March 26, 2008, 9:17 am

Induced Hypothermia Trial for Children

Advance for Directors in Rehabilitation reported on a clinical trial, funded by the National Institute of Neurological Disorders and Stroke, that will utilize induced hypothermia to reduce brain swelling in children suffering from traumatic brain injuries. The 12 medical centers that are participating are looking to enroll 340 children up to the age of 16 in the 5-year trial. Eligible individuals must have suffered from a severe brain injury caused by blunt trauma, excluding those who have suffered penetrating head injuries. While the study is not without risks, Pam Okada, MD associate professor of pediatrics at UT Southwestern states “Previous studies have shown hypothermia is not only safe in children following severe traumatic brain injury, but may improve their chance of survival”.

Researchers examine the effectiveness of induced hypothermia in children with severe TBI (2008) states:

Patients selected to receive hypothermia therapy will be cooled to between 32 and 33 degrees Celsius (89 to 90 degrees Fahrenheit), using special cooling blankets and/or cooled saline given intravenously. In addition to normal emergency care, they will remain cooled for 48 hours while being closely monitored in the intensive care unit. Children will be tracked by researchers for 1 year to record outcomes, with a battery of tests being conducted at six and 12 months following the injury.

According to federal and state laws, those who participate in a clinical research study must provide or, in the case of a child, have a guardian provide informed consent. Because of the nature of this trial and the fact that hypothermia must be induced within 6 hours of injury, it may be sometimes impossible to obtain consent at the time of brain injury.

For this reason, researchers are notifying the public that informed consent will be waived. Every attempt to contact family members to provide notification and obtain consent for continued participation will be made as soon as possible after enrollment.

Click here to read the full story in Advance for Directors in Rehabilitation

www.coolkidstrial.org

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March 24, 2008, 7:39 am

NSCD Summer Programs

Dr. Gainer just recently provided me with a pamphlet published by the NSCD, National Sports Center for the Disabled, which lists the outdoor therapeutic recreation activities they are offering for the summer of 2008. This agency has trained instructors and is able to make accommodations for individuals with many types of disabilities – ranging from emotional, to cognitive or physical.

NSCD offers one-day sports introductory clinics called AbilityCAMPS, which are free; as well as half-day & day adventures – ranging from $16 to $125; and Summer Camps that last anywhere from 2 to 4 days – also at a fee. The range of activities offered is impressive. Whether your interest is Camping, horseback riding, mountain biking, sports, or hiking – they have something for you.

NSCD also offers scholarships; the scholarship deadline for the summer season is Tuesday, April 1, 2008.

Click here to view NSCD’s Summer Programs Brochure and scholarship application

For more information contact Geoff Lanham, Development Director at 81-513-7571 or glanham@nscd.org

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March 19, 2008, 2:23 pm

A Trip to Remember

Dr. Rolf Gainer, Liz Lamers and I just recently attended the Iowa Brain Injury Association conference. We drove up on Wednesday, and returned on Friday – while it was a fast trip, it was truly a quality trip. The turnout was unbelievable, in attendance were: survivors, providers, case workers, and many others. Everyone was so warm and friendly, upon our arrival we attended a meeting facilitated by Ben Woodworth, Brain Injury Program Manager for the Iowa Department of Public Health, the topic of the discussion was “to identify components of the service delivery system and current resources available for people experiencing brain injury who exhibit challenging behaviors. ” The goal of the meeting was to identify resources for Iowans with brain injuries to facilitate their return home.

The next morning started about 7:00, there were many presentations to choose from – and deciding which one to attend was a difficult choice. Al Condeluci, Ph. D. started it all off with his presentation of “Cultural Shifting: Building Social Capital”, after which there were four breakout sessions: Joseph Richard II, MA, presented on educational program models for post concussion syndrome in student athletes; Al Condeluci, Ph.D. explored interdependence: the route to community; Tom Hensold, MS CADC shared on substance abuse treatment programming and TBI; while Vicki L. Castle presented on SaeboFlex Arm Training Program. During lunch we had to opportunity to socialize and meet with other professionals there, as well as a brain injury survivor who willing shared her story of recovery, as well as her struggles and frustrations.

