Gordon Johnson: I want to turn now to a topic that probably is under discussed when we talk about brain injury as a whole, but especially, severe brain injury. because most people associate this topic with mild brain injury. The topic is axonal injury, injury to our axonal tracts, the kind of tracts that we(…)
Gordon Johnson: Are there different levels of severity of axonal injury? Dr. Erin Bigler: Well, there are and basically how one should view this is sort of an umbrella classification. So the umbrella classification is traumatic axonal injury. So that encompasses all kinds of changes that may happen at the level of the axon. A(…)
Gordon Johnson: We also see diffuse axonal injury ranked in severity by DAI 1, DAI 2 and DAI 3 or mild, moderate and severe. Is that correct? Dr. Erin Bigler: Well that is correct. But the thing is that’s based on post-mortem, analyses. And so that’s not very helpful when you’re trying to use predictions on somebody who(…)
Gordon Johnson: A close corollary to the severe diffuse accidental injury is brainstem injury. Tell us about brainstem injury. Dr. Erin Bigler: Well brainstem injury typically has a pretty devastating outcome. We published a study a number of years ago wherein the hospital that the university’s affiliated with, we examined 244 patients who came in.(…)
Gordon Johnson: One of the reasons for the advancement in people surviving brain injury in your career is the fact that we are able to image where the pathology is now, is that true? Dr. Erin Bigler: Image where the pathology is and better ways to control brain swelling. Those, those two things are the(…)
Gordon Johnson: Doctor, we’ve covered the issues of severe brain injury and neuroanatomy and brain pathology. But what we really haven’t talked about is what is probably the area of greatest explosion of knowledge right now: The importance of the network in terms of how the brain works. But within that, the significance of these(…)
Gordon Johnson: Before we leave the analogy of the 405… We also talk about brain dysfunction as a finite thing, like the brain will be equally dysfunctional at 8:00 in the morning as 4:00 in the afternoon. And we know as behavioral scientists that that really isn’t true. Let’s think in terms of that 405,(…)
Gordon Johnson: You were going to show us, demonstrate some of the problems with networks and hubs with respect to this patient, is that correct? Dr. Erin Bigler: Yes. So this is a patient who sustained a severe traumatic brain injury in a head-on collision. Let me just start right here, just so we see(…)
Gordon Johnson: When we talk about hubs, we’re not really talking about hubs in the traditional computer sense (and not there that’s a traditional computer sense). I think of a hub as my USB hub, for example, where the information is actually exchanged. What we’re talking about is areas of the brain where there is(…)
Gordon Johnson: I’d like to also talk about why we sometimes have very significant disability after mild burn injury and remarkable, miraculous recoveries from severe. You and I had this conversation yesterday and we talked about the difference between the damage a tornado might do to Miami versus a hurricane. Dr. Erin Bigler: Yes. Gordon(…)
Gordon Johnson: As we go forward – you’re a professor of neuroscience, I’m student of it -as we go forward what do you see as the bright prospects for better recoveries, better understanding, better diagnoses with brain injuries? Dr. Erin Bigler: Well, one of the areas that I’m actively working in is actually look at(…)
Gordon Johnson: Talk to me about what brain injury people can do to do a better job of managing frustration. Dr. Erin Bigler: Well to a certain extent your mother’s old counsel of count to ten before you react is still a very worthwhile thing that I tell patients all the time. In head injury,(…)
Gordon Johnson: I would like to end our conversation with, some sense of optimism, some sense of feeling that no brain injury is necessarily something that you should despair of, to borrow from Hippocrates. Where is the hope as you sit there in that waiting room? Where is the hope when you’re struggling out in(…)
Gordon Johnson: What can we do to make brain rehabilitation more real world, to make it more environmentally appropriate? There’s a term of art, I can’t remember now, where you make, you really make it environmentally correct so that people don’t just get cognitive therapy or speech therapy. Dr. Erin Bigler: Mm hmm. Gordon Johnson: (…)
Gordon Johnson: One of my concerns as a brain injury advocate as we go forward is the risk of head injury to elderly people. We’re going to have more and more elderly and the elderly have relatively severe results. What are the concerns with respect to elderly and head injury? Dr. Erin Bigler: Well, as(…)
Gordon Johnson: Falls I think have now gotten to the point where they are a larger cause of traumatic brain injury than cars. We’re making our cars safer. Unfortunately we’re not working as hard to prevent falls. How important is the goal of making our surfaces more safe, as we go forward? Dr. Erin Bigler: (…)
If I were going to write an amnesia questionnaire? By Gordon S. Johnson, Jr. Overall considerations in assessing amnesia: Ask open-ended questions where you can get a feel as to the communication skills of the person injured. While amnesia is the most sensitive test and most significant test of post concussion dysfunction in the brain,(…)
What is Wrong with Children Playing Football? By Gordon S. Johnson, Jr. In an excellent article in Arizona Central by Nathan Brown, the movement towards baseline concussion testing for children in Pop Warner football is addressed. See http://www.azcentral.com/story/sports/2014/08/16/pop-warner-partners-mayo-clinic-concussions/14176461/ Note to Parents. If the experts believe that your child needs baseline testing for brain function to(…)
