Soon a blood test will help detect brain injury in infants

A team of scientists has come up with a new medical test that may help identify infants who may have had bleeding of the brain as a result of abusive head trauma, sometimes referred to as shaken baby syndrome.

Developed by the researchers at Children’s Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, the serum-based test, which needs to be validated in a larger population and receive regulatory approval before being used in clinical practice, would be the first-of-its-kind to be used to detect acute intracranial hemorrhage or bleeding of the brain.

Infants who test positive would then have further evaluation via brain imaging to determine the source of the bleeding.

“Abusive head trauma (AHT) is the leading cause of death from traumatic brain injury in infants and the leading cause of death from physical abuse in the United States,” said senior author Rachel Berger.

Missed diagnoses can be catastrophic as abusive head trauma can lead to permanent brain damage and even death. (AFP/iStock)

However, approximately 30% of AHT diagnoses are missed when caretakers provide inaccurate histories or when infants have nonspecific symptoms such as vomiting or fussiness. Missed diagnoses can be catastrophic as AHT can lead to permanent brain damage and even death.

The researchers collaborated with Axela, a Canadian molecular diagnostics company, to develop a sensitive test that could reduce the chances of a missed diagnosis by using a combination of three biomarkers along with a measure of the patient’s level of hemoglobin, the protein that carries oxygen in blood.

Axela’s automated testing system allowed the researchers to measure multiple biomarkers simultaneously using an extremely small amount of blood, an important characteristic of a test designed to be used in infants.

The test correctly detected acute intracranial hemorrhage because of abusive head trauma approximately 90% of the time, a much higher rate than the sensitivity of clinical judgement, which is approximately 70%.

“The test is not intended to replace clinical judgement, which is crucial,” said Berger. “Rather, we believe that it can supplement clinical evaluation and in cases where symptoms may be unclear, help physicians make a decision about whether an infant needs brain imaging.”

The specificity of the test or the ability to correctly identify an infant without bleeding of the brain who would not require further evaluation was 48%. The researchers aimed for the test to be highly sensitive rather than maximizing accuracy, since missing a diagnosis has more serious consequences than performing brain imaging in babies without the condition.

“This study illustrates the benefits of being able to perform highly sensitive tests at the point of care,” said co-author Paul Smith.



9-year-old Portsmouth girl battling rare brain tumor

Nine-year-old Ciara Brill began having headaches a couple of weeks before Christmas, but nothing that couldn’t be treated with children’s Motrin.

After Christmas, Ciara had a CT scan at a local hospital, where doctors found what her father Harold Brill described as a rare and fast-moving brain tumor.

The diagnosis has left Ciara – a third-grader at Little Harbour School – battling the malignant tumor and her and her parents dealing with her uncertain future.

“You can’t prepare for this, there’s just no way,” Brill said Saturday. “Myself and her mother, the tears are just on and off all day. We know what we’re watching her go through.”

But Harold and Ciara’s mom, Stacie Brill, have been buoyed by support from the Portsmouth community.

A Gofundme page was started to “create as much joy as possible for Ciara for as long as time allows” and help with paying for medical bills and helping the family financially. The page has already raised more than $30,000.


“This community has rallied behind us. Complete strangers have donated and helped us. I can’t thank everyone enough,” Harold Brill said. “There’s no place in the world I’d rather live than Portsmouth.”

Ciara also received “a package with a bunch of get-well cards” from her classmates at Little Harbour School.

“She just lit up when she got that,” he said.

Brill said the Gofundme page is crucial because he’s shut down his business to take care of his daughter full-time.

“We need a lot of prayers, any financial support is going to be extremely helpful,” he said.

Right now, 9-year-old Ciara is “doing fantastic,” he said, but her parents and their extended family worry about the future, because they’ve been told the rare tumor, Diffuse intrinsic pontine glioma (DIPG) is “fast moving, rapidly growing and aggressive.”

Ciara is a “huge animal lover,” Brill said, who loves arts and crafts and is full of life and spirit.

A photo on a Facebook page dedicated to her at http://bit.ly/2i4yyS0, shows her riding a dirt bike.

“She’ll try anything, she jumped right on that dirt bike,” Brill said with a laugh. “When she saw my 10-year-old boy riding it, she wanted to try it.”

The family is supposed to get Ciara’s biopsy results on Monday, so they can “learn about what this tumor is actually made of,” Brill said.

“It’s not just one form, there’s several different make-ups of this tumor,” he said.

