Traumatic Brain Injury

A traumatic brain injury can happen to anyone—a fall, a vehicle accident, a sport-related mishap. The AMS Vans Traumatic Brain Injury section keeps you current on topics dealing with brain injuries, including emerging treatments, technological advancements and caring for people with traumatic brain injuries.

‘Battle Mind’ One Reason for Large Number of Vets with TBI

Veterans and TBI - Traumatic Brain Injury

Traumatic brain injury, or TBI, has been dubbed the signature injury for soldiers involved in the war on terror, due largely to the insurgent style of fighting using roadside bombs and mortars, combined with multiple tours of duty. As a result, thousands of families are struggling to cope with the after effects of TBI, which are long-term and often undiagnosed until many years after a solider returns home.

David McRaney is an Army captain who always thought of himself as a quick thinker. Today, he likens his brain to a dial up internet connection. McRaney has trouble finding the right words to use, loses his train of thought mid-sentence, and has trouble recalling information he just read. He was in Afghanistan two years ago as a reservist when a mortar shell landed on the bunker he shared with three civilian contractors. The explosion killed the civilians and left McRaney with a traumatic brain injury that makes it difficult to follow direction or process speech.

Army Veteran David McRaney Struggles with TBI

TBI is typically the result of head trauma, such as a blow to the head or a violent jolt. In these cases, the brain collides with the inside of the skull. TBI also happens when a bullet or shrapnel penetrates the skull. Detection of TBI is difficult, and many people are not diagnosed until years after the initial injury, seeking help only when the symptoms progress over time. After severe criticism, the military has recently begun to take TBI more seriously. Evaluation of injuries has been changed, and soldiers are taken out of action if they have head trauma.

Diagnosing and treating TBI quickly is extremely important, but something that the military, especially during the first few years of the war, found to be very difficult. Some injuries, like McRaney’s, are easy to diagnose. He had shrapnel in his skull, and CAT scans showed trauma to his brain. Many other cases of TBI go undiagnosed because soldiers don’t report the injury.

soldier getting CAT scan for traumatic brain injury

“There’s a battle mind,” said Dr. Inge Thomas, coordinator of the TBI Injury Program at the Atlanta Veterans Affairs Medical Center. “Instead of going and getting rest, they go back in. They don’t want to be seen as sissies.”

While most people that who have mild TBI can fully recover with proper rest and medical management, many soldiers simply brush off the injury and go back into battle. In doing so, the injuries linger untreated, or worse, two or three head traumas happen over the course of a soldier’s career, which compounds the long-term side effects of TBI.

In February, a congressional report suggested that 15 to 23 percent of the two million soldiers who have served in Iraq and Afghanistan have experienced some form of TBI. That equates to between 300,000 and 460,000 cases in roughly ten years. Army experts disagree with those estimates, stating they have only diagnosed 126,000 cases of TBI in the decade since the wars began. Either way, the number is staggering and likely going to continue to grow.

As a consequence of the high number of traumatic brain injuries, the military has been forced to invest $633 million into over 200 research studies involving TBI. Some of the recent research, covered previously in our blog, has resulted in a blood test that can identify traumatic brain injury. Now the military is partnering with the NFL in an educational campaign aimed at reducing the stigma surrounding getting care for concussion and TBI.


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Football Great Junior Seau’s Suicide Linked to Traumatic Brain Injury?

football legend Junior Seau, who may have had a traumatic brain injury

As San Diego Chargers fans mourned the loss of Junior Seau, doctors raised the possibility that the apparent suicide was linked to traumatic brain injury. Also known as TBI, this condition can result from the concussions many professional football players endure. Some doctors see a growing link between head trauma, mental illness, and suicide, a connection that has been a focus of sports safety research following the deaths of other NFL players in recent years.

Chargers Football Junior Seau's Suicide Linked to Traumatic Brain Injury

Junior Seau played football in the NFL for 20 years, most recently as a member of the San Diego Chargers. He previously played for the Miami Dolphins and the New England Patriots, and he retired from professional football in 2006. Six years later, on May 2, 2012, he was found dead in his home with an apparent self-inflicted gunshot wound to the chest.

