Posts from ‘Traumatic Brain Injury(TBI)’
A recent BBC News piece highlighted the need in the U.K. for a full review of the treatment facilities and protocols for treating and supporting traumatic brain injury patients from injury, through rehabilitation, and return to life among the general community in proper supportive environments. Jim Stewart, a traumatic brain injury patient at the Musgrave Park Hospital Rehabilitation Center, awaits a return to his family’s home. Stewart cannot be placed with his family until the house is properly fitted with the equipment necessary for the specialized care his condition requires.
The Stewart family is one of many families struggling to support their loved ones with traumatic brain injuries. They have had to fight for assistance in restructuring their lives to be able to bring Jim Stewart back into their home. Their case underscores a community-wide lack of resources and strategies for caring for brain injury victims.
Stewart, like many other patients in the Regional Acquired Brain Injury Unit at Musgrave Park Hospital, has remained in the hospital long after he was authorized to be released into family or community care because there is nowhere for him to go to receive the support and care he needs. Nursing homes are not equipped to care for traumatic brain injury patients, and most families are even less so.
Traumatic brain injuries leave patients in a range of conditions¾from comatose and unresponsive, through a wide spectrum of physical and cognitive disabilities, to fully active and mobile with subtle cognitive dysfunctions. In more severe cases, families and hospital care staff are finding that most communities and family homes are completely unprepared to properly care for the brain injury victims over the long years of recovery.
Dr. John McCann of the Regional Acquired Brain Injury Unit at Musgrave lamented the lack of community institutions and support for brain injured patients. He called for the establishment of transitional care facilities to ease the transition from hospital to community living. Since brain injuries often leave both patients and their families “in a fog,” as McCann said, the navigation of the path from initial treatment to community placement can be especially treacherous, frustrating, and difficult.
“There is no nursing care home specifically for people with brain injuries and only a small number of homes are registered to provide the necessary care. However, these are full and there are waiting lists. It all puts pressure on patients’ families and on the availability of beds for other people who need specialized care,” the BBC News article reported.
These issues demonstrate a growing need for community education and awareness, a system-wide review of hospital and rehabilitation care, governmental support and assistance for families and patients, and the construction of transitional care facilities designed specifically for brain injury patients.
Military medical officials have expressed concern over an increase in spinal injuries among U.S. troops coming home from Afghanistan. Afghan insurgents have responded to the increased presence of heavily armored U.S. vehicles with larger and more powerful roadside explosives.
Roadside bombs have become the top killer of U.S. troops in Iraq and Afghanistan. Not only do the roadside bombs lead to crushed spines and other spinal injuries, they also result in traumatic brain injuries when soldiers are exposed to blasts, even with no impact to the head.
A USA Today story reported that the recent increase in spinal injuries occurred among soldiers in Afghanistan and not Iraq. The increase in spinal cord injuries among troops has arisen due to increased potency in roadside bombs used by insurgents. The U.S. Military issued 3500 Mine Resistant Ambush Protected (MRAP) vehicles as an attempt to deal with the roadside bombings. Unfortunately, Afghanistan insurgents responded with stronger and larger bombs.
Some of the 3500 MRAP vehicles deployed in Afghanistan have been lifted a few feet off the ground by roadside bomb explosions. Even though the MRAP vehicle may remain intact, some soldiers have suffered serious spinal cord injuries in the explosions. The MRAP vehicles cost about $1.4 million.
Medical professionals and Army engineers are comparing data to explore possible alterations and improvements to the MRAP vehicle design to make it safer for soldiers who are exposed to increasing roadside bomb possibilities. The MRAP vehicles, which cost about $1.4 million to make, have a hull designed in a V-shape, which helps to deflect the force of explosions away from the center of the vehicle, the USA Today article reported.
Since there are very few paved roads in Afghanistan, rebels can easily bury roadside explosives in the dirt roads, undetectable to soldiers driving along the roads at high speeds. Although the military has recently send over newer and lighter MRAP vehicles with better seating and harnesses, more improvements are still in the works to ensure the vehicles are safe for combat.
Doctors are matching up data on injuries with the victims’ positions in the vehicles at the time of the explosion and the vehicle type in which the accident occurred. Their hope is that engineers will be able to use the data to design more explosion-proof MRAP vehicles and to prevent any further incidence of spinal cord injuries if possible. USA Today reported that a doctor in Kandahar is currently at work designing a shock-absorbing seat that would provide a better guard against spinal cord injuries.
