People who have experienced a traumatic brain injury often face many challenges on their road to recovery. Not only must they overcome fundamental physical and cognitive tribulations, they often feel the need to reclaim their place in society. When Eliette Markhbein was struck by a car in 2004, the brain (and spinal) injury left the aspiring journalist searching for a renewed identity while struggling with the healing process. Eliette eventually became passionate about the power of the arts within rehabilitation, using the creative release to experience healing in more than just a physical way. “I turned to art as a respite from rehabilitation, to tame my pain as well as to search for answers within. I found strength, peace and clarity in the process.”
Using art to change perceptions of TBI, Eliette founded the Arts in Medicine program at the Mount Sinai Rehabilitation Center MSRC in New York, the hospital where she was treated. The program offers patients in the spinal cord and brain injury units a non-medical approach to recovery. Her works are now on display with others, as part of The TBI Project which aims to raise awareness about traumatic brain injuries. Portraits in this exhibit include those of rock and movie stars, Keith Richards and George Clooney; Congresswoman Gabrielle Giffords; ABC-TV news correspondent Bob Woodruff; athletes Troy Aikman (NFL Hall of Famer) and Pat Lafontaine (NHL Hall of Famer) among others.
Read more to see Eliette’s success of using art as a modality for the rehabilitation of traumatic brain injury patients. What do you think? Do you, or someone you know, use other creative outlets in rehabilitation?
http://www.sciencefriday.com/arts/2012/03/picturing-brain-injury/?utm_source=BrainLine.org&utm_medium=Twitter

Gen. Peter Chiarelli (Photo credit Susan Walsh)

On Sunday, NPR interviewed Gen. Peter Chiarelli, former vice chief of staff for the U.S. Army regarding US Troops mental health.  A candid and straight forward interview, covering a dynamic and not so straight forward topic.

For instance, the general noted that raising awareness is important “but at the same time, you do not want to leave the general public with the idea that everyone is suffering from these traumas.”  Who wants to hire a Vet with a disorder?

The interview touched on the need for better diagnostic tools as the troops. “I don’t trust those [current TBI survey] as much because soldiers know how to answer those in order to be able to go home to their loved ones and not be caught up in future evaluations,” Chiarelli says.

After 10 years, it appears that the military wants to take a more open and direct look at healthcare for it’s troops.  Have a read.  What do you think?

Troops’ Mental Health: How Much Is Unknown? http://www.npr.org/2012/03/18/148849289/troops-mental-health-how-much-is-unknown

Life is challenging in this day and age, rarely affording us the luxury to focus entirely on one task at a time. Daily life often demands that we divide our attention in most practical situations: work, sports, family, school, driving, cooking, etc. Divided attention is the ability to respond to more than one task at the same time or to attend to more than one task demand at once. These tasks typically include performing a simple sorting task while also monitoring time to determine when a certain interval has elapsed. People have to multitask all the time, in fact, some of the most common tasks we do in life require divided attention.

One example of divided attention would occur when driving to work while having to speak to an employer on a cell phone. This task requires us to pay attention to what our boss is telling us they need, thinking of how to get it done, all the while navigating through your environment in your car. Another example to consider is the simple process of cooking a meal. Whether a head of household or a professional cook, ensuring all ingredients are properly added to a dish, keeping things from burning in other pots, and watching the timer and temperature are just a few aspects of successfully making a meal.

If divided attention declines (or is impaired), our ability to handle multiple tasks suffers. For a person with a brain injury, the focus required for successfully performing more than one task at a time is difficult. Imagine the trouble a mother would have if she was unable to focus on cleaning, cooking, and attending to her children all at once. In order to address some of the challenges that people with traumatic brain injuries face, Blue Marble Game Co. has created an entertaining strategic adventure video game, the “Treasure of Bell Island.” This game engages the player in compelling and cognitively challenging game-play, while  tracking player performance metrics.

Within the game, there are several activities which focus on specific cognitive abilities, including divided attention. In one activity called “Shortcut,” the player (represented by the character Rusty) must create a shortcut through a cavernous tunnel as a means to continue exploring the island. Entering the tunnel at one end, Rusty must memorize a preset sequence of bells ringing and then proceed to a  unlocking mechanism on the other end of the tunnel where he must ring a matching set of bells in the same sequence. To effectively navigate through the tunnel, the player is tasked with keeping their finger on the touchscreen representation of Rusty to ensure his swift progress. During the journey through the tunnel, other incidents will occur to further challenge the player’s divided attention. Once the activity is finished results can be stored, sorted, and compared with outcomes in multiple areas.