Once they learn that, they can start to decide what kind of treatments are available, he said.

He’s literally been calling “doctors or hospitals all across the world,” to try to find a new treatment or drug to attack the tumor.

“Right now, with Ciara it’s quality over quantity,” he said.

DIPG is so rare only about 200 to 400 children in the United States are diagnosed with it every year, Brill said.

He knows about the Seacoast pediatric cancer cluster that has been detected by state officials, but Brill does not believe anything his daughter was exposed to caused the tumor.

“Like the doctor said it’s just pure bad luck,” Brill said.

Like other parents of children with cancer, Brill believes much more of what the United States spends on cancer research should be spent on children’s cancers.

“Only about 4 percent of the money spent goes into children’s cancer research, which is kind of disgusting,” he said. “Definitely, we should be doing a lot more as a country to save our children.”

The Gofundme page, created by Brill’s sister, Georgette Labate, states the tumor is “found in a part of the brain stem called the pons.”

“The pons controls essential bodily functions such as heartbeat, breathing, swallowing, eye movement, eyesight and balance,” the page states.

Brill hopes to hear from anybody who could share important information about the tumor that might help his daughter.

“I definitely like hearing from families who’ve been through this, to share their experiences and learn what they know,” he said.

Ciara, who is home from school, loves to hear from her friends and classmates. Her school is working to keep Ciara in touch with her classmates through the “Monkey in My Chair Program,” where a stuffed monkey sits on Ciara’s chair and her classmates can write messages to her.

The monkey then visits Ciara at her home and she gets to write messages back, Brill said.

“We’re just waiting for the kit to arrive,” Brill said. “She loves stuffed animals, any kind of stuffed animals.”

In the meantime, he and family members continue to research what treatments might be available for his daughter after the terrible diagnosis.

“No parent can prepare for that kind of information,” he said. “I still can’t wrap my head around it.”




Interruptions to rehab are common after stroke or brain injury, but many are preventable

Patients in inpatient rehabilitation after a stroke, brain injury, or spinal cord injury have significant rates of interruptions of their rehab program — often including being transferred back to the hospital for treatment of complications, reports a study in theAmerican Journal of Physical Medicine & Rehabilitation, the official journal of the Association of Academic Physiatrists. The journal is published by Wolters Kluwer.

But at least ten percent of these interruptions and transfers are potentially preventable, suggesting opportunities to improve patient outcomes while lowering the costs of care, according to the new research by Addie Middleton, PhD, DPT and colleagues of University of Texas Medical Branch, Galveston.

The researchers analyzed Medicare data on patients undergoing inpatient rehabilitation for one of three neurological conditions: about 72,000 patients with stroke, 7,100 with traumatic brain injury, and 660 with spinal cord injury (SCI). All were admitted to rehab directly from the hospital.

The analysis focused on two types of issues indicating that the patient’s rehab program wasn’t completed as planned: program interruptions, defined as being transferred to another facility, then back to the rehab center within three days; and short-stay transfers, defined as being transferred to a hospital or other facility before the expected length of stay at the rehab center. “Program interruptions and short-stay transfers are undesirable outcomes that may impact patient recovery and healthcare expenditures,” according to the authors.

The results showed that program interruptions occurred in about one percent of patients: 0.9 percent of those with stroke, 0.8 percent with brain injury, and 1.4 percent with SCI. In nearly all of these cases, the patient was transferred to an acute care hospital, usually because of some type of complication.

Short-stay transfers occurred in about 22 percent of patients with stroke or brain injury, and nearly 32 percent of those with SCI. About one-third of these patients were also transferred back to acute-care hospitals. (Others were transferred to skilled nursing facilities.)

Based on review, the researchers classified some of these events as “potentially preventable.” Across groups, about 11 to 12 percent of program interruptions might have been preventable. Of the short-term transfers, about 15 percent were potentially preventable in the patients with stroke, ten percent with brain injury, and four percent with SCI. Preventable causes of short-term transfers included problems like dehydration, heart failure, pneumonia, and urinary tract infections.

Inpatient rehabilitation is a common focus of policy reforms seeking to improve quality while reducing the costs of healthcare. The new study is one of the first to focus on the impact of program interruptions and short-stay transfers in patients with stroke, brain injury, or SCI.

The results suggest that “Inpatient rehabilitation facilities are performing well in preventing complications,” Dr. Middleton and coauthors write. “However,” they add, “given that more than one in ten of the rehospitalized patients returned to acute care for a potentially avoidable condition, there is still room for improvement.”