References:
- Zoroya, Gregg. (November 5, 2009). “Spinal Injuries Up Among Troops.” Retrieved December 6, 2009 from the USA Today website: http://www.usatoday.com/NEWS/usaedition/2009-11-04-1Aied04_ST_U.htm?csp=34
With healthcare reform dominating the news lately, many brain and spinal cord injury patients have to be pondering the question- what does this all mean for those of us with existing injuries? Will we get improved coverage? Or will we be left in the dust, worse off than we were before? Will Obama deliver on his promise to provide affordable health care for all Americans? The recent bill passed by the Senate Finance Committee may provide some answers. The bill, if passed into law by the Senate and the House of Representatives, would restrict insurance companies from being able to reject or charge higher premiums to those with pre-existing conditions.
While the Senate Finance Committee healthcare reform plan was fully expected to pass in last Tuesday’s vote, which it did, a new insurance-industry-funded report leaked over the weekend tried to convince voters that the Senate legislation would substantially increase premiums for individuals. A White House Spokesman told the Washington Times that the report, commissioned by America’s Health Insurance Plans (AHIP), was a “self-serving analysis from the insurance industry.”
The bill, if passed, would require all Americans to obtain health insurance, and would issue penalties to those who did not obtain it. Maine’s senator, Olympia J. Snowe, is the only republican senator on the committee who voted in favor of the health care reform bill. Snowe also helped by adding an amendment to the bill to reduce the penalties recommended for those who did not obtain health insurance in time, according to a Washington Times article. The amendment to reduce penalties was passed unanimously by the committee.
Since the bill was not stalled by the Senate Finance Committee, it now remains in the hands of the Senate to determine whether or not it will move closer to becoming law in a vote expected to occur later this month.
Republicans used the AHIP report to bolster their case against what some have termed, “Obamacare.” Senate minority leader Mitch McConnell, R-Ky, told USA Today that the health care plan in question will lead to, “higher premiums, higher taxes, and more government.” Senator Jay Rockefeller, D-W.Va said to USA Today that, “The [insurance] industry stands today as the greatest impediment to health care reform.”
The AHIP, who commissioned the controversial report, responded by saying, “We don’t see comprehensive cost control in any piece of legislation.”
While the Senate Finance Committee passed the healthcare reform bill on Tuesday, there still remains much work and compromise between democrats and republicans before a bill will be voted on and agreed upon between both the Senate and House of Representatives. They will all have to come to an agreement or a compromise before any serious overhaul of the health care system will be possible.
If passed into law, the bill passed to the Senate by the Senate Finance Committee would extend health insurance coverage to the over 30 million Americans currently without health insurance. The over 20 million illegal immigrants currently working in the United States would still remain without health insurance, as article in the Guardian reported.
The Senate Finance bill will cost $829 billion over ten years if passed into law, and will require all individuals to purchase health care if it costs 8% or less of their total income, and it will offer tax credits to individuals and families under 400% of the poverty line. The bill will also disallow insurance companies from denying coverage to or charging higher premiums for pre-existing conditions or gender.
The details of other proposed healthcare legislation currently being considered in various parts of congress, including President Obama’s personal recommendations, can be found in this article published in the New York Times.
(pic from metric.files.wordpress.com)
Admiral Michael Mullen, the chairman of the Joint Chiefs of Staff, is promoting a new Army policy that would limit the number of mild traumatic brain injuries an Army combat soldier can suffer before being relieved of combat duty. The new policy would limit soldiers’ exposure to three mild brain injuries, after which they would be reassigned to non-combat positions on Army bases.
Mullen is motivated partially by a disturbing story of a soldier who was exposed to 30 explosions at close range before being removed from combat duty. USA Today reported that if the policy were enacted, it is estimated that only about 400 soldiers, out of the 20,000 troops deployed in Afghanistan, would be removed from combat and put to work on bases for the duration of their tour of duty.
Admiral Mullen is motivated also by data published in recent studies on multiple concussions and traumatic brain injuries experienced by football players. The studies, reported on here, demonstrated that people whose brains had suffered multiple concussions would heal more slowly from future injuries and would be more likely to have more serious future concussions. The same studies also showed that multiple brain injury sufferers have also been shown to be at a higher risk for long-term brain dysfunction and complications.
We have explored some of the recent research on the physiological effects on the brain of repeated exposure of military personnel to explosive blasts. While the injuries are similar to those experienced by football players, the exposure to bomb blasts has a distinctly different and less understood effect on the brain.