Immediately following lunch Tim Feeney, Ph.D. facilitated a session on self-regulatory interventions, which was followed by Alarik Arenander’s, Ph.D. “Mind Over Matter: Regaining Control of Your Life and Rebuilding the Brain’s CEO – the Prefrontal Cortex- Through Practical Mental Interventions”. After which was another set of breakout sessions, once again I was faced with a tough choice, there was Michael Mason’s “The Firth Thing I tell Them: Personal Encounters with Brain Injury Survivors”, as well as Sue Bartlett’s “Using Functional Outcomes for Program Evaluation” after careful deliberation I opted to attended Ben Woodworth’s “How Did You Do That? Maximizing Funding”, which was very informative, providing information on how funding is actually accomplished, a truly in-depth look.

At 5:00 p.m. was the exhibitor Reception and Silent Auction, as well as hors’ d’oeuvre for everyone in attendance, the conversation was lively, and everyone appeared to have a good time. Some walked away with gifts (Jean Kelly, won our Oklahoma BBQ kit basket), and some did not. Like Geoffrey Lauer, Executive Director of the Brain Injury Association of Iowa, said “You gotta play to win”… it was a treat for all involved.

After the silent auction was completed, we went to dinner with about 20 people at Azalea’s. In attendance were On-With-Life’s Julie Fidler-Dixon, Judy Hilt and Kath Herring, Mike Mason (former Brookhaven Brain Injury Case Manager), and many, many more.

Friday, was a busy day for all three of us Dr. Gainer and Liz had presentations, and I had an evaluation to conduct.

Tim Feeney, Ph.D. started off the day with his presentation on “Helping People Without Making Them Helpless: Fun, Functional, & Other ‘F’ Words”, which was followed by Tom Brown’s “Neuro-Resource Facilitation and Dr Gainer’s presentation on “The Graying of Brain Injury: Aging & Lifespan Issues”. After which there were more breakout sessions, one of which was conducted by our own Liz Lamers. Her presentation “It’s a Long Way Home: The Rocky Road to Community Placement” was a smash – in fact there were still people vying for her attention 30 minutes after the conclusion of her presentation. While Dr. Gainer and I were waiting for Liz to finish up we talked for a while with Dann Larmore, MS/FAAMR, one of the event planners and a key member of the Iowa Brain Injury Association.- Then it was time for us to hit the road, we said our good-byes to the many people we had met, and made our promises to keep in touch – already looking forward to next year’s conference. We used the time on our trip home to talk about the conference, the positive energy of the Brain Injury Association of Iowa and their amazing ability to grow this conference into one of the premier state brain injury association events.

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, 12:34 pm

More Resources for Veterans’ suffering from TBI?

In the March 4^th edition of the American Speech-Language-Hearing Association newsletter Leader, Angela Foehl, Director of Private Health Plans Advocacy, reports on new ratings proposed for Veterans’ suffering from Traumatic Brain Injury. She shares that the proposed ruling would allow medical records from speech-language pathologists and audiologists to become evidence in VA claims. The new rule, proposed on Jan 3, would rename the Diagnostic Code 8045 in the VA Schedule for Rating Disabilities as “residuals of traumatic brain injury” in lieu of “brain disease to trauma”, what does this really mean? More money. The revision would allow for higher disability ratings ergo higher levels of compensation for those individuals suffering from TBI.

Furthermore the new ruling will provide codes for Hearing, and Cognitive Impairment. A diagnosis of hearing impairment will require testing conducted by a state-licensed audiologist, and “is rated with a matrix to calculate the combined disabling effect from the effected ears. Cognitive impairments and subjective clusters of symptoms will be rated under DC 8045, if separable from signs and symptoms of other, rated TBI disorders. . . the VA proposes to rate TBI residuals under either objectively demonstrable cognitive impairments of subjective ‘symptoms cluster’”.

Cognitive Impairment will be split into categories, such as speech-language and writing disorders, with numerous severity levels. Foehl (2008) writes:

ASHA states they provided recommendations about the lack of linguistic precision in the proposed regulation and various technical aspects of the proposed TBI rating methods. ASHA disagrees with the VA’s structural framework to evaluate cognitive impairment, especially the criteria for speech and language disorders, which are grouped into the broader category of speech, spoken language, and written language impairment.

ASHA’s position is that rating criteria for those disorders should be in separate categories, stratified by components. More specific criteria would allow a more precise, uniform rating approach and would reduce numbers of appeals. ASHA suggest that the VA use standard assessment tools for speech and language disorders – specifically ASHA’s function communication measures, used in the national outcomes measurement system data collection system – to more accurately evaluate speech and language disorders by scaled levels with precisely graded criteria.