Seau is not the first NFL player to commit suicide in recent years. Last February, Chicago Bears player Dave Duerson also shot himself in the chest. Terry Long, formerly of the Pittsburgh Steelers, and Andre Waters, the defensive lineman for the Philadelphia Eagles, took their own lives in recent years, as well.

a memorial for football legend Junior Seau

Many experts believe these deaths could be the result of chronic traumatic encephalopathy, or CTE. CTE is a degenerative and progressive disease found in people who have repeated head trauma, and has been found in the brains of several professional sports players that have taken their own lives. The disease has symptoms similar to Alzheimer’s, Parkinson’s, and Lou Gehrig’s disease. In the case of Duerson, who donated his brain for study to the “NHL brain bank,” CTE was the only disease found.

“Exactly how the brain damage causes mood disturbance is not clear,” said Dr. John Whyte, director of the Moss Rehabilitation Research Institute in Philadelphia. “There could be biological changes going on, or changes in the neurotransmitters that affect mood, or it could be a psychological factor that this brain injury has disrupted work and family life so much that it has really changed your life.”

“Some people may feel really bad one day, but they can say, ‘OK, this thought is out of proportion with reality,'” said Whyte. “Whereas, if you’re acting on impulse to certain emotions, you may feel bad one day and that can lead you to take action.”

images of damage done to the brain by CTE

In football, concussions are a fairly common occurrence. While experts are unsure why, research shows that once a person has one concussion, they are more prone to future concussions. When a concussion occurs, the brain is shaken inside the skull, and some level of brain trauma results. A study published last year in Neurosurgery showed that American football players that suffer three or more concussions were much more likely to end up with symptoms of depression. They are also five times more likely to develop Alzheimer’s disease.

The NFL is responding to the research, and in 2008 instituted new rules that make it a requirement for players diagnosed with a concussion to have clearance from an independent neurologist before being permitted to return to play.

“The focus on sports safety has become much more vigilant about brain injuries and stricter with return-to-play guidelines,” said Whyte. “But we certainly need more research to confirm whether these athletic-related injuries are leading to suicides.”


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Could Progesterone Speed Recovery from Traumatic Brain Injury?

scene at the Sugarland stage collapse

Many of us remember hearing about the tragic collapse of stage rigging at the Indiana State Fair last August that left seven people dead and over 40 injured. Andrea Vellinga was one of those victims. This wife and mother from Pendleton, Indiana suffered a major traumatic brain injury (TBI) when her skull was crushed in the collapse. After weeks in a coma, where she relied on a ventilator to help her breathe, it seemed unlikely that Vellinga would return to the same mobility as she had prior to the accident. But a clinical trial using progesterone may be the reason Vellinga is walking today.

Andrea Vellinga and neurologist Michael Turner MD

“Let me see you walk,” says Dr. Michael Turner, a neurosurgeon at Goodman Campbell Brain and Spine in Indianapolis.

With a huge smile, the 30-year-old Vellinga slips off a helmet she wears to protect her skull, slides off the exam table, and walks across the room. She even walks on her toes, like a ballerina, when requested to do so.

Indiana State Fair Collapse Andrea Vellinga TBI Recovery

Dr. Turner sums up her progress in one word: Awesome.

It’s possible her amazing progress is due to a quick decision made by Vellinga’s family just hours after the injury occurred. They enrolled her in a cutting-edge experimental trial called SyNAPSe. The trial uses the pregnancy hormone progesterone, which is known to help reduce swelling and improve memory in people who have suffered traumatic brain injuries.

Andrea in the hospital after traumatic brain injury

While it is possible that Vellinga could have received a placebo, doctors hope that her progress is linked to the drug. If so, it’s possible that progesterone could hold the key to a more successful recovery for the millions that suffer TBIs. Traumatic brain injuries are notoriously difficult to treat.

Despite the medication, Vellinga credits her family, especially daughter Lydia, for giving her the willpower to recover. “She is so cute. She holds my hand when we walk. She says, ‘Mommy, I don’t want you to fall and hit your head again,'” Vellinga said. “She always says, ‘Mommy, no more concerts, indoors or outdoors.'”

