feel exterior sensations. Pain can come as a result of your initial injury. Your doctor can prescribe medication to help with this pain.

If you are able to regain some mobility, such as using your arms to work a wheelchair or using a walker, you may experience muscle pain from overuse or strain. You may experience less pain as you gains strength and stamina. Your physical therapist may also be able to show you new techniques that will reduce your muscle strain.

Once your condition has been stabilized, rehabilitation can begin. It is important that rehabilitation begin as soon as possible so that your muscles do not atrophy. Today, new technology can assist physical therapists in providing you with the best chance of recovery. A number of specialists may assist your recovery, including a physical therapist, an occupational therapist, a recreation therapist, a rehabilitation nurse, a rehabilitation psychologist, a social worker, and a physician specializing in physical medicine (physiatrist).

Physical therapy will begin in the hospital. At first you will be usually helped to regain strength in your arms and legs. An occupational therapist will help you with fine motor skills and you will be taught new ways of accomplishing every day tasks. You will learn to use adaptive equipment such as a wheelchair and equipment that can make self-care and every day tasks easier (such as an adaptor to help fasten your clothes and specially designed phone to facilitate dialing).

Later, according to your needs and your personal preferences, you may be transferred to a rehabilitation facility or allowed to go home and receive daily physical therapy at home. Severe injuries generally require a period of recuperation in a rehabilitation facility so that all of your medical needs can be attended to and you can receive more intensive therapy than you might at home.

At the rehabilitation center you will receive more and advanced therapy as your condition improves. You and your family will be taught techniques for managing skin care and dealing with possible urinary tract infections. You will also receive help with adapting your home to your new situation.

Newer technology can greatly assist your adjustment to your new limitations. Modern wheelchairs are lighter weight and easier to maneuver than past models. Electronic wheelchairs with adaptive controls can assist people with limited or no use of their arms. Some wheelchairs can elevate to allow you to reach objects above your head and to converse at high level with someone. Other wheelchairs allow the owner to negotiate curbs and climb stairs without assistance.

Computer driven devices can assist you with a wide-range of activities. Voice-activated computers can assist you with online bill paying and other computer work; they can also allow you to dial and answer a phone without using your hands. New computer devices also can help with personal hygiene and with reading.

In recent years an exciting technology called functional neuromuscular stimulation (FNS) has helped many people with a spinal cord injury increase their muscle strength and sometimes regain function. FNS works by stimulating intact peripheral nerves to cause muscle contractions in paralyzed muscles. Electrodes for this stimulation can be placed on the skin surface or can be implanted.

An implantable system can allow people with a certain type of spinal injury to grasp objects with their hands. The device is controlled by the shoulders position. FNS is commonly used with tendon transfer surgery.

The legs may also benefit from FNS. When electrodes are places on the skin of the legs, people with certain forms of spinal cord injury can ride a stationary bicycle. This strengthens the muscles, the bones, and the cardiovascular system. It also provides a psychological boost.

FNS can also stimulate gait for some patients. This can allow you to walk short distances with the aid of a walker. Soon FNS technology may allow people with spinal cord injuries a near return to their former level of function.

In addition to physical changes that can be dangerous, people with spinal cord injury also experience physical changes that directly affect them emotionally. Sexual dysfunction is a common problem for males with a spinal cord injury.

Although men with a spinal cord injury may still experience erections, they may have trouble maintaining an erection. The majority of men with a spinal cord injury have difficulty ejaculating. If you are a man with a spinal cord injury and concerns about your sexual function, consult a urologist or a fertility specialist.

Women with spinal cord injury are generally still able to experience intercourse and become pregnant, but sexual intimacy may not be as pleasurable. Pregnancy for a woman with a spinal cord injury is considered high risk. If you are a woman with concerns about how your spinal cord injury will affect your sexuality and ability to have children consult with a fertility specialist or an obstetrician gynecologist.

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Traumatic Spinal Cord Injury Treatment & Rehab …

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Spinal cord injury – Symptoms and causes – Mayo Clinic

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A spinal cord injury damage to any part of the spinal cord or nerves at the end of the spinal canal (cauda equina) often causes permanent changes in strength, sensation and other body functions below the site of the injury.

If you’ve recently experienced a spinal cord injury, it might seem like every aspect of your life has been affected. You might feel the effects of your injury mentally, emotionally and socially.

Many scientists are optimistic that advances in research will someday make the repair of spinal cord injuries possible. Research studies are ongoing around the world. In the meantime, treatments and rehabilitation allow many people with spinal cord injuries to lead productive, independent lives.

Your ability to control your limbs after a spinal cord injury depends on two factors: the place of the injury along your spinal cord and the severity of injury to the spinal cord.

The lowest normal part of your spinal cord is referred to as the neurological level of your injury. The severity of the injury is often called “the completeness” and is classified as either of the following:

Additionally, paralysis from a spinal cord injury may be referred to as:

Your health care team will perform a series of tests to determine the neurological level and completeness of your injury.

Spinal cord injuries of any kind may result in one or more of the following signs and symptoms:

Emergency signs and symptoms of a spinal cord injury after an accident may include:

Anyone who experiences significant trauma to his or her head or neck needs immediate medical evaluation for the possibility of a spinal injury. In fact, it’s safest to assume that trauma victims have a spinal injury until proved otherwise because:

Spinal cord injuries may result from damage to the vertebrae, ligaments or disks of the spinal column or to the spinal cord itself.

A traumatic spinal cord injury may stem from a sudden, traumatic blow to your spine that fractures, dislocates, crushes or compresses one or more of your vertebrae. It also may result from a gunshot or knife wound that penetrates and cuts your spinal cord.

Additional damage usually occurs over days or weeks because of bleeding, swelling, inflammation and fluid accumulation in and around your spinal cord.

A nontraumatic spinal cord injury may be caused by arthritis, cancer, inflammation, infections or disk degeneration of the spine.

The central nervous system comprises the brain and spinal cord. The spinal cord, made of soft tissue and surrounded by bones (vertebrae), extends downward from the base of your brain and is made up of nerve cells and groups of nerves called tracts, which go to different parts of your body.

The lower end of your spinal cord stops a little above your waist in the region called the conus medullaris. Below this region is a group of nerve roots called the cauda equina.

Tracts in your spinal cord carry messages between the brain and the rest of the body. Motor tracts carry signals from the brain to control muscle movement. Sensory tracts carry signals from body parts to the brain relating to heat, cold, pressure, pain and the position of your limbs.

Whether the cause is traumatic or nontraumatic, the damage affects the nerve fibers passing through the injured area and may impair part or all of your corresponding muscles and nerves below the injury site.

A chest (thoracic) or lower back (lumbar) injury can affect your torso, legs, bowel and bladder control, and sexual function. A neck (cervical) injury affects the same areas in addition to affecting movements of your arms and, possibly, your ability to breathe.

The most common causes of spinal cord injuries in the United States are:

Although a spinal cord injury is usually the result of an accident and can happen to anyone, certain factors may predispose you to a higher risk of sustaining a spinal cord injury, including:

At first, changes in the way your body functions may be overwhelming. However, your rehabilitation team will help you develop the tools you need to address the changes caused by the spinal cord injury, in addition to recommending equipment and resources to promote quality of life and independence. Areas often affected include:

Bladder control. Your bladder will continue to store urine from your kidneys. However, your brain may not be able to control your bladder as well because the message carrier (the spinal cord) has been injured.

The changes in bladder control increase your risk of urinary tract infections. The changes also may cause kidney infections and kidney or bladder stones. During rehabilitation, you’ll learn new techniques to help empty your bladder.

Skin sensation. Below the neurological level of your injury, you may have lost part of or all skin sensations. Therefore, your skin can’t send a message to your brain when it’s injured by certain things such as prolonged pressure, heat or cold.

This can make you more susceptible to pressure sores, but changing positions frequently with help, if needed can help prevent these sores. You’ll learn proper skin care during rehabilitation, which can help you avoid these problems.

Circulatory control. A spinal cord injury may cause circulatory problems ranging from low blood pressure when you rise (orthostatic hypotension) to swelling of your extremities. These circulation changes may also increase your risk of developing blood clots, such as deep vein thrombosis or a pulmonary embolus.

