December 15, 2008, 9:08 am

Hopeful Outlook for 2009

One of my favorite brain injury advocates, Laura Schiebelhut, included a hopeful paragraph in her recent newsletter about brain injury legislative initiatives. It reads:

With the new year fast approaching and new resolutions starting to surface, I encourage each of you to consider signing up for the Brain Injury Association of America's Action Alerts. Throughout the year, you'll have opportunities to lend your support (usually by simply emailing your state representatives), and add your voice to thousands who are calling out for reform.

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December 8, 2008, 10:09 am

Read This Now

The Institute of Medicine has recently issued an important new report  that every healthcare professional needs to be aware of: Gulf War and Health: Volume 7: Long-Term Consequences of Traumatic Brain Injury.

It's a long report, but let me draw your attention to two critical pages. Click on the document's link marked "Summary" and look at pages 10-12. You'll find easy-to-read bulleted material that is a comprehensive list of known long-term issues of brain injury–and as important, a list of inconclusive findings that need additional research.

Here's an important excerpt to get you started:

Why is this such important reading? Because if the Insitute of Medicine says that there's sufficient evidence, then ANY field affected by the topics above need to be revisited in terms of brain injury.

That means that the National Boxing Association needs to address brain injury. That means that the Alzheimer's Association needs to address brain injury. Mental health centers, suicide hotlines, family doctors–they all need education. And the list goes on and on.

For many of you who advocate on the level of your local and state community, this is one of the key documents you've been waiting for. Use it as often as you can.

Click here to see the report.

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December 5, 2008, 6:30 am

Strokes and Portable CT Scanners

A Chicago hospital has attempted to decrease the time between stroke and CT scan by implementing the use of a portable CT scan. Following a stroke tPA must be administered before 3 hours have lapsed and since tPA is a dangerous drug, the fact that a stroke has occurred needs to be verified by a CT scan before the drug is administered. The hospital analyzed the length of time required to bring someone into their stationary CT scanner versus the length of time required to take the portable CT scanner to the patient.

While they found only a .1% difference, Dr. Alderson and Dr. Weinreb said that “while saving minutes from the door-to-scan time was helpful, the real issue with stroke is timely arrival at the hospital. Too often, Dr. Alderson said, patients arrive at the hospital complaining that symptoms started the previous night.”

Click here to read the full story

Lessen to be learned here – know the symptoms of stroke! “ Hope for Stoke” lists the following:

1) Strokee will have a crooked smile when asked to smile, if crooked call 911.

2) Ask the stroke to hold their arms out like they were sleep walking. If one is lower than the other call 911.

3) If speech is garbled or word is incorrect, call 911.

If any of the above signs are shown call 911 immediately and get to a hospital.

The American Heart Association lists the following “Stroke Warning Signs” :

If you notice one or more of these signs, don’t wait. Stroke is a medical emergency. Call 9-1-1 or your emergency medical services. Get to a hospital right away!

The American Stroke Association wants you to learn the warning signs of stroke:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

• Sudden confusion, trouble speaking or understanding

• Sudden trouble seeing in one or both eyes

• Sudden trouble walking, dizziness, loss of balance or coordination

• Sudden, severe headache with no known cause

Be prepared for an emergency.

• Keep a list of emergency rescue service numbers next to the telephone and in your pocket, wallet or purse.

• Find out which area hospitals are primary stroke centers that have 24-hour emergency stroke care.

• Know (in advance) which hospital or medical facility is nearest your home or office.

Take action in an emergency.

• Not all the warning signs occur in every stroke. Don’t ignore signs of stroke, even if they go away!

• Check the time. When did the first warning sign or symptom start? You’ll be asked this important question later.

• If you have one or more stroke symptoms that last more than a few minutes, don’t delay! Immediately call 9-1-1 or the emergency medical service (EMS) number so an ambulance (ideally with advanced life support) can quickly be sent for you.

• If you’re with someone who may be having stroke symptoms, immediately call 9-1-1 or the EMS. Expect the person to protest — denial is common. Don’t take “no” for an answer. Insist on taking prompt action.

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December 4, 2008, 2:23 pm

Stay Cool Intervention Saves Lives

Ambulances in New York City now make a critical decision if they are transporting a person who is in cardiac arrest. Rather than heading to the nearest hospital which for years has been the decision, the ambulance may head towards a hospital with hypothermic treatment designed the cool the person in cardiac arrest and prevent further brain injury from oxygen starvation even if that hospital is at greater distance. There are specific clinical indicators which come into play during the decision process. But, overall the odds of minimizing neurological damage for the person in cardiac arrest improve considerably if they can be treated with this novel approach in a timely basis. Michael Bloomberg, New York's Mayor, has been in the forefront of getting this program operational and other cities are expected to join New York in offering hypothermic treatment.