The researchers believe that potentially preventable rehospitalizations are a “clear target” for efforts to improve the quality of rehabilitation care. Future studies may identify modifiable risk factors that could be targeted for preventive efforts. Dr. Middleton and colleagues conclude, “Reducing rates of program interruptions and short-stay transfers will not just improve patient experiences of care, they will likely also translate to lower Medicare spending per beneficiary.”


Woman cowering in corner under shadow making a fist

The Women Who Face More Traumatic Brain Injury Than NFL Players

Thirty years ago, Kerri Walker, now a coordinator for a domestic violence shelter in Phoenix, found herself inexplicably driving down the left side of the road into oncoming traffic. “It felt totally normal,” she said, recalling how she was oblivious to the danger. Walker escaped an accident that day, but looking back now, it was the first clue she had an undiagnosed brain injury.

At the time, Walker, 51, was in the throes of an abusive relationship, she said. She estimated that over a 2 1/2-year period, she was hit in the head around 15 times — once with a gun — and violently shaken.

“I had major headaches, and every now and then I would have these moments when I would get dizzy and disoriented,” Walker said. But she didn’t connect her symptoms to the assaults until a year later, when a doctor at Geauga Medical Center in Ohio diagnosed her with traumatic brain injury, or TBI. “When you are in a relationship with that much trauma and violence, you don’t know what’s physical or what’s emotional or mental,” she said.

Soldiers returning from war and athletes are regularly diagnosed with TBI — a complex brain injury caused by a blow or a jolt to the head — and many subsequently receive support and services for the condition.

But domestic violence survivors have been largely left out of the picture.

On Tuesday, the Sojourner Center, one of the largest U.S. domestic violence shelters and where Walker works in Phoenix, is taking a big step to change that. The center, along with TBI experts at local hospitals and medical institutions, is launching an ambitious program dedicated to the study of TBI in women and children living with domestic violence.

The Sojourner BRAIN (Brain Recovery And Inter-professional Neuroscience) Program will study how common domestic violence-related TBI is, investigate short-term and long-term effects, develop domestic violence-specific tools to screen for head trauma, and provide individualized treatment plans.

“These women are falling through the cracks,” said Maria E. Garay, the CEO of Sojourner Center who is spearheading the initiative. “This is a public health epidemic. The fact that no one is tracking this is, to me, a crime.”

Robert Knechtel, the interim director of the BRAIN program, said there is a lack of comprehensive research on TBI in domestic violence survivors. “Most of the work has been done with athletes or the military,” he said. “This is a group that, by extrapolating some numbers, would dwarf the military and the athletes combined.”

The first question they hope to answer is what percentage of domestic violence survivors are suffering from TBI caused by domestic violence. By screening women and children at Sojourner — about 9,000 people are seen at the shelter annually, Knechtel said — they hope to develop an accurate estimate.

According to a rough calculation by Hirsch Handmaker, a radiologist working with Sojourner and CEO of a nonprofit raising awareness of concussions, as many as 20 million women each year could have TBI caused by domestic violence. If that number bears out, it would mean 6 percent of the population experiences domestic violence-related TBI each year.

Compare that with the Centers for Disease Control and Prevention’s estimate that 1.7 million people experience TBI every year, and 2 percent of the population, or 5.3 million Americans, are living with a disability caused by it.

“It’s obvious — if someone is a victim of domestic violence, they are going to have a high propensity for head injuries,” Handmaker said.


Graphic from the United States Centers for Disease Control and Prevention.

Symptoms of TBI range in severity, depending where they occur in the brain and how much damage has occurred over time. They include headaches, double vision, imbalance and decreased motor ability, as well as problems with memory, planning and learning, aggression, irritability and depression. Doctors say it’s important to get a diagnosis early so that testing and treatment can begin.

Garay, the CEO of Sojourner, said that despite the increased likelihood that a domestic violence survivor has a history of head injury, it’s not standard practice for shelters to screen for TBI. “We are not asking questions and we are not providing treatment,” she said.

One goal of the Sojourner program is to develop a screening tool that can be used by non-medical staff, such as social workers and shelter employees.

Jonathan Lifshitz, a neuroscientist at Phoenix Children’s Hospital who is working with Sojourner, said the program will start by using tools already developed for the military and athletes. “We don’t know what tests will be the most effective in this particular population,” Lifshitz said. “The BRAIN program is going to provide the evidence necessary to change practice in this field.”