Another problem with circulatory control is a potentially life-threatening rise in blood pressure (autonomic hyperreflexia). Your rehabilitation team will teach you how to address these problems if they affect you.

Respiratory system. Your injury may make it more difficult to breathe and cough if your abdominal and chest muscles are affected. These include the diaphragm and the muscles in your chest wall and abdomen.

Your neurological level of injury will determine what kind of breathing problems you may have. If you have a cervical and thoracic spinal cord injury, you may have an increased risk of pneumonia or other lung problems. Medications and therapy can help prevent and treat these problems.

Fitness and wellness. Weight loss and muscle atrophy are common soon after a spinal cord injury. Limited mobility may lead to a more sedentary lifestyle, placing you at risk of obesity, cardiovascular disease and diabetes.

A dietitian can help you eat a nutritious diet to sustain an adequate weight. Physical and occupational therapists can help you develop a fitness and exercise program.

Following this advice may reduce your risk of a spinal cord injury:

Drive safely. Car crashes are one of the most common causes of spinal cord injuries. Wear a seat belt every time you drive or ride in a car.

Make sure that your children wear a seat belt or use an age- and weight-appropriate child safety seat. To protect them from air bag injuries, children under age 12 should always ride in the back seat.

Dec. 16, 2017

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Spinal Cord Injury | Paralyzed Veterans of America

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Every year, more than 12,000 people in the United States sustain a spinal cord injury. A spinal cord injury / disease (SCI/D) changes a persons life in an instant, and can have life-changing consequences. Veterans who have experienced an SCI can take advantage of ongoing support and helpful resources and benefits through aParalyzed Veterans of America membership.

More than 5 million Americans are living with paralysis, one in 4 of them a result of spinal cord injury or disease. The spinal cord is the major channel through which motor and sensory information travels between the brain and body.

When injury or disease of the spinal cord occurs, conduction of sensory and motor signals across the site of lesion(s) is impaired, resulting in loss of motor and/or sensory function. To further define, tetraplegia refers to impairment of function in the arms as well as the trunk, legs and pelvic organs. Paraplegia refers to impairment of arm functioning is spared and trunk, legs and pelvic organ involvement is dependent of the level of injury.

Injuries are classified as incomplete if partial preservation of sensory and/or motor function is present below the level of injury, to include sensation at the lowest segment of spinal cord; and complete when sensory and motor function is absent in the lowest segment of the spinal cord.

Prior to the 1970s, life expectancy for people with SCI/D was significantly reduced, mostly because of urological or respiratory infections. Since the improved management of infections, life expectancy has increased; however, respiratory diseases and septicemia remain the leading cause of death for individuals with SCI/D. It is important for caregivers and clinicians to recognize atypical signs and symptoms of infection, including, but not limited to fever, chills, spasms, nausea, vomiting, and fatigue as warning signs of infection in individuals with SCI/D.

Autonomic Dysreflexia (AD) is a preventable condition that can result in death if not quickly treated. Those with spinal cord injury at the sixth nerve of the thoracic spine or above are most commonly at risk, and in some cases the seventh and eighth nerve. AD can affect individuals with complete and incomplete injuries.

Common signs and symptoms of AD include sudden/significant elevation of blood pressure, severe headache, profuse sweating, goosebumps, blurred vision, seeing spots, flushed skin, nasal congestion, slowed pulse, tightness in chest, and anxiety. If any of these are experienced, emergency treatment must be initiated to include: sit up or raise head to 90 degrees and remain upright until blood pressure is normal, based on individuals baseline blood pressure; check/empty bowel or bladder; loosen or remove tight clothing; monitor blood pressure every 5 minutes; and call health care professional, even if symptoms resolve.

In addition to those injured traumatically, neurologic impairment of the spinal cord (myelopathy) may predominantly occur in diseases such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), benign or malignant tumors, spinal stenosis, arterio-venous malformations, epidural abscess, and other vascular, inflammatory, or infections of the spinal cord itself.

Similar to spinal cord injury, spinal cord disease causes various patterns of deficits depending on which nerve tracts within the spinal cord or which spinal roots outside of the cord are damaged. Common warning signs of spinal cord disease include paresis, loss of sensation, change in reflexes, and autonomic dysfunction (bowel/bladder, erectile dysfunction, loss of ability to sweat).

With increased longevity for persons with SCI/D, co-morbidities such as metabolic disease, endocrine disease, and musculoskeletal disorders are becoming increasingly common and require comprehensive specialty care for the prevention or early detection of health complications seen in the aging population.

Within the Veterans Health Administration, the Spinal Cord Injury and Disease System of Care provides an interdisciplinary team approach to manage the physical, psychological, environmental, and interpersonal support of individuals living with SCI/D. At the onset of rehabilitation and throughout life time, this comprehensive system of care helps individuals with SCI/D attain, preserve, and enhance the health and quality of life.Heres how to find one near you.

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Spinal Cord Injury | Paralyzed Veterans of America

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Traumatic Brain Injury & Neurological Disorder Treatment …

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All brain injuries are serious. Some are life-threatening. But in many cases treatmentand healingis indeed possible. In fact, a high percentage of brain injury patients go on to lead productive and fulfilling lives. Long after rehabilitation has been completed, people with a brain injury need to sustain the gains made in rehabilitation to remain independent. Our goal is to make that outcome a reality.

The Neurologic Rehabilitation Institute (NRI) is an internationally recognized center for the treatment and rehabilitation of individuals over the age of 18 dealing with traumatic brain injuries and other neurological disorders.

Located on the park-like campus of Brookhaven Hospital in Tulsa, Oklahoma, NRI goes beyond traditional rehabilitation care to provide victims of traumatic brain injury with one of the most comprehensive and advanced treatment programs in America, offering complex care rehabilitation, intensive neurobehavioral rehabilitation and TBI dual diagnosis treatment.

This highly individualized treatment program, created by our interdisciplinary team of neurological specialists, is tailored to each patients unique set of needsbut the goal is always the sameto give individuals who have experienced a severe brain injury the highest level of independence possible.

NRI offers a wide range of treatment options and services including:

In addition, our Complex Care Rehabilitation Services include:

We are proud to announce our accreditation by the Commission on Accreditation of Rehabilitation Facilities, CARF International. CARF is an independent, nonprofit accreditor of health and human services.

The mission of CARF is to promote the quality, value, and optimal outcomes of services through a consultative accreditation process and continuous improvement services that center on enhancing the lives of persons served.

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Traumatic Brain Injury & Neurological Disorder Treatment …

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Traumatic brain injury – Wikipedia

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Traumatic brain injury (TBI), also known as intracranial injury, occurs when an external force injures the brain. TBI can be classified based on severity, mechanism (closed or penetrating head injury), or other features (e.g., occurring in a specific location or over a widespread area). Head injury is a broader category that may involve damage to other structures such as the scalp and skull. TBI can result in physical, cognitive, social, emotional, and behavioral symptoms, and outcome can range from complete recovery to permanent disability or death.

Causes include falls, vehicle collisions, and violence. Brain trauma occurs as a consequence of a sudden acceleration or deceleration within the cranium or by a complex combination of both movement and sudden impact. In addition to the damage caused at the moment of injury, a variety of events in the minutes to days following the injury may result in secondary injury. These processes include alterations in cerebral blood flow and the pressure within the skull. Some of the imaging techniques used for diagnosis include computed tomography and magnetic resonance imaging (MRIs).

Prevention measures include use of protective technology in vehicles, such as seat belts and sports or motorcycle helmets, as well as efforts to reduce the number of collisions, such as safety education programs and enforcement of traffic laws. Depending on the injury, treatment required may be minimal or may include interventions such as medications, emergency surgery or surgery years later. Physical therapy, speech therapy, recreation therapy, occupational therapy and vision therapy may be employed for rehabilitation. Counseling, supported employment, and community support services may also be useful.

