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DALLAS — It’s a time of year when people look forward to great things to come in the year ahead. The Dallas Morning News discovered the following great things to come for brain injury in North Texas.

Therapy for brain injuries

We’ve all heard the singsong phrase, “Practice makes perfect.”

If you can’t sing a song, practice singing. If you can’t play the violin, practice playing. If you can’t read a book, practice reading. For those of us with normal, intact brains, the more we practice, the more we eventually learn what we’re practicing.

Not so for someone with brain injury.

No matter how much they practice, most people who’ve suffered from a brain injury can’t learn even the most menial tasks they were able to do before the injury, like walking or opening a door, says Dr. Michael Kilgard, professor in the School of Behavioral and Brain Sciences at the University of Texas at Dallas.

“It’s just that the brain is in a state that’s not conducive for learning,” he says.

That’s why Kilgard and his team at UTD are working on a therapy that will change the state of neurons in a brain damaged by stroke, making them more conducive to learning.

How are they doing this?

Say you’re learning to play the piano. Normally, if you play the right note, you get excited about it, Kilgard says. Similarly, if you make a mistake, you get upset. Both conditions, getting it really right or really wrong, send a signal to the brain that says “learn whatever just happened,” Kilgard explains.

Now, take a patient who’s suffered from a stroke and is trying to relearn how to pick up a pen. He reaches out, fumbles for it, reaches again, and finally, clumsily, he grasps it.

The wife goes, “Oh, my gosh! You did it!”

The patient thinks only, “It’s just a pen. How exciting is it to grab a pen?”

The problem is, the patient is relearning something that shouldn’t be that hard to learn, so when he does it right, or even when he does it wrong, he’s not that excited. No excitement means no signal to the brain, and no signal to the brain means the chemistry in the damaged neurons isn’t turned on and the patient doesn’t learn anything.

“You practice all you want, but there’s no change and so you don’t get better,” Kilgard says.

So he and his team devised a way to send the signal on their own. They implant a device directly under the patient’s clavicle. When turned on, this device activates a nerve in the neck called the vagus nerve that sends information from the gut to the brain.

“When you stimulate this nerve, your brain says, ‘Whoa, something just happened,’ but you don’t actually notice it,” Kilgard says. “It’s underneath your conscious perception.”

In other words, it doesn’t distract the patient.

Now, while the patient is practicing picking up the pen, the therapist has a button that allows him to send a signal to the patient’s brain that says, “Learn whatever just happened.”

Kilgard and his team began vagus nerve stimulation in tinnitus patients — people with ringing in their ears. They chose the vagus nerve because it isn’t critical to the working of the rest of the body. When the tinnitus treatment began to prove effective, they started working with stroke patients. They saw good results with stroke patients tested in Europe, and are beginning testing patients in Dallas now.

Kilgard says it’s possible this treatment will be available in the U.S. in four years.

He says the best candidates are those suffering from neurological disorders where something has injured the brain, but nothing is happening to harm it now. This means people who suffer from post-traumatic stress disorder, cognitive memory problems and drug addiction are all potential candidates.– Elizabeth Hamilton, ehamilton@dallasnews.com

Brain-injury expert says concussions have devastating impact on football

COLLEGE STATION – Brain injuries suffered by NFL players are now becoming commonplace and many more cases are almost certain to occur with tragic results, said an expert from Boston College during a sports medicine symposium Friday at Texas A&M University.

Dr. Ann McKee, director of neuropathology at Boston College, also serves as a member of the Mackey White Traumatic Brain Injury Committee for the National Football League. She is an expert on brain injuries, especially those involving chronic traumatic encephalopathy, called CTE.

She has examined numerous brains of deceased NFL players, including that of former San Diego Charger Junior Seau, who committed suicide with a gunshot wound to the chest on May 2, 2012 at the age of 43. Later studies by the National Institutes of Health concluded that Seau suffered from CTE, a type of chronic brain damage that has also been found in other deceased former NFL players.

Since then, 5,000 former players have sued the NFL, alleging that it had hidden the dangers of concussions and brain injuries from them. Experts are trying to find out if there is a definite link between brain injuries that can lead to suicide and possibly domestic violence.

