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Thread: Brain Injury/What's the best hope for treatment now and in the future?

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    Senior Member Max's Avatar
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    Brain Injury/What's the best hope for treatment now and in the future?

    Brain Injury
    What's the best hope for treatment now and in the future?

    Chris Zdeb, Journal Staff Writer
    Edmonton Journal


    Monday, June 03, 2002

    The Journal
    John Payne credits his daughter's puppy Madison for helping him further enhance his emotional responses since his brain injury almost a year ago.


    John Payne cringes every time he sees the bare-headed kids whipping up, down and around the outdoor skateboard park near his St. Albert home.

    He's stopped kids rollerblading by and asked them why they're not wearing a helmet.

    His wife has chastised him to keep his mouth shut. "But what if they should fall and hit their heads? They could do so much damage, that they'll wish, too late, that they had worn a helmet," he says. They could end up brain injured like him.

    Motorcyclist slams into guardrail after failing to negotiate hairpin turn. Teens injured in single vehicle rollover. There are 2,000 headlines just like these written in Alberta each year. Payne's read something like: Man survives 15-foot fall from the roof of a chemical plant in Joffre.

    His public story ended with that headline 11 months ago; the private story had just begun. Payne hit his head twice -- the first time as he slipped on an unsecured metal sheet on the roof, the second after landing on his feet on the ground and keeling over.

    He went into a coma and it was only days later after he revived that doctors realized he'd had a stroke. There were months of rehabilitation, followed by the frustration that he would never be the way he was before the fall.

    Still, Payne will tell you he's luckier than most. His sense of smell has been mildly affected. Friends and family tell him he repeats himself a lot. And while he has use of the left side of his body, he is numb from head to toe. The family including wife Albertine and children Matt, 20, Celena, 18, and Lisa, 15, continue to adjust to "the stranger" living in their house. But the fall left him mostly untouched from the neck up, and for that Payne is grateful.

    He's asked if like actors Christopher Reeve, left paralysed after a horse riding accident, and Michael J. Fox, who's battling Parkinson's disease, he hopes for a medical breakthrough that might one day give him back what he's lost?

    Payne's recently read about research on nerve cell damage and how nerve cells can regenerate. "But I accept the fact that I'll get as good as I'll get and I don't expect that everything will ever be back to normal. It's not like I'm sitting here like a vegetable. Losing part of my physical abilities is a fair trade-off for what I've been able to keep."

    Still, it got us wondering about the latest developments in brain injury recovery. We asked three brain specialists for their insight. Here's what they said:

    Dr. John Bertoni, chairman of the department of neurology at Chreighton University in Omaha, Nebraska, and a Parkinson's researcher

    "There's a whole spectrum of things that look promising from the immediate kind of care someone gets, called brain resuscitation. There's a concept now that with strokes and other forms of brain injury there may be a central core of dead tissue or 'beyond hope' tissue and around this central core is the tissue that's sick, but can survive, if we do the right things. People are put in intensive care units now and there is close observation of the cerebral blood flow. In the old days, they would just be put in a hospital bed and be given their usual nutrition and it was hoped they would do all right.

    "For a young person who has a brain injury, the main threat immediately is edema, or swelling of the brain. And because a young person still has a size 10 brain in a size 10 skull, when the brain swells it has nowhere to go. If the brain swells against the brain stem, the centre for heart rate and breathing, those things will suffer and the patient will get worse or even die.

    "There are more heroic things that can be done such as actually splitting the skull and letting the bones expand so the swelling can be allowed to happen without injuring the brain itself.

    "There are ongoing studies using simple things such as cooling of the brain which is theoretically lowering the metabolism requirements and putting the brain at ease. But there's still some controversy about that.

    "There's some exciting long-term research as well. They know now that when there's an injury to the brain, that the brain itself calls forth its own brain stem cells and somehow they get to the part of the brain that needs the regeneration and the stem cells can actually become useful brain cells. The problem is the brain is such a jungle of connections, it's very hard to establish the necessary numbers of connections that would be normal. Still, it's amazing and I think some day this kind of research will pay off, but right now it's a primitive stage.

    "Then there's Parkinson's research, like I'm involved with, where attempts have been made to put stem cells from fetal tissue into the human brain. The research is in its infancy really, but the amazing thing is that the stem cells can survive and they can make some connections. The problem is to make sure that the proper information is coming into those cells, so that they fire when they need to and secondly, that the cells are making connections to the appropriate places.