Foehl, Angela. (2008). New ratings proposed for veterans’ TBI. The ASHA

Leader, 13(3).

Click here to read the entire article from ASHA

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March 14, 2008, 7:37 am

Jill Bolte Taylor: A Stroke Survivors Story

I just recently watched an amazing video, presented by scientist and stroke survivor Jill Bolte Taylor. She shares that her interest in studying the brain began with her brother who suffers from Schizophrenia. She explains that she traveled as an Advocate for NAMI (National Alliance on Mental Illness) on weekends and evenings, and by day was very involved in mapping the brain to decipher the biological difference between a “normal” brain, and the brain of those suffering from Schizophrenia, Schizoaffective, and Bi-polar disorder. She describes her life as very full and satisfying.

Then on December 10, 1996 she shares that she woke up with a “mental illness” of her own – she was suffering from a stroke. As she experienced the stroke, she was also using her scientific knowledge to explore and understand what was happening to her. She shares her experience in depth, walking through each stage of that first day, what she thought and how she felt and tying that back into the functions of the brain. Jill states that in the space of four hours she watched her “brain completely deteriorate in its ability to process all information on the morning of the hemorrhage I could not walk, talk, read, write or recall any of my life, I essential became an infant in a woman’s body”.

Jill goes on further to explain the differences between the right and left hemispheres of the brain. Explaining that the right hemisphere is all about the here and now, and thinks in pictures; the left hemisphere on the other hand thinks linearly and methodically, focused on the past and future, cataloging and thinking in language.

This was no simple journey for Jill, following the stroke she spent eight years recovering her ability to think, walk and talk. There is a lot of wonderful information in this video; I ended up watching it several times. I encourage you to watch it too.

Click here to watch the video TED | Talks | Jill Bolte Taylor: My stroke of insight (video)*

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March 13, 2008, 2:54 pm

Stories of People with Brain Injuries

Michael Paul Mason worked as a Brain Injury Case Manager at Brookhaven for over three years and in that period he developed a unique sense of the people with brain injuries, their families and the systems of care available to them. Much like the people he saw, he endured great frustrations and saw some amazing success as he helped people find funding and rehabilitation. His work grew into an interest far beyond the clinical evaluations he conducted and into who these people really are, the bottom of despair they experience, the amazing barriers they encounter and their personal triumphs. Mr. Mason's interest in brain injury took him far afield to a trauma hospital in Iraq where American soldiers, Iraqi civilians and insurgents were treated side-by-side, their lives saved, but to await some very different outcomes. He traveled around the United States and Canada meeting people with brain injury and in his book: Head Cases: Stories of Brain Injury and Its Aftermath, he eloquently tells each person's story of injury and recovery and shares his personal thoughts on their lives.

I heard Mr. Mason present two stories from his book at the 2008 Iowa Brain Injury Association conference in Des Moines on March 6, 2008. In each story, Mr. Mason allowed the voice of each person to be heard through his taped interviews. The stories of these two people were as different as day and night, but importantly what was conveyed to us in the audience was their personal  trials some of which remain ongoing and their resolutions to move forward in life. Although I happened to know both of the people for many years, I hadn't heard their story told that way and I have heard it many times before. This special quality is the vehicle for all the stories in Head Cases. Each person and their story frame the impact of brain injury on their lives and upon their futures. The book will be released in a few weeks and it should be required reading for all of us who are, know or work with people living with brain injury.

Michael Mason has moved on his career from Brookhaven, but he remains a great personal friend and an esteemed colleague. He continues to offer his help to state and national brain injury groups and is involved in the NABIS coalition of brain injury professionals, the Veteran's Administration and the Department of Defense to define the service pathway for our soldiers returning with a brain injury.

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March 12, 2008, 3:17 pm

Repetition Aids in Stroke Recovery

There are an estimated 50 million stroke victims worldwide, and that number is expected to increase as the baby boomers move into their 60s and 70s. With the expected increase, research has been ramped up in an attempt to ascertain what does and does not work in rehabilitation after stroke.