Playing the Shortcut activity offers the player the opportunity to repeatedly work on divided attention. In terms of neuroplasticity, repetition is a key means for the brain to re-grow and re-organize synaptic networks (i.e., make new connections). The more frequently a person uses a skill to approximate the successful performance of a task, the more opportunities there are for new connections to form and existing connections to strengthen.

The human brain is an amazing thing; a super computer with the consistency of soft tofu. From almost the point of our birth to our death, our brains are formative like plastic. While the brain isn’t literally made out of plastic, it is malleable; having the ability to change structurally and functionally as a result of input from the environment. Neuroplasticity quite literally means the ability of the brain to structurally alter and reorganize itself in response to stimuli. Brain activity associated with a given function can move to a different location as a consequence of everyday experiences, brain damage or recovery from injuries or disease. So while someone can be drastically affected by a mild traumatic brain injury (mTBI), the brain can be retrained and nerve cells re-wired. A servicemember who experiences an explosion, an athlete who receives a concussion, a person who survives a stroke, or a senior citizen, all experience neuroplasticity from injuries, aging or recovery of function.

The basic principle of neuroplasticity is that individual connections within the brain are constantly being removed or recreated, largely depending on how they are used. This plasticity occurs on a variety of levels, ranging from small changes in learning, to large-scale changes involved in cortical remapping in response to injury. A good example of neuroplasticity is how people gain knowledge through instruction or experience; going to school to learn or memorize a fact or skill. As students our brains make new persistent functional changes that represent new learned knowledge. And as we get older, even when neurons die, the brain can re-grow and re-organize synaptic networks to find new pathways.

One important aspect of Neuroplasticity is the concept of repetition. The more frequently a person learns or experiences something, the more opportunities for new connections to form, allowing the internal structure of existing synapses to change (and form). Using games in the rehabilitation process allows the repetition of specific action(s) while remaining entertaining and sustainable. Employing games in cognitive and physical rehabilitation is not a new concept. For years, clinicians have incorporated board, card, dice, and other games into rehabilitation programs. Games encourage players to overcome obstacles, offer entertainment while challenging the brain & body, and are adaptive in the level of challenge.

With the advent of video game technology such as the Nintendo Wii, Microsoft Kinect, and Sony Move platforms, video games offer rehabilitative benefits to a whole new demographic. Once played only by adolescents, video games can now be played by almost any age group and physical ability. Blue Marble Game Co. has taken gaming to the next level by using video games to make the rehabilitation and wellness processes fun, meaningful, engaging, quantifiable, and cost-effective. Using evidence-based medical knowledge and game design theory we are not only creating video games that support the benefits of neuroplasticity, but also a means to allow clinicians to directly evaluate and track improvements. In future blogs we will discuss specific cognitive domains trained and measured through Blue Marble’s video games.

Any questions or comments on this blog or links? We look forward to hearing from you and encourage your input.

Further Reading:

Neuroplasticity - http://en.wikipedia.org/wiki/Neuroplasticity

Brain Fitness - http://en.wikipedia.org/wiki/Brain_fitness

Is Your Brain Plastic? - http://www.brainready.com/blog/is_your_brain_plastic.html

The Brain More Than a Computer - http://amazinghumanbrain.blogspot.com/

Click here to view the video on YouTube.

Blue Marble Game Co.
Finally, one of the most unique challenges to come my way was to create a ‘game’ soundtrack for a health/serious ‘game’ that helps with therapy and rehabilitation for service members returning from combat zones. It is a Department of Defense funded game project for Blue Marble Game Co. I was given a set of unique guidelines to compose for the scenes and activities in the game. Blue Marble Game Co is perhaps at the very forefront of revolutionary games for this purpose as well as exciting touch screen and interactive elements. This is unique because this is not your typical Call of Duty type game, in fact, it’s on the envelope of an exciting new generation of interactive experiences that are not only fun to play but also helpful for people with health issues like mild traumatic brain injuries.