Health & Wellness: Traumatic Brain Injury

By Dr. Robert Van Boven - Board Certified Neurologist - Member of Lakeway Regional Mediacl Center

PUBLIC INVITE: Dr. Van Boven will give a free talk with refreshments on "Concussions - What you need to know" on Tuesday, March 18th at 6 p.m. at Lakeway Regional Medical Center, 100 Medical Parkway, Lakeway, TX 78738 (Directions) Call 512-571-5470 for more information.

What is traumatic brain injury?

A traumatic brain injury (TBI) can be the temporary disruption of function or destruction of brain cells, most commonly by a projectile or blow to the head. Forces are transmitted directly to the brain, or by head movement that cause the brain — which is slightly mobile within the skull — to sustain injury by moving around in space, and collide against the inner surface of the skull. TBIs are very common- more than 1.4 million occur in the US every year.

How are TBIs currently diagnosed?

A doctor assesses the patient’s signs and symptoms for evidence of brain injury, and may also use brain imaging to look for bleeding or other damage. However, in most cases of concussion or mild TBI (the most common injury) no abnormalities appear on CT or MRI because damage is microscopic and/or neurochemical. Therefore, the clinical history, signs and symptoms are crucial for diagnosis. Common symptoms may include headaches, light/noise sensitivity, dizziness, imbalance/incoordination, ringing in the ears, concentration or memory difficulties, irritability, and/or insomnia.

Any New Advanced Methods for Detection of TBI?

Lakeway Regional Medical Center (LMRC) will be ushering in advanced diagnostic technologies for detecting TBIs that are otherwise not detected by a routine CT or MRI. These technologies include:

Volumetric MRI analysis: This technique measures for loss of brain tissue (atrophy) that can occur after injury (or repetitive injuries). When cells die, the thickness of that region is reduced. This technology is also being used to study for risk of dementia.

Diffusion Tensor Imaging: This technology allows non-invasive study of microscopic damage of the neuropathways or connections between brain cells. The movement of water molecules along these pathways allows the evaluation of the integrity of these connections between brain regions and cells.

How do you manage a sport-related TBI?

If a concussion is suspected, the athlete should immediately exit play to prevent further injury. A licensed health care provider (LHCP) should evaluate for the confirming diagnosis and looking for signs of a more severe injury. Athletes should not return to play unless a LHCP establishes full recovery. Post-concussion symptoms usually resolve within hours, days, or weeks. Athletes with a history of multiple concussions may have a risk of developing permanent or lasting impairments.

Much research is underway to identify those at risk, protect against TBI, enhance recovery, and build resilience against long-term effects of TBI. The clinical trial that Dr. Van Boven co-directs, is evaluating two methods to help soldiers regain and improve their cognitive abilities. One method is via “brain-training” web-based exercises developed by world-renowned Neuroscientist Michael Merzenich and others at Posit Science. The other method is called real-time fMRI. In this method, patients attend to different sounds or pictures while in an MRI scanner and are also shown the level of activation of their brain related to task performance. They then train to use this visual feedback of their brain activity levels to see if it can help refine their ability to detect, discriminate, and recall information. If these strategies of enhancing brain function are proven effective, millions of persons with persistent problems from civilian or military TBIs may benefit.

About Dr. Robert Van Boven

Dr. Robert Van Boven did Neurology residency training at Harvard University’s Beth Israel-Deaconess Medical Center and at Northwestern University. He also completed postdoctoral fellowship training at the John Hopkins Hospital and at the National Institutes of Health. He has a special interest in brain plasticity- the neural basis of learning and restoration of function after stroke or traumatic brain injury (TBI). Dr. Van Boven is the partnering principal investigator on one of three Congressionally Directed TBI treatment trials awards in the nation. This Department of Defense-funded study is evaluating novel diagnostic and treatment methods for wounded warriors at Fort Hood, one of the largest US Military installations in the world.

  A native Chicagoan, Dr. Van Boven has lived in the Austin area since 2007. Prior to joining the Lakeway Regional Medical Center (LRMC), Dr. Van Boven has cared for veterans, soldiers, and their families at Fort Riley (Kan.) and Fort Hood.

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