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According to an article in the Wall Street Journal, by Thomas M Burton, researchers at Mt. Sinai School of Medicine in New York believe they have found a common thread running through many cases of seemingly unrelated social problems: a long- forgotten blow to the head.
The US Centers for Disease Control and Prevention estimates 5.3 million Americans suffer from mental or physical disability due to brain injury.
But what is new in this research is the contention that there are many other cases where a severe past blow to the head, resulting in unconsciousness or confusion, is the unrecognized source of such problems.
“Unidentified traumatic brain injury is an unrecognized major source of social and vocational failure,” states Wayne A Gordon, director of the Brain Injury Research Center at Mt. Sinai.
His team’s research has consistently found high rates of “hidden” head trauma when screening various populations in New York Schools, addiction programs as well as the general population.
The CDC acknowledges its 5.3 million estimate is an undercount: it is based on hospital admissions and doesn’t include people who sought no treatment or were sent home from a doctor’s office with little treatment.
Causes of brain injury can include bike and car accidents, sports concussions, abuse and falls that date back to childhood. (Doctors say that about 85% of common falls in infancy don’t produce long-term deficits, but some do.)
It is difficult to connect with certainty a long-ago blow to the head to memory and cognition problems years later. Many people do recover completely from severe head injury. And mental problems also arise from other causes. Furthermore, the Mt Sinai findings haven’t been completely published or widely evaluated by peers at other institutions.
The research on undiagnosed head injuries could be especially relevant for the homeless. Mt. Sinai researchers found that 82% of the homeless men they studied had suffered brain injury in childhood, primarily as a result of parental abuse.
Researchers in New Haven interviewed 5,000 people and found that while 7.2% recalled a past blow to the head followed by unconsciousness or confusion, those who did had more than twice the rate of depression and of alcohol or drug abuse.
They also had sharply elevated rates of panic disorder, obsessive-compulsive disorder (OCD) and suicide attempts.
This research began in the 1980’s, with Mt. Sinai’s Drs. Gordon and Mary Hibbard, who specialized in rehabilitation and neuropsychology. They were struck by how often the patients referred to them spoke of a brain injury that wasn’t in their medical records.
Later, the Hibbards devised a questionnaire to determine how many children in the city school system had head injuries followed by cognitive difficulties. Results were suggestive.
With a grant from the US Department of Education they set out to determine how many pupils enrolled in programs for children with learning disabilities had ever suffered a hard blow to the head. Startlingly, about 50% had.
Tamar Martin, who is a psychologist in the program says, “The accident can be three months ago, but by the time the symptoms happen, the accident is forgotten. Nobdy puts it together.”
About 5 years ago, the Mt Sinai team began looking at patients in alcohol and drug rehab centers. They determined that 54% had once suffered a hard blow to the head.
Steve Kipnis, medical director of a NY state agency for alcoholism and addiction, says his work has convinced him that many of the patients became alcoholic or addicted in part because of a head injury. Knowing about it, he says, helps in treatment.
“Someone can get hit in the head with a softball and still be working. They tend to be in denial. They get mood swings, they yell at a spouse. It’s a slow downward spiral, and that’s when alcohol and drugs [enter in].”
The Mt Sinai group began to work with Common Ground, a NY nonprofit that builds housing for the homeless. About 70% of the homeless people they tested came out in the 10th percentile or lower for memory, language or attention, according to Jennifer Highley, the group’s director of psychiatric services. Eighty-two percent had a significant blow to the head prior to becoming homeless, usually from parental abuse during childhood.
“People get abused as kids, making them inattentive in school and sometimes unable to learn,” says Highley.
A head injury and the emotional fallout from abuse can lead to alcoholism and addiction, she adds, and “that combination creates the inability to function and often leads to homelessness.”
sole source: Wall Street Journal article by Thomas M Burton on 1/29/08. www.wsj.com
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