Director of Brain Injury Research Discusses TBI study - Rehabilitation Institute of Chicago

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Published on December 11, 2015

Source: Examiner

Director of Brain Injury Research Discusses TBI study

Traumatic Brain Injury (TBI) affects nearly 2 million Americans each year. It is often connected to altered social behaviors, such as a military veteran struggling with a short temper. New research from the journal Social Cognitive & Affective Neurosci (SCAN) sheds light on a common effect of TBI, frontal lobe injuries, and in particular how frontal lobe injuries might affect a patient's’ ability to judge such things as a child’s misbehavior or a disagreement in the workplace.

Jordan Grafman, Ph.D., study investigator and director of brain injury research at the Rehabilitation Institute of Chicago (RIC) talked to Brandi Walker about how this research will help doctors, what causes TBI, and how much of an impact it has on a person’s life.

Brandi Walker: What occurrences cause traumatic brain injury (TBI)?

Jordan Grafman: TBI is pervasive in America, affecting 1.7 million patients per year — with many other people never being seen by a health professional who might have had a very mild concussion or “ding.” Given the large number of people having had at least a mild TBI, you probably know someone in your family, colleagues or friends who suffered a mild TBI during an everyday activity. Closed TBIs, where you hit your head, can be caused by car accidents, falls and sports injuries. In this case the brain is injured because it is moved within the skull by an outside force. TBI can also be caused by a penetrating brain injury where an object destroys part of the scalp and skull and enters the brain. This can occur with a bullet or shell fragment wound during combat or by an accidental penetration if you are using a tool or other device that malfunctions.

B.W.: Which part of a person's brain suffers the most when diagnosed with TBI?

J.G.: When a closed TBI is mild, the fibers that connect different parts of the brain are injured and the tendency is for the frontal lobes and anterior temporal lobes of the brain to be most affected. Severe closed TBI or penetrating TBI can affect any brain area. Most commonly, we determine which areas of the brain are damaged by having the person undergo a brain scan using magnetic resonance imaging or CT scan.

B.W.: How much of an impact does TBI have on their way of life?

J.G.: A single mild TBI may leave symptoms that recover over a few weeks, though some people are left with more persistent symptoms beyond that time period. More severe TBI will typically leave people with persistent impairments in cognition or social behavior. For example, repetitive closed TBI is often connected to altered social behaviors — from the veteran struggling with a short temper to the football player in hot water for public altercations.

B.W.: What medical treatments are available for a TBI patient?

J.G.: The TBI patient should be seen by a health professional, usually a medical doctor who specializes in TBI like a physiatrist or neurologist.

B.W.: How does a person learn to adjust to living with TBI?

J.G.: A person suffering a mild TBI will have to adjust for a few weeks or months with symptoms that eventually go away. With a more severe injury, and persistent impairments, people adjust in a variety of ways: they may use intact abilities to help compensate for those that are impaired; they may get rehabilitation and special training to take on returning to school or work, sometimes in a different role; and their family, friends and social circle often provide support and help so that the person is reintegrated back into their community and social life.

B.W.: How would this new research help doctors in developing future treatments for TBI?

J.G.: This study has important implications for clinical and real-world settings. Having deeper understanding of challenges faced by patients with frontal lobe injuries can guide doctors in providing patients with more effective treatment. By mobilizing cross-disciplinary teams including a range of specialists from cognitive neuroscientists to psychologists, physicians can target problems sooner and better guide patients in achieving improved outcomes. The goal is always to find new and better ways to help patients recovering from traumatic brain injuries — and their families — at home, at work and in society.

B.W.: What else should readers know about this new research?

J.G.: The ability to judge such things as a crime or a child’s misbehavior and then assess a reasonable amount of punishment is fairly indicative of one’s ability to rationally, socially integrate within society. It suggests how people will do in the real world; it’s an important predictor for life outcomes. If a patient is unable to assess crimes and other types of misbehavior, it indicates that she or he struggles with several important social skills, such as interpreting another person’s intentions, showing empathy and making rational judgments. People with brain injuries who lack some of these skills, which regulate behavior, have poorer prognoses for resuming normal work, school and family life.

This research is the first to assess this important ability. Our study found that those with frontal lobe injuries had trouble assigning appropriate punishments, and had lower test scores for two abilities: concept formation (the ability to put together different pieces of information to determine their overall theme) and altruism.

It’s also important to note that we continue working on similar research in our efforts at the Rehabilitation Institute of Chicago to improve the lives of people who have suffered traumatic brain injuries, stroke, frontotemporal degeneration, and other brain disorders.

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