In the second of a two-part feature looking at why it is so hard to get the right help from ACC following a concussion diagnosis, Fiona Terry considers the latest advancements in the treatment of traumatic brain injuries (TBIs). You can read Part I here.
Researchers at Auckland University of Technology hope to improve how we detect and manage traumatic brain injuries (TBIs) by using blood-based biomarkers.
“There’s evidence, particularly from the US, showing two blood proteins give very good indications of TBIs within 24 hours of injury,” says AUT professor Alice Theadom.
“We’re looking at whether the markers are clinically useful after those 24 hours, to map how people recover over time.”
It could transform how these injuries are diagnosed and treated.
“Having a blood test that’s objective will give a clear indication of whether someone needs more support with recovery.”
A TBI is caused when shaking of the brain shreds and tears the neural pathways on the outer layer of the brain. “That’s why we see people struggling in so many different areas,” says Theadom. “Because the brain is having to repair so many neural pathways.
“Even if you wear a helmet, that protects your skull but doesn’t stop your brain moving within the fluid inside your skull. If you fall, knock your head or have an impact to the body – you don’t even have to hit your head directly – that causes shaking of the brain.”
Latest research shows most people are expected to recover from a mild TBI naturally within two weeks, depending on the severity of their condition. But just as doing too much too soon delays recovery, so does doing too little, Theadom says.
“The advice is to nudge into the symptoms, gradually increasing the amount that can be tolerated each time. It’s about finding the balance between challenging your brain so that it realises which connections to rebuild, while not triggering symptoms too much.”
Theadom, together with others in the BIST working group, has also been involved in formulating ACC recovery advice for patients with TBIs. To help speed recovery, its recommendations include limiting screen use, avoiding further injury as well as alcohol, caffeine and other recreational drugs, and no air travel for 24-48 hours.
It notes the warning signs to look out for: fainting, seizures, repeated vomiting, slurred speech and headaches are some of them. It also advises breaking up daily activities into blocks and taking breaks before symptoms get more noticeable.
AUT associate professor Kelly Jones emphasises the focus is on a safe, graduated, symptom-guided approach to return to activity, with ongoing monitoring of symptoms. “If symptoms worsen or return, then the cognitive load is too much and should be reduced to allow for the brain to recover.”
She also advises staying hydrated and nourished with small sips of water and small bites to eat throughout the day to reduce the risk of headaches and vomiting.
The best first step for anyone experiencing a concussion is to get a medical check, whether that be at a GP or emergency department, she adds.
“It’s important to ensure an ACC claim is submitted following an injury, due to the possibility of needing ongoing support, and that those experiencing ongoing symptoms return to their family GP,” Jones says.
“While the brain’s behind everything we do it’s surprisingly vulnerable to injury. It’s a soft, jelly-like substance surrounded by fluid contained in a hard shell and just like any other part of our body, if we knock it, it can bruise, bleed and swell. I think people are not aware of its vulnerability.”