“We have known about CTE since the 1920s, when it was first associated with boxing,” McKee said.

“We are just now learning its devastating effects on football players, from youth league to the NFL. It is totally different from Alzheimer’s because CTE is caused specifically by trauma.”

That CTE is directly associated with football and blows to the head are obvious, McKee noted. She said she had studied the brains of 80 former football players and 77 of them showed definitive signs of CTE.

“CTE results in memory loss, mood swings, change of behavior, and sometimes suicide,” McKee said.

“We have found it in the brains of healthy 18-year-old high school players, and it simply should not be there. It results in shrinkage of the brain, and we examined the brain of one former NFL player whose brain at the time of his death was the size of a 1-year-old child.”

McKee said one of the most disturbing aspects of CTE is that the disease continues even when an athlete is no longer playing.

“There is no doubt that the disease progresses even after a player has retired,” she explained.

“A player may retire in his early 30s, and by the time he is approaching 40 or so, he begins to have memory loss and dementia. The disease is still spreading in his brain.

“We have no treatments for CTE,” she added.

“Plus, the only sure way to determine if a player has it is through an autopsy and not while the person is still living.”

Her appearance was part of the Huffines Discussion, organized by the Huffines Institute for Sports Medicine and Human Performance, which featured an array of speakers discussing issues and trends in sports medicine.

The Sydney and J.J. Huffines Institute for Sports Medicine and Human Performance, part of the Texas A&M Department of Health and Kinesiology, was created with a $2.5 million endowment to focus on information and research findings among strength and sport conditioning coaches, athletic trainers, health and wellness coordinators, clinicians, sports psychologists and rehabilitation specialists and is home of the Texas A&M Coaching Academy.

Its goal is to be the bridge between scientists, practitioners and the general public in sports medicine and human performance.

Senate Committee approves 2014 TBI Reauthorization Act

The U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) approved the TBI Reauthorization Act of 2014, S. 2539 introduced by Senators Orrin Hatch (R-UT) and Bob Casey (D-PA).

This legislation addresses traumatic brain injury (TBI), a significant and expensive public health challenge, by supporting a variety of activities related to TBI at several agencies within the Department of Health and Human Services, under the authority granted by the Traumatic Brain Injury Act of 1996 and subsequent reauthorizations.

The legislation reauthorizes programs to help ensure that hospitals and medical facilities have the resources they need to ensure that all patients with traumatic brain injuries get the care they need and includes an increased focus on brain injury management in children.

The Committee approved a TBI Manager’s Amendment which removed Health Resources and Services Administration (HRSA) from sections relating to the State and Protection & Advocacy grant programs leaving the administering agency to be determined by the Secretary of the Health and Human Services (HHS). This is the same as the House bill.

The Amendment also included a provision calling for the Secretary of the HHS to develop a TBI Coordination Plan not later than 18 months after the date of enactment. And, a new section was added directing the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct a scientific review of the management of children with the TBI.

The full Senate will need to pass the bill. As the bill differs from the House version, the House will need to consider these changes.

U.S. House Committee Advances Bipartisan TBI Reauthorization Bill

The U.S. House Committee on Energy and Commerce voted December 11 to advance the “Traumatic Brain Injury Reauthorization Act of 2013.”

Originally passed in 1996 and reauthorized in 2000 and 2008, the TBI Act represents a foundation of coordinated and balanced public policy in prevention, education, research and community living for people with traumatic brain injury.  The TBI Act specifically allocated federal funds for programs supporting individuals with brain injury to federal agencies including the Centers for Disease Control (CDC), the National Institute for Health (NIH) and the Health Resources Administration (HRSA).

The TBI Act, authored by Rep. Bill Pascrell (D-NJ), reauthorizes programs at the Centers for Disease Control and Prevention to track and reduce the incidence of  TBI and to provide support programs for TBI patients and their families.

The committee approved  H.R. 1098,  authored by Rep. Bill Pascrell (D-NJ), by voice vote.

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