Concussion

The human brain is the one element in the universe that can both preserve and destroy mankind as we know it. This highly organized structure with over a hundred billion nerve cells (neurons) has over a thousand trillion connections between those nerve cells. As highly organized as it is, in an instant, the human brain can be damaged or destroyed by external forces. It is the most important “computer processor” known to the universe, that defines who we are and what others perceive us to be. The complexity of such a system as it sits in our skull is unfathomable. On a metaphysical level, this is a galaxy. Chapter 1 - Tragedy in an instant – The reality of radical change in an instant, people with Traumatic Brain Injury (TBI) or Concussion and their loved ones know. Can you imagine yourself as a fully functional human being caring for your family or holding down a job or performing as a student in school, and suddenly not being able to perform any of these functions at a level that you know you were previously able to perform? Meet Mario (Case # 1), a 24 year old dental student from Venezuela, an avid sportsman that lived for the thrill and exhilaration that only a few experience while participating in extreme sports. Mario suffered a form of Traumatic Brain injury that is rarely seen, called “Second Impact Syndrome” (SIS). ...........Learn about how Mario's premature return to playing his sports before he recovered from his first concussion. The second injury nearly took his life and caused him severe disability...... Mario’s brain injury was severe enough that it resulted in a major disruption of his brain hierarchical organization which caused him to be in a comatose state for over one year. Chapter 2 - From Head to Tail….. What is the BEHT Method? – The BHET Method deals with the hierarchical disorganization and subsequent reorganization that occurred in Mario’s brain and the over 50 million victims worldwide who are affected each year with this condition. Understanding the nature of Concussion/TBI in the context of dimensions and domains forms the basis for establishing severity of injury and in determining outcome. Understanding the hierarchical organization at the time of injury and thereafter is the basis of the BHET Method. The domain and dimensional approach helps us answer fundamental questions such as… Will someone emerge from a coma? Can I overcome the phobia of going out in public? Is the dizziness and the vertigo (spinning sensation) permanent? Why can’t I multitask and sustain attention? How about the problems of memory and anger management - will they ever go away? Will I ever be able to enjoy a good night of sleep? Should I stop this medication that I am utilizing to prevent seizures? Can I ever drive again? How about my sexuality? How about the restoration of my rights as an individual and would I ever work again? Chapter 10 -- It’s About Time that we Pay Attention! I recently learned that the American Academy of Neurology receives more inquiries about Concussion and TBI when compared to other neurological disorders. For those of us who attend meetings in our field, it has become one of the most popular subject being discussed. This is clearly a sign of the time. What the public fail to understand about TBI is that TBI/Concussion as it stands is a significant cause of disruption in our social order and is responsible for disruption in families causing divorces, child and spouse abuse, loss of wages and jobs, criminal and antisocial behavior and substance abuse. In fact, whenever I evaluate a patient with history of anger management, violence, panic attacks, motion sickness, headaches, severe anxiety, phobias, obsessive compulsive disorders, attention deficit, bipolar disorders and even schizophrenia, I would ask them or their family members if they recall even the most insignificant incident of trauma to the head. An individual may have hit their head as a child, infant or adult on the cupboard, or on the side of the pool, or during a sporting event, or while navigating the monkey bar or being involved in a car or in a bicycle accident. These individuals may not have thought anything of the fact that they were dizzy or experienced vertigo or trouble concentrating. Let us look at the impact of Concussion/TBI on the penal and criminal justice systems. “Within five years following injury, nearly one-third of individuals with TBI report some involvement with the criminal justice system”, says Farrer et al Studies on the Jail and prison population reveal that between 25% and 87 % of inmates reported head injury. Chapter 13 -- “Time is Brain” Following TBI; compromise of the blood supply to the brain, requires immediate restoration in order to protect the nerve cells and the supporting cells. As a point of illustration, JL Saver published ……. in a patient where there is interruption of a major blood vessel to the brain; approximately 120 million neurons, 830 billion synapses (connections) and 714 kilometers (447 miles) of myelinated nerve fibers are lost each hour. Compromise in the blood circulation, oxygen and nutrition to the brain can result in the loss of brain cells and their connection if the circulation, oxygen and nutrition is not restored rapidly following injury. “Time is Brain” has to do with protecting neurons before and after injury from dying and to try and restore their hierarchical organization and function in as short a time as possible. A term we utilize to describe this form of protection in the nervous system is “Neuroprotection”. Chapter 26 -- So what is the story about CTE? The demons of chronic headaches, fading memories, damaged relationships, lost dreams, unfulfilled lives; this intense state of human suffering brought on by chronic traumatic encephalopathy (CTE), has been described by one of my Ex-NFL players as “ a living hell”. The Mayo Clinic defines chronic traumatic encephalopathy (CTE) as brain degeneration likely caused by repeated head traumas and can be definitively diagnosed at autopsy after someone dies I have listened and read with interest the Story of Benet Omalu, the Nigerian born neuropathologists, who has popularize the term Chronic Traumatic Encephalopathy (CTE). As a victim of the traditional approach to medical care, medical systems and medical research; his story has become the catalyst for all to wake up and take note. In his book “Truth has no sides”, he tells the story of how a not so well known neuropathologists literally lost his job, was asked to recant a landmark paper on the subject of CTE published in the Journal of Neurosurgery. The article described the findings of CTE in a famous NFL player named Mike Webster. This story was later told in a movie called “Concussion” starring Wil Smith. Chapter 14 -- Understanding BHET?—from head to tail…. Understanding how computes are set up and operate, what happens when things go awry and how to fix them, computer scientists hierarchically organize computer systems in terms of “Computer Dimensions”. The concept of Brain Hierarchical Evaluation and Treatment (BHET) Method is based upon Nervous System Dimensions. Here are just a few Dimensions to compare and contrast the hierarchy of the human nervous system and computer systems: Dimension --- Input, processing and output: