The Brain Injury Association of America (BIAA) notes, “Help should take the form of encouragement, not criticism or treating the person as a child.” On Wednesday, we discussed how two of the most common treatment approaches for depression are medications and psychotherapy. However, if a TBI victim suffering depression is unwilling to engage in either treatment, the BIAA says that a friend or family member can help by “reaching out to a trusted friend, doctor or religious leader who might encourage acceptance of treatment.” The BIAA also says friends and family members can encourage the depressed person “to make the phone call to set up the first appointment or, if needed, to agree to have a family member call on his/her behalf.”

When a depressed TBI victim does become involved in therapy, friends and family members can still help in other small ways, possibly by helping remember medications, helping set up a reminder system for remembering medications or simply supporting the individual in getting out of the house more often. The BIAA notes that help may also involve participating in family therapy or marital therapy to discuss and address problems that can only be solved as a family group. “It always means providing supportive actions, without turning the adult depressed person into a child,” the BIAA says.

While it is understandable for people who suffer TBIs to feel depression about the effects of their injuries, it is important for the people closest to the victims to help them take steps toward activities that will ultimately help them improve.

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The first step in dealing with depression is for the victim to acknowledge having a problem. This can often be easier said than done, as many TBI victims can immediately go into denial about feeling depressed. However, friends and family need to express their support and offer assistance in helping the victim take steps to deal with the issue. The BIAA notes that these victims will have to “take steps to cope actively with depression,” meaning that they should move away from behaviors that maintain the depression, such as using drugs and alcohol, endlessly criticizing themselves or hanging out with equally negative friends.

After making these initial steps in identifying and addressing the problem, the BIAA says the next step is to seek professional help. The BIAA recommends looking for a professional who is both familiar with brain injury and specializes in helping people with emotional problems. Indiana residents can utilize the Brain Injury Association of Indiana (BIAI) for help obtaining a referral. A professional will discuss two of the most common treatment approaches for depression: medications and psychotherapy.

The BIAA notes that three “shoulds” apply to wise use of medications:

• One should keep in contact with the prescribing physician.
• The dosage should not be increased or decreased without consulting the doctor.
• One should create a system to help in remembering to take medications as prescribed.

As a final point about getting help, the BIAA notes that the “most important thing the depressed person can do is to stay actively engaged in seeking means to improve his or her mood.” In other words, if one medicine, therapist or other action does not work, the depressed person should try another approach. The BIAA also advises that caution should be taken with the use of antidepressant drugs and side effects should be carefully considered and monitored, as “people with TBI may be more susceptible to side effects than are people in the general population.”

While it is important for the TBI victim battling depression to reach out for help, friends and family members should also make efforts to offer assistance. On Friday, we will discuss some of the things relatives and loved ones of TBI victims can do to help the afflicted recover from depression.

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That comment is important because it reinforces the basic truth that, regardless of their profession before being hurt, a majority of the people struggling with traumatic brain injuries (TBIs) all share significant battles with depression. A study published in the May 19, 2010 issue of the Journal of the American Medical Association (JAMA) stated that not only was the incidence of major depression among people with TBIs nearly eight times greater than would be expected in the general population, but less than half of those found to have major depression received any treatment during the first year.

The Brain Injury Association of America (BIAA) notes that depression after TBI is “not ‘just’ a difficult and painful emotional experience,” but also “compounds many of the challenges that individuals with TBI typically face after injury.” The BIAA says multiple research studies show post-TBI depression being associated with “poorer rehabilitation outcomes, reduced activities of daily living, increased experience of failure, increased stress, reduced employment, more frequent divorce, increased family burden, reduced social-recreational activity, increased sexual problems, reduced life satisfaction and poorer health-related quality of life.” Suicidal thoughts also increase in individuals who experience a TBI and are depressed.

While it has been stated that prevention is the only cure for TBIs, the BIAA notes that the good news is that depression is open to healing. This week, we will discuss ways in which family members and caregivers can recognize and help TBI victims deal with depression.