Kim Gandy, president of the National Network To End Domestic Violence, said undiagnosed TBI may play a role in some women beingunable to leave an abusive relationship.

“Having a brain injury makes it a lot harder for her to get a job and support herself and her kids,” Gandy said. Some symptoms of TBI, such as problems with memory and irritability, may disadvantage a woman if she takes legal actions to protect herself. “She may have more difficulty making her case to the judge, to a police officer, getting a restraining order,” Gandy said, explaining that women with TBI may appear uncooperative or unreliable in court.

While Gandy acknowledged that brain injury is a significant and under-explored issue for domestic violence survivors, she cautioned that a push to diagnose may have unintended consequences. “It could be used against the women in custody battles, or in a variety of ways,” she said. “It’s a very realistic concern.”

Chris Nowinski, executive director of the Sports Legacy Institute, said a TBI diagnosis can have repercussions for athletes as well. “There are instances of athletes who are diagnosed with two concussions in one NFL season who get tagged as a ‘concussion case’ and are never signed again by another team,” he said.

But for the patient, Nowinski said, there are tremendous benefits to having a brain injury diagnosed. “Rehabilitation, treatment and simply an understanding of why you’ve changed,” he said. “The vast majority of people can overcome a brain injury and return to a normal level of functioning.”

kerri walker

Kerri Walker, pictured playing with her grandson, Nick, in 2012. Credit: Facebook.

For Kerri Walker, a TBI diagnosis meant she finally had an explanation for all her cognitive issues. “The one thing that abusers tell us over and over is that we are stupid,” she said. “The relief factor for so many women is going to be unmeasurable.”

It’s taken her a long time — and a lot of work — to adjust to a life with brain injury.

Four months after Walker left her abusive partner, she said, a brain aneurysm ruptured, requiring surgery. Since then, she’s spent years learning how to live with — and accept — the effects of cumulative brain injuries.

“It’s changed me for the rest of my life,” Walker said. “My short-term memory is shot. I’ll be writing and I’ll mix up letters. All of a sudden, I’ll write an E backwards. I had to find a new normal for myself.”



Parents and coaches try to better recognize brain injury in young athletes

More than 100 8- to 14-year-olds flooded the fields at Southwood Park to complete what looked a lot like field sobriety tests: touching their fingers to their noses, walking a straight line toe to heel and reciting the months of the year backward.

“What we’re doing here today, we are actually assessing brain function,” said Cristin Rassi, an advanced practice nurse and leader of the concussion program at Illinois Neurological Institute.

By the end of this week Rassi and about 400 medical professional volunteers will have performed ImPACT neurocognitive assessments on nearly 3,000 players in the Junior Football League as coaches, parents and medical providers take a more proactive approach to protecting the children’s brain health.

As we start to better understand the long-term effects of concussions through research and high profile media reports about ex-football players and other athletes, parents, players and coaches are starting to think differently about how brain injuries are recognized and treated at all levels.

“That’s my son, actually,” Rassi said, pointing out a player completing one of the balance tests. “Believe it or not, my husband is a football coach, and I have done brain injury and concussion for a long time, so this is my way to give back to the community.”

The ImPACT tests are one of a variety of tools available to test things like memory, coordination and balance. A preseason test helps to establish a baseline.

Should a player sustain a concussion, he’d be treated by standard protocols including being pulled from activities and maybe from school. When it’s time to return, he can be re-tested to compare his results to the preseason baseline and determine if there are lingering symptoms of the concussion that aren’t obvious to parents and coaches who have historically made the decisions of when a child returns to the field.

The decision of when a child can safely return to play can be a difficult one for parents and coaches to make, especially when they’re unsure what the subtle symptoms of concussion are and a child is begging to get back to sports.

Having this baseline testing and the training provided by INI and other organizations has been a game-changer for coaches, said Gregg Lockwood, director of Morton JFL.

Coaches aren’t trained to diagnose or treat concussions, but they are better equipped now than ever before to know when to pull a player from the field, send a child to the emergency room or call an ambulance.

“It’s making our coaches a little bit more comfortable as to what to recognize, the symptoms, what to recognize for, their role and most importantly that we lean on the side of caution. If that coach has the least little bit of inkling that that player isn’t right, then he’s done. He’s shut down. We notify mom and dad and get mom and dad involved immediately,” Lockwood said.

Repeated brain injuries can have serious consequences, Rassi said, especially for developing brains. Conditions like chronic traumatic encephalopathy have NFL players questioning their careers. Other risks, like second impact syndrome, are rare but can be life-threatening.

