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Neuroplasticity and Traumatic Brain Injuries

Pamela Foglesong, Kimberly Kocak, Brianna Duda, Maisha Wade, and Lizette Villavicencio

University of Phoenix

PSY/340

May 18, 2015

Dr. Purvi Patel

This era knows much more about the mind than did early thinkers some hundreds of years prior. It was originally thought that the brain worked separate from the body, and that neither contributed to the physiology of the other. Basic structures of the brain were soon discovered through various examinations and experimentations, yet still there were questions left unanswered. How does the brain know to send signals to the body? How does one gather information or recall memories. These are questions that have now been answered through the most recent research and thus, new curiosities have come to light. Neuroplasticity has been a riveting topic of conversation and research over the past few years and for those who have experienced traumatic brain injuries, there is uplifting news.

Neuroplasticity, otherwise known as cortical mapping, refers to the brain’s ability to change and adapt as a result of experience. (Cherry, 2015). In addition to the minds helpful way of moving new information around, it has the ability to reform itself when injury occurs, allowing the affected to thrive under less than perfect conditions. William James, a psychologists in the late 1890’s, was one of the first to suggest that the brain was not as unwavering as once believed and that the mind shows resilience to even the most horrid of changes or injuries. Mechanical injury, or injury to a person by way of blunt force or other non-internal trauma, can be a debilitating experience. Researchers and medical professionals have worked for countless years to find the answers on improving or aiding a person’s recovery after such an injury. We will explore how the brain works to reconfigure itself in these cases and how certain interventions can assist in helping the afflicted to heal from the inside out.

Over 2 million Americans are affected by Traumatic Brain Injuries (TBI) each year in the United States (Davis, 2000, P.1), making TBI’s a major health concern. The first thing to understand is the term, mechanism of injury. The mechanism of injury is described by Dr. Alice E. Davis as “the relationship between the impact of mechanical forces to the head and the resultant physical and physiologic effects to the brain.” (Davis, 2000, Pg. 1). This can occur in a car accident, a fall, sports and even intentional blunt force trauma caused by another person striking someone with an object or fist.

When the mechanism happens it creates the primary injury. These injuries include concussions, contusions, lacerations, intraparenchymal hemorrhage (bleeding in the brain tissue), epidural hematomas (buildup of blood between the brain and skull), subdural hematomas or traumatic subarachnoid hemorrhage (Caufield, 2008). All of these terms really relate to bleeding, swelling, lacerations, shearing and tears within the brain itself. The secondary injury occurs in the next hours, days and weeks. It’s caused from hypoxia (not enough oxygen to the brain), through swelling of the brain against the skull and internal bleeding of the brain. (Davis, 2002) A TBI is considered to be a “progressive damage” (Davis, 2002, P. 2) to the brain. There is the initial impact that creates damage and then you have the aftermath, the body’s reaction, to that impact and it creates secondary damage.

Although the damage from a TBI is often considered irreversible, this is where the plasticity of the brain comes into play. Depending on what has been damaged, which can often take weeks to determine, many times through occupational therapy, the brain will build new pathways to accomplish the task that the damaged area of the brain once operated. The brain often has the neuroplasticity (flexibility) to reassign jobs with the right training, patience, hard work and determination.

Rehabilitation methods for those with a brain injury include cognitive rehabilitation. Cognitive rehabilitation is used to "improve a person's ability to perform cognitive tasks by retraining previously learned skills and teaching compensatory strategies" (Tsaousides & Gordon, 2009). To begin cognitive rehabilitation, a patient is given an assessment, which is done to gain a better understanding of their cognitive strengths and weaknesses post the brain injury. The assessment goal is to become aware of the individual's affected cognitive areas and to determine exactly which areas need further assessment.

Traumatic brain injury, (TBI), leads to many consequences, such as cognitive disruptions (memory, concentration, organizing thoughts and confusion), physical disruptions (headaches and vision) and psychosocial disruptions (anxiety and depression). "Although cognitive rehabilitation targets cognitive and psychosocial functioning more directly, improvements in cognitive functioning could lead to improvements in physical functioning indirectly" (Tsaousides & Gordon, 2009).

The goal of cognitive rehabilitation is to give patients back their cognitive, physical, and psychosocial skills. Such skills include attention, memory, learning, language (identifying words and forming sentences), executive function (to be independent), processing speed (processing information) and psychomotor function. Cognitive and communication disruptions post a brain injury are more effective when treated early on. The focus of this type of rehabilitation is to help the individual get back what they have just recently lost and/or forgotten.

Several pharmacological studies have been conducted to evaluate the efficiency of different medications used on patients with traumatic brain injuries. Although not one single medication can be determined to be the best choice there are several medications that have promising outcomes. Anti-inflammatories such as atorvastatin, simvastatin, rosuvastatin and premorbid have shown positive results by improving the reduction of neuronal loss, reduced amnesia, and improved functional abilities. Use of progesterone in trials using animals was positive, the effects of progesterone have demonstrated to be positive yet further studies are in progress to support past trials. Another drug that has proven positive results has been Ciclosporin-A. The use of this drug has been clasified as safe in trial using mice and further trials will continue to determine the safety in trials using humans. (Rosenfeld, 2012) Another hormone drug that has positive results is erythropoietin this drug helps with motor and cognitive function in patients by reducing the volume of lesions in the brain.(Rosenfeld, 2012) The benefits of using erythropoietin are that the drug has a half-life which means that administration of the drug can be delayed. If successful trials using the inexpensive drug tranexamic acid can help families with patients that have suffered traumatic brain injury by reducing mortality and disability rates.(Rosenfeld, 2012) Currently studies using this drug have been inconclusive however promising and continued studies will keep hope in the medical field.

References:

Rosenfeld, J. V., Maas, A. I., Bragge, P., Morganti-Kossmann, M., Manley, G. T., & Gruen, R. L. (2012). Early management of severe traumatic brain injury. The Lancet, 380(9847), 1088-98. doi:http://dx.doi.org/10.1016/S0140-6736(12)60864-2