Review shows computerized training can help TBI and stroke victims

  • The first review of computerized training programs to improve attention in those who have suffered a brain injury has reported favorably.

A systematic literature review of computerized training for attention and executive function in adults who suffered a brain injury (TBI or stroke) has concluded that there is encouraging evidence that such programs can help.

The review found 23 of 28 studies reported significant improvements in attention and executive function, with the remaining five showing promising trends. The studies included 11 that focused on TBI, of which 8 reported significant improvement; 5 that focused on stroke, of which all 5 showed significant improvement; 12 mixed-populations, of which 10 showed significant improvement.

Further studies are needed to confirm these results, as various methodological issues, such as a small number of participants, and inadequate controls, need to be addressed. The 28 studies included 9 that were rates as "class I" (the highest standard), 9 class II, and 7 that were class III (no controls). Almost all (26/28) of the studies involved fewer than 50 participants, with some having as few as 1 to 4. Most studies didn't specify how severe the injuries were, something which makes a big difference to treatment and expectations. Over a third of the studies (11) didn't have any control group, and only a few used the best sort of control - a comparable activity (as opposed to, say, no treatment). Only four studies provided any long-term follow-up.

As you can see, a lot of work is needed yet. Moreover, most programs were unique to the study, so we're still some way off producing recommended protocols. Only one program was used on multiple occasions (5): Cogmed QM (originally called RoboMemo).

Still, notwithstanding all these caveats, the review does support the value of specific training for those suffering brain injury.



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Why rest is critical after a concussion

  • A mouse study shows how repeated concussions affect the brain, and confirms the value of having several days of rest after injury.

In the study, mice were repeatedly given extremely mild concussive impacts while anesthetized. The brain's response to a single concussion was compared with an injury received daily for 30 days and one received weekly over 30 weeks.

Mice with a single insult temporarily lost 10-15% of their neuronal connections (dendritic spines), but there was no inflammation or cell death. With three days rest, all neuronal connections were restored.

However, those given daily concussions did not show a loss in dendritic spines, and it's thought that the brain habituates to the repeated shocks. It's further suggested that the loss of synapses is actually a protective effect, allowing the brain to regain normal calcium flow. The long-term effect of this not happening is unknown.

Those given a week of rest between each insult did show the normal dendritic spine loss, however.

Additionally, when a mild concussion occurred each day for a month, there was inflammation and damage to the white matter, and this damage continued for months after the last impact.

These findings are consistent with what has been seen in humans, where white matter inflammation has been found to be a long-lasting consequence of TBI.

On a more positive note, in this model of very mild concussion, there was no increase in tau tangles, suggesting this might be limited to more serious injuries.



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Tau tangles why TBI increases risk of Alzheimer's

  • Mouse study shows tau tangles may be behind increased Alzheimer's risk for those who have suffered a traumatic brain injury.

We know that traumatic brain injury increases the risk of later developing neurodegenerative disorders such as Alzheimer's disease, but we haven't known why. New mouse studies suggest a reason.

In the research, mice who had a toxic form of tau protein (taken from mice who had suffered TBI) injected into their hippocampus, showed impaired memory and cognition. Moreover, levels of the aggregated tau protein not only increased in the hippocampus, but also in the cerebellum (which is quite some distance away from the hippocampus). This is consistent with other research showing that tau tangles spread from the initial injection site, using mice modeling Alzheimer's disease.

The study followed on from previous research showing that this form of tau protein increases after a traumatic brain injury and may contribute to development of chronic traumatic encephalopathy (a condition experienced by many professional athletes and military personnel).

The findings support the hypothesis that many of the symptoms of TBI may be down to an increase in these tau tangles, and that this may also be responsible for the increased risk for neurodegenerative disease. As an obvious corollary, it also suggests that the tau tangles are an important therapeutic target.



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Reduced blood flow in brain after clinical recovery from concussion

  • Some athletes who experience sports-related concussions have reduced blood flow in parts of their brains even after clinical recovery.

Adding to evidence that the standard assessments are inadequate to determine whether concussed athletes are fit to return to action, an advanced MRI technique that detects blood flow in the brain shows that hat brain abnormalities persist beyond the point of clinical recovery after injury.

The study compared 18 concussed players and 19 non-concussed players. For the concussed players, MRI was taken within 24 hours of the injury and eight days afterward. Baselines were taken before the football season.

While clinical assessments showed that the concussed players were back to normal at the eight day mark, the MRI demonstrated a significant blood flow decrease at eight days compared to the first post-injury MRI.

While the significance of this is still not clear, it may be that the brain is more vulnerable to another injury.

The study was presented at the annual meeting of the Radiological Society of North America (RSNA).



