Protect – Watch Your Head
Every 15 seconds, someone in the United States suffers a traumatic brain injury. Of the 1,000,000 people treated in hospital emergency rooms each year, 50,000 die and 80,000 become permanently disabled because of traumatic brain injury (TBI). This is higher than the combined incidence of Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis.
Brain injuries occur more frequently than breast cancer or AIDS. One out of every fifty Americans is currently living with disabilities from TBI. There’s even an association between head injury and Alzheimer’s disease later in life. Mild traumatic brain injury (MTBI), also known as concussion, can damage your brain at the cellular level . Worse, repetitive head injuries , even minor ones, can have serious repercussions – including permanent brain damage or death.
You don’t have to be knocked out in order to sustain a brain injury. Mild traumatic brain injury (MTBI) is becoming a serious public health problem. Most brain injuries are considered mild and appear to be trivial blows to the head, but it turns out that the consequences are not so mild and often lead to deep and prolonged impairments of the brain. A Scottish study found that 47% of people classified as having mild head injuries were actually disabled to some extent one year later, and that they received little rehabilitation or follow-up care with social workers.
Mild Traumatic Brain Injury and Personality Changes:
Many psychiatric delusions appear to be associated with mild traumatic brain injury. Examples include content-specific personality changes, such as when the patient believes that family members are impostors or identical doubles. An extremely common delusion among domestic abusers and stalkers is pathological jealousy and preoccupation with another person.
Repercussions of Repetitive Head Injuries
Brain injury causes lesions that appear and change over time in the prefrontal cortex and its pathways to the older regions of the brain. This explains the wide spectrum of complex neurobehavioral complaints following MTBI: compulsive and explosive behavior, sensory anomalies, memory loss – as well as behavioral dis-inhibition, domestic violence, and alcohol intolerance.
Children’s Head Injuries:
According to the Brain Injury Association, traumatic brain injury is the most frequent cause of disability and death among children and adolescents in the United States. Each year, more than a million children sustain brain injuries, ranging from mild to severe trauma.
Youths Most At Risk For Brain Injury – Statistics:
If you are between the ages of 15 and 24 and drive a motor vehicle, ride a bicycle, or play sports, then you are at the top of the risk-list for head injury. Men are nearly twice as likely as women to injure their brains, but all of us are quite vulnerable. Transportation accidents (cars, bikes, horses) account for nearly half of all traumatic brain injury, followed by falls (25%). Firearms (assaults and suicide) represent about 10%.
Falls are the most common cause of playground injuries and result in a higher proportion of severe injuries than either bicycle or motor vehicle crashes. Brain injuries account for 75% of children’s deaths from falling off of playground equipment. Traumatic brain injury is significantly underdiagnosed and has no cure, therefore prevention is crucial. Helmets, seat belts, air bags, and car seats have proven to reduce brain injury and death.
Age, Gender, And Brain Injury Survivor Factor Statistics:
Data from more than 2,300 hospitalized patients of all ages indicate that gender and age influence the outcome of serious brain injury. For children under ten years old, young girls were found to be four-times more likely to die from head injury than boys.
Hormones seem to play a role. Higher levels of testosterone in young men may offer protection by bulking up brain mass, just as it bulks up muscles. For young women, however, high levels of circulating estrogen could make them especially vulnerable to head injury. In older individuals this injury “gender gap” is reversed. University of California, San Diego researcher Dr. Azadeh Farin said that “women in their 50s, 60s, or 70s are roughly twice as likely to survive traumatic brain injuries than men in the same age group.”
Early Injuries Can Have Long Term Effects:
Although young children with brain injury usually recover their mental abilities quite rapidly, they can have serious problems later. “These kids have incredible learning deficits even when the IQ returns to normal,” said Dr. Sandra Bond Chapman, a University of Texas neurologist. She noted that 70% of children’s brain injuries affect the frontal cortex.
Because growth in the brain’s frontal regions continues throughout young adulthood, early injury there can damage formation of the protective myelin insulation around neurons . This can impair their ability to control emotions and inhibit inappropriate behavior. These kids have trouble responding to subtle social cues and planning difficult tasks.