Jane Kalmes, a hockey mom and physician’s assistant in a Prompt Care office, helped build up the concussion screening program within the Peoria Youth Hockey Association. She treats concussions regularly in her office and has provided sideline evaluations to children injured playing hockey or lacrosse alongside her sons.

Her own son was one of the first hockey players to benefit from PYHA’s preseason screening process last year when he sustained a concussion early in the season.

“As a parent, you have to turn around and say, ‘I’m sorry, Johnny, but your brain is more important than this game. I know it sucks, and you want to play, but we have to make sure that you’re OK to go out and play,'” Kalmes said. “Most parents are OK with that.”

And it’s not just the hard-hitting sports that can cause concussions, Kalmes said. Concussions can occur in sports such as volleyball, track and cheerleading, as well as non-competitive play, like playing on swingsets or playgrounds. While many primary care physicians and pediatricians aren’t trained in pre-concussion screenings, several brain and sports specialists in the Peoria area are, she said, such as INI, Midwest Orthopeadic Center and Great Plains Orthopeadics.


Kids’ Mild Brain Injury Can Have Long-Term Effect And Mortality Risk

Image result for Kids' Mild Brain Injury Can Have Long-Term Effect And Mortality RiskYoung people who suffer even mild head trauma are more likely to have serious issues later on, including psychiatric problems and premature death, a new study suggests.

Researchers compared 100,000 Swedes who suffered at least one traumatic brain injury (TBI) before age 25 with their unaffected siblings. The investigators found that those who had had head injuries were consistently more likely to die early and have problems functioning as adults.

The effects of an early life TBI — a blow to the head or penetrating head injury that disrupts brain function — were more striking among those who were older when they were injured, whose injury was more severe, or who had repeated head injuries, the findings showed.

“The key finding is that these increased risks remained elevated even after comparison with unaffected siblings, which is consistent with [the notion] that TBIs partly cause these outcomes,” study author Dr. Seena Fazel said. Fazel is a professor of forensic psychiatry at the University of Oxford in England.

“The worst outcome is clearly premature mortality,” Fazel added, “but after that the increased risks of psychiatric hospitalization are notable.”

About 1.7 million Americans suffer a traumatic brain injury each year, according to the U.S. Centers for Disease Control and Prevention. Falls and motor vehicle crashes are the leading causes.

Fazel and his colleagues analyzed long-term data of cases in which most patients had one mild head injury, or concussion. Participants, who were born between 1973 and 1985, were 13 years old on average when they were hurt. After age 26, they were followed for an average of eight years.

Previous research on long-term health of people with TBI has addressed more severe injuries and diagnoses. But Fazel noted that his study uncovered risks from even mild head injuries.

TBI consistently was linked to premature death, psychiatric treatment, and low educational attainment. Those who had TBI were also more likely to wind up on welfare or dependent on disability pensions.
Notably, those who had TBI had a more than 10 percent risk of being diagnosed with a psychiatric disorder in adulthood and a 2 percent risk of dying prematurely. Compared to their unaffected siblings, TBI patients were twice as likely to be hospitalized for psychiatric problems and 80 percent more likely to receive a disability pension, according to the report.

Dr. Bradley Sandella, program director of sports medicine at Christiana Care Health System in Wilmington, Del., said he wasn’t surprised by most of the findings.

“For some time, there has been speculation within the medical community that there is a strong link between traumatic brain injury and psychiatric issues,” said Sandella, who wasn’t involved in the new research.

“Essentially, the belief is that the brain injury can trigger or exacerbate the symptoms of a psychiatric illness,” he added. “I found it somewhat surprising that there was a higher increase in mortality at a younger age. While I am aware there could be a minor spike in suicides, a 2 percent absolute risk increase is surprisingly high.”

Fazel and Sandella agreed that the findings underscore the need to prevent and manage TBIs.

Certain efforts have already paid off, Sandella noted. Concussions among school-age athletes are being better handled by teaching football players safer tackling techniques and keeping athletes off the field when a head injury is suspected.
“However, more needs to be done, including the banning of dangerous or reckless plays in sports that place people at risk for injuries,” Sandella said.

Fazel zeroed in on younger children. “Improving parental supervision for toddlers and preschool children [is recommended], as falling is the most common form of TBI in young children,” he said.

Sandella said early involvement of a mental health professional in management of concussions will help head off future psychiatric issues.

