Video Transcript - Damage Control: Diagnosing and Treating Mild Traumatic Brain Injury

Brain MRI

Jerry's story:
I was on a bike ride on a Sunday morning, and I don't remember falling. The next thing I remember is being woken up by the paramedics and being put into the ambulance.

Inside concussions:
We were on a foot patrol en route to a raid on an IED cell. I was leading my team across this intersection. All I remember is being lifted up and landing on my back and looking at the stars.

Josh's story:
As a result of my injury, though, I just can't get my left arm and leg to work the way I want it to. And it's frustrating, frustrating, frustrating!

Traumatic brain injury (TBI) is a growing concern, particularly among young athletes and members of the military.

Dr. Alain Ptito
Neuropsychologist
Montreal Neurological Institute
McGill University

A traumatic brain injury occurs when a force, a blunt force or a penetrating force, is applied to the head and causes an alteration in brain function.

The causes may range from motor vehicle accidents to falls to sports and recreation accidents.

TBI range from mild concussions to severe brain injuries.

Dr. Heidi Sveistrup
Professor
University of Ottawa

The majority of TBIs are mild, or concussions, where there may be a brief change in a person's mental status, or level of consciousness. Symptoms may not be that severe. And on the other end of the spectrum, they can be quite severe, where you have extended periods of loss of consciousness, periods of amnesia, and severe traumatic brain injuries can result in death.

Dr. Donald T. Stuss
Scientific Director
Ontario Brain Institute

But in general, traumatic brain injury means some cell death, some brain damage directly due to the trauma.

Researchers are attempting to improve diagnostic techniques, particularly for mild TBI, such as concussions.

Alain Ptito: An fMRI looks at the functional. The f stands for functional – so functional magnetic resonance imaging. And what we do is we look at the activity of the brain while the individual is carrying out a task.

And we are hoping to put together the structural MRI and the functional MRI to arrive at a better diagnosis.

We have shown that when the subject that has symptoms is carrying out a task, the areas that are involved, the brain areas that are involved in that task lack activation – they are hypoactivated. And as the symptoms resolve, those regions of the brain that are hypoactivated, or have less activation, come back to normal.

TBI symptoms vary widely, depending on which part of the brain is damaged.

Donald T. Stuss: So there are people who are dizzy, because the vestibular, or balance system is affected. There are people who are just slow in processing. So if you disconnect, again think of the way neurons are connected, if you have faults in the linkages of the brain, things will be slower.

Damage is primarily in the frontal and temporal lobes – not always, but primarily. These areas themselves are very complex. And damage if it's in a particular part will cause different symptoms, different problems.

Currently, there are limited treatment options for patients with TBI.

Donald T. Stuss: Part of the problem in the treatment approaches for TBI is the fact that medically, there's not much we can do. If, for example, there is a hemorrhage, we can deal with that. So you need to stabilize the individual. We haven't yet got to the point that we can say, "We can stop these neurons from deteriorating and breaking apart." So people are doing very basic research trying to understand the pipeline of changes after TBI that ends up in brain cell death.

So if we're looking at the viewpoint of the treatment approaches, one of them is education, one of them is waiting, but the third is, to a great degree, teaching people cognitive strategies – so brain training. And the strategy we are teaching people is how to use their abilities in a way to compensate.

Technologies such as virtual reality (VR) may help facilitate recovery from TBI.

Heidi Sveistrup: In virtual reality therapy, computers are used to create environments where users have the opportunity to interact with virtual objects within a virtual world.
It's important to note that the virtual reality therapy doesn't replace a therapist, but rather it's used by a therapist as an adjunct approach. So in our study we have the therapist working alongside the user inside the virtual world.

Virtual reality systems can be used to provide feedback about the results of a movement. So a knowledge of results – were you successful in the task? But of equal importance, the virtual reality systems can be set up to provide knowledge of performance – information about how the person did the task.

With adult traumatic brain injury survivors, who were more than two years post-injury, we were able to show that a 5–6 week program of fairly intense exercise resulted in significant improvements in clinical measures of balance and mobility.

Some of the most interesting results, however, were the more personal comments that our participants and some of their family members made as the individuals were participating in our studies. For example, one participant said that because of his improvements in balance, he and his dad had signed up for weekly doubles badminton. And he reported that he didn't think that he would have tried to do this before the program.

Much more research is needed to improve the diagnosis and treatment of TBI.

Alain Ptito: We are hoping to develop tools that will be sensitive enough to detect changes in structure, to detect potential damage following a traumatic brain injury.
Heidi Sveistrup: For virtual reality therapy, many research groups including our own will continue to identify key aspects of virtual reality therapy that will be most beneficial to an individual with a traumatic brain injury.

Donald T. Stuss: We need to have the kinds of studies that are integrative, that take a look at imaging, that have an approach that is interdisciplinary, that follows patients, not just in the hospital at the surgical side, but follows patients into their homes. We need to have studies that understand what environment they return to, what they need to adapt their lives, and how they are coping.

Credits:

"Brain MRI," Rishi Kumar

"Inside Concussions," U.S. Army

"Jerry's Story" and "Josh's Story," Be Smart. Be Well. This video or a portion of this video is the property of Health Care Service Corporation. All rights reserved.