    "The people that need this kind of work like Michael J. Fox and others, are hoping stem cell research can pay off, but there's a lot of ethical questions. There may be some more ethical ways to get stem cells from one individual or maybe make stem cells for the use of other tissues from other animals."

    Dr. Julianna Nagy, specialist in physical medicine and rehabilitation at Edmonton's Glenrose Rehabilitation Hospital

    "There is a lot of research being done on this and the United States has pushed to look at methods of curing spinal cord injury or curing brain injury. Things have progressed but much of the research is still at the very basic science level. They're looking at things in tissue slices or they're looking at things in mice and rats, that kind of stage.

    "There are lots of different approaches being taken. Number one is preventing damage in the brain and number two is improving things in the first few hours after damage has occurred. In the last five years, they've discovered that the brain does indeed regenerate itself, but it regenerates at a very slow pace and it does so to sort of keep abreast of what you might lose naturally because of aging.

    "If you have a stroke or a brain injury and you lose, hypothetically, five billion brain cells and your brain is making 100 new cells every day, it's going to take a long time to replace all those brain cells on top of the cells being created against the aging process.

    "Compared to 50 years ago, we are light-years ahead, but in terms of that kind of Star Trek advance where you put a scanner over the whole body, identify what's wrong and then apply a syringe to the head and inject the brain cells you need, no, we're not quite there yet.

    "In that first year after their injury, people are going to see some pretty significant changes, but it's not so much a regenerative process as a healing process.

    "Similarly, the brain cells that are repairable, heal, though it can take a year or two. But the brain cells that died are gone. If you need 1,000 brain cells to do a particular job and 500 have died because of an injury, you're not going to be able to do that job very efficiently with the 500 brain cells you have left."

    Dr. Richard Fox, an Edmonton neurosurgeon

    "Do I honestly think that that's going to happen? No I don't actually. I look after the head injury side of things quite a lot and I'm actually doubtful that we're going to see anything in the near future that's going to significantly change the huge morbidity from head injury.

    One hopes, of course, that there may be some genetic techniques, gene transfer techniques to try and stave off these seemingly irreversible processes, but I don't see that in the next couple of years. Once you slam your head into a brick wall, it's pretty hard to put it back together again.

    "I'm involved in Think First, which is a head and spine injury prevention program, and I think the key here is prevention."

    "A study in Ontario is following students who have been exposed to the Think First program in school and students who haven't been exposed to the program and comparing them to see what kind of trouble brings them in contact with the health care system. The main information so far is that you can teach injury prevention to kids and it does work.

    "It's an issue of reduction of injury, not elimination, because you'll never eliminate the true accident. But much of what we call accidents aren't accidents, they're just disasters waiting to happen, and then of course they do. It's related to risk-taking behaviour, whether that's not wearing a helmet or driving too fast or drinking and driving or driving when you're tired. If you go looking for trouble you certainly can find it."

    Hard Knocks

    -- Approximately 5,500 Albertans each year suffer a stroke or "brain attack" cutting off blood and oxygen to the brain cells. Another 3,500 Albertans are brain injured annually because of aneurysm, drug overdose, lack of oxygen, diseases, infections and tumors.

    © Copyright 2002 Edmonton Journal

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    Senior Member Scott Buxton's Avatar
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    Yikes! I'm optimistic; I must be because I acquired traumatic brain injury from a MVA 1 1/2 years ago. Improvement is much slower than I would have guessed from my special ed training; I was a sp ed teacher for kids with neurological challenges. Sleepiness and visual perception are big issues for me. Patience is good! Do well. Scott.

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    To see what hit me on the head and back, is to beleive that miracles do happen. I have SCI, TBI, and every broken bone in between. Takes a long time? Huh!!!! I thought if I got home I could get better, figure out what was wrong, and come up with a plan, boy was I wrong, it's taken almost 3 years but I am slowly coming around. It's been a lot of hard work, that I don't regret, but much longer, than I imagined. I type with two hands [ and all my fingers ] and can do alot of the things I need to do. Legs don't work right yet, but I'm woking on it, and will continue to. Never say never, jump off the diving board and here I go. Isn't ther somrthing thay can spraay on me and make it all go away? No, not yet, and I continue to work and fight onward!!!!!

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