The USA Today article reported that, “up to 300,000 service members may have suffered a mild TBI in the Iraq and Afghanistan wars.” It is data like this that has spurred Admiral Mullen to take action to prevent soldiers from suffering serious long-term brain damage that could be prevented by a simple change in policy.
The U.S. Marines already operate under a policy that limits marines to three mild traumatic brain injuries before removal from combat, and the Army is currently designing a policy that will likely follow suit. Although further research is ongoing, the workings of the brain and how it reacts to injuries remain mysterious and not fully understood. Yet, as more and more studies are published, it’s inspiring to see military leaders using current scientific data in the design of their policies and protocols.
(pic from ameddcsdl.org)
A study published in the September issue of Archives of Surgery on data from the National Trauma Databank held implications that may inspire further research into possible healing functions of alcohol in the bloodstream of traumatic brain injury patients. The study compared and analyzed data from a database of 72,294 people. The researchers were only able to utilize 53% (38,000 people) of the data because the other 47% of patients were not tested for alcohol at the time of their injuries.
The data showed a 9.7% death rate for brain injury victims with no alcohol in their blood compared to a 7.7% death rate for brain injury patients with alcohol in their systems. The study also showed a higher incidence of complications for patients with alcohol in their blood, but less severe and faster healing injuries than those with none.
The study was conducted by a team of researchers at Cedars-Sinai Medical Center in Los Angeles. The study’s main author, Dr. Ali Salim, reported that other smaller human studies showed that alcohol has a diminishing effect on the body’s production of catecholamines, which produce adrenaline in the body. The scientists speculated that using ethanol in small doses may prove effective at reducing the severity of traumatic brain injuries.
Other scientists warn against jumping to conclusions just yet, and think that it it too soon to judge whether or not alcohol will prove to be a safe and effective part of a brain injury treatment plan. Dr, Homer C. N. Tien of the University of Toronto, Dr. M. Sean Grady from the University of Pennsylvania, and even Dr. Ali Salim, the study’s author all cautioned against assuming too much from the results of the study prematurely. They made the point that the study was on administrative, and not clinical, data.
The three doctors all suggested that further research and clinical studies would be necessary before considering the use of alcohol as a part of a treatment plan for traumatic brain injury patients. It is encouraging that studies such as this one are conducted, and that scientists at medical centers and universities around the globe continue to seek better and more effective treatments for traumatic brain injury.
(pic from drugs.ie)
Four Stages, One Man
By
Benjamin Luskin
When I look back on my life from the ripe old age of 27, I remember many great moments. I recall exciting events, convincing conversations, and adored acquaintances, each of which helped me to build my character and plot my course through life. Yet, when I consider what moment was most influential in my life, I realize that it was not a memory at all, but rather something which I have no memory of.
On Sept. 28, 1994, on a deserted highway on the coast of Lake Superior, the van I was riding in was hit head-on by a semi-truck going 60 MPH. Lucky for me, my seat belt stopped me from flying forward to an early dismissal, but all the same, my head rocked forward so fast that my brain smashed into my skull, sending me into a coma right there on the side of the highway.
Lying there, not breathing, with nothing but my vital signs in-tact, my future looked grim. But then an angel arrived, resuscitated me, called a helicopter, and then drove away. Soon, the emergency helicopter arrived, packed me in, and flew off to the Duluth Emergency Center. To this day, the identity of the angel is unknown.
Following a lengthy three month stay at the hospital, in which I relearned how to walk, talk, eat, and breathe, I proceeded through four successive stages of development before arriving to where I am today. These stages were as follows: denial, acceptance, rejection, and transformation. In the following speech, I will briefly describe the main themes of each stage to you, so that you may better understand the subsequent progression.
Immediately following release from the hospital, after my bracelet had been clipped, I entered the first stage of denial. During this time, I often looked to Alfred E. Newman’s profound words, “what, me worry?” for guidance. Like other kids my age, I could not see beyond a short-term perspective. Happiness was but a sensual and immediate concept to me, so I did a lot of hanging out. I pursued some pleasures, a few vices, and generally did not think of my injury. And then I graduated from high school, left my familiar home in Minnesota and headed for Portland, Oregon, where I started a new life as a college student at Lewis and Clark College.
In this new environment, my limitations suddenly became apparent. Try as I might, I could not seem to integrate into my new environment. My high school strategies for survival proved inadequate and I was left dangling in thin air. Have you ever tried to cut a thick, juicy tenderloin with a dull knife? It doesn’t work, and that’s precisely how I felt. My tools were useless.
