Clinics

Treating the trauma of brain injuries

February 02, 2017

Adityarup "Rup" Chakravorty, Waisman Communications

The Thurman family
Tristan Thurman (far right) with family members Kylie, Quinn, Garrett and Rhianna Thurman (Photo provided by Marisa Bartlett)

 One Wednesday in September, 15-year-old Tristan Thurman went to soccer practice at his high school. The team had just lost a game the day before because the other team had scored goals heading the ball, so this practice session was dedicated to heading drills.

Tristan suffered a traumatic brain injury (TBI) at soccer practice.

Tristan remembers feeling slightly dizzy after practice. By that Friday morning, he was throwing up, couldn't walk straight, and in a lot of pain.

Tristan was initially diagnosed with a possible mild concussion. When his condition did not improve within a couple of days, his diagnosis was changed to a severe concussion and, finally, mild traumatic brain injury.

The months following the diagnosis were excruciating for Tristan. “I had severe headaches,” he says. “The first couple of days after the concussion, I slept for 16 hours straight, but after that I would get maybe a couple of hours of sleep a night because I just couldn't sleep through the pain.”

The constant, debilitating pain was not Tristan’s only symptom; he also started to have trouble with his short-term memory, and struggled with having to miss school and not being able to spend time with his friends.

“Some days I would sit on my bed for the entire day, because if I tried to get up, I would fall down,” says Tristan. “We actually got a husky puppy just to keep me company--I would sit on the couch or the bed, and she would sit on my lap, and if I fell asleep, she would sleep by me.”

Months of different treatment regimens brought only sporadic relief for Tristan, says his mother, Marisa Bartlett.

“I knew we had to find a solution to the pain. It wasn’t that the doctors weren’t trying – they did what their protocols told them to do, but nothing was working,” she says. “As a mother you never want to see your child sobbing because the pain won’t stop.”

The following January Tristan had his first appointment at the Pediatric Brain Care Clinic at the Waisman Center.

This clinic is a partnership between the Waisman Center and UW Health and the American Family Children’s Hospital (AFCH). It is an interdisciplinary clinic for infants, children, and adolescents with, or at risk for, developmental and/or behavioral disabilities associated with an acquired brain injury. The clinic also sees children who have had cardiac surgery and have been on by-pass machines because these children are at risk for brain injuries.

“Traumatic brain injuries [such as the concussion that Tristan suffered] can cause a wide range of symptoms, including headaches, difficulty sleeping or feeling sleepy during the day, and significant mood changes--people may become more irritable, and there's a high incidence of anxiety and depression,” says Peter Ferrazzano, a critical care pediatrician, who is the director of the Pediatric Brain Care Clinic and a Waisman Center researcher.

To effectively treat the physical and psychological symptoms of traumatic brain injuries (TBIs), each patient at the clinic is seen by a multidisciplinary team, says Lynne Sears, the clinic coordinator.

“We have neuropsychologists who see the majority of our patients for cognitive assessments; pediatric neurologists as well as a neurology nurse practitioner to address post-concussive headaches; and a vocational rehab specialist who works with school age children to make sure they are transitioning back to school smoothly.”

Peter A Ferrazzano, MDIn addition to his work with the Brain Care Clinic, Ferrazzano also conducts research on pediatric brain injury. He leads UW-Madison’s participation in the ADAPT study, a multi-institution initiative that explores how different interventions influence outcomes for children with severe TBI. Ferrazzano, and fellow Waisman researcher Andrew Alexander, are also performing a multi-site study using advanced neuroimaging techniques to better understand specific repercussions of TBI on the developing brain. Their goal is to identify new ways to diagnose and monitor TBI-induced cognitive dysfunction.

Marisa remembers her and Tristan’s first visit to the clinic: “We were there for over four hours and we saw several members of the clinic team, including pediatric neurologist David Hsu and pediatric neuropsychologist Alanna Kessler-Jones.

Tristan was told to wean off of the pain medication he was on (because he was having rebound effects) and put on a different treatment regimen. “Within two weeks of the visit, he had at least a 50% improvement of his symptoms,” says Marisa. 

The Brain Care Clinic team aims to provide quick relief from the pain and distress of TBIs, though that’s not always possible. “Our goal in the clinic is to quickly tease out each of the individual symptoms of TBIs, and then identify the therapies that our patients need to get back to full functioning as fast as they can,” says Ferrazzano.

Tristan and Marisa visited the Brain Care Clinic three times, and within a few weeks, “I could see Tristan’s cognition and memory coming back,” says Marisa. “I was very cautious, but one day he walked into the kitchen and said, "Mom, I am a lot better! That was a day filled with tears of joy and relief.”

Clinic coordinator Sears also worked with Tristan’s school to make sure his transition back to school went smoothly. “Once the Brain Care Clinic got involved, we didn’t have any issues,” says Marisa. “I think the school was happy to be able to speak to Lynne [Sears] and get information about the specific accommodations that Tristan needed.”

Tristan’s recovery was rapid, and he is back to playing club soccer, although he is not allowed to intentionally head the ball. “His club coach lost his career to concussions, so he taught the whole team how to play without needing to head the ball and instead they learned to use the chest and shoulders,” says Marisa.

Helping children and their families return to their lives is exactly why the clinic is here, says Ferrazzano. “Our motivation is seeing children get back to their normal lives, and we aim to provide not only pain and symptom relief but also the emotional, psychological and systemic support they need to get there.”

To learn more about the Pediatric Brain Care Clinic, please visit http://www.waisman.wisc.edu/clinics-braincare.htm

To learn more about Peter Ferrazzano’s research, please visit http://www.waisman.wisc.edu/pi-FerrazzanoPeter.htm

To learn more about concussions, please visit https://medlineplus.gov/concussion.html