Understanding Movement Disorders: A Deep Dive into TBI and its Impact

0:00:08 - Kiley Como Welcome to another episode of Mind Matters: Navigating Head Injuries and Concussions eveyone. My name is Kiley Como. I am the firm's treatment coordinator. My background is I'm a registered nurse specializing in neurological intensive care unit bedside nursing. And so today we're with our brain and concussion group attorney Thomas.

0:00:36 - Thomas Ozbolt Establishing a clear link between the traumatic brain injury that happened in, you know, whatever crash and or incident and having subsequent movement disorders. That's crucial, and it involves thorough medical documentation, expert testimony, eyewitness testimony and a deep understanding of how the law recognizes and compensates for these interconnected health issues. Now, talking about movement disorders specifically, these are defined as abnormal, uncontrollable movements of the body that are characterized by either excessive activity, which is called hyperkinesia, or slowed, hypokinesia, activity of the limbs, trunk and or head. So you have excessive activity, hyperkinesia, slowed activity, hypokinesia. Traumatic brain injury can produce either type as well as movement abnormalities that might be difficult to categorize.

0:01:18 - Kiley Como Okay, so that's interesting. So let's get a little more specific. Tell me about some specific movement disorders.

0:01:22 - Thomas Ozbolt Yeah, the most common ones that are seen in TBI are tremor, dystonia, and Parkinson's disease, believe it or not.

0:01:30 - Kiley Como Okay, so what do you mean by tremors or dystonia?

Right, yeah, tremor you know, kind of has an association maybe with some of us of the older generation of those little creatures in the movie Tremors. But a tremor is a rhythmic oscillation of an extremity or the head, which can one: either occur while the limb or head is not moving. It's called a resting tremor. Number two, while the body part is being used, like if you're eating or drinking it's a kinetic tremor. Or, number three, while it's held in a certain position, you know, while your body's held in a certain position. That's what you call a postural tremor.

Tremor is the most common, most traumatic movement disorder and usually only affects the upper extremities, so your arms. It typically occurs following a motor vehicle accident where you have a rapid deceleration force. So you know, sudden stop, you know you're driving, maybe a head on collision, sudden stop. Or you know you're running into the back of somebody. So in most of our cases it would likely be a head on collision. With these more severe TBI, tremor can first manifest as long as a month to a year following head trauma. It can cause difficulty obviously eating, drinking, doing a lot of everyday things due to the shaking that happens in your body.

0:02:45 - Kiley Como All right, yeah, so that sounds pretty serious. So how do we go about treating this?

0:02:48 - Thomas Ozbolt Medication can help to improve it and there's been some success with neurosurgical intervention. That happens either by destroying or through ablation, or stimulating, through deep brain stimulation or DBS, certain brain structures through the precise stereotactic placement of electrodes. It's actually placing, you know, an electrode inside your brain to affect deep brain stimulation, which just sounds like something from the future. Yeah, it can be effective to an extent.

0:03:20 - Kiley Como Yeah, so that's interesting. I've actually taken care of many patients over the years that have had those same types of procedures that you're talking about, and you're right, it does look like something from the future. It's very, very intricate, patients are very sick, but it's just some fascinating technology that we have these days to take care of patients that are suffering from TBI.

Have you seen it actually be put in? I have, yeah. What does that look like?

0:03:44 - Kiley Como It's very detailed, it takes a lot of time. There's a lot of work in preparation that goes involved, goes along with that, not just the surgeon but, you know, nursing staff standing by, I mean respiratory therapy. A lot of times these patients are on ventilators or, you know, really critically ill otherwise, because, as you mentioned, the brain controls everything, right. Yeah, so when you've got that deep level brain injury, you're talking about some pretty massive overall injuries to the rest of the body.

0:04:13 - Thomas Ozbolt That probably involves a massive team in terms of medical professionals involved in that, probably some highly trained people. Absolutely, and days, weeks in the ICU, yeah, pretty easily.

0:04:24 - Kiley Como Is there any information on, like these success rates of these types of interventions?

0:04:28 - Thomas Ozbolt Yeah. So one long-term study of post-traumatic tremors reported that 65% of the patients had complete resolution or marked reduction of the tremor following the surgery. At the same time, for those folks, post-operation complications and adverse response rates kind of complicate that, because those are showing up in 50 to 90% of the cases. So it's really mixed. You know it's kind of a coin flip on, you know, if you're going to have something significant happen as a complication as a result of that from what one study tells us right now.

0:05:03 - Kiley Como Yeah, you're right. I think a lot of that takes a really patient person, support people around that person who suffered that injury. It's not just the care you get right away but, as you just mentioned, the recovery time it takes. You really got to be in it for the long haul and you've got to be a strong type of person to get through that sort of thing.

0:05:21 - Thomas Ozbolt I'm sure their families are probably in the same situation. Being there by the bedside, so that's not just affecting this person, it's also having a massive impact on the people around.

0:05:31 - Kiley Como Matter of fact, most of their work comes in after the hospitalization because, you know, in the hospital the nursing team, the doctors, are taking care of that patient. But once that patient goes home or to rehab, that's where the family really has to step up, because they're really the major support at that point. When you talk about rehab, it's like how long can that last?

Months. Months, yeah. And that's hard. Even say years in some instances? It could be. I mean there could be some permanent disability, absolutely. But yeah, certainly several weeks of intensive rehab, inpatient, and then you know outpatient rehab, for you know many weeks to months of that, if not into, you know, over a year of that sort of thing. And that's not just physical rehab, you're talking cognitive rehab, speech therapy, I mean, depending on the injury, could be head to toe.