During this time, however, I also found myself engrossed in a collage of new ideas and beliefs. And so it was that I became intrigued by the ancient Chinese philosophy of the Dao, or the way, and spent many hours seated in the tall grass of a nearby ravine contemplating its meaning. As a result, I slowly but surely began to accept my lot and just “go with the flow.”
In this new stage of acceptance, I acknowledged my limitations and worked around them, focusing my efforts on intellectual pursuits and self-discovery. One could say I became a bit of a college hermit, reading books by candle light late into the evening. Consequently, college became a worthy venture, fulfilling and entertaining. I excelled in my studies, graduated with a Bachelors Degree in Religious Studies, gained employment with the Portland Public Schools, discovered martial arts, met my girlfriend, and poof, had a baby.
At which point, I was catapulted into the next stage of my development, one of rejection. I realized that I needed to stop dealing with my life as it unfolded, but rather take control of my life if I wished to manifest my desired lifestyle. And so, quick as a lightning flash, I quit my job, moved to Eugene, and entered the blue collar world of hard physical labor. Following suit, I came to devalue intellectual pursuits and academic knowledge and took pride in the new identity I had created for myself. I worked hard and lived an honest and simple life, returning home each day covered in dirt and sweat to a singing partner and a cooing baby daughter.
After several months, however, this romantic existence began to fade. Unable to perform sufficiently, I lost my jobs, sank into depression, and became consumed with self-pity. I spent entire days in bed, convinced that I would never be good at anything worthwhile, that I was destined to be a charity case. In retrospect, it seems that I had become so frustrated, so helpless that I began to crave despair. In the words of Richard Farina, (I’d) “been down so long it looked like up to me.” I refused all help from others, preferring torment to relief, until one day I grudgingly allowed a job-coach to help me find a job at Lane Community College.
Though it was not apparent to me at the time, this job turned out to be my ticket to the next phase of development, transformation. What started out as a basic method to make ends meet soon became a waterfall of opportunity. For the first time in my life, I discovered that my skills were perfect for the job. As a result, I gained confidence, earned my co-workers respect, and like magic, my limitations disappeared.
I was encouraged to develop my ideas and soon implemented a non-combative martial arts training program for my clients as well as designed and drafted a program newsletter. Ideas kept flowing and before long I had developed a new program for rehabilitation and written an extensive article on its design. Then I began a rehabilitation business, “Launch Empowerment Mentoring,” attracted several initial clients, volunteered with various organizations, and taught workshops at Oregon Country Fair.
Which brings me to where I am today, a busy, busy, content, and jubilant young man.
Today, in addition to my job at Lane Community College, I continue to develop and expand my business, travel to Portland once a month for life coach certification training, attend training seminars and tackle various tasks as an intern for LILA, train diligently in martial arts, better my public speaking skills with Toastmasters International, and broaden my horizon through music, reading, and writing. All this, in addition to being an affectionate partner and devoted father to two beautiful girls.
In conclusion, it was not the event, the traumatic incident, that most affected my life, but the challenges it incurred. In rising to meet these challenges, I transformed into a stronger, more capable individual. I looked to these challenges to discover the nature of my strengths and in which realms they might best flourish. I have since used this knowledge to manifest a choice lifestyle and could not be happier.
One last thing before I sit down. I invite each of you to consider your own greatest challenges through life. How did they affect who and where you are today?
Apple’s App Store, well known for its tight strictures and uptight policies regarding the iPhone applications it chooses to accept, has stepped in it this time.
The Baby Shaker, a $.99 application for the iPhone that requires users to shake their phone in order to quiet crying babies, incited outrage from brain injury organizations and children’s groups, causing it to be removed two days after its release.
“See how long you can endure his or her adorable cries before you just have to find a way to quiet the baby down!” read the iTunes description.
Apple has apologized for the mistake, though they have yet to address how Baby Shaker, created by Sikalosoft, made it into the App Store in the first place.
“This application was deeply offensive and should not have been approved for distribution on the App Store,” Apple said in a statement.
Visit the Sikalosoft web site and you will find a statement acknowledging the app’s poor taste, “Yes, the Baby Shaker iPhone app was a bad idea. You should never shake a baby! Even on an Apple iPhone Baby Shaking application. In case you are unaware Baby Shaker was an Apple iPhone application that was greatly lacking in taste. It was approved by Apple for download upon the iPhone”.
