SAVE THE OPEN INTERNET - Here's How

Movie "Concussion" (December 2015) Raises Awareness of Chronic Traumatic Encephalopathy (CTE)

Click on this link to see the official trailer for the movie "Concussion" starring Will Smith next month: https://youtu.be/LVRIntuk7uc

https://youtu.be/LVRIntuk7uc

I've been waiting almost a full year to see this movie coming out next month about Chronic traumatic encephalopathy (CTE), which, despite the NFL's best attempts to suggest the diagnosis is not based on good science, and despite the money they have spent trying to obscure and discredit the research, is a real and significant problem, that doesn't just affect football, but any sport that causes a series of "minor" sub-concussive injuries until a final "minor" injury tips the scale, revealing significant and continuing decline of brain function.

Ask Muhammed Ali if CTE is a myth.

A Need For New Bicycle Helmet Standards

Consumer Reports. June 2015.

I was excited when I skimmed a Consumer Reports (2015) on bicycle helmet safety to see a mention of ventilation and rotational injury. However, I was disappointed that no attempt was made to measure either factor. 

The article mentioned that most helmets today protect against linear impact injuries, but don't protect against brain injuries. Then it used the fact that the medical profession has a lot of difficulty quantifying brain injury, and used that issue as an excuse for not testing the effectiveness of helmets in preventing brain injuries.

While the medical consensus is that rotational acceleration of the brain is the cause of injury (Condi, 2015), there is no consensus about how or even whether a traumatic brain injury can be diagnosed at the time of an accident. Capillaries can be sheared, decreasing oxygen supply, without causing enough bleeding to be detected by CAT scans or MRIs. Axons can be stretched and damaged, but memory may not be affected by these losses until weeks after an accident.

However, it is relatively simple to create an inexpensive and disposable brain analog that can be included in a helmet to detect conditions likely to cause brain injury. These devices consist of a set of ink drops, enclosed in permeable membranes, and suspended in a liquid gel. If ink stains the gel, it may be assumed a brain would have been damaged. The depth of color indicates the amount of damage. (needs documentation)

The Kingston Impact Simulator (KIS) test (2013) has been used to test how helmets protect against angular impacts, which is assumed to cause rotation, but it does not directly measure rotation, nor does it consider impact from all possible angles.

The 1960's style leather helmets were criticised because they were not effective against impact injuries, which are the main cause of immediate death after an accident, but the old leather helmets actually prevented more brain injuries than most hard helmets, because most bicycle injuries do not involve high impact danger, but they do cause rotational motion that causes the most shearing of axons and capillaries in the brain.(Condi, 2015)

Clearly a bicycle helmet greatly improves the likelihood of surviving an accident. That fact is not in doubt.

However, I wonder how many of those bicycle accidents were caused by wearing a helmet? Helmets can cause accidents by causing heat build-up, by distracting the rider, and by blocking the rider's vision.

I know that all three of my bicycle accidents as an adult (prior to the "big one," when I wasn't wearing a helmet), happened because I passed out due to heat exhaustion because my bicycle helmet didn't allow adequate ventilation.

I've learned my lesson. I will never ride a bicycle without a helmet. But proper fit, and ventilation will be priorities in selecting a helmet. I'll also be aware of the temperature along the way, and I'll have a back-up plan to get out of the heat in case the temperature rises too quickly. (I already carried three bottles of ice water with me.)

I won't be satisfied that my helmet is providing the most important kind of protection until manufacturers start publishing Kingston Impact Simulator test results, which measure a helmets ability to shield riders from angular impacts that cause rotational injury. Most bicycle accidents happen at under 30 mph, and most brain damage under 30 mph is due to rotational injury, not impact injury. Helmet manufacturers argue that impact protection provides rotation protection, but that is an often repeated conjecture that conflicts with the results of angular momentum helmet studies (2004), because those studies demonstrated significant differences in the amount of protection based on the angle of impact. (Angle of impact translates into direction and degree of rotation.)

