August 29, 2008, 8:11 am

Physical Fitness Matters

MedPage Today’s Judith Groch shares that according to researchers at Johns Hopkins, the University of Maryland and the Maryland VA Medical Center, treadmill walking with gait training not only improved walking speed and fitness, but also “appeared to rewire brain circuits in patient’s who’d had a hemi paretic stroke years earlier”. Functional MRI brain scans were conducted on the treadmill walkers and researchers found increased activation in the posterior cerebellar lobe, the midbrain, and the cortical brain areas. The results were not limited to individuals with new injuries; the researchers also saw significant improvement even nine years after a stroke.

Interesting enough, they also found that: “Patients with the most improvement in walking showed the greatest changes in brain activity, the researchers said, but added that it was not clear whether these changes were caused by more walking or whether participants walked better because brain activity in these key areas increased.”

Click here to read the full article

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August 27, 2008, 2:20 pm

Advocacy

Many soldiers are coming back from Iraq with brain injuries, and the New York Times has been following the stories as they develop. Just recently they published a story on Sergeant Shurvon who suffered from a brain injury following a roadside bomb attack in Iraq. Shurvon received treatment at the Rehabilitation Institute of Chicago (R.I.C.), a private hospital, which would not have been possible without strong family advocates to fight on Shurvon’s behalf. The New York Times reports, “15 soldiers wounded in Iraq or Afghanistan have made their way – often with the relentless advocacy of their families helping to pry payment for the military for private treatment – to Zollman’s ward.”

What to do? Contact your congress, get the VA bills passed to allow for funds to treat our injured soldiers and loved ones in civilian facilities which offer the technology and professionals required to address the aftermath of devastating injury.

Click here to read Shurvon’s story

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August 26, 2008, 1:31 pm

Helmet Safety

Wayne Laepple in the Daily Item explains that it doesn’t matter how old or young you are: wear a helmet. Laepple reports that “Deana Clester, a community health educator at Evangelical Community Hospital, tries to educate children under 14 about helmet usage.” A fall from as little as two feet above ground can result in a traumatic brain injury. Furthermore, according to Clester, in 2006 about 275,000 non-fatal bicycle accidents happened a day in the United States alone (that’s more than 800 accidents a day), and that less than 25% of children wear a helmet when they ride their bikes.

She explains that “the helmet should sit level on the head, about two fingers width above the eyebrows, and should fit snugly so it doesn’t wobble. It should always be buckled.”

Click here to read the full article

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August 19, 2008, 11:10 am

Where do you stand on End-of-Life Treatment?

MedPage Today reports that healthcare providers and the general public have differing opinions. Researchers have found that nearly two-thirds of Americans believe that an individual in a vegetative state can still be saved by a miracle. However, only a fifth of doctors agree.

The researchers surveyed both the public and trauma specialists. 1,006 Americans were contacted via a random-digit-dialing telephone survey, while using a convenience sample of medical personnel “involved in trauma care, including medical directors of trauma units, trauma nurses, and emergency services personnel.

While there were some similarities in the two groups, there were also some significant differences. 51.9% of the public and 62.7% of professionals say they would want to be present while an injured loved one was resuscitated, and most of both groups said they would trust a physician’s decision to withdraw treatment when it would be futile. 72.4% of the public vs. 44.3% of professionals believed that patients “have a right to demand care not deemed appropriate by the physician”. According to the study:

61.3% of the public and 20.2% of professionals believe that a miracle can a save person in a persistent vegetative state, and 57.4% of the public said divine intervention can save a person when doctors think treatment is futile, compared with just 19.5% of trauma professionals.

Interestingly, on the tough question of when to stop life-sustaining treatment, 72.8% of the public and 92.6% of professionals think if there’s no hope for recovery, the focus of care should shift to the comfort of the dying patients.

But among the minority who disagreed, 86.2% of the public and 33.3% of the professionals said treatment aimed at recovery should continue regardless of cost. On the other hand, when such aggressive care meant taking resources away from those with a better chance of life, members of the minority changed their minds — 56.1% of the public and 62.8% of the professionals said the care should cease.

Click here to read the full article

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August 15, 2008, 2:05 pm

Combat Sets the Stage for Psychiatric and Substance Abuse Problems

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, 1:22 pm

Life Support

Have you made a living will? Would you want to be kept alive at all costs even though you are not aware of your surroundings and the chance of recovery is next to nothing? The issues surrounding life support can be quite controversial.

Medpage today reports on a case where doctors were ordered to continue end-of-life care for one Samuel Golubchuk. Samuel was an 84 year old man admitted to a hospital in October of 2007 with pneumonia and pulmonary hypertension, as his health deteriorated he was moved to the ICU. Samuel, who was placed on life support, grew progressively worse.

Samuel’s attending physician spent 10 days discussing the issue with family members – however the family refused to withdraw life-support sharing that to do so is essentially murder. The family was able to get continued treatment for Samuel by court order.

Samuel eventually died on June 25th, after approximately eight months on life support. During that time he “developed pressure sores because his failing circulatory system couldn’t provide enough blood flow to the affected areas.” Dr Kumar revels in an email interview that “I thought it was quite likely he would die from this if not aggressively and routinely debrided. However, if the kind of debridement he needed was provided, by the end he would have had little flesh left between his knees and the small of his back”. According to Dr. Kumar this procedure is tantamount to torture, as it was both painful and medically futile.

What can be done in situations such as these? First of all, have a living will. Let friends and family members know exactly what you would want to happen if you were to be in a similar state. According to the article in MedPage today, there is a lot of gray area when it comes to these types of situations. The College of Physicians and Surgeons of Manitoba guidelines leaves the decision to end life support with the treating physician. The American Medical Association doesn’t state who has the responsibility of determining whether or not to continue life support – it does however: “enjoins its members to respect patient autonomy and to make ‘reasonable efforts’ to figure out what a patient would have wanted, including consulting family members or other patient surrogates, asking ethics committees, or even going to court.”

Texas on the other hand does back up its doctors. Under the Texas Advance Directives Act, “a doctor can refuse to continue ‘inappropriate’ life-support. The issue is then referred to an ethics committee and if the committee agrees with the doctor, the patient’s surrogate has 10 days to either accept the ruling or find another facility that will continue the life-support.”

Click here to read the full article

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August 11, 2008, 7:34 am

Real-time TBI Monitor on the Horizon

Johns Hopkins University researchers have developed software that can potentially help early detection and treatment of traumatic brain injuries among U.S. service members. The software is designed to integrate real-time data with information from the patient’s electronic medical record, “and present visualization over a network to a physician in a remote location who could then diagnose TBI and direct treatment.”

This new software will allow physicians to determine if the individual needs treatment for TBI before they even hit the hospital door. According to Buxbaum in HealthIt, even prior concussive events could be included.

“The result is to virtually transfer the physician to the battlefield,” said Rampersad. “The physician can triage and assess the situation before the patient is even removed. This tool also allows one physician to monitor a large number of people at the same time and to better triage the wounded.”

“Traumatic brain injury needs to be treated as soon as possible,” Fackler added.

“My sense is that getting the information not a problem,” said Dr. Myron Yaster, an anesthesiologist at Johns Hopkins Children’s Center and a member of the group. “The problem is information overload. The idea behind this tool is for a physician to see who is in trouble and who isn’t with a quick look at the screen.”

Click here to read the full article

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August 1, 2008, 1:04 pm

Economics Turns to Neuroscience for Answers

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, 12:35 pm

Bill Aiding Wounded Vets to Reach House Floor Next Week

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