Apple reviews hundreds of apps every day, a number that argues for the occasional error in judgment, and their quick action to remove the game bodes well for their reputation. Yet the choice to approve the game in the first place points out a glaring flaw in their procedures – “bad taste” may have a variety of definitions depending on the audience, but when in doubt, error on the side of caution.
Never, ever shake a baby. And while we realize that a game is just that – a game, the inference that there is something entertaining about the act is enough, in our opinion, to justify the removal of this app.
The National Center on Shaken Baby Syndrome lists multiple consequences of shaking a baby, from seizures and permanent brain damage to death. With close to 1,500 U.S. children experiencing severe or fatal head trauma from child abuse every year, we’d rather see applications underlining proper education. Rock your child to sleep, don’t shake it to death.
Over the last couple of years we have been hearing of the push to digitize health records, in hopes of streamlining a patients data for easy access across medical facilities. Yesterday the Mayo clinic announced a partnership with Microsoft’s HealthVault to launch the Mayo Clinic Health Manager, a tool that gives people the ability to store their medical records online as well as sign up for alerts and reminders. This is only the latest in a procession of new online storage services being offered to interested patients.
Using these services you can import your health records from your doctors, hospitals, labs, prescription drug plans, and other healthcare providers by typing them in yourself or uploading data directly from devices such as blood-pressure monitors. Now with just a couple clicks of your mouse, you can view your entire medical history – what medications you have taken, which ones you are currently on, adverse reactions, operations, diagnosis, and even childhood diseases. What’s online is up to you and, if he is a participant in the government supported push for electronic records, your doctor.
We aren’t going to advocate for or against the digitizing of your healthcare history, but we do want to make sure you are taking into consideration the potential dangers of such a move. While the convenience of hopping online to find out what date you started a particular medication may make the process of filling out your insurance claim easier, keep in mind that what’s easy access for you is just as easy for someone else. Yes, we are talking about hackers. Those information pirates that keep developing more and more insidious data-mining processes.
What does it matter if some stranger is copying your medical information? What can it hurt besides your feelings of privacy? A lot, actually.It isn’t just insurance claims that are affected by your medical history, your reputation is also potentially at risk.
M. Eric Johnson, director of the Glassmeyer/McNamee Center for Digital Strategies at Dartmouth’s Tuck School of Business, released a paper in which he said he and his fellow researchers “were able to uncover a number of medical records and other files with medical information online, using file-sharing services generally associated with song-swapping, like LimeWire and Kazaa”. He went on to note that many of our records are already in electronic form on computers in small clinics and laboratories whose security can’t begin to match that offered by the larger data storage facilities.
Johnson cites numerous instances of leaked records leading to identity theft, medical insurance fraud, and even financial fraud. Don’t forget, your social security number is more often than not is included in your medical records, and adding that information to identifying data such as your date of birth, address, and full name give thieves everything they need to make a profit from your information.
When you are considering making your records electronic, make sure you choose a company that has multiple safeguards in place. While there are always ways around even the toughest Internet security, the likelihood of keeping your information private greatly increases depending what program provider you go with. Google Health has partnered with Medco, as Microsoft’s HealthVault has teamed up with the Mayo Clinic, giving the resulting storage systems more clout than lesser known companies such as iHealthRecord or myPHR, but before you make a choice, research them well – your private data is on the line!
Image from here.
Researchers at the Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research at UCSF have developed a way to reverse the age of adult stem cells (fibroblast cells), using microRNAs to effectively turn them back into embryo-like cells. While not quite a Benjamin Button scenario, these new findings have the potential to aid in brain injury repair by replacing damaged cells in areas affected by a traumatic impact.
These newly “young” cells have the ability to do what the controversial cells from embryos can – they are able to become any cell type (a state known as “pluripotency”). This makes it possible for scientists to stop their use of retroviruses that have been employed to create this cell flexibility, making stem cell therapy safer.
According to the study, previous methods for creating cells similar to embryonic stem cells used DNA to influence the production. The issue with this method is that three of the four genes promote an uncontrolled growth reaction in the cells, much like cancer.
The use of microRNAs has further benefits as reprogramming a patients cell instead of introducing a foreign one prevents it from being rejected, an issue that scientists have long been working to find a way around.
You can read more in the April 12, 2009 advanced online edition of the journal Nature Biotechnology.
Image from emergentarchitecture.com.
