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As we live longer lives, we should all be concerned with the greatest human asset—our mental capacity.

Dianne Cash, BrainHealth Leadership Council

Traumatic Brain Injury (TBI)

The Center for BrainHealth devotes significant research attention to traumatic brain injury (TBI). For good reason. TBI resulting from a car crash, fall, sports concussion, or similar head shock can turn normal life upside down in an irrevocable instant. Many brain injury survivors are unable to lead independent lives after their trauma. In fact, Centers for Disease Control reports estimate that five-and-a-half million Americans require daily assistance as a direct result of a TBI.

Traumatic brain injury is the leading cause of acquired long-term disability, with the highest rates occurring during adolescence, a period when important brain abilities are still in development. In one study, researchers at BrainHealth investigate whether one month of intensive Center-developed Strategic Memory and Reasoning Training (SMART) or fact-based (rote memory) training:

  • Enhances critical thinking skills in adolescents with chronic TBI

  • Generalizes to non-trained functions of the brain


This study:

  • Evaluates the outcomes of SMART (which has a proven record of success teaching students to derive core or gist meanings while eliminating unimportant details) or rote memory training on measures of frontal lobe (the area of the brain paramount to productive mental robustness that allows successful navigation through daily decision-making and problem-solving) function that are not directly part of the training

  • Importantly, uses the latest functional magnetic resonance imaging (fMRI) – which takes a motion picture of the brain as it learns new tasks – before and after training to view any resulting changes in the brain


Two dozen participants between the ages of 12 and 18, each of whom suffered either a moderate or severe TBI at least one year prior, will be recruited. Following baseline assessments, participants will be randomly placed into either SMART or rote memory training groups. Group members will then undergo eight 45-minute one-on-one training sessions over 30 days using identical text-based content. The effects of training will be measured immediately following the training as well as one month later; generalized effects of training will also be evaluated immediately after training, utilizing separate measures of inhibition, working memory, nonverbal reasoning, and reading comprehension. Participants will undergo 30-minute fMRI scans before and immediately following training, too. Significance: To date, few studies have concentrated on repairing higher-order brain function in adolescents with TBI, despite scientific evidence of the brain’s ability to modify itself in response to intensive training. This novel Center for BrainHealth-designed research study searches for ways that traumatic brain injury impairment can be reduced in these young people.

Center for BrainHealth scientists explore in depth the cognitive effects of traumatic brain injury (TBI) on children in other ways, too. “It is important for us as researchers to know what’s going on neuroanatomically in youth with TBI so that we can better target specific areas in therapy,” said Lori Cook, Ph.D., who directs children with head injury studies at the Center.

Towards that end, BrainHealth investigators have developed research projects that specifically examine youth with TBI. In a paper published in the peer-reviewed journal Topics in Language Disorders, Sandi Chapman, Ph.D., chief director of the Center for BrainHealth, Jacque Gamino, Ph.D., the Center’s head of Attention Deficit Hyperactivity Disorder research, and Dr. Cook reported study results that revealed that youth with TBI were able to recall specific details at a comparable level to their non-TBI peers, although those with injury demonstrated significantly reduced ability to combine details into broader abstracted ideas.

BrainHealth's Drs. Chapman and Cook recently presented important findings to the annual business and scientific meeting of the Academy of Neurologic Communication Disorders and Sciences (ANCDS) in New Orleans. Their kickoff talk at the conference was entitled “Neurocognitive Stall in Pediatric TBI: New Directions for Preventing Later Emerging Deficits.” In it, they explained what “neurocognitive stall” means in regard to pediatric traumatic brain injury, discussed proactive methods for detecting and monitoring later emerging deficits in teenagers who have suffered earlier brain injuries, and raised awareness of cognitive training protocols to mitigate later impairments in higher-order cognitive skills in adolescents with chronic brain injury.

Recent behavioral and imaging research has shown that, in order to maximize brain function, TBI treatment strategies need to be directed to higher-order critical thinking skills mediated by the brain’s frontal lobes. Center for BrainHealth-developed SMART, a treatment program created to address such higher-order abilities as strategic attention and complex reasoning, offers fresh hope for TBI patients.

The Center’s Molly Keebler and Asha Vas had their work with TBI patients recently recognized by BrainHealth’s Think Ahead Group (TAG), a troupe of young professionals with a singular passion: promoting brain health. The pair’s research entitled “Neuroscience to Neuro-Rehabilitation: New Frontiers in Brain Training” won the TAG Research Award based on its proven potential to help brain injury survivors lead better, more independent lives. The inaugural $25,000 award, selected in a blind ballot voted on by members of TAG’s Board of Directors, was selected from two dozen research proposals. The funding will allow Mrs. Keebler, a Center research clinician of long standing, and Mrs. Vas, a doctoral student, to expand their life-enhancing TBI research.

Did You Know?

  • Countless individuals experience brain injuries and never receive medical care.
  • 1.4 million brain injuries occur in the United States each year.
  • Symptoms of a brain injury may not appear until days or weeks following an injury.
  • Some brain injuries go unrecognized because people look fine even though they act or feel differently.

Center for BrainHealth Programs

Center for BrainHealth is currently working on a variety of notable studies of adult and childhood traumatic brain injury. These projects examine genetic factors and recovery, assessment and virtual reality intervention for social cognition problems, cognitive and psychological outcomes compared with structural changes in the brain, memory deficits detected in functional brain imaging, and growth hormone abnormalities following injury. More information about brain injury is available in the Research and Clinical/Treatment sections.

About Traumatic Brain Injury

Traumatic brain injury (TBI) occurs when an individual sustains an injury to the head and internal brain damage results. The damage may be restricted to a small specific area of the brain or may be more serious and involve more comprehensive harm. Depending on the size and location of the injury, cognitive deficits and behavioral issues often emerge. TBI is a common consequence from accidents, such as motor vehicle collisions, and is the most common cause of death in children in the United States.

Brain injuries are classified in terms of mild, moderate, and severe based on the extent of damage. Symptoms vary by type of injury and by individual, but many common symptoms occur. Some examples of immediate symptoms include:

  • Dizziness
  • Headaches
  • Blurred vision
  • Coma
  • Seizures

More long-term effects can emerge. Examples of these symptoms include:

  • Memory problems
  • Lack of inhibition
  • Intense anger and/or aggression
  • Personality changes
  • Inattention and lack of concentration
  • Problems organizing, planning, and problem-solving
  • Language impairment


Treatment

Periodic evaluation of physical, cognitive, emotional, behavioral, and language skills is important following a TBI to determine what problems a patient is experiencing. Though progress is often expected in these areas during recovery, focusing on specific areas of concern can speed recovery and aid the patient in compensating for deficits.
Immediate treatment involves care to life-threatening injuries. Often surgery is necessary to remove blood clots in the brain, drain excess fluid in the brain, or to remove a portion of the skull to allow for brain swelling. Once a patient is stabilized, care is individualized to the patient’s needs. Rehabilitation of physical, cognitive, and speech problems often is necessary.