TBI is a major cause of death and disability worldwide, especially in children and young adults. Males sustain traumatic brain injuries more frequently than do females. The 20thcentury saw developments in diagnosis and treatment that decreased death rates and improved outcome.

Traumatic brain injury is defined as damage to the brain resulting from external mechanical force, such as rapid acceleration or deceleration, impact, blast waves, or penetration by a projectile.[2] Brain function is temporarily or permanently impaired and structural damage may or may not be detectable with current technology.[3]

TBI is one of two subsets of acquired brain injury (brain damage that occur after birth); the other subset is non-traumatic brain injury, which does not involve external mechanical force (examples include stroke and infection).[4][5] All traumatic brain injuries are head injuries, but the latter term may also refer to injury to other parts of the head.[6][7][8] However, the terms head injury and brain injury are often used interchangeably.[9] Similarly, brain injuries fall under the classification of central nervous system injuries[10] and neurotrauma.[11] In neuropsychology research literature, in general the term “traumatic brain injury” is used to refer to non-penetrating traumatic brain injuries.

TBI is usually classified based on severity, anatomical features of the injury, and the mechanism (the causative forces).[12] Mechanism-related classification divides TBI into closed and penetrating head injury.[2] A closed (also called nonpenetrating, or blunt)[6] injury occurs when the brain is not exposed.[7] A penetrating, or open, head injury occurs when an object pierces the skull and breaches the dura mater, the outermost membrane surrounding the brain.[7]

Brain injuries can be classified into mild, moderate, and severe categories.[12] The Glasgow Coma Scale (GCS), the most commonly used system for classifying TBI severity, grades a person’s level of consciousness on a scale of 315 based on verbal, motor, and eye-opening reactions to stimuli.[14] In general, it is agreed that a TBI with a GCS of 13 or above is mild, 912 is moderate, and 8 or below is severe.[3][8][15] Similar systems exist for young children.[8] However, the GCS grading system has limited ability to predict outcomes. Because of this, other classification systems such as the one shown in the table are also used to help determine severity. A current model developed by the Department of Defense and Department of Veterans Affairs uses all three criteria of GCS after resuscitation, duration of post-traumatic amnesia (PTA), and loss of consciousness (LOC).[13] It also has been proposed to use changes that are visible on neuroimaging, such as swelling, focal lesions, or diffuse injury as method of classification.[2]Grading scales also exist to classify the severity of mild TBI, commonly called concussion; these use duration of LOC, PTA, and other concussion symptoms.[16]

Systems also exist to classify TBI by its pathological features.[12] Lesions can be extra-axial, (occurring within the skull but outside of the brain) or intra-axial (occurring within the brain tissue).[17] Damage from TBI can be focal or diffuse, confined to specific areas or distributed in a more general manner, respectively.[18] However, it is common for both types of injury to exist in a given case.[18]

Diffuse injury manifests with little apparent damage in neuroimaging studies, but lesions can be seen with microscopy techniques post-mortem,[18][19] and in the early 2000s, researchers discovered that diffusion tensor imaging (DTI), a way of processing MRI images that shows white matter tracts, was an effective tool for displaying the extent of diffuse axonal injury.[20][21] Types of injuries considered diffuse include edema (swelling) and diffuse axonal injury, which is widespread damage to axons including white matter tracts and projections to the cortex.[22][23] Types of injuries considered diffuse include concussion and diffuse axonal injury, widespread damage to axons in areas including white matter and the cerebral hemispheres.[22]

Focal injuries often produce symptoms related to the functions of the damaged area.[10] Research shows that the most common areas to have focal lesions in non-penetrating traumatic brain injury are the orbitofrontal cortex (the lower surface of the frontal lobes) and the anterior temporal lobes, areas that are involved in social behavior, emotion regulation, olfaction, and decision-making, hence the common social/emotional and judgment deficits following moderate-severe TBI.[24][25][26][27] Symptoms such as hemiparesis or aphasia can also occur when less commonly affected areas such as motor or language areas are, respectively, damaged.[28][29]

One type of focal injury, cerebral laceration, occurs when the tissue is cut or torn.[30] Such tearing is common in orbitofrontal cortex in particular, because of bony protrusions on the interior skull ridge above the eyes.[24] In a similar injury, cerebral contusion (bruising of brain tissue), blood is mixed among tissue.[15] In contrast, intracranial hemorrhage involves bleeding that is not mixed with tissue.[30]

Hematomas, also focal lesions, are collections of blood in or around the brain that can result from hemorrhage.[3]Intracerebral hemorrhage, with bleeding in the brain tissue itself, is an intra-axial lesion. Extra-axial lesions include epidural hematoma, subdural hematoma, subarachnoid hemorrhage, and intraventricular hemorrhage.[31] Epidural hematoma involves bleeding into the area between the skull and the dura mater, the outermost of the three membranes surrounding the brain.[3] In subdural hematoma, bleeding occurs between the dura and the arachnoid mater.[15] Subarachnoid hemorrhage involves bleeding into the space between the arachnoid membrane and the pia mater.[15] Intraventricular hemorrhage occurs when there is bleeding in the ventricles.[31]

Symptoms are dependent on the type of TBI (diffuse or focal) and the part of the brain that is affected.[33] Unconsciousness tends to last longer for people with injuries on the left side of the brain than for those with injuries on the right.[7] Symptoms are also dependent on the injury’s severity. With mild TBI, the patient may remain conscious or may lose consciousness for a few seconds or minutes.[34] Other symptoms of mild TBI include headache, vomiting, nausea, lack of motor coordination, dizziness, difficulty balancing,[35] lightheadedness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, and changes in sleep patterns.[34] Cognitive and emotional symptoms include behavioral or mood changes, confusion, and trouble with memory, concentration, attention, or thinking.[34] Mild TBI symptoms may also be present in moderate and severe injuries.[34]

A person with a moderate or severe TBI may have a headache that does not go away, repeated vomiting or nausea, convulsions, an inability to awaken, dilation of one or both pupils, slurred speech, aphasia (word-finding difficulties), dysarthria (muscle weakness that causes disordered speech), weakness or numbness in the limbs, loss of coordination, confusion, restlessness, or agitation.[34] Common long-term symptoms of moderate to severe TBI are changes in appropriate social behavior, deficits in social judgment, and cognitive changes, especially problems with sustained attention, processing speed, and executive functioning.[27][36][37][38][39]Alexithymia, a deficiency in identifying, understanding, processing, and describing emotions occurs in 60.9% of individuals with TBI.[40] Cognitive and social deficits have long-term consequences for the daily lives of people with moderate to severe TBI, but can be improved with appropriate rehabilitation.[39][41][42][43]

When the pressure within the skull (intracranial pressure, abbreviated ICP) rises too high, it can be deadly.[44] Signs of increased ICP include decreasing level of consciousness, paralysis or weakness on one side of the body, and a blown pupil, one that fails to constrict in response to light or is slow to do so.[44]Cushing’s triad, a slow heart rate with high blood pressure and respiratory depression is a classic manifestation of significantly raised ICP.[3]Anisocoria, unequal pupil size, is another sign of serious TBI.[32]Abnormal posturing, a characteristic positioning of the limbs caused by severe diffuse injury or high ICP, is an ominous sign.[3]

Small children with moderate to severe TBI may have some of these symptoms but have difficulty communicating them.[45] Other signs seen in young children include persistent crying, inability to be consoled, listlessness, refusal to nurse or eat,[45] and irritability.[3]

The most common causes of TBI in the U.S. include violence, transportation accidents, construction, and sports.[35][46] Motor bikes are major causes, increasing in significance in developing countries as other causes reduce.[47] The estimates that between 1.6 and 3.8million traumatic brain injuries each year are a result of sports and recreation activities in the US.[48] In children aged two to four, falls are the most common cause of TBI, while in older children traffic accidents compete with falls for this position.[49] TBI is the third most common injury to result from child abuse.[50] Abuse causes 19% of cases of pediatric brain trauma, and the death rate is higher among these cases.[51] Although men are twice as likely to have a TBI. Domestic violence is another cause of TBI,[52] as are work-related and industrial accidents.[53] Firearms[7] and blast injuries from explosions[54] are other causes of TBI, which is the leading cause of death and disability in war zones.[55] According to Representative Bill Pascrell (Democrat, NJ), TBI is “the signature injury of the wars in Iraq and Afghanistan.”[56] There is a promising technology called activation database-guided EEG biofeedback, which has been documented to return a TBI’s auditory memory ability to above the control group’s performance[57][58]

