TBI is a form of acquired brain injury resulting from sudden trauma to the head. Symptoms of TBI can range from mild, to moderate, to severe. A person with mild TBI (mTBI) may or may not experience a loss of consciousness. Other symptoms of mTBI include headache, confusion, lightheadedness, dizziness, blurry vision, tinnitus, dysgeusia, fatigue, changes in sleep patterns or behavior, and impairment of memory or cognition.
Since an accurate diagnosis is key in determining the management and predicting the outcome of patients with head trauma, it is important to use all modalities available for diagnosis, specifically DTI. Accurate diagnosis of brain injuries is critical. Without it, medical professionals cannot take steps forward to help patients.
Traditional methods of imaging brain disorders are largely insufficient; they may lack diagnostic specificity, which leads to errors and delays in diagnosis while frequently missing critical treatment windows. Advanced MR imaging expands the range of tissue properties “visible” to a clinician, including the detection of important biomarkers and the imaging of tissue function. These capabilities provide enhanced diagnostic capabilities, more rigorous ways of determining treatment parameters, and measuring response to treatment.
The medical team at CNS has changed the landscape for people suffering with mild– to moderate–TBI. From sports-related concussions, to assaults, to motor vehicle accidents, CNS research has successfully shown that advanced MRI imagining is far more sensitive than clinical imaging standards.
Our team has presented their work in high-visibility journals, scientific conferences, and before National Institutes of Health and Department of Defense-sponsored workshops. They have testified before Congress on brain injury in NFL players after studying 45 former players in an NFL-sponsored study. The advanced MR imaging available at CNS has been admissible in court as material evidence, often tilting the balance of cases. Their ground-breaking work will become the standard for confirming the diagnosis and prognosis of mild brain injury and ensuring maximum outcome.
Since 2000, more than 300,000 members of the U.S. Armed Forces have sustained a TBI. TBI in combat veterans is strongly associated with Post Traumatic Stress Disorder (PTSD) and other physical health problems.
These medical concerns affect the quality of life not only for veterans, but of their:
Veterans afflicted with mTBI face higher risks for other psychological problems and suicide. They have higher rates of unhealthy behaviors—smoking, overeating, and unsafe sex—and higher rates of physical health problems and mortality. They also tend to miss more work or report being less productive.
These conditions can impair relationships, disrupt marriages, aggravate the difficulties of parenting, and cause problems in children that may extend the consequences of combat injury and trauma across generations.
TBI and PTSD in veterans extends beyond the soldier and family and into the community. One of the strongest indicators between PTSD and criminogenic behaviors in incarcerated veterans was the presence of a TBI. When a veteran suffers from a combination of TBI and PTSD, his/her symptomology often includes irritability, cognitive impairments, insomnia, impaired vision, depression, fatigue, and anxiety. There is also a link between these conditions and homelessness.
The damaging consequences from lack of treatment or under-treatment suggests that those afflicted, as well as society at large, stand to benefit from with access to effective care.
There are currently no evidenced-based models of treatment to guide clinical practice for this population. There is limited research on treating both PTSD and TBI either psychologically or pharmacologically. These consequences can have a high economic toll; however, most attempts to measure the costs of these conditions focus only on government-sponsored medical/treatment costs. The direct costs of treatment are only a fraction of the total costs related to mental health and cognitive conditions. Far higher are the long-term individual and societal costs stemming from lost productivity, reduced quality of life, homelessness, domestic violence, the strain on families, and suicide. Therefore, it is important to consider the direct costs of care in the context of the long-term, societal costs of providing inadequate care or no care at all.
A RAND Corporation study calculated the cost effect of directing more veterans into treatment and improving the quality of care. The per-case cost of TBI was found to be substantially higher than the cost of PTSD, but costs varied based on injury severity. Estimates of the one-year cost of mTBI ranged from $27,260 to $32,760 per case. Estimates of moderate to severe TBI costs ranged between $268,900 and $408,520 per case. Based on RAND Corporation’s calculations, the total annual cost associated with diagnosed cases of TBI (2,776 total cases through mid-2007) ranged between $591 million and $910 million. Delivering effective care and restoring veterans to full-functioning mental health has the potential to significantly reduce these longer-term costs. Accurate diagnosis of brain injuries is critical in order to improve quality of life for veterans, their families, and our communities.