“Collaborative efforts can have a dramatically positive effect on the patient’s journey toward optimal health after a traumatic brain injury,” he said.


7 Ways to Support a Loved One With Traumatic Brain Injury

Hand holding.If someone you love is dealing with a traumatic brain injury (TBI), you may want to offer support, but not know how. As a survivor of TBI, these are my thoughts on how to support a friend or family member going through this difficult experience.

Understanding traumatic brain injury begins by thinking about basic things we take for granted each day. You probably take for granted that when you wake up, you will go to sleep that night as the same person you were when you began your day. You thought the same thoughts, had the same feelings, dreams, goals and abilities as you did the day before. You expect that the next day you will still look at yourself in the mirror and recognize your face, body and voice as yours. You know yourself. Whether or not you like yourself, you have full recognition of your body, mind and spirit. You may not be content or satisfied with who you’ve become, but you understand how you got that way, and you think about what you need to do to change, grow and progress.

Now, imagine waking up one day and within the course of your normal activities, a blow to the head removes all that. Imagine your sense of self disappearing like a document in your computer that you forgot to save. You remember it, mostly, kinda. You search for it; you know it’s there, somewhere, but no matter how hard you search, you just can’t find it. So you try to make a new one, as close to the old one as possible, but all the subtle nuances and specific details are gone. All you can do is try to make copy of the “you” that used to be.

You may feel like an impostor. You may feel like you’re living someone else’s life, but it’s your life. You’re lonely for yourself. You feel lost.

Things that were so important before may have no meaning. Relationships that you once treasured can be difficult to connect with. You understand the meaning of the lyrics in Gordon Lightfoot’s song, “If You Could Read My Mind” because you walk around like a ghost in your own life “with chains around your feet,” agonizing because “the feeling’s gone and you just can’t get it back.”

Picture yourself getting into your car that only you drive, and suddenly, the seat is in the wrong position. You try the adjust it back to where you’ve always had it, but your most comfortable setting is gone. The steering wheel won’t tilt into place, and the HVAC system no longer has your temperature of choice. The radio has been reprogrammed without any station you recognize. The wipers stick and squeak. The defrost only works on one side of the window. The gas tank is on the other side. You try to drive it anyway, but no matter how hard you try, you just can’t get the speed up. You can’t see, your back hurts, it’s too cold/hot, the music is too loud, the wipers are driving you crazy, and you are so frustrated by everyone honking at you that you just pull over, put your head in your hands and cry.

Now imagine that car is your brain. That’s TBI.

7 Ways to Support a Loved One With Traumatic Brain Injury

1. Believe them. The pain is real. The fatigue is real. The confusion and mood changes aren’t their fault. It’s an injury. Treat it that way. Talk about depression and suicidal thoughts and feelings. I started a Facebook page that contains articles about TBI depression and other mental health issues.

2. Rehabilitation is vital. And it’s not all the same. Get your loved one into the best program you can find as soon as possible. If you’re in the USA, the Brain Injury Association of America has many resources on their website. It’s easy to get overwhelmed. Have your friends and family look for resources and do research for you. My friend Trina Chambers-Bradlee and I started a page to help others find financial help because I had a difficult time finding resources.

3. Not all concussion doctors are equal. Regardless of their status in the medical community, if you feel that the care is unsatisfactory for your situation, find another doctor.

4. An anti-inflammatory diet may be crucial. Fish oil shows evidence of being extremely helpful after brain injury. J.J. Virgin wrote a an e-book about her son’s recovery called “Walking Hope” in which she outlines how they used fish oil in his care. There are many functional medicine doctors and books online with more information about diet.

5. Join support groups. Whether they are in your rehabilitation center, online or at the hospital, support groups are vital to understanding TBI. Don’t try to get through this alone. Support groups will help you deal with all the things that the doctor doesn’t know or doesn’t have time to tell you.

6. Don’t give up. The more tools you put in your toolbox, the better you’ll be able to handle what’s happened. The more help you get for yourself, the more you’ll be able to help your loved one.

7. This is a life-changing event. However, there is life after TBI. The more you understand that you now have to put in extra effort for your loved one, the more enrichment you’ll both receive. Learning about TBI and experiencing it is like learning a new language for both of you. Think of yourselves as if you have suddenly been thrust into a new, strange country. The more you learn and adapt, the more opportunities you’ll have to rebuild a successful life together.

Editor’s note: This is based on one person’s experiences and should not be taken as medical advice. Consult a doctor or medical professional for any questions or concerns you have.