Description:
Traumatic Head/Brain injury is a common impact of torture. THI/TBI can be a very debilitating illness not only associated with high rates of PTSD and depression but also major functional and cognitive deficits and physical disabilities. Every torture survivor needs a THI/TBI check in.
This webinar presents the important history of the diagnosis of THI/TBI in the torture field beginning with Dr. Leo Ettinger’s pioneering work with holocaust survivors in Norway in the 1950s and Dr. Richard Mollica’s team’s recent neuroimaging studies at Harvard. Recognition of the heterogeneous symptoms of THI/TBI will be taught, including variations based on the nature of injury, mechanism of injury, and severity of injury. Common tools for screening THI/TBI will be presented, alongside potential interventions used to treat symptoms and recognize when and where to refer people with THI/TBI for evaluation and treatment.
This webinar will benefit the caretakers of survivors of torture with a scientific approach to identification and treatment of THI/TBI.
Objectives:
By the end of this webinar, participants will be able to:
- After attending this webinar, participants will be able to:
- Recall the historical significance of identifying THI/TBI in survivors of extreme violence
- Understand the neuroscience of THI/TBI in survivors of torture
- Recognize the high prevalence of THI/TBI in survivors of torture
- Recognize how traumatic brain injury results in heterogeneous symptoms, which vary depending on the nature, mechanisms, and severity of injury
- Learn common tools for screening for TBI and post-concussive symptoms
- List the interventions used to treat TBI symptoms and recognize when and where to refer people with TBI for evaluation and treatment
Question (that we did not have the time to give to the presenters):
Could you briefly explain in a bit more detail how cortical connectivity negatively impacted THI and TBI?
Response: Dr. Mollica suggested reviewing this article as it explains this question well:
Hayes JP, Bigler ED, Verfaellie M. Traumatic Brain Injury as a Disorder of Brain Connectivity. J Int Neuropsychol Soc. 2016 Feb;22(2):120-37. doi: 10.1017/S1355617715000740. PMID: 26888612; PMCID: PMC5734864.
References and resources:
- PowerPoint of Presentation: 1 slide per page | 3 slides per page
- Eitinger, L. (1961). Pathology of the concentration camp syndrome: Preliminary report. Archives of General Psychiatry, 5(4), 371-379.
- Tanielian T, Jaycox LH, et al. (2008). Invisible Wounds of War. RAND Center for Military Health Policy Research: Santa Monica, CA.
- Hoge CW, McGurk D, et al. (2008). Mild traumatic brain injury in US soldiers returning from Iraq. N Engl J Med; 358(5): 453-63.
- Mollica, R. F., Chernoff, M. C., Berthold, S. M., Lavelle, J., Lyoo, I. K., & Renshaw, P. (2014). The mental health sequelae of traumatic head injury in South Vietnamese ex-political detainees who survived torture. Comprehensive psychiatry, 55(7), 1626-1638.
- Mollica, R. F., Lyoo, I. K., Chernoff, M. C., Bui, H. X., Lavelle, J., Yoon, S. J., … & Renshaw, P. F. (2009). Brain structural abnormalities and mental health sequelae in South Vietnamese ex–political detainees who survived traumatic head injury and torture. Archives of General Psychiatry, 66(11), 1221-1232.
- Keatley, E., Ashman, T., Im, B., & Rasmussen, A. (2013). Self-reported head injury among refugee survivors of torture. The Journal of Head Trauma Rehabilitation, 28(6), E8-E13.
- Saadi A, Williams J, Parvez A, Alegría M, Vranceanu AM. Head Trauma in Refugees and Asylum Seekers: A Systematic Review. Neurology. 2023 05 23; 100(21):e2155-e2169. PMID: 37019660; PMCID: PMC10238158.
- Saadi A, Anand P, Kimball SL. Traumatic brain injury and forensic evaluations: Three case studies of U.S. asylum-seekers. J Forensic Leg Med. 2021 Apr:79:102139. doi: 10.1016/j.jflm.2021.102139. Epub 2021 Mar 11. PMID: 33740607 DOI: 10.1016/j.jflm.2021.102139
- Saadi A., Khoury M., Dietiker C., Mass A., Jacquemet N., & Kuhn T. (2022). Module 8: Traumatic Brain Injury. In Emery E., DeFries T. Asylum Medicine Training Initiative: Asylum Medicine Introductory Curriculum.
- Cognitive assessments in multicultural populations using the Rowland Universal Dementia Assessment Scale: a systematic review and meta-analysis. (2015, March 17). Canadian Medical Association Journal, 187(5), E170. DOI:10.1503/cmaj.140802
TBI Assessment Methods:
- The OSU TBI Identification Method, adapted from Corrigan and Bogner’s (2007) study, demonstrated initial reliability and validity.
- HELPS Brain Injury Tool: The original HELPS TBI screening tool was developed by M. Picard, D. Scarisbrick, R. Paluk, 9/91, International Center for Disabled, TBI-NET, U.S. Department of Education, Rehabilitation Services Administration, Grant #H12A00022.
Symptom Checklists:
- Glasgow Coma Scale
- Neurobehavioral Symptom Inventory
- Rivermead Post-Concussion Symptom Scale
- Post-Concussion Symptom Scale
- Standardized Assessment of Concussion
Cognitive Screening:
- Montreal Cognitive Assessment (recognizing multiple versions, MOCA-B)
- Louis University Mental Status Exam (SLUMS)
- Rowland Universal Dementia Assessment Scale (RUDAS)
Disability Exemption for Citizenship N-648 Additional Resources
Presenters:
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Dr. Richard F. Mollica , Director, Harvard Program in Refugee Trauma (HPRT)
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Altaf Saadi, MD, MSc , Neurologist at Massachusetts General Hospital (MGH) and Assistant Professor of Neurology at Harvard Medical School