* When shopping for a helmet, I would like to know the Kingston Impact Simulator rotational impact test results, including whether test helmets were cracked during testing, and not just the degree to which the impact was reduced by the helmet
* I would like to see an airflow rating with best and poorest ventilation when riding into and away from a 20 mph wind at 20 mph. Vents must be designed with baffles that cause some airflow even when riding with the wind.
* I would like helmets equipped with heat alarms: a simple metal coil mounted inside a helmet expands with heat, and sets off an alarm when the temperature inside the helmet exceeds a safe temperature.
* I would like to see all helmets (bicycle, motorcycle, football, hockey, etc) designed to hold a cheap disposable dye capsule that responds to jarring and rotation the way the brain does, so dye beads suspended in a gel capsule stain the surrounding gel causing the gel to go through a range of color changes to indicate the likelihood and degree of brain injury after an accident. Emergency personnel could take a glance at this capsule and immediately know whether the individual has experienced a sub-concussive injury (because a series of "mild" injuries can cause serious brain damage), a concussion, or a more serious brain injury.
* I would like to see two-vector rotation impact test results showing the simulated level of brain injury (using disposable dye capsules) when a helmet protecting that capsule is dropped 4 feet onto a conveyor belt running at 30 mph (simulating a bicycle accident).


References:

The Best Bike Helmet for You: The bottom line on protecting your brain. (2015). Consumer Reports. Retrieved from http://www.consumerreports.org/cro/magazine/2015/06/best-bike-helmet-for-you/index.htm

Cai, X. (2015). A prototype helmet fitting system. Retrieved from http://qspace.library.queensu.ca/.../Cai_Xingcheng_201501...

Camarillo, D. B., Shull, P. B., Mattson, J., Shultz, R., & Garza, D. (2013). An instrumented mouthguard for measuring linear and angular head impact kinematics in American football. Annals of Biomedical Engineering, 41(9), 1939–49. doi:10.1007/s10439-013-0801-y
http://www.ncbi.nlm.nih.gov/.../PMC39.../pdf/nihms470591.pdf

Condi, F. X. (2015). Helmets, Sensors, and More: A Review. Practical Neurology, 15(2), 32–36. Retrieved from http://practicalneurology.com/.../helmets-sensors-and...

Foster, T. (2013, January). The helmet wars. Popular Science, 282(1), 50-77. Retrieved from
http://web.ebscohost.com/src/pdf...

Karton, C., Rousseau, P., Vassilyadi, M., & Hoshizaki, T. B. (2014). The evaluation of speed skating helmet performance through peak linear and rotational accelerations. British Journal of Sports Medicine, 48(1), 46–50. doi:10.1136/bjsports-2012-091583
http://www.researchgate.net/.../00b7d5203928b50ff8000000.pdf

Kis, M., Saunders, F., ten Hove, M. W., & Leslie, J. R. (2004). Rotational acceleration measurements--evaluating helmet protection. The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques, 31(4), 499–503. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15595255

Kis, M., Saunders, F. W., Irrcher, I., Tator, C. H., Bishop, P. J., & ten Hove, M. W. (2013). A method of evaluating helmet rotational acceleration protection using the Kingston Impact Simulator (KIS Unit). Clinical Journal of Sport Medicine, 23(6), 470–7. doi:10.1097/JSM.0b013e318295a80f

How can I be objective about my own brain health? Some personal reflections.

When things go wrong, or make me angry, that's when I tend to post my thoughts to Facebook.

Sometimes I make positive posts as I'm coming out of a slump, which tend to be a form of self-encouragement. When things are very bad or very good, I'm not on Facebook at all, generally. I also don't tend to post when I'm mentally at my best. That's when I'm doing catch-up projects for the times when I was not doing as well. I post a lot of things just to make sure I have a record of an important event. Everything I post gets archived and indexed for personal searches on Evernote, and often Facebook is the tool I use to overcome memory difficulties, by sharing what has happened. Posting creates records, and it also involves others. Involving others ensures my continuing awareness of my own life, because other people talk with me about my posts, and remind me of my own life in a social context.