Head Injuries In Sports:
For decades we have all enjoyed watching athletic teams face off and score those points. As participants, we have taken pride in stretching our athletic performance. Whether we block the offense, make a winning pass, or simply run up and down the field, sports will always be a source of pleasure, challenge and fitness.
Unfortunately contact sports and some recreational sports carry risks for serious head injury. While you may think that is obvious, you may not be aware of the small repetitive brain injuries that can cause long-term damage. If you know someone who is playing soccer or football, you will want to read these startling facts.
An estimated 300,000 cases of traumatic brain injury occur each year from sports and recreation accidents. In a series of articles on TBI, the Journal of the American Medical Association (September 8, 1999) presented evidence linking sports-related concussions with lower scores on several tests of mental function.
Injuries associated with 10 different team sports (5 boys’ and 5 girls’) were surveyed at 235 U.S. high schools. From the data, more than 62,000 mild traumatic brain injuries are estimated to occur each year in these sports. One potential cause of mild traumatic brain injury that concerns researchers and parents is the heading of soccer balls – especially by children whose brains are still developing. Also, because younger girls are increasingly taking up the sport. While little research has been done with children and adolescents, several studies have shown that adult soccer players have mental deficits measured in many parameters.
National Soccer Team Head Injury Study:
A Norwegian study of active and former national soccer team players investigated the incidence of head injuries caused mainly by heading the ball. One-third of the players had central cerebral atrophy, and 81% had mild to severe deficits in attention, concentration, and memory. Players who headed the ball more frequently during competition had higher rates of cognitive loss.
In 1998, Dutch researchers showed that professional soccer players’ performance on memory, planning, and visual-perceptual tasks declined as their number of concussions and frequency of heading the ball increased. Amateur soccer players had similar results: performing significantly more poorly than control athletes on cognitive tests for attention, memory, and planning abilities.
A Message For Soccer Parents:
Although most sports-related head traumas come from contact with the ground, goalposts, or other players, heading soccer balls is an obvious factor – especially when practiced thousands of times during a season. A ball kicked at full force is estimated to hit a player’s head with 175 pounds of force.
“No child under the age of 14 should head the ball,” cautions Dr. Lyle Micheli, chair of the Sports Medicine Department at Children’s Hospital in Boston.
He argues that kids have not fully developed the musculoskeletal maturity or coordination to properly handle a header until they’re about 14 years old. Micheli also points out that some kids in the U.S. use larger, professional-sized soccer balls, whereas in Europe most children gradually work up to the adult-sized ball.
According to the American Academy of Pediatrics Committee on Sports Medicine and Fitness: “Head and facial injuries account for 4.9% to 22% of soccer injuries, of which approximately 20% are concussions. . . Eye injuries are another subset of soccer-related head injuries.”
Regarding heading, their recommendation was published in a policy statement in the March 2000 issue of Pediatrics.
“Researchers have expressed concern about cognitive deficits appearing in youth soccer participants after much shorter exposure time to heading the ball. . . The potential for permanent cognitive impairment from heading the ball needs to be explored further. Currently, there seems to be insufficient published data to support a recommendation that young soccer players completely refrain from heading the ball. However, adults who supervise participants in youth soccer should minimize the use of the technique of heading the ball until the potential for permanent cognitive impairment is further delineated.”
Sports Injury And Long Term Effects Study:
A growing body of data suggests that those who suffer repetitive head injuries in sports may be at greater risk for neurodegenerative diseases later in life. The cumulative damage from successive concussions can increase the risk of premature senility, Alzheimer’s disease , and Parkinson’s disease, neurologists warn.
According to researchers at the University of Pennsylvania School of Medicine, the brain has an increased vulnerability to severe, perhaps permanent, injury for at least a full day following a concussion. In a study with mice, the effects of a second brain trauma within 24 hours seemed temporary. The mice returned to almost normal and did well on tests of cognitive and motor skills. But, at about 56 days, there was “a measurable breakdown in motor skills and, subsequently, a breakdown in the cells of the brain,” said Tracy K. McIntosh, Ph.D., the Director of the Penn Head Injury Center.