Andea Vellinga recovering with help from her daughter

While she may not be planning any concert-going in the near future, Vellinga will be returning home in May, just in time for her 31st birthday.


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Journalist Turns Painter After Traumatic Brain Injury

Artist and TBI survivor Elliette Markhbein, at work

Eliette Markhbein was a young journalist with a bright future when she was struck by a speeding car while biking in 2004. The accident split her helmet in half “like a ripe watermelon” and left her with serious injuries to her brain and spinal cord. While struggling to recover from the collision, Markhbein began painting, which she found took her mind off of the physical and emotional devastation she was facing. “When I was painting I did not have to face my injury. It was addictive. It was better than morphine,” she said.

Markhbein portait of TBI survivor Claudia Carreon

Eventually, Markhbein returned to college to study painting. Her work on a self-portrait led her to a project depicting the faces of others with traumatic brain injuries. Her subjects include Congresswoman Gabrielle Giffords, the victim of a Tucson shooting in 2011; journalist Bob Woodruff, wounded by a roadside bomb in Iraq in 2006; Trisha Meili, the “Central Park Jogger” assaulted in 1989; and Claudia Carreon, an Army veteran injured in a head on collision in Iraq in 2003. Even actor George Clooney, who sustained a brain injury while filming in 2005, is included in her portraits.

Markhbein portrait of TBI survivor Alexis Verrzal

Markhbein creates each painting using a series of steps that themselves resemble TBI. She draws each portrait on paper, then cuts it into irregular squares, which are then reassembled into paintings on canvas. The effect is one of an interrupted, slightly dislocated portrait, that one cannot help but try to reassemble in the mind’s eye.

Markhbein portrait of TBI survivor Trisha Meili

Markhbein’s paintings were recently on display with The TBI Project, which is sponsored by the Brain Injury Association of America and the Society of Arts in Healthcare. Eventually, the pieces will be auctioned to help fund the Artists in Residence program, which will help people with TBIs in hospital and rehabilitation settings.


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New Tool Renders Traumatic Brain Injuries (TBI) in Color

Brain Injury High Definition Fibert Tracking Map

Every year in the United States, 1.7 million people suffer a traumatic brain injury (TBI). One problem with these types of injuries is that there has been no way to determine the extent of the damage. Some traumatic brain injuries cause swelling that goes away on its own with no noticeable effect, while other injuries cause permanent disability or even death. But scientists are now testing an experimental scanning tool that lights up the injury, much like an x-ray is used for injury of the bones.

Brain cells send signals to each other through a system of nerve fibers, or axons, which are similar to the design of a telephone network. The brain cells run along fiber tracks in the white matter of the brain. This new tool processes high-powered MRIs with the help of a computer program, where tracks of nerve fibers are depicted in vivid colors. Individual tracks are rendered in distinct colors, allowing breaks in the fiber paths to be seen.

Imaging from new MRI tool that depicts traumatic brain injury in vibrant colors

“We now have, for the first time, the ability to make visible these previously invisible wounds,” says Dr. Walter Schneider of the University of Pittsburgh, who is leading development of the experimental scan. “If you cannot see or quantify the damage, it is hard to treat it.”

Traumatic brain injuries are among the top injuries of soldiers serving in Iraq and Afghanistan, with military estimates of over 200,000 affected soldiers. Most of these injuries result in concussions, but repeated injuries can result in permanent neurological problems. While a concussion means that the brain swells and heals, those unseen breaks in the fiber pathways can cause problems later in life. Current diagnostic equipment only permits doctors to see swelling or bleeding.

new MRI imaging of traumatic brain injuries

Research is beginning with military and civilian patients to see if the test can consistently pinpoint the damage. Scientists hope that one day the tool could help guide rehabilitation. Other diagnostic tools are also being developed and tested, including a type of CT scan that measures changes in the blood flow inside of the brain. While the hope is to effectively diagnose traumatic brain injuries, Dr. Rocco Armonda, a neurosurgeon at Walter Reed National Military Medical Center, cautions that safety and awareness are still the best precautions.