However, excessive posts create an overall negative picture of my life. Recently I have started noticing that many people seem to believe I have nothing to contribute. I don't feel that's true, although honesty demands I acknowledge it is true, sometimes. I believe I have finally crossed the point since my head injury that I am aware and sharp more hours of each day than I am slow and confused (although I'm never as sharp as I imagine I once was...).

It is hard to decide what activities are most profitable. The obvious things tend to be so draining on my mental focus that it's hard to distinguish between the things that are actually hurting my health and the things that are helping me get stronger. "No pain, no gain" is what I have believed for a long time, but recently the wise choice has been don't push too hard or you'll go backward instead of forward.

My current strategy is to make sure I cover a group of "basic" activities that every healthy person should do: Bathe and shave, plan meals and snacks, and don't let feelings push my appetite. Do something physically active each day, track the time, and keep increasing it. Do something mentally challenging each day, even it it's just a puzzle, but don't let the mental fatigue push me to the point that I need to take a nap sooner than I would other wise.

Keep scheduling naps rather than allowing how I'm feeling to dictate them. (I'm down to 16 hours of sleep a day. My goal is to keep it at ten hours, knowing my sleep needs will always be greater than most.)

I have made a new (probably strange-sounding commitment) to eat one ounce of dark chocolate per day, one ounce of walnuts or pecans (or almonds, if I run out of the others) per day, a cup of blueberries, (or the equivalent amount of resveratrol, zinc, magnesium, potassium, and vitamin C as supplements if we are out of blueberries) each day. A limit of 1600 calories per day, while making sure V8 low sodium vegetable juice plus fresh vegetables and fruit accounts for more than half of those calories. (My doctor ordered 1500 calories, but I at that level, I kept cheating and lying to myself, and was actually consuming more than 1600 calories when I tried to stay at that level, and I was feeling deprived all the time, which probably accounts for the difficulty. 1600 seems ideal to me. I loose weight at that amount, but much more slowly than I would at 1500, but I don't catch myself "forgetting" about things I should be recording.

Also on the list is to do something social each day (mostly this means not squandering the opportunities that present themselves by keeping mentally alert as much as possible), and following a generally consistent schedule and chore list. Finally, tracking daily progress via notes and a daily written reflections so I have an objective basis for evaluating my progress.

I want to locate or create a daily set of questions to answer to make my daily progress easier to evaluate. A big problem with recovering from mental difficulties (in my case because of a brain injury) is the tendency to feel better because I'm less aware of being worse, and vice versa--the days that feel the worst can indicate greater awareness, and actually would objectively be the better days. I'm not satisfied that I have established a truely objective means to evaluate my day-to-day progress even yet.

My most recent example of this dichotomy (how I feel versus how I am) was when I got the knee injections of cortisone toward the end of August(?). The lack of pain was amazing, and my impression was that I was doing better mentally also, but as the pain slowly returned, I became more and more aware I had actually slipped mentally. Now that the pain is beginning to come back full-force, my mental clarity is obviously better, not because I feel better, but because my writing is clearer, and my awareness of my deficiencies is stronger than ever. (The beginning of next week, I'm getting a lubricant injection in both knees to make up for missing cartilage. The lubricant won't ease pain as the cortisone did, but it also won't have the negative effects on focus and memory.)

I think my best posts have been the ones I have written to help someone else through a problem. One of my goals (which again, will be difficult to measure objectively) is to use this principle (of focusing on others) to benefit myself.

The roles of confidence and faith in recovering after a TBI

The items in the list below are the results of a brain-storming session I indulged in prior to writing this post.