“Our findings represent the first real attempt to look at the science behind head injuries – and we were startled to see how permanent the damage can be,” he said. This has serious implications for amateur and professional athletes, as well as victims of abuse and accidents, because permanent cognitive damage is not immediate. The effects of repetitive head injury may not be felt for months later.
Head Injury Links to Alzheimer’s Disease:
Today, nearly half of the Americans over 85 have Alzheimer’s disease and it is estimated that 14 million Americans will have Alzheimer’s disease by the middle of this century (2050) unless a cure or prevention is found. Meanwhile researchers continue to unravel the mystery of this brain degenerative disease and many have found links to head injury.
Head Injury and Alzheimer’s Disease Studies:
The link between head injury and the risk of Alzheimer’s disease (AD) is indicated by data from the MIRAGE study (Multi-Institutional Research in Alzheimer Genetic Epidemiology). Patients with AD were nearly ten times more likely to have a history of head injury that resulted in loss of consciousness. The study suggests that “head injury with loss of consciousness and, to a lesser extent, head injury without loss of consciousness, increased the risk of AD.”
Research led by Dr. Douglas H. Smith at the University of Pennsylvania supports previous epidemiological links between a single episode of brain trauma and the development of AD later in life. In animal studies, scientists induced brain injury without direct impact, similar to what humans often experience in automobile accidents. Analysis of damaged brain cells revealed extensive amyloid beta and tau accumulation, as well as plaque formation all typical findings in Alzheimer’s disease. These changes were evident as early as 3 to 10 days after the injury.
An analysis of injured World War II veterans links serious head injury in early adulthood with Alzheimer’s disease in later life. The study by researchers at Duke University and the National Institute on Aging also suggests that the more severe the head injury, the greater the risk of developing AD. While the findings do not demonstrate a direct cause-and-effect relationship between head injury in early life and the development of dementia, they show an association between the two that needs to be studied further.
Head Injury Links to Violence:
Many people attribute violent, antisocial, aggressive behavior to environmental factors such as childhood abuse, but it may surprise you to learn that there can be physical factors as well. Researchers are finding more and more links between violent behavior and brain damage to certain regions of the brain. While no cure is currently available, these eye-opening studies reinforce the need for protection against head injury.
Early Brain Damage and Development in Social and Moral Reasoning:
Children who experience early damage in the prefrontal cortex never completely develop social or moral reasoning. As adults, even on an intellectual level, they cannot refer to such behavior because they have little concept of it. In contrast, individuals with adult-acquired damage are usually aware of proper social and moral conduct, but are unable to apply such behaviors.
Neurology professor Dr. Antonio Damasio and colleagues at the University of Iowa College of Medicine reported on two cases of early brain damage to the prefrontal cortex. As adults, both patients showed the same two distinctive features: an almost total lack of guilt and an inability to plan for the future – but were normal in almost every other type of mental ability.
The patients had problems with violence and resembled “psychopathic individuals, who are characterized by high levels of aggression and antisocial behavior performed without guilt or empathy for their victims,” commented Raymond Dolan of Institute of Neurology in London. Their brains were just not capable of acquiring social and moral knowledge even at a normal level.
The Biology of Violence Prefrontal Cortex Study:
Since the 1980s, scientists have correlated damage to the prefrontal cortex with psychopathic behavior and the inability to make morally and socially acceptable decisions. Unfortunately, this forehead region of the brain is often the site of injury.
Researchers at the University of Sweden have found the prefrontal cortex to be precisely the area of the brain that is impaired in murderers, rapists, and other violent criminals who repeatedly re-offend. At the November 1999 annual meeting of the Society for Neuroscience, Asa Bergvall presented findings on their study of violent offenders. The results were quite startling.