Neuroplasticity is essential in recovery from a stroke, the brain has to be able to essentially rewire itself, and to this end, researchers are finding that more is better. Utilizing a concept called “massed practice” entails that an individual practice specific movements form many hours (between 5 and all during a 2 to 3 week time span, versus the currently used “distributed practice” which involves shorter practice periods of 15 minutes to 2 hours over several months.

Research indicates massed practice promotes greater recovery after stroke. Massed practice is the foundation of constraint-induced therapy and has opened the floodgates of a new perspective on dosage as it relates to stroke recovery. Summing it up: “More is better”-more resistance, more repetitions, more speed and more duration. The therapist sets the stage for stroke survivors to drive their own nervous system toward the massive neuroplastic changes needed for the fullest possible recovery.

While the article does admit there are problems with using massed practice in hospitals, skilled nursing and outpatient settings, it also proposes there are ways around this suggesting the use of constraint-induced therapy (mCIT) which allows for the massing of practice while the patient is at home.

Click here to read the full article in Advance for Directors in Rehabilitation

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March 11, 2008, 2:11 pm

The Future of Mind Reading

Believe it or not, it looks like the ability to read minds is becoming a reality – for machines at least. Jeremey Manier reports in the Chicago Tribune that a research team has managed to decipher the brain’s code, deducing what an individual is looking at based solely on brain activity. The astonishing study was published on Wednesday in the journal Nature by neuroscientists at the University of California at Berkeley. They scientists used a brain scan to find patterns of activity when people looked at black and white images or ordinary items; a software program then drew on activity in the brain’s vision center to guess which images they saw. While the technology is currently very limited, deciphering only set pictures, and at an accuracy of 92 percent, the ethical debate is already rearing its head.

The ability to “mind read” has numerous potential advantages: such as aiding communication for people who are paralyzed, locked-in-syndrome, or otherwise disabled. However, with such ability comes responsibility as well, if this technology is developed it could be used to extract information from unwilling subjects.

Click here to read comments about the original publication or to purchase the entire article from Nature News

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March 3, 2008, 9:30 am

Closing a Few Doors has its Advantages

Dan Ariely suggests that keeping your options open may actually hinder you in the long run. For most, it is difficult to close doors, buying the camera with the extra bells and whistles for “just-in-case”, as well as investing time in relationships with individuals you no longer have anything in common with.

In the M.I.T. experiments, the students should have known better. They played a computer game that paid real cash to look for money behind three doors on the screen. (You can play it yourself, without pay, at tierneylab.blogs.nytimes.com.) After they opened a door by clicking on it, each subsequent click earned a little money, with the sum varying each time.

As each player went through the 100 allotted clicks, he could switch rooms to search for higher payoffs, but each switch used up a click to open the new door. The best strategy was to quickly check out the three rooms and settle in the one with the highest rewards.

Even after students got the hang of the game by practicing it, they were flummoxed when a new visual feature was introduced. If they stayed out of any room, its door would start shrinking and eventually disappear.

They should have ignored those disappearing doors, but the students couldn’t. They wasted so many clicks rushing back to reopen doors that their earnings dropped 15 percent. Even when the penalties for switching grew stiffer — besides losing a click, the players had to pay a cash fee — the students kept losing money by frantically keeping all their doors open.

Why were they so attached to those doors? The players, like the parents of that overscheduled piano student, would probably say they were just trying to keep future options open. But that’s not the real reason, according to Dr. Ariely and his collaborator in the experiments, Jiwoong Shin, an economist who is now at Yale.

They plumbed the players’ motivations by introducing yet another twist. This time, even if a door vanished from the screen, players could make it reappear whenever they wanted. But even when they knew it would not cost anything to make the door reappear, they still kept frantically trying to prevent doors from vanishing.

Apparently they did not care so much about maintaining flexibility in the future. What really motivated them was the desire to avoid the immediate pain of watching a door close.

This study shows that we as human beings frequently invest our time in keeping doors open, when it would probably behoove us to close some doors – making time to open new ones, or just explore the ones we currently value. Dr. Ariely hypothesizes that closing a door on an option is experienced as a loss, and that keeping doors open translates into wasted time and missed opportunities. Sometimes this means we are working longer hours at our jobs – and missing out on time with our loved ones. He urges us to re-evaluate our current open doors, and close the ones we can, resigning from committees, prune holiday card lists, and rethink hobbies.

Click here to read the entire article from the New York Times

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