July 25, 2006, 7:47 am

End of the Pipeline for Blast Injury Survivors

USAToday.com has a recent article about the lack of follow-up care available to veterans of the Iraq War. From the emergency room in Baghdad through the acute rehab phase, veterans have a veritable dream team of quality care, but the continuum ends there. Here’s a snippet from the article:

“At many (VA) facilities, there just is no established traumatic brain injury program and they have no traumatic brain injury specialists,” Schuster said. “They kind of operate on a fill-in-the-gap protocol.”

Traumatic brain injury is becoming one of the signature combat wounds of the Iraq and Afghanistan wars, with about 1,200 reported as of March.

In a recent study of 52 brain-injured veterans, including Ted Wade, the VA Inspector General found that access to care is frequently difficult and many veterans and their families reported problems dealing with the VA health care system.

What are the implications? My guess is that we’re going to see a deluge of Iraq TBI veterans filling up rehab beds outside of the VA system, to the point where they could overwhelm the current structures in place. I’ll be attending a NASHIA conference in September that will address this very issue, so I’ll follow up this post with more information at a later date.

Click here to read the full article.

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July 20, 2006, 10:07 am

Rolling Stone Gathers a Brain Injury

Keith Richards, legendary guitarist for the Rolling Stones, recently sustained a brain injury while, um, well read below:

Richards, 62, also disclosed this week that his brain injury had not been sustained by falling out of a coconut tree but from a large shrub. It had originally been reported that the guitarist needed surgery after a tumble from a large palm while picking coconuts on holiday in Fiji.

With Richards being such a larger-than-life personality, nobody in his circle seems to detect that there’s been any change in Richards’ personality or behaviors. Richards is already back to rocking the stadiums on a European tour.

Click here to read about Keith Richards’ TBI

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July 10, 2006, 7:59 am

Differences in Coma, PVS, Minimally Conscious & Locked-In Syndrom

Ever wonder what the differences are between coma, persistent vegetative state, minimally conscious state, and locked-in syndrome?

Here’s an excellent chart that outlines the various characteristics of each condition. As Jake Young at Pure Pedantry eloquently puts it:

“To emphasize the point, there is a huge area of difference between someone who has essentially only the housekeeping functions in the brain and someone who — for reasons metabolic or traumatic — comes in and out of consciousness intermittently. It is very unfortunate that Terry Wallis was misdiagnosed in this case, because the prognosis for individuals with minimally conscious state — while not fabulous — is much better than for a persistent vegetative state.”

Click here to read his great explanation on the appeal of the Terry Wallis case.

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, 7:30 am

"Rewiring" Another Name for Plasticity

Perhaps you’ve come across the story of Terry Wallis, an Arkansas man who emerged from a coma after twenty years. The media is portraying this is an unprecedented, unexpected event, but in reality, it’s just research catching up with theory.

Paul Bach-y-Rita, MD, is a pioneer in the field of brain plasticity. He theorized about the brain’s capacity to restructure itself, and today he’s taken his ideas one step further:

“The brain is capable of major reorganization of function at all ages, and for many years following brain damage. It is also capable of adapting to substitute sensory information following sensory loss (such as blindness; tactile loss in Leprosy; damaged vestibular system due to ototoxicity, or general balance deficit as result of stroke or brain trauma), providing a suitable human-machine interface is used. One such interface is the tongue BrainPort interface. Sensory substitution allows studies of the mechanisms of late brain plasticity, in addition to offering the possibility of practical solutions for persons with major sensory loss potentially including persons with spinal cord injury.”

As brain imaging technology provides us with greater details about the cellular workings of the brain, we’re discovering an internal universe for more mysterious and than we have dreamed.

Click here to read a recent article on the marvels of brain plasticity.

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July 3, 2006, 10:15 am

Advances in Emergency Medicine

In a pilot study underway in the Pittsburgh area and several other cities, including Toronto, some paramedics will be administering a hyper concentrated saline solution containing Dextran. The hyper concentrated solution with Dextran is expected to provide better control of brain swelling and other decimating effects of brain trauma leading to increased survivability potential.

Studies like this in trauma medicine are leading to increased survivability from injuries which previously ended in death. But there are questions. As more individuals survive severe brain injury, will rehabilitation services be available? Will there be financial resources to pay for the extended care needed by these new survivors?

Click here to read full article, courtesy of the Pittsburgh Post-Gazette.

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