“What makes the biggest difference is everybody–little kids riding their bicycles, athletes playing sports, soldiers at war–is aware of TBI,” he says.


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Will Head Injuries Bring About the End of Football?


In just a few years from now, the NFL will celebrate its 100th anniversary. Honors will be given to the 75th anniversary team and dynasties led by coaches such as Belichick, Halas, Lambeau, Landry, Lombardi, Noll and Walsh. According economists Tyler Cowen and Kevin Grier, that celebration may not happen because brain injuries associated with playing football threaten the future of one of America’s favorite past-times.

The economists suggest that brain injuries such as chronic traumatic encephalopathy (CTE) and the increase in liability lawsuits over head injuries make football too costly a sport, in terms of insurance and legal costs–and especially in lives. Many of the country’s top athletes have switched to other sports because of the long-term effects of repeatedly banging one’s head into another person. If this trend continues, football as we know it may become a thing of the past.


Dwindling football talent may signal the elimination of the sport from conferences that don’t have football as their primary sport, such as Pac-12, Ivy, Big Ten, and ACC. Advertising dollars will flow elsewhere, and TV deals will shrink as viewers stop tuning in to watch a sport that’s no longer popular. Could you even imagine a world without Sunday or Monday night football? No Super Bowl?

As unsettling as it may be to diehard football lovers, football’s end may be inevitable because of parents–parents of the young boys who take the hard hits to make their school, families and hometowns proud. At some point, these parents will decide that the glory of the sport is not worth the long-term prospect of watching their sons struggle with permanent brain damage.

There was a time when parents who refused to allow their kids to play football would get a side glance. That’s no longer the case. Parents whose kids would rather play basketball, soccer, or baseball are relieved they don’t want to play football.

Kids will choose to play other sports, like baseball rather than the head injury prone football

Cowen and Grier believe that a time will come when football will be played primarily in the southeast region of the country. The players will either be poor, from broken homes, or foreigners, characteristics they would share with athletes in another sport that lost popularity in the past century: boxing.

Weigh in with your opinions on the safety and future of American football.


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Gabrielle Giffords’ Traumatic Brain Injury, Recovery

Gabrielle Giffords making amazing recovery after traumatic brain injury

Gabrielle Giffords is making an astonishing recovery after she was shot from point-blank range through the brain. Her peculiar case shows off the ability of the brain to restore and sustain functions after a traumatic brain injury (TBI).

Dr. Sanjay Gupta, neurosurgeon and CNN chief medical correspondent says, “The brain was once thought to be completely immutable (or not capable of change) after childhood.”

“I’m still amazed from time to time at how well people do, and I think that we have simply underestimated the resilience and regenerative capacity in the human brain,” says Dr. Stephan Mayer, professor of neurology and neurological surgery at Columbia University.

Gabrielle Giffords recovery pics, post traumatic brain injury

It is now understood that thanks to brain plasticity and “mirror neurons” located on the opposite side of the brain from the damaged area, it is possible to form new brain cells even in adulthood in treatment such as rehab. Some cases have even shown the ability to form new brain connections that allow an individual to even move or talk again. The brain can be retaught basic tasks and skills but the severity of the injury must also be put into consideration as well. According to the Centers for Disease Control and Prevention, studies have shown that nearly 1.7 million people suffer at one point in life a traumatic brain injury in the US. Nearly 80% of them actually get treatment and leave the emergency department.

“We’re now sort of entering an era when we realize the brain is not that different from the rest of the body in its ability to heal,” says Mayer.

Doctors and scientists are finding that parts of the brain that were even destroyed or missing can be over taken by the remaining parts and be relearned. The brain cells that are near the damaged cells can reconnect with one another, forming new circuits which can resume the function of the missing cell. The smaller the lesions, the better recovery is expected in this way. Patients who are younger still have more capability of regaining functions, but there is hope for any age.

“You need to be really actively engaged. You need to be working hard on trying to get back,” Mayer said. In other words the patient needs to be constantly challenged. He added that some patients even say that after years of recovering, life is actually better than it was before their brain injury.

“A certain kind of person develops a profound appreciation for life that maybe we all lose sight of sometimes.”