Traumatic Brain Injury

nancy chiavorlotti

Traumatic Brain Injury Research at Kessler Foundation explores the effects of brain injury and tests the effectiveness of rehabilitation treatments to improve quality of life for individuals with traumatic brain injury (TBI). A TBI is caused by a bump, blow, or jolt to the head that causes damage to the brain. It is estimated that 1.7 million people in the US sustain a TBI each year. According to the New Jersey Department of Health and Human Services, approximately 175,000 NJ residents are currently living with disabilities caused by brain injury. TBI  is also the signature wound of our veterans returning from Iraq and Afghanistan. Immediate medical intervention is necessary to prevent further consequences of the injury. Common effects of a TBI include lack of proper social inhibition and etiquette, deficits in cognition, chronic cognitive fatigue, difficulty formulating strategies and performing numerous tasks, and a lack of motivation to start a task.

Directed by Nancy Chiaravalloti, PhD, Kessler Foundation’s TBI Research examines the social and cognitive—thinking, learning, and memory—problems that result from brain injury. Researchers develop interventions to increase a person’s ability to socialize, perform complex tasks, return to work, and feel like integrated members of society. TBI findings are published in international peer-reviewed medical journals. Research is funded through private, state and federal agencies. All research studies are non-invasive. Participants are tested through paper and pencil tests, computer assessments, and neuroimaging. Kessler Foundation is a leader of neuroimaging research and examines the structure of the brain, changes over time, and brain activity when performing various thinking tasks. In 2013, studies will utilize the Foundation’s new 3T MRI scanner. Kessler Foundation will be the only organization to have its own in-house imaging center strictly for research purposes. The Foundation is also partnering with the University of Southern California to use virtual reality technology to assess individuals before and after treatment. Learn about active studies and how to participate in TBI research studies.

The Foundation conducts additional TBI research in its Neuroscience and Neuropsychology Laboratory, which also studies other neurological disorders. Kessler Foundation’s TBI Research is known as a center for excellence around the nation. It is the lead site for the Northern New Jersey Traumatic Brain Injury Model System (NNJTBIS)—a collaborative effort between Kessler Foundation, Kessler Institute for Rehabilitation, the University of Medicine and Dentistry of New Jersey (UMDNJ), Saint Joseph’s Regional Medical Center, Morristown Medical Center, and Hackensack University Medical Center. Model systems are federally-funded grants through the National Institute on Disability and Rehabilitation Research (NIDRR) that promote collaboration through research to develop a standard of care and identify what issues matter most to individuals with TBI in order to live full and satisfying lives. As a data collection site, Kessler Foundation follows a person from the time of injury throughout their lives. Model systems also evaluate individuals with the disability across all demographic and geographic backgrounds. Kessler Foundation is one of only eight centers in the nation with dual model systems in TBI and spinal cord injury (SCI). Read the latest TBI newsletter, presented by Kessler Foundation and its NNJTBIS collaborators.

Recent News & Research Discoveries for individuals with traumatic brain injury:

◾The New Jersey Commission on Brain Injury Research recently awarded grants to Kessler Foundation’s Starla Weaver, PhD, a post doctoral fellow, and Helen Genova, PhD, a research scientist. Dr. Weaver’s study will focus on deficits in executive functions—such as planning, organizing, and performing tasks in a sequence—after TBI. Deficits in executive function lead to less independence in social and employment settings. Dr. Weaver will seek to improve executive function in TBI through targeting the process of task switching, which is thought to control many executive functions. Dr. Genova will strive to predict the progress of cognitive dysfunction, a common disability caused by TBI, in an effort to improve early rehabilitation and guide patients and families along the recovery process. To assess the brain, she will use diffusion tensor imaging (DTI) to study the location, track, maturation, and orientation of the brain’s white matter.

◾Fatigue is commonly reported by people with TBI. Anthony Lequerica, PhD, research scientist at Kessler Foundation, explores the causes of fatigue in his line of research as well as in collaborative NNJTBIS research. He and his colleagues discovered that while fatigue is an indicator of poor quality of life, it is generally not caused by insomnia. Sleep quality, however, is a factor of fatigue. Dr. Lequerica is currently studying the effects of Rozerem—a common sleep aide—on sleep quality and, therefore, daytime fatigue. As daytime fatigue decreases, individuals with TBI can engage in more activities and improve their overall life satisfaction.

◾The TBI Model Systems examine recovery across various races, cultures, ethnicities, and socioeconomic communities. Anthony Lequerica, PhD, Denise Krch, PhD, research scientists at the Foundation, and their model systems collaborators are examining the best ways to evaluate quality of life among the Hispanic population and the factors influencing employment post-injury. They found that age of injury, Functional Independence Measure (FIM) scores, and employment status at one year post-injury are the most important factors in determining life satisfaction. While 77 percent of Hispanic individuals are competitively employed prior to their injuries, only 27.8 percent are employed one year following their TBI. Factors influencing employment include pre-injury employment and education, cause of the injury, Glasgow Coma Scale at emergency admission, associated SCI, days of amnesia, vocational scores at rehabilitation discharge, FIM cognitive and motor scores at rehabilitation discharge, days in acute care, and days in rehabilitation care.

◾TBI researchers at Kessler Foundation recently analyzed demographic factors that are associated with rehabilitation progress after TBI. They found that even after controlling for injury severity and age, other factors such as education level and income at the time of injury showed significant relationships with patient progress in rehabilitation. It is possible that education and income are associated with a complex set of variables indicative of socioeconomic status. Gaining a better understanding of how these demographic factors interact can help medical professionals be more equipped to know how to help each person as he or she recovers

 

What is Traumatic Brain Injury?

Traumatic brain injury (TBI), a form of acquired brain injury, occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue.  Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain.   A person with a mild TBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking.  A person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation.

Is there any treatment?

Anyone with signs of moderate or severe TBI should receive medical attention as soon as possible. Because little can be done to reverse the initial brain damage caused by trauma, medical personnel try to stabilize an individual with TBI and focus on preventing further injury. Primary concerns include insuring proper oxygen supply to the brain and the rest of the body, maintaining adequate blood flow, and controlling blood pressure. Imaging tests help in determining the diagnosis and prognosis of a TBI patient. Patients with mild to moderate injuries may receive skull and neck X-rays to check for bone fractures or spinal instability. For moderate to severe cases, the imaging test is a computed tomography (CT) scan. Moderately to severely injured patients receive rehabilitation that involves individually tailored treatment programs in the areas of physical therapy, occupational therapy, speech/language therapy, physiatry (physical medicine), psychology/psychiatry, and social support.

 

What is the prognosis?

 Approximately half of severely head-injured patients will need surgery to remove or repair hematomas (ruptured blood vessels) or contusions (bruised brain tissue). Disabilities resulting from a TBI depend upon the severity of the injury, the location of the injury, and the age and general health of the individual. Some common disabilities include problems with cognition (thinking, memory, and reasoning), sensory processing (sight, hearing, touch, taste, and smell), communication (expression and understanding), and behavior or mental health (depression, anxiety, personality changes, aggression, acting out, and social inappropriateness). More serious head injuries may result in stupor, an unresponsive state, but one in which an individual can be aroused briefly by a strong stimulus, such as sharp pain; coma, a state in which an individual is totally unconscious, unresponsive, unaware, and unarousable; vegetative state, in which an individual is unconscious and unaware of his or her surroundings, but continues to have a sleep-wake cycle and periods of alertness; and a persistent vegetative state (PVS), in which an individual stays in a vegetative state for more than a month.