Confidence and Executive function

Confidence and Motivation
Confidence and Focus

Confidence and Rebalancing Left and Right brain responsibilities

Confidence and sequential thinking

Confidence and Event-Memory

Over a lifetime of learning, each of us continually builds upon a personal model that represents our understanding of reality, or "how things work." A brain injury, by changing the way our own minds work, can make our previous mental models obsolete, and can result in a crisis of confidence that can be more disabling to us functionally, than it is to our actual capability to recover.

A few moments ago I had an epiphany in which I realized that confidence enables a person who appears to be functional after a brain injury to be able to work effectively without succumbing to sudden overwhelming mental exhaustion as we doubt and test and retest the basic assumptions that form our personal models of reality.

Confidence is not just an attitude. It is intimately connected with the years of experience of successes and failures that went into building the personal mental models with which we understand the world around us. When a brain injury disrupts our personal balance between left and right-brain thinking, there will naturally be a crisis of confidence during the transition. If sequential language-oriented management of our mental model has been compromised, and is in the process of being replaced by a more visually oriented management process, we may recognize why we previously thought the way we did, but if we can no longer test the and verify the trustworthiness of our thought processes as quickly as we once could, we loose confidence over our entire sense of reality. Every premise must be re-tested, and in some cases, new and possibly even better reality models may result, potentially improving us. However, if we do not understand the role of confidence and the need to risk trusting our new perspectives as we chose to trust our previous perspectives when we were younger, our confidence may never be restored, and we may forever be caught in a preparatory mode of rediscovering our personal sense of reality. At some point, there must be a transition from questioning everything, to trusting our own judgment once again, even if our "new" judgment does not have the benefit of years of trials. We must start over in learning to trust ourselves. Yet, having already navigated this challenge in the past, it should not be as difficult, if we choose to believe in ourselves as we once believed.

When I speak of "functional recovery," I am speaking of how we recover our functional capabilities, as opposed to how we may have hoped to recover old abilities via physical healing. Functional recovery involves accepting that some of our losses were permanent, and won't be coming back. Functional recovery means finding new ways to solve old problems. It also introduces the hope that our more experienced minds may come up with superior ways to do things, which may help us turn some of our losses into gains. I firmly believe that last point should become the basis of our hope for the future, that we should not hope to be "nearly as good" as we were before, but that we should see the changes we are being forced to make as an opportunity to build a better foundation for a more efficient and more useful model of reality.

Perseveration - Persistent Repetition After Brain Injury

I stumbled across this video a few minutes ago. As with "flooding," I had never heard this term before I saw it used in a video by the Northern Brain Injury Association of British Columbia. The description of perseveration brings to mind my own difficulties with what I have called distraction "loops," several incidents of which, I have written prior posts. My distraction loops are due to a combination of mental fatigue and multi-step tasks in which a component step in the task interrupts my "big picture" of what I'm doing, causing me to either finish the subtask and then, having forgotten the reason for the subtask, causes me to wander on aimlessly, or in the other common scenario, realizing I have lost my sense of what I'm doing, I go to my notes, and start the same task over, eventually coming to the distracting task, and repeating it, often loosing hours before some external distraction finally causes me to stop acting in a half-awake mode, and enables me to stop and focus.

I fear I have not described this ongoing difficulty well. I may revisit this post when I find a way to describe the experience of "distraction loops" better.

Flooding - Becoming Overwhelmed After Brain Injury

I've never heard of the term "flooding" for mental overload, but this is precisely what I deal with multiple times a day when I warn the people around me that I am near my mental fatigue limit. I used to have nearly a half hour from the time I started noticing the mental shutdown until it made me unable to handle simple tasks, but that time has shortened considerably. Now I often feel the shut-down symptoms only moments before I "crash," which means if I'm driving a car, it's time to pull over, regardless of traffic or other considerations. If I can beat the "crash," and get some rest before it overtakes me, I can be "good" again in ten minutes; but once I crash, it can take hours to recuperate.