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Brain connectivity changes with working memory after TBI

  • A brain imaging study reveals how working memory is impaired after traumatic brain injury.

Brain imaging while 11 individuals with traumatic brain injury and 15 healthy controls performed a working memory task has revealed that those with TBI showed greater connectivity between the hemispheres in the fronto-parietal regions (involved in working memory) and less organized flow of information from posterior to anterior parts.

The study used a new task, known as CapMan, which allows working memory capacity and the mental manipulation of information in working memory to be distinguished from each other.

The discovery may help in the development of more effective therapies.



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Childhood concussions impair brain function two years later

  • A small study found children who had experienced a sports-related concussion two years earlier still showed cognitive impairments, with younger children showing greater deficits.

A study involving 30 children (aged 8-10), of whom 15 had experienced a sports-related concussion two years earlier, and all of whom were athletically active, found that those with a history of concussion performed worse on tests of working memory, attention and impulse control, compared to the controls. This impaired performance was also reflected in differences in brain activity. Additionally, those who were injured at a younger age had the largest cognitive deficits.

All of this points to a need for focused and perhaps prolonged interventions, especially for younger children.



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Concussion not well understood, but widely feared

  • A survey of US adults suggests worry about concussion goes hand in hand with a lack of understanding.

An online national survey of 2,012 adult Americans (of whom 948 were parents) has found that, while the vast majority (87%) don’t know the definition of a concussion and many don’t know the injury is treatable, there is a high level of concern and even fear across the country.

  • 89% believe concussions are a moderate to severe health concern
  • 32% of parents live in fear that their child will get a concussion
  • 25% of parents do not let their kids play some contact sports because of fear of concussion
  • while 57% have personal experience with concussions, 26% did not see a health care professional when someone in their family had one
  • 37% admit that they are confused about what a concussion truly is
  • headaches, and dizziness/motion sensitivity are recognized as symptoms by 58%, and cognitive difficulty by 55%
  • only 34% recognize fatigue as a symptom, and only 13% recognize changes in mood as a symptom
  • 79% incorrectly believe or are unsure that there is no real way to cure a concussion; the symptoms can only be lessened
  • 81% aren’t comfortable that they would know how to manage or treat a concussion if they sustained one
  • only 49% know that a person doesn't need to stay awake for 24 hours after sustaining a concussion
  • only 25% understand that safety equipment—such as helmets or mouth guards—cannot prevent the majority of all concussions


The full report can be downloaded at http://rethinkconcussions.com/wp-content/uploads/2015/09/harris-poll-report.pdf


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Trauma changes the brain even in those without PTSD

  • A review of previous research has compared brain activity in those with PTSD who experienced trauma, those who experienced trauma but didn't develop PTSD, and those who never experienced trauma.
  • Those who had PTSD had differential activity in two brain regions.
  • Those who had experienced trauma had differential activity in several brain regions associated with emotional regulation, regardless of whether they'd developed PTSD.

A meta-analysis of studies reporting brain activity in individuals with a diagnosis of PTSD has revealed differences between the brain activity of individuals with PTSD and that of groups of both trauma-exposed (those who had experienced trauma but didn't have a diagnosis of PTSD) and trauma-naïve (those who hadn't experienced trauma) participants.

The critical difference between those who developed PTSD and those who experienced trauma but didn't develop PTSD lay in the basal ganglia. Specifically:

  • PTSD brains compared with trauma-exposed controls showed differentially active regions of the basal ganglia
  • trauma-exposed brains compared with trauma-naïve controls revealed differences in the right anterior insula, precuneus, cingulate and orbitofrontal cortices, all known to be involved in emotional regulation
  • PTSD brains compared with both control groups showed differences in activity in the amygdala and parahippocampal cortex.

The finding is consistent with other new evidence from the researchers, that other neuropsychiatric disorders were also associated with specific imbalances in specific brain networks.

The findings suggest that, while people who have experienced trauma may not meet the threshold for a diagnosis of PTSD, they may have similar changes within the brain, which might make them more vulnerable to PTSD if they experience a subsequent trauma.

The finding also suggests a different perspective on PTSD — that it “may not actually be abnormal or a 'disorder' but the brain's natural reaction to events and experiences that are abnormal”.



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Bright light therapy may help those with mild TBI

A small study involving 18 individuals with at least one mild traumatic brain injury with related sleep disturbance has shown that six weeks of morning bright light therapy resulted in a marked decrease in subjective daytime sleepiness, and improved nighttime sleep.

Sleep, because of its role in brain plasticity, is likely to be important for brain recovery, but unfortunately sleep problems are common in those with TBI.

The research was presented on June 3, in Baltimore, Md., at SLEEP 2013, the 27th annual meeting of the Associated Professional Sleep Societies LLC.



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