0:06:14 - Thomas Ozbolt So when we talk about the impact of what a crash and what it takes from a person, that's really what we're looking to bring justice to the situation. It's like to have that taken from you as a human being, your ability to function for months on end, and just you know the movement disorders that go along with it. That's, I mean, what would you give up, you know, what would you accept to have that happen in your life? Let's talk about dystonia. Tell me a little bit more about that. Yeah, dystonia.

So, unlike tremor, dystonia is a slow movement that's characterized by involuntary, sustained muscle contraction. This often happens with repetitive twisting movements or abnormal postures. So in some instances, dystonic movement can be accompanied by tremor or rapid jerking movements. And this, you know, is one of those things that can also happen in the general population with something called torticollis or you know another name for that's rye neck, or task specific forms like writer's cramp. If you think about kind of, you know, how, how that can show up in people. Maybe you might know something about torticollis or rye neck, because I sure don't. I know I've seen it before, I've heard it talked about as abnormal posture, but do you know what I'm talking about?

0:07:24 - Kiley Como Yeah, yeah, it's just turns into kind of a muscular disorder at that point more or less, if you want to put it that way. But that's more that kind of a long term and that you know some of the therapies that a person can go through afterwards can help avoid some of that. You know, when the muscles are held in one position, if for any length of time they tend to stiffen up, tighten up, kind of you've heard a foot drop, something like that, similar situation where those muscles just kind of, and tendons just kind of tighten up and you know it's hard to kind of get them free and mobile again.

0:07:53 - Thomas Ozbolt So, first and foremost, post-traumatic dystonias. Typically they don't resolve on their own. So if you're waiting for it to just go away on your own, it's not a great idea. You need to go to the doctor. Now, medical treatment, you know, usually doesn't work either, with the exception of botulinum toxin or Botox injections believe it or not. These are most effective for focal dystonia, for the neck or hand. But just like a tremor, you have precise neurosurgical procedures involving ablation or stimulation of specific brain structures, like that deep brain stimulation we've talked about. That's been done, but it's also had less effective outcomes. So there's just not a lot there right now in terms of medical treatment for this, unfortunately.

0:08:39 - Kiley Como Let's talk a little bit about Parkinson's disease. You mentioned that that's one of those types of movement disorders you might come across when dealing with TBI.

0:08:45 - Thomas Ozbolt Yeah, Parkinson's disease. You know, first thing I think about when I hear that, it's not traumatic brain injury, but it is an example of a hypokinetic movement disorder that's characterized by what's called bradykinesia. That's defined as a slowness or poverty of movement. So you've got bradykinesia, postural instability and a resting tremor. There's often, but not always, a resting tremor in one or both hands. Later there's a progressive difficulty in standing, initiating steps, walking, handwriting, speech and balance control over a matter of several years. And as the disease worsens, dementia may become prominent, leading to required assistant living or assistance with your living.

0:09:29 - Kiley Como So you're not saying that TBI always or even only causes Parkinson's right?

0:09:35 - Thomas Ozbolt Right. Nobody's coming out and saying that, that's definitely important, but because the exact cause of this it's not known, but evidence points to a combination of factors that includes environmental factors such as exposure to pesticides and herbicides, well water consumption believe it or not certain medication, and multiple head trauma. It can occur in the general population spontaneously, as early as 40 to 50 years old usually. But what Parkinson's does is, it destroys the neural pathways in the brain that utilize the neurotransmitter dopamine. So when you have treatment with this, it's focused on replacing that dopamine with various medications, but there's no cure.

0:10:17 - Kiley Como So that makes me think of Muhammad Ali. So we all know Muhammad Ali. Now we're seeing a lot of Michael J Fox when we're talking about this type of movement disorder. What does that mean?

0:10:26 - Thomas Ozbolt Yeah, definitely the most prominent individuals that you associate with this and did a lot to advance treatment options and bring awareness and research money into this. But when you think about this, it's believed that Parkinson's, it doesn't arise from a single incident of head trauma. So it's not the sort of thing where we're saying, hey, you know, 30 year old, you know John Smith, driving down the road, gets crushed by a tractor trailer and has a TBI as a result of that has Parkinson's disease. But it's more a result of repeated head injuries, which does raise a host of concerns for young football, soccer players, young athletes or any other person who's involved in contact sports who then suffers a traumatic brain injury in a motor vehicle, for example.

0:11:52 - Kiley Como Yeah, it's such a mysterious disease, such a mysterious organ in the brain. I know we've been going at it for decades and still I feel like barely scratching the surface there.

0:12:01 - Thomas Ozbolt Yeah, I think we talk about it a lot, but it's kind of like the ocean. You know, we know just a little sliver of what's underneath the waters that make up most of our earth, you know 5% of those, and what we know about the brain is largely the same. It's a really interesting comparison. It's depths are unchartered.

0:12:21 - Kiley Como Yeah, but I am really liking seeing the push toward understanding it more. Like you mentioned football and you know CTE or chronic traumatic encephalopathy and the role that repeated impacts play. So football, boxing, all that sort of thing, it's brought a lot of awareness to the disease in general. So you know it's a good thing to see.

0:12:40 - Thomas Ozbolt Yeah, those tools being, you know, brought to everyday people rather than, you know, just kind of high profile, that's going to change the landscape and really, I think, help our clients and people who we serve to get the tools they need to get over these, you know, tremendous life altering injuries.

0:12:57 - Kiley Como All right, so that's going to do it for us. If you need help with any of this, you can always call us at 980-999-9999. Remember to hit like and subscribe, remember to hit the bell for notifications and if you're in pain, call Shane.