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Breakthrough in diagnosing imbalance in TBI patients

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Doctors are seven times more likely to miss cases of balance dysfunction in TBI patients

A condition that causes loss of vertigo perception and imbalance has been diagnosed in traumatic brain injury patients for the first time, which could yield breakthroughs in the development of new treatments and diagnostic tests.

Of 37 patients with acute traumatic brain injury (TBI) involved in the study, 15 were diagnosed with a newly – characterised neurological diagnosis called vestibular agnosia – a condition in the brain which results in loss of vertigo perception and imbalance.

The impact of such a condition is shown through statistics which reveal TBI patients with balance problems are twice as likely to be unemployed six months after their injury, compared to those without balance dysfunction.

The research, from Imperial College London and clinicians at Imperial College Healthcare NHS Trust, also found that these patients have worse balance problems than TBI patients without vestibular agnosia and are unlikely to experience dizziness – one of the main criteria to assess balance problems in TBI patients.

As a result, doctors are seven times more likely to miss cases of balance dysfunction in TBI patients with vestibular agnosia than in those without.

The study is the first to show vestibular agnosia in TBI patients and the researchers believe that current guidelines should be updated to include screening and laboratory tests for TBI patients for vestibular agnosia so that it can be diagnosed and managed at an earlier stage.

“Imbalance affects a majority of TBI patients leading to them having falls fairly frequently,” says study lead Dr Barry Seemungal, consultant neurologist at Imperial College Healthcare NHS Trust and honorary senior lecturer in the Department of Brain Sciences at Imperial College London.

“It can affect patients’ physical and mental wellbeing, as well as affecting patients financially as it can make it hard for them to return to work post treatment.

“Some of these adults also have to support a family or care for elderly patients, meaning the knock-on effect of ill-health in this group is multi-generational. Frequent falls in this patient group also have a financial impact on the NHS due to frequent readmissions to hospitals.

“Our study is the first to identify loss of vertigo in some TBI patients and explain why they have balance problems and falls. This finding could lead to the development of new treatments and diagnostic tests.

“Importantly, current guidelines require updating so that clinicians can screen for vestibular agnosia in TBI patients at a much earlier stage as common treatable balance problems will be missed if the patients do not have access to these tests.

“We believe that diagnosing and treating these balance problems early will lead to a quicker recovery and a better quality of life for our patients.”

TBI is the commonest cause of chronic disability in under 40s and imbalance is one of the major complaints.

A key step in treating TBI imbalance is to understand the underlying causes, but previous studies could not identify a clear-cut cause in TBI patients with chronic imbalance.

Additionally, doctors looking after TBI patients only look for balance problems if patients complain of dizziness, which some patients who have frequent falls don’t experience.

Vestibular agnosia is a condition linked to both loss of vertigo perception and imbalance, due to damage to a neural circuit in the right temporal lobe of the brain.

Although vestibular agnosia can be observed at the bedside, it is most accurately diagnosed in the laboratory using a test developed by Dr Seemungal.

There are currently no specific treatments for vestibular agnosia but its recognition is important as patients may be at risk of falls and may have treatable inner ear problems, despite not complaining of vertigo.

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Smoking linked to stroke in new study 

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Guido Falcone, assistant professor of neurology at Yale School of Medicine, was the senior author of the study

Adults who smoke, or are genetically predisposed to smoking behaviours, are more likely to experience a subarachnoid haemorrhage (SAH), new research has revealed.

The study found that while smokers are at a higher risk of SAH, that rises to over 60 per cent among those with genetic variants that predispose them to smoking.

The research, published in Stroke, a journal of the American Stroke Association, establishes a link between smoking and the risk of SAH for the first time.

While it has been proven in other types of stroke, this is pioneering research in its link with SAH – a type of stroke that occurs when a blood vessel on the surface of the brain ruptures and bleeds into the space between the brain and the skull.

Results of the study show:

  • the relationship between smoking and SAH risk appeared to be linear, with those who smoked half a pack to 20 packs of cigarettes a year having a 27% increased risk;
  • heavier smokers, those who smoked more than 40 packs of cigarettes a year, were nearly three times more at risk for SAH than those who did not smoke; and,
  • people who were genetically predisposed to smoking behaviours were at a 63% greater risk for SAH.

Researchers also stated that while their findings suggest a more pronounced and harmful effect of smoking in women and adults with high blood pressure, they believe larger studies are needed to confirm these results.

“Previous studies have shown that smoking is associated with higher risks of SAH, yet it has been unclear if smoking or another confounding condition such as high blood pressure was a cause of the stroke,” says senior study author Guido Falcone, assistant professor of neurology at Yale School of Medicine.

“A definitive, causal relationship between smoking and the risk of SAH has not been previously established as it has been with other types of stroke.”

During the study, researchers analysed the genetic data of 408,609 people from the UK Biobank, aged 40 to 69 at time of recruitment (2006-2010).

Incidence of SAH was collected throughout the study, with a total of 904 SAHs occurring by the end of the study.

Researchers developed a genetic risk scoring system that included genetic markers associated with risk of smoking and tracked smoking behaviour data, which was collected at the time each participant was recruited.

“Our results provide justification for future studies to focus on evaluating whether information on genetic variants leading to smoking can be used to better identify people at high risk of having one of these types of brain haemorrhages,” said lead study author Julian N. Acosta, neurologist, postdoctoral research fellow at the Yale School of Medicine.

“These targeted populations might benefit from aggressive diagnostic interventions that could lead to early identification of the aneurysms that cause this serious type of bleeding stroke.”

