For something so delicate, the human brain is a remarkably resilient piece of machinery. With increased understanding of the brain and how it operates—and, in some ways, how it can heal itself—local physicians are learning that the brain is even more remarkable than once thought.
“Years ago,” says David F. Long, M.D., medical director of the Brain Injury Program at Bryn Mawr Rehab Hospital, “if you had an injury or something else that happened to the brain, the lore was that once something happened to the brain cells, there was nothing you could do about it. But we’ve found that’s not true.
“The brain is much more dynamic and more able to change than had been recognized in the past,” he continues. “Conceptually that’s really important, and it affects what we do across all different kinds of therapies.”
This applies to injuries both severe and mild, such as concussions, and this is one reason why physicians prescribe adequate rest to give the brain time to heal in the aftermath.
“Increasingly we’re seeing tremendous growth in the number of concussions treated,” says Dr. Long, who also works with patients dealing with anoxia or inter-cranial hemorrhaging, as well as the occasional Alzheimer’s patient. “A lot of folks are here partly because more people are aware of it, so that’s turned out to be a large volume of brain injuries in total. … Interestingly, we tend to think of football and hockey—the contact sports—but the incidence of concussions is much higher than we think in soccer and basketball and other sports, so it’s important to think across the board.”
Each year, an estimated 1.7 million people sustain a traumatic brain injury, according to the Center for Disease Control and Prevention, Washington, D.C. Of those, approximately 75 percent are concussions or other milder forms of brain injury. Even so, traumatic brain injury is a contributing factor to a third of injury-related deaths in the United States.
Long term, the effects of concussion can have tragic consequences, as evidenced by recent news in professional sports. Chris Pronger, team captain and star defenseman for the National Hockey League’s Philadelphia Flyers, has missed most of the 2011-2012 season and—it has been rumored—might never play hockey again due to the lingering effects of a serious concussion. More recently, some have speculated that the suicide of former National Football League linebacker Junior Seau arose from traumatic brain injuries sustained over the course of a 20-year career. If proven, he wouldn’t be the only one.
To Dr. Long’s point, better awareness has led to improved treatment and, thankfully, prevention. For example, many local high schools are now using ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) neurocognitive evaluations for student athletes. These evaluations compare an athlete’s pre-injury test results with post-injury results to help determine whether a student is ready to return to play, which can also prevent the cumulative effects of concussion.
Team Approach
In addition to treating concussions, Donald M. McCarren, D.O., of Collegeville-based Neurologic Health Associates helps patients through a variety of neurological injuries and developmental disorders—from chronic pain and stroke to multiple sclerosis and Parkinson’s disease. His interest and passion for this ever-changing field are so intense, they seem almost contagious.
“In neurology there are disorders for which you can’t provide a cure,” he says. “When I was in medical school I thought it wouldn’t be long before they had a good treatment for Alzheimer’s, but they still don’t. For other cases, there are times when you truly can get to help and cure someone of their problem, and it’s times like those that are really rewarding because it changes someone’s life.”
Suburban Philadelphians have a number of excellent options for quality neurological care, including Princeton Brain and Spine Care’s state-of-the-art facilities in Pennsylvania and New Jersey. Also, Bryn Mawr Rehab Hospital, which has a 41-bed inpatient brain-injury unit, has developed a continuum of care for people who have experienced a brain injury. The Malvern-based practice works with patients who have suffered injuries from motor-vehicle accidents, falls, equestrian mishaps and assaults. Some might have acute stages of coma, from those in a largely vegetative state to those who have some awareness and interaction.
“We want to know a lot about the particulars of an injury,” Dr. Long says, “so you know what to expect: What was the cause, and was it traumatic? Was there a lack of oxygen? How far out in time are they from when the injury occurred? How old are they? All those things can impact the recovery that we see. We’ve very aware of all those factors, and we can do rehabilitation for patients even with the most severe injuries.”
The goal with patients who have severe injuries is to increase the patient’s ability to communicate and regain consciousness and awareness, according to Dr. Long. From there, treatment focuses on helping patients focus on daily care activities and return to normalcy. Severely injured patients often have significant muscle problems as well—namely, spasticity, which is the excessive contraction and tightness of the muscles—meaning they also have to undergo physical therapy, medication or even surgery to improve his or her outcome.
“We use what is very much a team approach, with different therapy disciplines—speech therapy, recreation therapy, psychology, cognitive therapy, nursing, case management—to help people on the way to recovery,” says Dr. Long. “I also can’t stress enough the importance of family in recovery from neurological [difficulties]. Many people who have injuries make pretty good recoveries, but there’s still a degree of social isolation these folks experience. The goal is to do anything you can to help transition them back into the community.”
Although advancements in neurology and brain-injury rehabilitation have been largely conceptual, they are also technological. Indeed, the technology used to treat neurological injuries and disorders has made great strides. For example, a partnership between Abington Memorial Hospital and Phoenixville Hospital enables an acute stroke patient at Phoenixville to be evaluated via telemedicine technology by a team of board-certified neurologists at Abington.
“When I was in medical school, they were just starting to have CAT scans,” Dr. Long says. “Now they have MRI scans with remarkable anatomical resolution, and other scans that give you the ability to understand what the brain is doing under certain circumstances.”
He’s referring to functional magnetic resonance imaging, or fMRI, which is not yet widely available for clinical use. Even so, it’s a remarkable look ahead into neurology’s likely future. New research suggests that some patients with severe injuries do show signs of consciousness or awareness—some level of brain activity—even when they appear to be in a largely vegetative state.
Although changes in technology and understanding have clearly advanced the quality of treatment for patients with brain injuries, Dr. Long has a suggestion: prevent the injuries from happening in the first place.
“Wearing a seat belt, not texting in the car, wearing a helmet when riding a bicycle or motorcycle—these are basic ideas but people still don’t do them,” he says. “Accidents happen every day.”