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Because May is Older Americans Month we have been focusing this week on TBI prevention for people aged 65 and older, an age group that the Centers for Disease Control and Prevention (CDC) says is among the most likely to sustain a TBI. If a parent, grandparent or other older family member recently sustained a fall, the CDC says these may be signs and symptoms of a possible TBI:

• Low-grade headache that won’t go away
• Having more trouble than usual remembering things, paying attention or concentrating, organizing daily tasks, or making decisions and solving problems
• Slowness in thinking, speaking, acting or reading
• Getting lost or easily confused
• Feeling tired all of the time, lack of energy or motivation
• Change in sleep pattern—sleeping much longer than before, having trouble sleeping
• Loss of balance, feeling light-headed or dizzy
• Increased sensitivity to sounds, lights, distractions
• Blurred vision or eyes that tire easily
• Loss of sense of taste or smell
• Ringing in the ears
• Change in sexual drive
• Mood changes like feeling sad, anxious, or listless, or becoming easily irritated or angry for little or no reason

The CDC also points out that people caring for someone with a TBI do not have to do it alone, and the agency lists a number of participating organizations that provide additional resources and materials about TBIs, including:

As the CDC notes, learning about TBI and how to prevent it can help older adults live better lives and stay independent. During Older Americans Month, we can all take steps to pay tribute to elderly relatives and friends in our community by helping keep reduce their chances of suffering one of these debilitating injuries.

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The CDC also notes that falls are the most common cause of TBI among older adults. While you cannot see a TBI in an older person, there are steps you can take to help prevent an older person from sustaining a TBI. The Brain Injury Association of Indiana (BIAI) provides these 10 things you can do to help prevent falls:

1. If possible, get the older adult to participate in regular, moderate exercise such as walking—but be sure to check with his or her doctor first.
2. Make sure all medications are up-to-date. Go over prescriptions with his or her physician to watch for medications that can cause dizziness or loss of balance.
3. Install handrails for the bathroom, along stairways and along steps outside.
4. Have older adults wear shoes with non-skid soles and low heels.
5. Check furniture placement so that there is a clear path.
6. Remove rugs, or at least make sure they have non-skid backing.
7. Thoroughly clean up all spills from floor and take special care after floors have been wet mopped.
8. Provide adequate lighting for all areas including night lights for bedrooms and bathrooms.
9. Provide support when walking, especially when stepping up curbs and uneven pavement.
10. Remind older adults of the need to be patient with themselves—tell them not to rush, take their time and be safe

On Friday we will discuss more ways you can help prevent older friends and relatives from sustaining TBIs and resources available for families with a loved one who has sustained a TBI.

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According to the Brain Injury Association of Indiana (BIAI), one in three Americans aged 65 and older suffers a fall each year and 30 percent of these falls require medical treatment. As BIAI notes, a fall can be much more traumatic and cause more severe injuries for the elderly than for a younger person. The injuries an elderly person sustains after hitting his or her head during a fall can be massive, because veins and arteries are easily torn. According to BIAI, brain injuries account for half of the deaths of elderly people who sustained falls, and the “others are due to a variety of causes including heart failure, strokes, infections and existing chronic conditions made worse by a broken hip or other injuries sustained in the fall.”

One of the best ways we can pay tribute to older persons in our communities and in our families is to help the elderly prevent falls and avoid possibly sustaining TBIs. For the remainder of the week, we will discuss steps that all of us can take to help older friends and relatives with such injury prevention.

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The good news is that the National Highway Traffic Safety Administration (NHTSA) reports that motorcycle helmet use increased from 48 percent in 2005 to 67 percent in 2009. Furthermore, motorcycle helmets saved 1,829 lives in 2008, according to NHTSA.

According to the most recent data available from the NHTSA, 76 percent of the 119 motorcyclists killed in Indiana in 2008 were not wearing helmets. Just as we have implored bicyclists to wear helmets, the same goes for motorcyclists as well. NHTSA analysis shows that 15 percent of hospital-treated helmeted motorcyclists suffered traumatic brain injuries (TBIs) compared to 21 percent of hospital-treated unhelmeted motorcyclists. TBI severity varied by helmet use, as illustrated by this table found in an October 2009 NHTSA report:

Helmet Use by TBI Severity

“Helmeted motorcyclists were significantly less likely to experience TBI,” the agency said in its conclusion, noting that TBIs were “of particular concern in our study” and the injury “was associated with significantly higher hospital charges … Additionally, motorcyclists with TBI were much less likely to be discharged home and more likely to require rehab or to be discharged to long-term care facilities following their hospitalizations. Both destinations are likely to result in costs and burdens for the injured motorcyclists beyond the scope of this study’s data.”

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Despite those injuries, the Courier-Journal reported on April 22, 2012, that Senkowski “has been home for a little more than three weeks and has enjoyed every moment.” Not only did Operation Homefront, a nonprofit organization that provides assistance for military troops and their families, donate a 1992 Plymouth van equipped for Senkowski and his family, but the Courier-Journal reported that Rob Cummins, an Alexandria resident and owner of Halfpriced Harleys in Fishers, donated a power chair after raffling off one of his motorcycles. “I just felt moved to do something,” Cummins told the Courier-Journal. “I made it my personal mission to get Tim’s story out there and get people to donate to the family.”