The type, direction, intensity, and duration of forces all contribute to the characteristics and severity TBI.[2] Forces that may contribute to TBI include angular, rotational, shear, and translational forces.[30]

Even in the absence of an impact, significant acceleration or deceleration of the head can cause TBI; however in most cases a combination of impact and acceleration is probably to blame.[30] Forces involving the head striking or being struck by something, termed contact or impact loading, are the cause of most focal injuries, and movement of the brain within the skull, termed noncontact or inertial loading, usually causes diffuse injuries.[12] The violent shaking of an infant that causes shaken baby syndrome commonly manifests as diffuse injury.[60] In impact loading, the force sends shock waves through the skull and brain, resulting in tissue damage.[30] Shock waves caused by penetrating injuries can also destroy tissue along the path of a projectile, compounding the damage caused by the missile itself.[15]

Damage may occur directly under the site of impact, or it may occur on the side opposite the impact (coup and contrecoup injury, respectively).[59] When a moving object impacts the stationary head, coup injuries are typical,[61] while contrecoup injuries are usually produced when the moving head strikes a stationary object.[62]

A large percentage of the people killed by brain trauma do not die right away but rather days to weeks after the event;[63] rather than improving after being hospitalized, some 40% of TBI patients deteriorate.[64]Primary brain injury (the damage that occurs at the moment of trauma when tissues and blood vessels are stretched, compressed, and torn) is not adequate to explain this deterioration; rather, it is caused by secondary injury, a complex set of cellular processes and biochemical cascades that occur in the minutes to days following the trauma.[65] These secondary processes can dramatically worsen the damage caused by primary injury[55] and account for the greatest number of TBI deaths occurring in hospitals.[32]

Secondary injury events include damage to the bloodbrain barrier, release of factors that cause inflammation, free radical overload, excessive release of the neurotransmitter glutamate (excitotoxicity), influx of calcium and sodium ions into neurons, and dysfunction of mitochondria.[55] Injured axons in the brain’s white matter may separate from their cell bodies as a result of secondary injury,[55] potentially killing those neurons. Other factors in secondary injury are changes in the blood flow to the brain; ischemia (insufficient blood flow); cerebral hypoxia (insufficient oxygen in the brain); cerebral edema (swelling of the brain); and raised intracranial pressure (the pressure within the skull).[66] Intracranial pressure may rise due to swelling or a mass effect from a lesion, such as a hemorrhage.[44] As a result, cerebral perfusion pressure (the pressure of blood flow in the brain) is reduced; ischemia results.[32][67] When the pressure within the skull rises too high, it can cause brain death or herniation, in which parts of the brain are squeezed by structures in the skull.[44] A particularly weak part of the skull that is vulnerable to damage causing extradural haematoma is the pterion, deep in which lies the middle meningeal artery, which is easily damaged in fractures of the pterion. Since the pterion is so weak, this type of injury can easily occur and can be secondary due to trauma to other parts of the skull where the impact forces spreads to the pterion.

Diagnosis is suspected based on lesion circumstances and clinical evidence, most prominently a neurological examination, for example checking whether the pupils constrict normally in response to light and assigning a Glasgow Coma Score.[15] Neuroimaging helps in determining the diagnosis and prognosis and in deciding what treatments to give.[68]

The preferred radiologic test in the emergency setting is computed tomography (CT): it is quick, accurate, and widely available.[69] Follow-up CT scans may be performed later to determine whether the injury has progressed.[2]

Magnetic resonance imaging (MRI) can show more detail than CT, and can add information about expected outcome in the long term.[15] It is more useful than CT for detecting injury characteristics such as diffuse axonal injury in the longer term.[2] However, MRI is not used in the emergency setting for reasons including its relative inefficacy in detecting bleeds and fractures, its lengthy acquisition of images, the inaccessibility of the patient in the machine, and its incompatibility with metal items used in emergency care.[15] A variant of MRI since 2012 is High definition fiber tracking (HDFT).[70]

Other techniques may be used to confirm a particular diagnosis. X-rays are still used for head trauma, but evidence suggests they are not useful; head injuries are either so mild that they do not need imaging or severe enough to merit the more accurate CT.[69]Angiography may be used to detect blood vessel pathology when risk factors such as penetrating head trauma are involved.[2]Functional imaging can measure cerebral blood flow or metabolism, inferring neuronal activity in specific regions and potentially helping to predict outcome.[71]Electroencephalography and transcranial doppler may also be used. The most sensitive physical measure to date is the quantitative EEG, which has documented an 80% to 100% ability in discriminating between normal and traumatic brain-injured subjects.[72][73]

Neuropsychological assessment can be performed to evaluate the long-term cognitive sequelae and to aid in the planning of the rehabilitation.[68] Instruments range from short measures of general mental functioning to complete batteries formed of different domain-specific tests.

Since a major cause of TBI are vehicle accidents, their prevention or the amelioration of their consequences can both reduce the incidence and gravity of TBI. In accidents, damage can be reduced by use of seat belts, child safety seats[48] and motorcycle helmets,[74] and presence of roll bars and airbags.[30] Education programs exist to lower the number of crashes.[68] In addition, changes to public policy and safety laws can be made; these include speed limits, seat belt and helmet laws, and road engineering practices.[55]

Changes to common practices in sports have also been discussed. An increase in use of helmets could reduce the incidence of TBI.[55] Due to the possibility that repeatedly “heading” a ball practicing soccer could cause cumulative brain injury, the idea of introducing protective headgear for players has been proposed.[75] Improved equipment design can enhance safety; softer baseballs reduce head injury risk.[76] Rules against dangerous types of contact, such as “spear tackling” in American football, when one player tackles another head first, may also reduce head injury rates.[76]

Falls can be avoided by installing grab bars in bathrooms and handrails on stairways; removing tripping hazards such as throw rugs; or installing window guards and safety gates at the top and bottom of stairs around young children.[48] Playgrounds with shock-absorbing surfaces such as mulch or sand also prevent head injuries.[48] Child abuse prevention is another tactic; programs exist to prevent shaken baby syndrome by educating about the dangers of shaking children.[51] Gun safety, including keeping guns unloaded and locked, is another preventative measure.[77] Studies on the effect of laws that aim to control access to guns in the United States have been insufficient to determine their effectiveness preventing number of deaths or injuries.[78]

Recent clinical and laboratory research by neurosurgeon Julian Bailes, M.D., and his colleagues from West Virginia University, has resulted in papers showing that dietary supplementation with omega-3 DHA offers protection against the biochemical brain damage that occurs after a traumatic injury.[79] Rats given DHA prior to induced brain injuries suffered smaller increases in two key markers for brain damage (APP and caspase-3), as compared with rats given no DHA.[80] The potential for DHA to provide prophylactic benefit to the brain against traumatic injury appears promising and requires further investigation. The essential concept of daily dietary supplementation with DHA, so that those at significant risk may be preloaded to provide protection against the acute effects of TBI, has tremendous public health implications.[81]

Furthermore, acetylcysteine has been confirmed, in a recent double-blind placebo-controlled trial conducted by the US military, to reduce the effects of blast induced mild traumatic brain and neurological injury in soldiers.[82] Multiple animal studies have also demonstrated its efficacy in reducing the damage associated with moderate traumatic brain or spinal injury, and also ischemia-induced brain injury. In particular, it has been demonstrated through multiple studies to significantly reduce neuronal losses and to improve cognitive and neurological outcomes associated with these traumatic events. Acetylcysteine has been safely used to treat paracetamol overdose for over forty years and is extensively used in emergency medicine.