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New campaign to reduce stroke risk launched on Stroke Prevention Day 

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Almost nine out of ten strokes are associated with modifiable risk factors

A 12-week campaign is being launched today – Stroke Prevention Day – to help raise awareness of how the risk of stroke can be reduced. 

The campaign encourages people to make one small positive change to their lifestyle to reduce the possibility of stroke, which is the fourth highest cause of death in the UK. 

According to the Stroke Association UK, 89 per cent – almost 9 in 10 – strokes are associated with modifiable risk factors in the Western countries, including lifestyle elements that can be changed to reduce risk, such as weight, diet and blood pressure. 

New research commissioned by the charity, which is leading the campaign, has also revealed: 

  •  Only 1 in 20 (6%) UK adults think they’re at high risk of a stroke, despite the fact that the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women
  • Almost half (47%) of the country don’t know that high blood pressure is a top risk factor for stroke 
  • 3 in 4 people (73%) said that they have had no information about stroke reduction recently, which rises to over 4 in 5 (85%) of over-65s, who are most at risk of having a stroke.

Blood pressure is the biggest cause of stroke, with 55 per cent of stroke patients having hypertension when they experience their stroke. Further, around 1 in 4 adults from 55 years of age will develop AFib. 

“While these numbers are concerning, they also demonstrate that with increased awareness, we can all take simple steps to reduce our risk,” says Charlie Fox, sales director of OMRON Healthcare, who are supporting the Stroke Association campaign alongside Patients Know Best. 

“As an incredibly important risk factor for stroke, having a healthy heart should be a top priority and remain front of mind.”

AFib can be asymptomatic and may not be present during a medical appointment as episodes can be occasional, which means it is often left undiagnosed. 

But given its seriousness, those who may be at risk should routinely record electrocardiogram (ECG) measurements, according to current medical guidelines. 

Through doing so at home will enable patients to become more in control of their health, with OMRON being one of the companies developing the technology to support them in doing so. 

“The public wants and needs to be more in control of its health, which is why we create products and services that are suitable for use at home as part of our Going for Zero strokes pledge,” adds Fox. 

“OMRON Complete, for example, is an upcoming, clinically validated home blood pressure monitor with a built-in ECG which can help detect AFib which we’re excited to launch in the coming months. 

“It is our hope that through this awareness programme and by equipping the public with the tools it needs, we can make having an empowered and informed lifestyle the new normal.”

People with a Patients Know Best (PKB) Personal Health Record can also log readings to get a more complete picture of their health journey. This allows them to look back with ease and share readings with clinical teams and caregivers in a safe, secure and meaningful way.

Fox concludes: “Your blood pressure provides important health insights. Monitoring it regularly alongside your ECG readings empowers you with knowledge, helps you act sooner, and can even save your life”.

More information about the campaign and how you can make your one small change can be found here: www.stroke.org.uk/PreventionDay

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What are the IDDSI Levels and why do they matter?

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Wiltshire Farm Foods takes you through the importance of the IDDSI Levels

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Dysphagia, more commonly known as swallowing difficulties, can be prevalent amongst those in neuro rehabilitation. For those in recovery, understanding how their swallowing has been affected, what solutions are available and which nutritional, delicious and above all, safe, meals they should be eating, is of paramount importance.   

When someone starts to experience dysphagia, they are most commonly seen by a speech and language therapist (SLT) and a dietitian. Together, they will create a plan for the management of dysphagia. A speech and language therapist will explain in detail the importance of texture modified food and drinks and will work with you to carefully understand the right texture modification for you. 

What is IDDSI?

This is where IDDSI can help you understand your recommended texture modified diet in more detail.  IDDSI stands for International Dysphagia Diet Standardisation Initiative. This is a committee that have developed a framework of 8 levels which provide common terminology to describe food textures and the thickness of liquids for those living with dysphagia.

The purpose of IDDSI is to create standardised terminology and descriptors for texture modified foods and liquids that can be applied and understood globally – across all cultures and age spans.

Before the introduction of IDDSI, there were national descriptors in the UK which were formed by opinion rather than international standards. Having different terminology, categories and definitions in different countries caused some instances of food being of incorrect consistency. The IDDSI framework was fully adopted by food manufacturers and healthcare settings in the UK in March 2019.

The framework consists of levels for both drinks (liquids) and foods, some of which overlap as you can see in the image above. Here is a breakdown of each category in the IDDSI FOODS framework. 

Level 3 – Liquidised/Moderately Thick

  • Can be drunk from a cup
  • Does not retain its shape
  • Can be eaten with a spoon, not a fork
  • Smooth texture with no ‘bits’

Level 4 – Pureed/Extremely Thick

  • Usually eaten with a spoon (a fork is possible)
  • Does not flow easily
  • Does not require chewing
  • Retains its shape
  • No lumps
  • Not a sticky consistency

Level 5 – Minced

  • Can be eaten with either a fork or a spoon
  • Can be scooped and shaped
  • Small lumps are visible, but are easy to squash with tongue
  • Biting is not required
  • Minimal chewing required

Level 6 – Soft & Bite-Sized

  • Can be eaten with fork or spoon
  • Can be mashed/broken down with pressure
  • Chewing is required before swallowing

How can I check my meals are made to IDDSI standards?

You can check to see whether your food is compliant with the IDDSI Framework by watching these IDDSI Food Test videos.

To discover a Softer Foods range which is IDDSI compliant and created with your patients’ needs in mind, register here for the opportunity to try some complimentary meals from Wiltshire Farm Foods.

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