Click here to read the story from the New York Times of December 4, 2008
http://www.nytimes.com/2008/12/04/nyregion/04cool.html?_r=1&ref=health&pagewanted=all

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, 10:43 am

Embedding of Objects :a form of Self Mutilation

The "embedding" of objects as a form of self-mutilation/self-injury is noted to be in the rise. Individuals who engage in this form of injury often begin as "cutters" and progress to embedding objects in their self-inflicted wounds. With cutting behavior, individuals report initial pain and then emotional relief with the sight of blood or with the injury site itself. Embedding causes constant pain and discomfort, including pain which occurs each time the person moves or touches that part of their body. Of the individuals involved in embedding objects, 70% repeated the behavior and 71% increased the size of the objects and intensity of the behavior. Self-injurious behaviors have long been associated with histories of physical or sexual abuse as well as a variety of psychiatric diagnoses. The self-injurious behaviors have been noted to have an addictive quality. William Shiels, D.O., Chief of Radiology at Nationwide Children's Hospital in Columbus recently reported on his findings. Dr. Shiels is advocating for a national registry for individuals with self embedding and is campaigning for the inclusion of the behavior as a unique clinical entity in the next update of the Diagnostic and Statistical Manual of Mental Disorders (DSMV).

At Brookhaven, we have identified a group of young adults who swallow objects and share many of the characteristics observed by Dr. Shiels. We have experienced some success with Naltrexone, combined with intense levels of psychotherapy and a highly structured treatment milieu. The young people with these problems pose great difficulty in most treatment programs and challenge the professional staff. We have recognized that all of our patients with "swallowing" behaviors come to us with substantial abuse histories and long histories of institutional placement.

We encourage clinicians to identify variants of self-injurious behaviors and to work together, as Dr. Shiels suggests, to develop dialogue and share strategies. To read a summary of Dr. Shiels recent presentation "click here"  http://www.medpagetoday.com/MeetingCoverage/RSNA/12007

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, 10:16 am

Traumatic Memories and Brain Function

Our prefrontal cortex plays a significant role in managing traumatic memories. Nivedita Agawal, M.D. of the University of Udine in Italy presented his study on the role of the prefrontal cortex in managing traumatic memories. Dr. Agawal used functional MRI to study the activity in the prefrontal cortex and hippocampus. Individuals with traumatic memory issues showed reduced activity in the prefrontal cortex. This study helps us to better understand the brain basis for disorders like PTSD and options for treatment like Transcranial Magnetic Stimulation.

Click here to read the summary of the study:
http://www.medpagetoday.com/MeetingCoverage/RSNA/12008

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December 2, 2008, 1:44 pm

A Closer Look at the Numbers

Penny's most recent post dropped a rather shocking statistic that I'd like to revisit:

“the number of civilians in the United States living with a long-term disability from traumatic brain injury is now estimated to be 3.17 million”

Let's paraphrase for emphasis. More than 3 MILLION Americans are DISABLED by BRAIN INJURY. Got it? Okay, now let's reframe the numbers a little.

3 Million is:

• 1% of the US population.
• The entire population of Chicago.
• Five times the population of Washington DC.

Got it? Okay, now consider the following.

• NINE states have NO long-term brain injury rehabilitation centers.

By my estimates, there are fewer than 3,000 beds in the US for long-term brain injury rehabilitation centers. The math simply doesn't add up, America.

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, 7:57 am

Exercise and Stay Young!

Aerobic exercise may prevent the loss of small blood vessels in the brain, preventing cognitive decline in the elderly according to a study conducted by Feraz Rahman, M.S. a student at Jefferson Medical College in Philadelphia. Rahman made his findings known at a meeting of the Radiological Society of North America. Previous studies found that exercise reverses small vessel disease elsewhere in the body and increases brain volume and cognitive function in the elderly.  While the study needs to be expanded into a longitudinal study, it offers important thinking towards the health benefits of aerobic exercise throughout one's life.

Click here to read the Medpage report on the study:
http://www.medpagetoday.com/MeetingCoverage/RSNA/11961

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December 1, 2008, 2:34 pm

The Brain: A User's Guide

McGill University has developed a fantastic teaching tool to help our understanding of brain function. The guide can be customized according to the level of knowledge of the user, from basic to advanced and each function of the brain can be viewed from different perspectives and understandings ranging from social to biological. This guide is "a must" for the brain injury toolbox.

Click here for the address of the McGill University site:
http://thebrain.mcgill.ca/flash/index_d.html

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, 9:26 am

Happy Holidays

Veterans suffering from traumatic brain injury have taken the spotlight this past year. However, it is not only our veterans that need to be concerned. Traumatic Brain Injury and Concussions can happen here at home just as easily as overseas. We are in the midst of the holidays, a time to gather with families and friends to celebrate, and a little thing like weather isn’t going to stop us. Use caution, ask someone else to drive if you are tired as slick roads and exhaustion from holiday festivities can make a deadly combination.

The Journal of Head Trauma Rehabilitation reports that, “the number of civilians in the United States living with a long-term disability from traumatic brain injury is now estimated to be 3.17 million”. So be careful out there, play responsibly. If you plan on going skiing, snowboarding, even ice skating – wear a helmet.

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