It is important to begin emergency treatment within the so-called “golden hour” following the injury.[83] People with moderate to severe injuries are likely to receive treatment in an intensive care unit followed by a neurosurgical ward.[84] Treatment depends on the recovery stage of the patient. In the acute stage the primary aim of the medical personnel is to stabilize the patient and focus on preventing further injury because little can be done to reverse the initial damage caused by trauma.[84] Rehabilitation is the main treatment for the subacute and chronic stages of recovery.[84] International clinical guidelines have been proposed with the aim of guiding decisions in TBI treatment, as defined by an authoritative examination of current evidence.[2]

Certain facilities are equipped to handle TBI better than others; initial measures include transporting patients to an appropriate treatment center.[44][85] Both during transport and in hospital the primary concerns are ensuring proper oxygen supply, maintaining adequate blood flow to the brain, and controlling raised intracranial pressure (ICP),[3] since high ICP deprives the brain of badly needed blood flow[86] and can cause deadly brain herniation. Other methods to prevent damage include management of other injuries and prevention of seizures.[15][68] Some data supports the use of hyperbaric oxygen therapy to improve outcomes.[87]

Neuroimaging is helpful but not flawless in detecting raised ICP.[88] A more accurate way to measure ICP is to place a catheter into a ventricle of the brain,[32] which has the added benefit of allowing cerebrospinal fluid to drain, releasing pressure in the skull.[32] Treatment of raised ICP may be as simple as tilting the patient’s bed and straightening the head to promote blood flow through the veins of the neck. Sedatives, analgesics and paralytic agents are often used.[44]Hypertonic saline can improve ICP by reducing the amount of cerebral water (swelling), though it is used with caution to avoid electrolyte imbalances or heart failure.[2]Mannitol, an osmotic diuretic,[2] appears to be equally effective at reducing ICP.[89][90][91] Some concerns; however, have been raised regarding some of the studies performed.[92]Diuretics, drugs that increase urine output to reduce excessive fluid in the system, may be used to treat high intracranial pressures, but may cause hypovolemia (insufficient blood volume).[32]Hyperventilation (larger and/or faster breaths) reduces carbon dioxide levels and causes blood vessels to constrict; this decreases blood flow to the brain and reduces ICP, but it potentially causes ischemia[3][32][93] and is, therefore, used only in the short term.[3] Administration of corticosteroids is associated with an increased risk of death, and so it is recommended that they not be given routinely.[94]

Endotracheal intubation and mechanical ventilation may be used to ensure proper oxygen supply and provide a secure airway.[68]Hypotension (low blood pressure), which has a devastating outcome in TBI, can be prevented by giving intravenous fluids to maintain a normal blood pressure. Failing to maintain blood pressure can result in inadequate blood flow to the brain.[15] Blood pressure may be kept at an artificially high level under controlled conditions by infusion of norepinephrine or similar drugs; this helps maintain cerebral perfusion.[95] Body temperature is carefully regulated because increased temperature raises the brain’s metabolic needs, potentially depriving it of nutrients.[96] Seizures are common. While they can be treated with benzodiazepines, these drugs are used carefully because they can depress breathing and lower blood pressure.[44] TBI patients are more susceptible to side effects and may react adversely or be inordinately sensitive to some pharmacological agents.[84] During treatment monitoring continues for signs of deterioration such as a decreasing level of consciousness.[2][3]

Traumatic brain injury may cause a range of serious coincidental complications that include cardiac arrhythmias[97] and neurogenic pulmonary edema.[98] These conditions must be adequately treated and stabilised as part of the core care for these patients.

Surgery can be performed on mass lesions or to eliminate objects that have penetrated the brain. Mass lesions such as contusions or hematomas causing a significant mass effect (shift of intracranial structures) are considered emergencies and are removed surgically.[15] For intracranial hematomas, the collected blood may be removed using suction or forceps or it may be floated off with water.[15] Surgeons look for hemorrhaging blood vessels and seek to control bleeding.[15] In penetrating brain injury, damaged tissue is surgically debrided, and craniotomy may be needed.[15] Craniotomy, in which part of the skull is removed, may be needed to remove pieces of fractured skull or objects embedded in the brain.[99]Decompressive craniectomy (DC) is performed routinely in the very short period following TBI during operations to treat hematomas; part of the skull is removed temporarily (primary DC).[100] DC performed hours or days after TBI in order to control high intracranial pressures (secondary DC) has not been shown to improve outcome in some trials and may be associated with severe side-effects.[2][100]

Once medically stable, people may be transferred to a subacute rehabilitation unit of the medical center or to an independent rehabilitation hospital.[84] Rehabilitation aims to improve independent function at home and in society and to help adapt to disabilities [84] and has demonstrated its general effectiveness, when conducted by a team of health professionals who specialise in head trauma.[101] As for any person with neurologic deficits, a multidisciplinary approach is key to optimising outcome. Physiatrists or neurologists are likely to be the key medical staff involved, but depending on the person, doctors of other medical specialties may also be helpful. Allied health professions such as physiotherapy, speech and language therapy, cognitive rehabilitation therapy, and occupational therapy will be essential to assess function and design the rehabilitation activities for each person. Treatment of neuropsychiatric symptoms such as emotional distress and clinical depression may involve mental health professionals such as therapists, psychologists, and psychiatrists, while neuropsychologists can help to evaluate and manage cognitive deficits.[84]

After discharge from the inpatient rehabilitation treatment unit, care may be given on an outpatient basis. Community-based rehabilitation will be required for a high proportion of people, including vocational rehabilitation; this supportive employment matches job demands to the worker’s abilities.[102] People with TBI who cannot live independently or with family may require care in supported living facilities such as group homes.[102]Respite care, including day centers and leisure facilities for the disabled, offers time off for caregivers, and activities for people with TBI.[102]

Pharmacological treatment can help to manage psychiatric or behavioral problems.[103] Medication is also used to control post-traumatic epilepsy; however the preventive use of anti-epileptics is not recommended.[104] In those cases where the person is bedridden due to a reduction of consciousness, has to remain in a wheelchair because of mobility problems, or has any other problem heavily impacting self-caring capacities, caregiving and nursing are critical. The most effective research documented intervention approach is the activation database guided EEG biofeedback approach, which has shown significant improvements in memory abilities of the TBI subject that are far superior than traditional approaches (strategies, computers, medication intervention). Gains of 2.61 standard deviations have been documented. The TBI’s auditory memory ability was superior to the control group after the treatment.[57]

Prognosis worsens with the severity of injury.[105] Most TBIs are mild and do not cause permanent or long-term disability; however, all severity levels of TBI have the potential to cause significant, long-lasting disability.[106] Permanent disability is thought to occur in 10% of mild injuries, 66% of moderate injuries, and 100% of severe injuries.[107] Most mild TBI is completely resolved within threeweeks, and almost all people with mild TBI are able to live independently and return to the jobs they had before the injury, although a portion have mild cognitive and social impairments.[77] Over 90% of people with moderate TBI are able to live independently, although a portion require assistance in areas such as physical abilities, employment, and financial managing.[77] Most people with severe closed head injury either die or recover enough to live independently; middle ground is less common.[2] Coma, as it is closely related to severity, is a strong predictor of poor outcome.[3]

Prognosis differs depending on the severity and location of the lesion, and access to immediate, specialised acute management. Subarachnoid hemorrhage approximately doubles mortality.[108] Subdural hematoma is associated with worse outcome and increased mortality, while people with epidural hematoma are expected to have a good outcome if they receive surgery quickly.[68] Diffuse axonal injury may be associated with coma when severe, and poor outcome.[2] Following the acute stage, prognosis is strongly influenced by the patient’s involvement in activity that promote recovery, which for most patients requires access to a specialised, intensive rehabilitation service. The Functional Independence Measure is a way to track progress and degree of independence throughout rehabilitation.[109]

Medical complications are associated with a bad prognosis. Examples are hypotension (low blood pressure), hypoxia (low blood oxygen saturation), lower cerebral perfusion pressures and longer times spent with high intracranial pressures.[2][68] Patient characteristics also influence prognosis. Factors thought to worsen it include abuse of substances such as illicit drugs and alcohol and age over sixty or under two years (in children, younger age at time of injury may be associated with a slower recovery of some abilities).[68] Other influences that may affect recovery include pre-injury intellectual ability, coping strategies, personality traits, family environment, social support systems and financial circumstances.[110]

