TBI Trend and Growth

Traumatic Brain Injury (TBI) affects a wide variety of people nationwide. One constant
does remain; the human condition suffers, both internally and externally. Studies confirm that
caregivers of those who suffer from TBI may experience feelings of burden, distress, anxiety,
anger, and recurring depression (Brain Injury Association of America [BIAUSA], 2015). More
detrimental is the alarming number of deaths and disabilities caused by TBI, which contribute to
roughly 30% of ALL injury related deaths in the U.S. (Centers for Disease Control and
Prevention [CDCP], 2014). The effects of TBI can include impaired thinking or memory,
movement, sensation, or emotional function (CDCP, 2014). The ferocity and utter devastation of
those afflicted with this condition are severely hindered in life and in turn the negative prognosis
can have an enduring effect on relatives and even on a community as a whole. The proposed
study will review current literature and collective research models and data based on neural stem
cell transplantation on injured brains and their positive outcomes; as well as, the facilitation of
newly implemented procedures for localized drug therapy on their respective injury sites. Studies
are primarily collected in controlled laboratory setting and modeled on mice for efficacy of
desired treatment protocol. Study goals will also encompass current newly invested research at
the University of Miami Miller School of Medicine and the University of Michigan Medical
School so as to further support the indicated research listed above.
Background: Origins of TBI and Impact
TBI is primarily found in patients who suffer from penetrating head injuries that disrupt
the normal function of the brain. It is important to note that not all blows and bumps necessarily
result in TBI formation, but, is based on how serious head trauma is and can range from mild
(i.e. brief change in mental status) to severe (i.e. an extended period of unconsciousness or major
loss of cognitive and motor function) (CDCP, 2014). According to the CDCP (2014), most cases
of TBI result in mild symptoms, like concussions, but if left unchecked can result in serious
injury or even death in some cases. TBI has a very unpredictable form of recovery and many
factors can contribute to the ultimate outcome, such as, pre-morbid personality and oriented goal
direction of healthcare team and patient alike, length of coma, specific area of the brain or brain
stem damaged, family support, age the injury occurs, and care of specialized rehabilitation
services (BIAUSA, 2015).
General Problem Statement
The general problem is represented with the figures provided by the CDCP in 2010;
about 2.5 million Emergency Department (ED) cases were associated with TBI; either presented
singly or in combination with another injury here in the United States (CDCP, 2014). TBI was a
diagnosis in more than 280,000 hospitals and of those cases 50,000 ended in death before and
while at the ED (CDCP, 2014). Based on the collection of data by the CDCP (2014), leading
causes of TBI include: Falls (40.5%), unknown (19.0%), struck by/against (15.5%), motor
vehicle/ traffic accident (14.3%), and assaults (10.7%). Data also suggests that falls account for
the greatest reason for TBI from 2006-2010 (CDCP, 2014). Falls also disproportionately affect
the youngest and oldest age groups across the board, although no definitive correlation expresses
causation between the older you are the More likely you are to fall and the younger you are the
Less likely you are to fall and become burdened with TBI.
Specific Problem Statement
The specific problem in TBI is that it can be rooted based on scientific evidence that out
of the 73 institutions currently focused on TBI research, only three are using neural stem cells to
promote neurogenesis in the brain and out of those three institutions, only two have a drug
approved by the FDA that increases glucose activity in injured bregma regions of the brain
(National Institute of Neurological Disorders and Stroke [NINDS], 2016). As aforementioned in
the previous paragraph, TBI is a major source of death and disability here in the US; not only
does it account for a large portion of ED care and attention, treatment procedures and positive
outcomes in today’s world of modern day medicine are very sporadic in nature and thus can be
emotionally devastating on the family of the afflicted patient. Sometimes good days are followed
by bad days in the ICU and that doesn’t always imply permanent reversals of conditions due to
TBI (i.e. paralysis, mental retardation, comatose, concussion, etc.). Only the University of Miami
Miller School Of Medicine and the University of Michigan Medical School have been able to
successfully immobilize the lingering effects of decreased brain glucose metabolism due to TBI,
as well as, genetically modify neural progenitor cells (NPC’s) in order to increase
histopathological outcomes thus increasing hippocampal neurogenesis in patients who suffered
from Projectile Ballistics Brain Injuries [PBBI] (Bramlett et al., 2015). If clinical professionals
began to implement the models and research methods that have been tested in the lab setting,
then it is ultimately believed that TBI treatment outcomes and prognosis will be headed towards
the right direction.
Purpose of the Study
The purpose of this research will be to gather existing data set for analysis on TBI
research and test the effectiveness associated with transplantation of NPC’s and the results of
localized drug therapy on major traumatic injury sites of the brain. After statistical data has been
compared to those research facilities that are not implementing this treatment methodology,
literature review of information pertaining to efficacy of lab results and extrapolation of data
synthesis; as to why most research is going to be gearing towards this new path of medicine in
the near future will also be discussed in detail. Overall the researcher hopes to raise awareness of
the achievable goals and positive steps that have been affiliated with this specific type of
research methodology. By examining the impact of the programs at the University of Miami and
the University of Michigan and the integration of existing knowledge in the fields of
neuroscience and emergency medicine, more preventative resources including newly integrated
assessments such as genetically modified pro-survival multi-neurotrophin will be allocated to
this specific type of injury nationwide (Blaya, Furones-Alonso &,Tsoulfas, 2015).
Research Questions
The researcher hopes to address these questions in particular:

  1. Is there a correlation between increasing brain glucose utilization on affected TBI mice
    that have been injected with Chronic A20?
  2. Is there sufficient clinical evidence to support that the usage of neural progenitor cells
    expand neurogenesis activity within TBI structures of the brain?
  3. Does surgical intervention create better treatment outcomes than injected NPC’s and
    Schwann cells within the brain stem on TBI patients over an extended period of time?
  4. What are the effects of neural stem cell transplants on endogenous neurogenesis and
    neurobehavioral outcomes of PBBI patients (type of TBI)?
  5. In regards to PBBI patients, how does delivery of optimal site and cell concentration to
    produce maximal engraftment of neural stem cells increase motor and cognitive behavior in rat
    model (brain function similar to humans)?

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