Trains and boats and brains

• In 2016-17 there were 348,453 UK admissions to hospital with acquired brain injury (ABI) - 531 admissions per 100,000 
• In 2016-17 there were approximately 954 ABI admissions per day to UK hospitals – one every 90 seconds
• ABI admissions in the UK have increased by 10% since 2005-6
• Men are 1.5 times more likely than women to be admitted for head injury. However, female head injury admissions have risen 23% since 2005-6
• In 2016-17, there were 132,199 admissions for stroke - an increase of 10% since 2005-6 (one every four minutes)

Information from report by Headway.org.uk

Trains...

Phineas Gage was an American railroad construction foreman from the early 1800's who, as a result of an accident as bizarre as it was horrific, advanced our knowledge of brain function and psychology. Gage had a job as a blaster on the railroads, this involved boring a hole into rock, filling it with blasting powder,  and packing (tamping) sand or clay on top to contain the blast. Tamping was done with a 'tamping iron'; a javelin-shaped metal bar. The story goes that, as Phineas was tamping one of these blast holes, he was distracted by one of his men, he turned to speak which brought his head in-line with the hole, just as the tamping iron sparked, setting off the charge.

This next bit is not for the squeamish... (you can skip to the next header) 

The blast sent the tamping rod through the bottom of Gage's jaw, behind his left eye, through the left frontal lobe of the brain and out through the top of his head. Reports from the time stated that Gage was thrown backwards and landed on the ground, convulsing, but within a few minutes spoke and then walked "with little assistance" and sat upright in the cart to ride nearly a mile back to the hotel in town where he was staying. The local doctor was summoned and reported finding Gage sitting in a chair outside the hotel.

...you're safe now

At a time when there was little to no distinction between horrific injury, medical curiosity and what passed as entertainment, Gage gained a fair bit of celebrity for his feat of survival. However, one of the most notable and lasting impacts was the apparent alteration in Gage's behaviour (although it is widely accepted that these have been exaggerated). The doctor who had treated him reported; 

"His contractors, who regarded him as the most efficient and capable foreman in their employ previous to his injury, considered the change in his mind so marked that they could not give him his place again. The equilibrium … between his intellectual faculties and animal propensities, seems to have been destroyed. He is fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom) … his mind was radically changed, so decidedly that his friends and acquaintances said he was "no longer Gage."

...and boats...

On Sunday 7th April the 165th Men's Boat Race was won by Cambridge (The 74th Women's was also won by Cambridge). However, a significant portion of the press coverage this year was focussed around the Cambridge two-seat, former Olympian, Atlantic rower, Marathon runner, and at 46, the oldest person to compete in the boat race; James Cracknell.

Whilst Cracknell's age was one headline, there was also a great deal of press interest in his private life; in particular the recent separation from his wife; Beverly Turner. Turner has been relatively candid about the difficulties she experienced and the reasons for the separation, not least of which she saw as stemming from a brain injury he had received some nine years previously.

In 2010 Cracknell had been taking part in an event to cycle, run, row or swim from LA to New York. He had been riding along the Arizona highway in the early hours of the morning when he was hit by the wing mirror of a tanker travelling at 70 mph. The fact that he was wearing a helmet undoubtedly saved his life and he has since been very vocal about their importance.

...and brains

The force of the impact caused what is referred to as a contretemps injury where the brain is thrown forwards against the inside of the skull like the hammer in a bell. The impact of the brain against the front of the skull resulting in significant bruising and damage to the frontal lobes. The injury not only left Cracknell prone to epileptic fits and with short-term memory loss, but, as with Gage, his personality appeared to change. Turner explained that the doctors treating her husband had warned her that his personality might be on “Planet James for a while … [and] made it sound as if I would be married to a drunk teenager. And they were right.” Cracknell too acknowledged this change; "… often, after seeing friends, I’d wake up with a list of people I’d offended and needed to apologise to." 

Injury often serves to advance our understanding and whereas we can see a muscle move a limb or the direct effects of an organ like a kidney, the brain is much more difficult to observe. Injuries such as the type Gage experienced serve as a starting-point for research and through this we have unlocked some of the processes previously hidden from us. We know, for example that the frontal lobes play a significant role in executive functioning; things such as regulating behaviour and emotions, planning, staying focussed and working memory, to name a few and the observed changes in behaviour in cases such as Gage and Cracknell, would appear to support this. However, we need to be careful saying brain injury is a *cause* of behaviour change. We need to recognise that there is clearly a significant psychological impact of a life-threatening event; do you become more driven, less concerned with the impact of your behaviour on others and more determined to do the things you want to do because you have faced death and lived?

"There's a perception that a brain injury is like a broken leg and it will just get better, but a brain injury will affect you for the rest of your life in a negative way" - James Cracknell quoted in the Cambridge News