The signature injury from the 'War on Terror' is mTBI (concussion, PCS). So many soldiers got mTBI and the powers that be realized conventional mainstream diagnostics and treatment were of no use for rehabilitation. The private sector was brought in to try and solve the problem (this is all in the US) with alternative treatments. Their brain injury diagnostics were based on car industry and sports industry research. Both of these systematically simulated TBI injuries on animals from rats to apes and tested different imaging techniques. Then they did postmortem histopathological analysis, looking at brain sections under a microscope to confirm the damage. Following that they looked at the brains of people who had mTBI but had died of other causes and found damaged axons. Then they used DTI on live patients with mTBI and found damaged axons.
Doing tests with different scanning techniques they found CT scans identified fluid in the brains of 90% severe TBI, 60% moderate TBI and 7% mild TBI. MRI scans are similar. Diffusion tensor imaging (DTI) scans showed all categories of TBI have axonal injuries that are not picked up on CT or MRI.
The sport industry pioneered sensors in helmets (American football) and modeled the impact characteristics of players that got concussions using computer technology. Adding both the car and sports industry research together a whole new picture of mTBI emerged. Axonal injury reduces the connections between the sensory, memory and cognitive regions of the brain. Damage to the head causes visual and vestibular problems.
Private optometrists, sports physiotherapists and chiropractors can solve visual and vestibular issues. Neuroplastic cognitive therapy such as in the Arrowsmith program corrects sensory, emotional and cognitive brain dysfunctions. Preliminary brain functional (EEG, fMRI) scans have been produced to indicate this.
It seems strange that many top sports players and car drivers recover from 'concussions' relatively quickly but normal folk suffer for years. The answer may be that there are two different approaches for treating TBI.
Hopefully the ABI Bill is influenced by results from the 'War on mTBI.'
Yes, it was fortunate - and jolly interesting for me that my neurologist sent me to a specialist sports physio for my rehab - sports physios seem to have access to a whole different body of research to the GP. Though I hasten to add that the treatment I had from a regular local physio was entirely different from the work the concussion specialist sports physio did. So like neurologists, physios also aren't all created equal. Theo Farley was my sports physio who studies and lectures on concussion - and who made so much difference to my overall functioning. performanceready.co.uk/post...
There is a two tier system, it's about time there was a one tier system. Fingers crossed, ABI Bill. The private sector is up to date the normal heath system is 40 years out of date.
I think it also depends who you stumble across in both systems. My first private neurologist was just trying to treat my 24/7 headaches with standard migraine meds and I just had a lot of really very unpleasant drug reactions, and no change in my headaches - although he got me a quick MRI, which was my first priority based on discussion with my GP and a retired consultant friend - he really wasn't a concussion specialist, though he did send me for the neuropsychology testing which confirmed that something had indeed gone awry. When he was looking for another neurologist to refer me to, he found one chap who he said was the best in the field ( I didn't get his name...) but said that he only did NHS work. Then he sent me onto his second choice of a private neurologist.
I must note that when I've been to NHS consultants for different stuff - so long as you make a point of asking questions - they will freely give you a lot of their time. Whereas private consultants stick very rigidly to their time schedule - annoyingly cutting down your appointment time if they happen to have fallen behind during the day on other appointments.
I think it would be good to have a simple, single set of guidelines that keep up to date with current research and adapt appropriately and offer realistic multiple need rehabilitation methods and techniques. The health system we have now is not a single system, there are health authorities with different regional hospitals and each have a different diagnostic criteria. Health authorities have different guidelines, devolved heath systems, England, Scotland, NI and wales each have different systems, funding and priorities. It's all a bit pot luck. The government and devolved authorities need to get a grip.
Though as a very analytic friend remarked when discussing this, that although a great deal of research has sprung from sports injury and the military, that the limitations must be that they are mainly focused on getting people just fit enough to go back into the front line in warfare and sport.
Totally PV - though my point is that the research funded by the military or in sport will only go so far - they need people just fit enough to fight or play - not necessarily to function in complex day to day roles. Though most of us would be more than happy to even get that much rehab I guess!
I used to be in the military, after a mTBI you don't go back to a war zone, you are a liability, you do home based menial jobs or get pensioned off. In the US it's the same but over there if you have done military service you get top end medical insurance cover. I think the quality rehab is to save on long term costs.
Strangely the only thing that really stands out in the ABI Bill is the estimated cost, £15 billion a year (2015). They/we could all do with reducing that at the moment.
Oh that's really interesting PV - so my cynical friend was overly so then. Does that include 'just' being in the vicinity of blasts as well though? I agree - in the States heading off possible legal action might be an issue as well.
Interesting about the costs of the ABI bill. What are the main wins likely to be in the legislation ?
Main wins would be an up to date system and all BI's are taken seriously in all aspects of life. BUT we'll wait and see because it may turn into fudge covered in glitter.
Interesting conversation - most advances in the world come from the military and war, the amounts of money spent to guard/increase political power are eye-watering.
As for the rest of us, we're on the coat-tails and if it doesn't kill hard luck.
There was a brain injury treatment near me at the time I was injured, put together by a doctor who trained outside this country, and so he had no credential here. It was completely private pay, and a lot of professional sports people went to it.
The cost for the treatment program was about 20,000 pounds, plus there would have been travel and accommodation expenses.
Basically, you had to be pretty well off to be able to manage that.
The government would have gotten more out of me in taxes than that, if I had been able to do it. I don't think that kind of thing is really considered properly. Though, if the person setting it up had his credentials recognized here, at least some of it would have been covered.
15 ish years later, I did another search and that clinic isn't there any more, but there are a handful of others now - all very expensive, all private pay.
In the meanwhile, there was another clinic in town that did treatments - I ran in to someone who paid for their young adult son to go, and while they said it helped a lot, it certainly did not make him able to continue studying and working at the level he had before. (Again, it was in the 20k range, and it ran about 3 years and then disappeared.)
I am not sure if these things disappear as there aren't enough people who can pay to attend them, or if they don't have a good track record and word gets out, or just what. Or, maybe they go set one up somewhere where people have more money.
Considering neurological issues involving a brain not communicating with the rest of the body properly is the 2nd most common thing neurologists treat (after headache) it may be that the powers that be simply consider it too expensive to fund. Which may be rather short sighted on their part.
Other options exist alright but you have to pay a lot of money to access them. Many of these methods are used in major league sports after concussion injuries. Strange how sports stars recover relatively quickly while the general population struggle on for years.
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The NICE guidelines for diagnosis and rehabilitation of TBI of all types have been updated. Good news and bad news.
High IQ Brain Injury Book
Having trouble coming to psychological terms with a brain injury. How do you do it ?