Life satisfaction has been known to decrease for individuals with TBI immediately following the trauma, but evidence has shown that life roles, age, and depressive symptoms influence the trajectory of life satisfaction as time passes.[111]

Improvement of neurological function usually occurs for two or more years after the trauma. For many years it was believed that recovery was fastest during the first six months, but there is no evidence to support this. It may be related to services commonly being withdrawn after this period, rather than any physiological limitation to further progress.[2] Children recover better in the immediate time frame and improve for longer periods.[3]

Complications are distinct medical problems that may arise as a result of the TBI. The results of traumatic brain injury vary widely in type and duration; they include physical, cognitive, emotional, and behavioral complications. TBI can cause prolonged or permanent effects on consciousness, such as coma, brain death, persistent vegetative state (in which patients are unable to achieve a state of alertness to interact with their surroundings),[113] and minimally conscious state (in which patients show minimal signs of being aware of self or environment).[114][115] Lying still for long periods can cause complications including pressure sores, pneumonia or other infections, progressive multiple organ failure,[84] and deep venous thrombosis, which can cause pulmonary embolism.[15] Infections that can follow skull fractures and penetrating injuries include meningitis and abscesses.[84] Complications involving the blood vessels include vasospasm, in which vessels constrict and restrict blood flow, the formation of aneurysms, in which the side of a vessel weakens and balloons out, and stroke.[84]

Movement disorders that may develop after TBI include tremor, ataxia (uncoordinated muscle movements), myoclonus (shock-like contractions of muscles), and loss of movement range and control (in particular with a loss of movement repertoire).[84] The risk of post-traumatic seizures increases with severity of trauma (image at right) and is particularly elevated with certain types of brain trauma such as cerebral contusions or hematomas.[107] People with early seizures, those occurring within a week of injury, have an increased risk of post-traumatic epilepsy (recurrent seizures occurring more than a week after the initial trauma).[116] People may lose or experience altered vision, hearing, or smell.[3]

Hormonal disturbances may occur secondary to hypopituitarism, occurring immediately or years after injury in 10 to 15% of TBI patients. Development of diabetes insipidus or an electrolyte abnormality acutely after injury indicate need for endocrinologic work up. Signs and symptoms of hypopituitarism may develop and be screened for in adults with moderate TBI and in mild TBI with imaging abnormalities. Children with moderate to severe head injury may also develop hypopituitarism. Screening should take place 3 to 6 months, and 12 months after injury, but problems may occur more remotely.[117]

Cognitive deficits that can follow TBI include impaired attention; disrupted insight, judgement, and thought; reduced processing speed; distractibility; and deficits in executive functions such as abstract reasoning, planning, problem-solving, and multitasking.[118]Memory loss, the most common cognitive impairment among head-injured people, occurs in 2079% of people with closed head trauma, depending on severity.[119] People who have suffered TBI may also have difficulty with understanding or producing spoken or written language, or with more subtle aspects of communication such as body language.[84]Post-concussion syndrome, a set of lasting symptoms experienced after mild TBI, can include physical, cognitive, emotional and behavioral problems such as headaches, dizziness, difficulty concentrating, and depression.[3] Multiple TBIs may have a cumulative effect.[115] A young person who receives a second concussion before symptoms from another one have healed may be at risk for developing a very rare but deadly condition called second-impact syndrome, in which the brain swells catastrophically after even a mild blow, with debilitating or deadly results. About one in five career boxers is affected by chronic traumatic brain injury (CTBI), which causes cognitive, behavioral, and physical impairments.[120]Dementia pugilistica, the severe form of CTBI, affects primarily career boxers years after a boxing career. It commonly manifests as dementia, memory problems, and parkinsonism (tremors and lack of coordination).[121]

TBI may cause emotional, social, or behavioral problems and changes in personality.[122][123][124][125] These may include emotional instability, depression, anxiety, hypomania, mania, apathy, irritability, problems with social judgment, and impaired conversational skills.[122][125][126] TBI appears to predispose survivors to psychiatric disorders including obsessive compulsive disorder, substance abuse, dysthymia, clinical depression, bipolar disorder, and anxiety disorders.[127] In patients who have depression after TBI, suicidal ideation is not uncommon; the suicide rate among these persons is increased 2- to 3-fold.[128] Social and behavioral symptoms that can follow TBI include disinhibition, inability to control anger, impulsiveness, lack of initiative, inappropriate sexual activity, asociality and social withdrawal, and changes in personality.[122][124][125][129]

TBI also has a substantial impact on the functioning of family systems[130] Caregiving family members and TBI survivors often significantly alter their familial roles and responsibilities following injury, creating significant change and strain on a family system. Typical challenges identified by families recovering from TBI include: frustration and impatience with one another, loss of former lives and relationships, difficulty setting reasonable goals, inability to effectively solve problems as a family, increased level of stress and household tension, changes in emotional dynamics, and overwhelming desire to return to pre-injury status. In addition, families may exhibit less effective functioning in areas including coping, problem solving and communication. Psychoeducation and counseling models have been demonstrated to be effective in minimizing family disruption [131]

TBI is a leading cause of death and disability around the globe[133] and presents a major worldwide social, economic, and health problem.[2] It is the number one cause of coma,[134] it plays the leading role in disability due to trauma,[68] and is the leading cause of brain damage in children and young adults.[7] In Europe it is responsible for more years of disability than any other cause.[2] It also plays a significant role in half of trauma deaths.[15]

Findings on the frequency of each level of severity vary based on the definitions and methods used in studies. A World Health Organization study estimated that between 70 and 90% of head injuries that receive treatment are mild,[135] and a US study found that moderate and severe injuries each account for 10% of TBIs, with the rest mild.[64]

The incidence of TBI varies by age, gender, region and other factors.[136] Findings of incidence and prevalence in epidemiological studies vary based on such factors as which grades of severity are included, whether deaths are included, whether the study is restricted to hospitalized people, and the study’s location.[7] The annual incidence of mild TBI is difficult to determine but may be 100600 people per 100,000.[55]

In the US, the case fatality rate is estimated to be 21% by 30days after TBI.[85] A study on Iraq War soldiers found that severe TBI carries a mortality of 3050%.[55] Deaths have declined due to improved treatments and systems for managing trauma in societies wealthy enough to provide modern emergency and neurosurgical services.[96] The fraction of those who die after being hospitalized with TBI fell from almost half in the 1970s to about a quarter at the beginning of the 21stcentury.[68] This decline in mortality has led to a concomitant increase in the number of people living with disabilities that result from TBI.[137]

Biological, clinical, and demographic factors contribute to the likelihood that an injury will be fatal.[132] In addition, outcome depends heavily on the cause of head injury. In the US, patients with fall-related TBIs have an 89% survival rate, while only 9% of patients with firearm-related TBIs survive.[138] In the US, firearms are the most common cause of fatal TBI, followed by vehicle accidents and then falls.[132] Of deaths from firearms, 75% are considered to be suicides.[132]

The incidence of TBI is increasing globally, due largely to an increase in motor vehicle use in low- and middle-income countries.[2] In developing countries, automobile use has increased faster than safety infrastructure could be introduced.[55] In contrast, vehicle safety laws have decreased rates of TBI in high-income countries,[2] which have seen decreases in traffic-related TBI since the 1970s.[47] Each year in the United States, about two million people suffer a TBI,[13] approximately 675,000 injuries are seen in the emergency department,[139] and about 500,000 patients are hospitalized.[136] The yearly incidence of TBI is estimated at 180250 per 100,000 people in the US,[136] 281 per 100,000 in France, 361 per 100,000 in South Africa, 322 per 100,000 in Australia,[7] and 430 per 100,000 in England.[53] In the European Union the yearly aggregate incidence of TBI hospitalizations and fatalities is estimated at 235 per 100,000.[2]