Cummins’ great-uncle, Andrew Cummins, was honored by the city of Alexandria for his Medal of Honor and his efforts during the 1898 battle at Santiago de Cuba during the Spanish-American War. Additionally, the Courier-Journal reported that his father, Jimmie Cummins Sr., is a disabled World War II veteran and brother Jimmie Cummins Jr. is a Vietnam War veteran.

In addition to those efforts, WXIN-TV reported that Senkowski not only received a computer that can handle voice-activated software, but the family also learned that several non-profits will be teaming up to build a home that the wounded soldier can move around in. According to WXIN, the family picked out the land where they would like to build the home and hope to put a down payment on it using donations they have received. Senkowski told WXIN that the time with his family has given him “the strength to push through the pain and recover both physically and emotionally.” While he will have to return to Walter Reed National Military Medical Center for continued treatment, Senkowski told WXIN that all he wants is to return home and help his wife raise their two young boys.

“She’s always worrying that she’s going to do this on her own, and this might have taken everything that we had away, and I’m hoping that this is showing I’ll be there, but I won’t be able to do as much as I did, but I’ll be there to support her as much as I can,” Senkowski told WXIN.

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Last week, we discussed National Playground Safety Week, a time to focus on the risks of children’s outdoor play environments. On April 22, 2012, one Iowa newspaper called attention to a different type of kid’s safety issue that has also resulted in paralysis, traumatic brain injuries (TBIs) and even death: bullying. The Sioux City Journal devoted its entire front page that Sunday to an editorial about 14-year-old Kenneth Weishuhn, the South O’Brien High School teenager (featured in the news video above from KTIV-TV) who took his own life about a month after he had told family and friends he was gay.

As the Journal’s editorial noted, some say that “bullying is simply a part of life.” While bullying has certainly been occurring at schools across the country for many years, advances in technology have helped the harassment extend far beyond the school grounds. According to Reuters, Weishuhn’s classmates left death threats on his cell phone’s voicemail and “spewed hateful comments via social media,” “including a cruel Facebook page allegedly created solely to harass the boy.” Weishuhn’s death comes as “Bully,” a documentary about the problem in American schools, plays in theaters across the country. The movie follows the lives of five students, including one 12-year-old in Sioux City, Iowa.

The problem, however, is not isolated to one specific area of the country. In New Jersey, MSNBC reported on April 19, 2012, that a student paralyzed by a bully six years ago agreed to a $4.2 million settlement with the school board in the district where he was a student. In Florida, a 17-year-old boy has been charged as an adult and could be facing up to 50 years in prison if convicted for severely beating a then 15-year-old female classmate and causing a TBI following a text message exchange. And last December, here in Indiana, one former Columbus North High School student agreed to a $150,000 settlement of her lawsuit claiming school officials failed to stop bullying by a male classmate.

Parents must make it a point to take an active role if their child is a victim of bullying. They should not only speak to teachers and school representatives, but also be certain to document all discussions about the issue. If the assault is physical, they should call the police right away. If the principal or superintendent does not seem concerned, parents should speak with a local attorney.

Above all else, parents can no longer dismiss bullying as just being “a part of life.” If these situations are ignored, the results can be serious, life-changing injuries or deaths.

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Indiana was one of those 27, having improved from a C- in 2000 to a B+ in 2004. While the NPPS grade for Indiana’s park playgrounds dropped slightly from a C+ in 2000 to a C in 2004 and the child care playgrounds remained a C+ in both surveys, the grade for Indiana’s school playgrounds improved from a C in 2000 to a B+ in 2004.

Because falls remain the leading cause of traumatic brain injuries (TBIs) in the United States, perhaps the biggest area of concern with Indiana’s evaluation on the state report cards would be the grade of F issued in 2000 and 2004 for “Appropriate depth of loose fill” on all three types of playgrounds. The NPPS and CPSC say that acceptable loose-fill materials include hardwood fiber chips or mulch, pea gravel, sand and shredded rubber, and loose-fill surfaces should be maintained to a depth proportionate to the height of the equipment. They note that a 12-inch depth is a good guideline for equipment up to 8 feet in height. While playground safety experts highly recommend the use of various loose-fill or synthetic surface materials, it is also noted that “there are no perfect playground surfaces.”

It should also be noted that Indiana’s playgrounds did still make overall fall surfacing improvements for all three types of playgrounds in the state. Between 2000 and 2004, the overall grades regarding fall surfacing improved from a C- to a B on school playgrounds, from a D+ to a C on childcare playgrounds and from a C to a C+ on park playgrounds.

The grades from the NPPS for “Supervision” also decreased for Indiana, which is a concern and needs to be improved.

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