“The violent offenders are like the controls in every task but one, which taps prefrontal function,” says Bergvall. “In that, it was as if they were retarded.” They had an impaired ability to shift their attention in order to view the world in a different way – a function linked to the lateral prefrontal cortex. Other, higher order executive functions of their prefrontal cortex appeared to be unimpaired.
University of Southern California psychopathologist Adrian Raine has documented prefrontal damage in people with Antisocial Personality Disorder, which is characterized by irresponsibility and deceitfulness, lack of emotional depth and remorse. The antisocial men actually had 11-14% less brain tissue volume in their prefrontal cortexes, compared to normal males – a deficit of about two teaspoons’ worth.”
Neural Circuit Damage and Violent and Aggressive Behavior:
The “amygdala” is a pair of small almond-shaped structures situated between the cerebral cortex and the limbic/emotional center of the brain. When this neural circuit for processing emotional information is damaged, the prefrontal cortex cannot interpret feedback from the limbic system.
Most Vulnerable Area of the Head – Prefrontal Cortex:
Unfortunately, the area of the head most vulnerable to injury is also where the most fragile and crucial region of the human brain is located. Behind your forehead lies your prefrontal cortex , the center of your higher-order “executive functions,” as well as home to your social awareness and moral conscience.
Injury to the prefrontal cortex can affect your most human qualities: the ability to process information and solve problems; to concentrate, remember, and learn. Damage here can lead to personality changes that manifest in impulsive and socially inappropriate behavior, depression, and violence.
The prefrontal cortex is the last to form the deep fissures that give the outer layer of the human brain its characteristic cauliflower-like appearance – and its vast array of higher functions. In the womb, this area is the slowest to develop. After birth, brain cells in the prefrontal cortex form connections more slowly than any other brain area, and levels of the key neurotransmitter dopamine rise very gradually.The prefrontal cortex bestows humans with “executive functions,” such as working memory and multi-tasking.
In the rough and tumble sport of rugby – whose players do not wear helmets – as many as 25% of injuries appear to involve the brain trauma of concussion. A quarter of playing days lost from rugby involved such head injuries.
What usually happens in brain injury at the cellular level is a combination of primary and secondary damage known as “axonal injury.” Axons are the microscopic nerve fibers of neurons, the brain cells that communicate with each other. Axons form the long connecting nerve fibers of the neural networks throughout the brain.
After a closed head injury, the shifting and rotation of the brain inside the skull causes a shearing injury to the brain’s complex circuitry. This axonal shearing can occur in localized areas or throughout the brain. The latter is called “diffuse axonal shear.” Furthermore, the brain cells particularly important to learning and memory (cholinergic neurons), are apparently more vulnerable to trauma than other neurotransmitter systems.
“First, the nerve fiber itself may be damaged and begin to swell. The swelling usually acutely reduces functioning of that cell but some neurocognitive functions may be restored soon after as swelling reduces. The process of scarring, however, follows and can take weeks, months, or even years, to complete. As the axon scars over, fewer and fewer impulses can be carried through the tough scar tissue, and the axon may begin to necrotize (die) and lose connectivity function over time. This accounts for a number of symptoms which could worsen with time.”
For the past decade, Drs. Maxwell and Graham at the Institute of Biomedical and Life Sciences, University of Glasgow, Scotland have focused on the effect of brain injury at the level of the axon. They have concluded that “two different mechanisms of injury may be occurring in non-impact injury to the head. The first is shearing of axons and sealing of fragmented axonal membranes within 60 minutes. A second mechanism occurs in other fibres where perturbation of the axon results in axonal swelling and disconnection at a minimum of 2 hours after injury.” Axonal shear is a microscopic tear along the myelin sheath surrounding the nerve fiber that is often followed by microswelling and the formation of scar tissue. According to Kit W. Harrison, Ph.D., at the Houston Behavioral Health Associates:
Marvel of engineering that it is, the human skull is no match for the kinds of insults it faces. Collisions with metal or asphalt, goalposts or someone else’s noggin, create forces that can severely damage the brain’s tender tissues and disrupt its intricate circuitry.
Protect your brain!!
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