TBI is present in 85% of traumatically injured children, either alone or with other injuries.[140] The greatest number of TBIs occur in people aged 1524.[5][30] Because TBI is more common in young people, its costs to society are high due to the loss of productive years to death and disability.[2] The age groups most at risk for TBI are children ages five to nine and adults over age 80,[105] and the highest rates of death and hospitalization due to TBI are in people over age 65.[106] The incidence of fall-related TBI in First-World countries is increasing as the population ages; thus the median age of people with head injuries has increased.[2]

Regardless of age, TBI rates are higher in males.[30] Men suffer twice as many TBIs as women do and have a fourfold risk of fatal head injury,[105] and males account for two thirds of childhood and adolescent head trauma.[141] However, when matched for severity of injury, women appear to fare more poorly than men.[86]

Socioeconomic status also appears to affect TBI rates; people with lower levels of education and employment and lower socioeconomic status are at greater risk.[7]

Head injury is present in ancient myths that may date back before recorded history.[142] Skulls found in battleground graves with holes drilled over fracture lines suggest that trepanation may have been used to treat TBI in ancient times.[143] Ancient Mesopotamians knew of head injury and some of its effects, including seizures, paralysis, and loss of sight, hearing or speech.[144] The Edwin Smith Papyrus, written around 16501550BC, describes various head injuries and symptoms and classifies them based on their presentation and tractability.[145]Ancient Greek physicians including Hippocrates understood the brain to be the center of thought, probably due to their experience with head trauma.[146]

Medieval and Renaissance surgeons continued the practice of trepanation for head injury.[146] In the Middle Ages, physicians further described head injury symptoms and the term concussion became more widespread.[147] Concussion symptoms were first described systematically in the 16thcentury by Berengario da Carpi.[146]

It was first suggested in the 18th century that intracranial pressure rather than skull damage was the cause of pathology after TBI. This hypothesis was confirmed around the end of the 19thcentury, and opening the skull to relieve pressure was then proposed as a treatment.[143]

In the 19thcentury it was noted that TBI is related to the development of psychosis.[148] At that time a debate arose around whether post-concussion syndrome was due to a disturbance of the brain tissue or psychological factors.[147] The debate continues today.

Perhaps the first reported case of personality change after brain injury is that of Phineas Gage, who survived an accident in which a large iron rod was driven through his head, destroying one or both of his frontal lobes; numerous cases of personality change after brain injury have been reported since.[24][26][27][36][37][41][149][150]

The 20th century saw the advancement of technologies that improved treatment and diagnosis such as the development of imaging tools including CT and MRI, and, in the 21st century, diffusion tensor imaging (DTI). The introduction of intracranial pressure monitoring in the 1950s has been credited with beginning the “modern era” of head injury.[96][151] Until the 20thcentury, the mortality rate of TBI was high and rehabilitation was uncommon; improvements in care made during World War I reduced the death rate and made rehabilitation possible.[142] Facilities dedicated to TBI rehabilitation were probably first established during World War I.[142] Explosives used in World War I caused many blast injuries; the large number of TBIs that resulted allowed researchers to learn about localization of brain functions.[152] Blast-related injuries are now common problems in returning veterans from Iraq & Afghanistan; research shows that the symptoms of such TBIs are largely the same as those of TBIs involving a physical blow to the head.[153]

In the 1970s, awareness of TBI as a public health problem grew,[154] and a great deal of progress has been made since then in brain trauma research,[96] such as the discovery of primary and secondary brain injury.[143] The 1990s saw the development and dissemination of standardized guidelines for treatment of TBI, with protocols for a range of issues such as drugs and management of intracranial pressure.[96] Research since the early 1990s has improved TBI survival;[143] that decade was known as the “Decade of the Brain” for advances made in brain research.[155]

No medication is approved to halt the progression of the initial injury to secondary injury.[55] The variety of pathological events presents opportunities to find treatments that interfere with the damage processes.[2]Neuroprotection methods to decrease secondary injury, have been the subject of interest follows TBI. However, trials to test agents that could halt these cellular mechanisms have met largely with failure.[2] For example, interest existed in cooling the injured brain; however, a 2014 Cochrane review did not find enough evidence to see if it was useful or not.[156] A 2016 review found that maintaining a normal or low normal temperature appeared useful in adults but not children.[157] High quality evidence to support targeted temperature management below normal however is poor.[158]

In addition, drugs such as NMDA receptor antagonists to halt neurochemical cascades such as excitotoxicity showed promise in animal trials but failed in clinical trials.[96] These failures could be due to factors including faults in the trials’ design or in the insufficiency of a single agent to prevent the array of injury processes involved in secondary injury.[96]

Other topics of research have included investigations into mannitol,[159]dexamethasone,[160]progesterone,[161]xenon,[162]barbiturates,[163]magnesium,[164]calcium channel blockers,[165]PPAR- agonists,[166][167]curcuminoids,[168]ethanol,[169]NMDA antagonists,[96]caffeine.[170]

In addition to traditional imaging modalities, there are several devices that help to monitor brain injury and facilitate research. Microdialysis allows ongoing sampling of extracellular fluid for analysis of metabolites that might indicate ischemia or brain metabolism, such as glucose, glycerol, and glutamate.[171][172] Intraparenchymal brain tissue oxygen monitoring systems (either Licox or Neurovent-PTO) are used routinely in neurointensive care in the US.[173] A non invasive model called CerOx is in development.[174]

Research is also planned to clarify factors correlated to outcome in TBI and to determine in which cases it is best to perform CT scans and surgical procedures.[175]

Hyperbaric oxygen therapy (HBO) has been evaluated as an add on treatment following TBI. The findings of a 2012 Cochrane systematic review does not justify the routine use of hyperbaric oxygen therapy to treat people recovering from a traumatic brain injury.[176] This review also reported that only a small number of randomized controlled trials had been conducted at the time of the review, many of which had methodological problems and poor reporting.[176] HBO for TBI is controversial with further evidence required to determine if it has a role.[177][176]

As of 2010, the use of predictive visual tracking measurement to identify mild traumatic brain injury was being studied. In visual tracking tests, a head-mounted display unit with eye-tracking capability shows an object moving in a regular pattern. People without brain injury are able to track the moving object with smooth pursuit eye movements and correct trajectory. The test requires both attention and working memory which are difficult functions for people with mild traumatic brain injury. The question being studied, is whether results for people with brain injury will show visual-tracking gaze errors relative to the moving target.[178]

The original version of this article contained text from the NINDS public domain pages on TBI

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Welcome to the Brain Injury Association of America

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Welcome to the Brain Injury Association of America (BIAA)

Brain injury is not an event or an outcome. It is the startof a misdiagnosed, misunderstood, under-funded neurological disease.People who sustain brain injuries must have timely access to experttrauma care, specialized rehabilitation, lifelong disease management,and individualized services and supports in order to live healthy,independent, and satisfying lives.

BIAA’s mission is to advanceawareness, research, treatment, and education and toimprove the quality of life for all people affected by brain injury. Weare dedicated to increasing access to quality health care and raisingawareness and understanding of brain injury. With a network of state affiliates, local chapters, and support groups, we are the voice ofbrain injury.