Through this initiative, CNS will focus on innovation, diagnosis, and hope for combat veterans and others suffering TBI.
Advanced MR imaging, such as SWI and DTI, expands the range of tissue properties “visible” to a clinician, including the detection of important biomarkers and the imaging of tissue function, offering hope to combat veterans and their families through treatment at the Eisenhower Center.
With enhanced diagnosis comes enhanced treatment and hope for combat veterans and their families.
These capabilities provide enhanced diagnostic modalities, more rigorous ways to determine treatment protocols, and to measure a subject’s response to treatment. CNS and the Eisenhower Center will work conjointly to research the efficacy of treatment modalities, including cognitive therapy, neurofeedback, photic and HEG stimulation techniques, and recreational therapy through the Eisenhower Center’s Camp Liberty.
Additional research in diagnosis and treatment of PTSD will also be examined during this study.
The Center for Neurological Studies is using their patented technology to detect mild-to-moderate brain injuries in combat veterans who have been exposed to a bomb blast.
A body of medical research continues to link the repetitive head injuries incurred by football players with lasting brain damage and CNS is proud to be contributing to that research. Since the National Football League agreed to compensate for the care and treatment of its retired players, CNS has conducted imaging scans and neurobehavioral evaluations with a number of these former players.
If you’ve experienced a traumatic brain injury while playing football, CNS may be able to assist you with a diagnosis. Whether you played professionally, at the collegiate level, or as a high school or club amateur, please contact us for more information.
Dr. Benson shared his experience in applying advanced neuroimaging to former football players before a specially convened U.S. House of Representatives’ committee exploring legal issues related to football head injuries.
Currently, CNS is studying the efficacy of using Human Growth Hormone to treat traumatic brain injuries in former NFL players. Growing awareness of concussions and repetitive head injuries have led researchers to explore ways to reverse the impact of traumatic brain injuries (TBIs). Among these treatments is human growth hormone replacement therapy (HGHRT).
“There is consensus in the medical community that many former professional athletes are at risk for cognitive and psychiatric impairment that results in a deficiency in one or more hormones that can significantly impact a person’s quality of life,” says Randall Benson, M.D., President and Medical Director at CNS and lead investigator on the study.
CNS is conducting a placebo-controlled interventional study in growth hormone deficient former athletes in order to reduce their symptoms and improve their quality of life. Based on a previous pilot study, and experience with hundreds of patients treated for trauma-induced pituitary hormone insufficiency, “we expect that there will be significant improvement in symptom burden and quality of life for our study participants,” Benson says.
CNS has embarked on its own research into HGHRT with retired professional football players. In the earlier pilot study, CNS provided 15 former athletes with endocrine testing that showed 14 of them with growth hormone deficiency. Eleven of those 14 showed a marked reduction in symptoms and improved quality of life after hormone replacement protocols were applied.
These early, promising observations add to the hypothesis that former football players with symptoms commonly associated with repetitive head injuries—insomnia, impaired memory, suicidal ideation, fatigue, anxiety, and others—can have a dramatically improved quality of life with HGHRT.
“CNS has unique capabilities and understanding of the brain that have helped a number of former athletes, including me, get their lives back on track,” says CNS ambassador and former Detroit Lions quarterback Eric Hipple.
“It’s still very early in the process, but we’re excited about the opportunity to further test our theories,” says Dr. Benson. “The results can apply well beyond athletes and help the hundreds of thousands of others who suffer TBIs annually in non-sports related accidents. This is an often undiagnosed or misdiagnosed problem and growth hormone replacement therapy could be a big part of the solution.”
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