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Brain Injury Awareness: Life After Diagnosis

Tuesday, March 22, 2016

An estimated 2.4 million people in the United States, including children, sustain a traumatic brain injury, according to the Brain Injury Association of America. And another 795,000 individuals sustain an acquired brain injury from non-traumatic causes. Traumatic brain injuries are defined as an alteration in brain function often caused by falls, assault or a person’s head being struck by or against something.

Brain injuries can range from mild to severe and have an effect on the way a person interacts with his or her environment. This can include physical impairments such as speech, vision, hearing and motor coordination, as well as cognitive impairments such as short-term memory deficits, slowness of thinking and limited attention span.

During National Brain Injury Awareness Month, most organizations will focus on prevention methods, which are crucial. However, we must not forget those individuals who have suffered an injury and whose quality of life may be changed forever.

Duke University School of Nursing (DUSON) faculty members Karin Reuter-Rice, PhD, CPNP-AC, FCCM, FAAN, and Charles Vacchiano, PhD, CRNA, FAAN, have both dedicated countless hours to studying the changes that occur as a result of brain injury.

Reuter-Rice’s research focuses on genetic markers associated with brain injury and neurocognitive-functional outcomes in children and adolescents. Children, 0 to 4 years old, are at risk for suffering brain injury as a result of a fall or abuse such as shaken baby syndrome, whereas adolescents are more likely to sustain a brain injury from sports or a motor vehicle collision.

Vachianno's research focuses on uncovering concussion damage to reveal hidden deficits. During a 26-year career in the U.S. Navy, Vacchiano worked as a nurse anesthetist and director of the Biomedical Sciences Division at the Naval Aerospace Medical Research Laboratory. He learned a lot about how the brain behaves when exposed to certain stressors.

One post-injury factor that contributes to an individual’s quality of life is emotional impairments. “Cutting-edge research has helped us determine that individuals who’ve suffered a brain injury have a higher rate of depression and suicide, are socio-economically disparate and face other negative social outcomes,” Reuter-Rice said. “For instance, if a child experiences a brain injury, whether mild or severe, their life changes. They go from being a healthy active child to temporarily or permanently losing the ability to live a life. It may prevent playing outside with their friends and/or playing organized sports.”

“These children start to feel isolated and often times will experience personality changes that most families aren’t equipped to deal with. We know that older children are at risk for substance abuse because they look for ways to feel better,” she added.

While science has improved over the years to offer more options for adults, there is still a need for more nursing science to help back up the recommendation for post-care recovery in pediatrics.

“Even for families who have health insurance, there are a limited number of visits for physical, occupational and speech therapy. If a patient doesn’t make a full recovery before their visits expire, what happens then?” Reuter-Rice said.

Unlike the cases that Reuter-Rice often sees, the patients that Vacchiano sees as part of his study may have less obvious signs of a brain injury. “For individuals who suffer a concussion, the full cognitive effects may not be immediate,” he said. “Long-term post-concussion cognitive problems may occur months or even years after the injury. So, wouldn’t it be great to be able to diagnose individuals who will potentially develop long-term cognitive impairment and get them treatment before it affects their quality of life?”

For two years, Vacchiano has been testing a simple way to do just that – exposure of patients who have had a concussion to mild hypoxia, or a mild reduction in the amount of oxygen they breathe. Exposure to mild hypoxia can impair some degree of normal cognitive function that is masking or covering up an existing cognitive defect due to a concussion. Uncovering the cognitive defect might allow it to show up on conventional computerized cognitive testing as a reduction in reaction time or memory or higher thinking processes and suggest the patient should seek follow-up care.

Since the start of this study, 64 individuals have participated. Half of the participants have been diagnosed as having a concussion at some point in their life and the other half serve as a normal control group for comparison.

Vacchiano induces the mild state of hypoxia with a device he developed and patented called the Reduced Oxygen Breathing Device. This device delivers a custom mixture of oxygen and nitrogen through a mask, simulating any type of reduced-oxygen environment desired. According to Vacchiano, most people aren’t able to notice the difference in the various oxygen concentrations. For the testing method to be considered of clinical value, people who have had a concussion and have some degree of ongoing cognitive impairments due to the damage will do slightly worse on a cognitive test than those who have not had a concussion.

“Individuals who perform slightly worse on the cognitive test and reflect hidden impairments in the part of the brain that’s been damaged would give us the evidence needed to take steps to treat them,” said Vacchiano. “Providing treatment earlier would potentially provide us with a window of opportunity to prevent long-lasting impairments.”

Both Vacchiano and Reuter-Rice agree that more research on recovery after brain injury can improve the physical, cognitive and emotional quality of life for patients with brain injuries and their families.