Please contact your elected officials and tell them that now is the time to permanently repeal the Medicare therapy cap. Congress needs to take action. What can you do? Call your electe.. Read More…

The Brain Injury Association of Ameirca (BIAA) is pleased to announce that Congressional Brain Injury Task Force, co-chaired by Reps. Bill Pascrell, Jr. (D-N.J.) and Thomas J. Rooney (R-Fla.), has.. Read More…

The latest edition of THE Challenge! is now available for free download. This issue, “Being Your Best Self,” features inspirational stories by brain injury survivors and informative articles by brain .. Read More…

GODSPEED: The Story of Page Jones, was released today on iTunes (, Amazon ( Read More…

Vienna, Va. The Brain Injury Association of America salutes the Trump Administration for directing the Department of Health and Human Services to declare the nations opioid crisis a pub.. Read More…

Please join us for an important briefing The Silent Epidemic in America Brain Injury and Domestic Violence Oct. 25 from 10-11 a.m. in the Congressional Meeting Room North in .. Read More…

Brain injury – including traumatic brain injury and stroke – is not an isolated event or an outcome. For many, the issues become chronic, requiring long-term management of multiple health conditio.. Read More…

The Graham-Cassidy-Heller-Johnson Proposal to Repeal the Patient Protection and Affordable Care Act is moving rapidly, and the Brain Injury Association of America is relying on you to take action .. Read More…

For the second year, the Brain Injury Association of America (BIAA) is proud to be collaborating with a New England student to educate the public on the impact of concussions. Brooke Mills, stud.. Read More…

The Law Offices of De Caro & Kaplen, LLP ( presented the inaugural De Caro & Kaplen, LLP Traumatic Brain Injury Scholarship on September 1, 2017 to Courtney Bruun-And.. Read More…

Award Winners Recognized for Contributions to Research and Clinical Care Vienna, Va. The Brain Injury Association of America (BIAA) has announced that Tessa Hart, Ph.D., has been named .. Read More…

The Brain Injury Association of America lost an important member of our family last month, Alice Demichelis. Alice was an extraordinary advocate for her son, Robert, and for all individuals who su.. Read More…

Click here for more News & Announcements…

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Welcome to the Brain Injury Association of America

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Traumatic brain injury – Diagnosis and treatment – Mayo Clinic

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Because traumatic brain injuries are usually emergencies and because consequences can worsen swiftly without treatment, doctors usually need to assess the situation rapidly.

This 15-point test helps a doctor or other emergency medical personnel assess the initial severity of a brain injury by checking a person’s ability to follow directions and move their eyes and limbs. The coherence of speech also provides important clues.

Abilities are scored numerically in the Glasgow Coma Scale. Higher scores mean less severe injuries.

If you observed someone being injured or arrived immediately after an injury, you may be able to provide medical personnel with information that’s useful in assessing the injured person’s condition.

Answers to the following questions may be beneficial in judging the severity of injury:

Tissue swelling from a traumatic brain injury can increase pressure inside the skull and cause additional damage to the brain. Doctors may insert a probe through the skull to monitor this pressure.

Mild traumatic brain injuries usually require no treatment other than rest and over-the-counter pain relievers to treat a headache. However, a person with a mild traumatic brain injury usually needs to be monitored closely at home for any persistent, worsening or new symptoms. He or she also may have follow-up doctor appointments.

The doctor will indicate when a return to work, school or recreational activities is appropriate. It’s best to avoid physical or thinking (cognitive) activities that make things worse until symptoms have resolved. Most people return to normal routines gradually.

Emergency care for moderate to severe traumatic brain injuries focuses on making sure the person has an adequate oxygen and blood supply, maintaining blood pressure, and preventing any further injury to the head or neck.

People with severe injuries may also have other injuries that need to be addressed. Additional treatments in the emergency room or intensive care unit of a hospital will focus on minimizing secondary damage due to inflammation, bleeding or reduced oxygen supply to the brain.

Medications to limit secondary damage to the brain immediately after an injury may include:

Anti-seizure drugs. People who’ve had a moderate to severe traumatic brain injury are at risk of having seizures during the first week after their injury.

An anti-seizure drug may be given during the first week to avoid any additional brain damage that might be caused by a seizure. Additional anti-seizure treatments are used only if seizures occur.

Emergency surgery may be needed to minimize additional damage to brain tissues. Surgery may be used to address the following problems:

Most people who have had a significant brain injury will require rehabilitation. They may need to relearn basic skills, such as walking or talking. The goal is to improve their abilities to perform daily activities.

Therapy usually begins in the hospital and continues at an inpatient rehabilitation unit, a residential treatment facility or through outpatient services. The type and duration of rehabilitation varies by individual, depending on the severity of the brain injury and what part of the brain was injured.

Rehabilitation specialists may include:

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

A number of strategies can help a person with traumatic brain injury cope with complications that affect everyday activities, communication and interpersonal relationships. Depending on the severity of injury, a family caregiver or friend may need to help implement the following approaches:

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Muscular Dystrophy | Distrofia Muscular | Dystrophy Treatment

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Some Patients Give Up ..

Some others Dont Give Up…

and for Some Others , we don’t let them to Give Up

Even A Slight delay of the Progress of the Disease

Gains Valuable time for our Lives untill the Final Cure .

(M.D & M.S Members of Royal Cells Group )


The Great Importance of delaying the Progress of :

Muscular Dystrophy & Multiple Sclerosis

Muscular Dystrophy & Multiple Sclerosis belong to Degenerative Incurable Diseases today that affect progressively and other Vital organs of the Human Organism with great risk for severe complications .

Until the Day that the Final Cure will be invented , Patients must Follow Natural Remedies that are enabled to Special Nutrition & Special Physiotherapy , that are able to push back & delay the maximum possible the progress of these diseases.

Royal Cells Group contributes to this effort , to Gain the extra time Patients need, in order to stand firm till the cure of these diseases will be discovered in future .

Royal Cells Group

Is a Group of patients – all around the world – who use voluntarily Nectar “T Natural Daily Nutrition additionally with Special food in order to:

*Achieve Natural Reaction of their human Organism to fight by itself their degenerative diseases*Slow down the speed of progress of the degenerative diseases in order to Avoid or Delay complications dangerous for the life of patients*Prevent the expansion of the degenerative Diseases *Succeed a better quality of life .*Increase Life span & Endow the extra time , Patients need , in order to stand firm till the Cure will be discovered in future .

According to Patients reports , Nectar T achieves :for Muscular Dystrophy*Slow down the speed of progress of the disease from 20% up to 70%*Prevent the expansion to other Vital Organs from 30% up to 80%*Succeed a better quality of life from 40% up to 80%

for Multiple Sclerosis*Slow down the speed of progress of the disease from 30% up to 80%*Prevent the expansion to other Vital Organs from 30% up to 80%*Succeed a better quality of life from 30% up to 80%

for Fertility & Pregnancy problems

Outstanding results for Fertility and Pregnancy problems for both Males & Females , due to the capability of Nectar T to grand Bees naturally with the capability to gestate

Nectar T Natural Daily Nutrition is the entire feed of the Queen Bee that Activates the sleeping abilities of the Bee organism in order to extend her life span 40 times more than other bees , make her invulnerable to diseases and grands her also the capability to gestate.This Activation of the sleeping abilities to the bee organism due to Nectar T nutrition – seems to influence positively also the human organism.

Diseases can be helped with Nectar “T”Although -ccording to Official and Non Official reports- Nectar “T” intervenes in about 5000 diseases, Royal Cells Group specializes for :Multiple sclerosisDuchene Muscular Dystrophy Becker Muscular Dystrophy Myotonic Muscular Dystrophy FSH Muscular Dystrophy Congenital Muscular Dystrophy L.G Muscular Dystrophy Friedreich’s Ataxia

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Muscular Dystrophy | Distrofia Muscular | Dystrophy Treatment

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| Muscular Dystrophy Association

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Join Us for the 2018 MDA Clinical Conference

To accelerate progress in our mission to save and improve lives, MDA is proud to bring together more than 500 medical and scientific neuromuscular experts at our 2018 Clinical Conference, to be held March 11-14 at the Hyatt Regency Crystal City in Arlington, Va. Register now to save your seat.

Cytokinetics has reported negative results from its international phase 3 VITALITY-ALS trial to test the investigational drug tirasemtiv in people with ALS. The trial missed its primary endpoint of change from baseline in SVC after 24 weeks of treatment with tirasemtiv as compared to placebo. Based on these results, Cytokinetics has announced it will suspend the development of tirasemtiv.

We’re happy to announce more than $3 million in funding for 13 new research grants. They join the 29 research and development grants already announced this year in the quest to end muscular dystrophy, ALS and related life-threatening diseases. Read on to learn about the summer 2017 grant recipients and research projects the MDA community is now supporting.

Alexion Pharmaceuticals announced Oct. 23, 2017, that the U.S. Food and Drug Administration (FDA) has approved eculizumab (brand name Soliris) as a treatment for adult patients with generalized Myasthenia Gravis (gMG) who are anti-acetylcholine receptor antibody-positive. Soliris is the first in a new class of drugs to be approved for MG in the U.S.

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