News From the Field

Mirror Images May Assist the Brain During Rehab
The Heart and Stroke Foundation reports from this year’s World Stroke Congress that using a mirror during therapy may support the brain’s efforts to recover from stroke.

Japanese research shows that a mirror placed between the legs of patients during rehab exercise helped increase the speed of leg-lifting activity up to 12%.  They suggest that the mirror image may “trick” the mind in some way, helping to support physical recovery.  (Story)

Brain Interface Making Speech Recovery Possible
Erik Ramsey suffered a brain stem stroke nine years ago, leaving him almost totally paralyzed.  But thanks to an implanted electrode, some software and a collaboration, Erik is learning to talk again.  The software interprets signals from Erik’s brain to his vocal tract as he attempts to make sounds, translating his thoughts into sounds.   He can hear his voice in real time, providing him feedback on his pronunciation, helping him to hone his speaking skills.  According to an article in New Scientist, over the course of just a few weeks he improved his speech accuracy from 45% to 80%.

The “brain interface” is collaboration between a Georgia company, Neural Signals and a research team at Boston University.  It currently works best with vowel sounds, and improvements are needed to better articulate consonants as they require more coordination of the body’s vocal system.

Early and Frequent Mobility Keeps Depression at Bay for Stoke Patients
Post stroke depression is a major concern to patient and family, but it also is associated with less participation in therapy and a poorer rate of recovery. 

Dr. Toby B. Cumming at the National Stoke Research Institute in Australia tested the impact of early mobilization on stroke patients.  On average their study group was up and mobilizing within 18 hours after the stroke (the standard care group wasn’t mobile until after 30 hours).  The early results of Dr. Cumming’s study shows that increased physical activity in the days immediately after a stroke has a positive effect on patient’s general mood, leading to more effective rehabilitation and recovery.  (Reuter’s story)

Understanding “Spreading Depression” in Brain Neurology Key to TBI Treatment
Researchers at the University of Cincinnati are leading a $2 million research project, focusing on a brain injury phenomenon called “spreading depression.”  Spreading depressions are electrical failures in the brain’s neural network activity that spread beyond the initial injury site to other parts of the brain.  As many as 60% of brain injury patients experience this phenomenon.

Researchers are trying to determine over how long a period spreading depression continues after injury.    This is key information for early brain injury treatment because as these electrical disruptions spread, they cause increased tissue death or damage due to of the loss of blood and oxygen to those affected areas.  Understanding spreading depression will help in developing early TBI treatment.

The research is being funded by the U.S. Department of Defense as a large number of Iraq and Afghanistan war veterans are being afflicted by brain injury.  (Story)  The DOD has also recently awarded a $60 million grant to the University of California, San Diego to study TBI and its relation to post-traumatic stress disorder.

TBI Sufferers Show Significantly Lower Empathy
The Brain Blogger points to a recent study in the Journal of International Neuropsychological Society that shows that 61% of sufferers of traumatic brain injury exhibit low scores on the Balanced Emotional Empathy Scale (BEES), meaning they had less ability to empathize with others.  The study seems to indicate that the low scores were not influenced by the severity of the brain damage, suggesting that even mild TBI can have lasting effects and that TBI interrupts general social cognition. 

It’s interesting to note that almost simultaneously the University of Michigan has found in a recent study there that nearly one out of five delinquent youths suffer from some level of TBI.  The question comes to mind, could a decreased level of empathy in TBI patients be related to the increased delinquency among youth who have some form of TBI?

Brain and Spinal Injury News Alerts

Employed Caregiver Program Broadcast

A broadcast on “Innovative Employer Caregiving Programs” for employed caregivers is airing on the web and by satellite on September 17, 2008 from 11:00 a.m. – 12:00 noon (Pacific Time).    The Department of Health and Human Services New Freedom Initiative Subcommittee (NFI) is producing the broadcast.

The broadcast is for employers, caregivers and organizations that provide caregiver services.  It will include presentations from employers and organizations that have successfully instituted programs to help their employed caregivers.  Presenters will discuss their programs, experiences, and how their successes can be replicated by others.

Assisting caregivers is an important topic for employers as their full or part-time employees are increasingly being called upon to care for an aging, sick or injured loved one. Helping caregivers through developing intelligent programs keep employees productive and able to balance all the demands on them. There will be a 30 minutes Q&A session by conference call following the broadcast. Employers looking to create services or programs should tune in.   

The broadcast will be available on the web through the National Institutes of Health.  There is also an audio line to listen in via telephone.

To get all the information about accessing the broadcast, and to register click here.  You need to register to get broadcast access details.

Congressional Brain Injury Task Force Newsletter

With 1.4 million Americans experiencing traumatic brain injury and 5.3 million living with long-term and severe brain-related disabilities, the Congressional Brain Injury Task Force is now publishing a quarterly newsletter.  The mission of the Task Force is to educate and promote awareness of brain injury and to support funding for research.

The newsletter recaps legislative activity, studies and reports, media coverage and upcoming events related to brain injury.  While much of the activity in the Task Force is driven by the increased incidence of brain injury in soldiers in Iraq, much of the information and funding impacts anyone with brain injury.

The link to the full newsletter is here.

New Brain and Spinal Injury Web Site and Blog

MIT’s Technology Review brings us a report about a new Brain and Spinal Cord Injury web site and blog.  It is a rich resource, aimed at helping with learning to cope after a life-altering accident.  Spend just a few minutes there and you will see that they are building an extensive knowledge base of information about rehabilitation, recovery, research, coping and treatment. 

You’ll find a growing video library and a daily blog on the latest news and developments.  The blog has a unique “Technology Thursday” posting each week which highlights new technological developments for treatment or assistance. Topic categories on the blog make for easy searching of more specific topics related to brain or spinal injury.  Soon they will have a comprehensive list of treatment centers. 

The website and blog are definitely worth checking out.  You’ll find them here.

America’s Heroes At Work

The U.S. Department of Labor has just unveiled a new web site, America’s Heroes at Work, supporting the employment and success of returning Vets who have TBI and/or post-traumatic stress disorder (PTSD).  It is designed for employers and workforce development organizations or departments and includes fact sheets, presentation & training tools, success stories, on-the-job challenge resources and best practices.

The initiative is jointly managed by the Office of Disability Employment Policy and the Veteran’s Employment and Training Service in collaboration with several federal agencies including the Department of Defense, the Small Business Administration and the Social Security Administration among others.

“The Human Spirit Cannot Be Discounted.”

“I have learned on my journey that the human spirit cannot be discounted. The human spirit is something the doctors can't quantify. It is something they can't give a statistic on. But it is an amazing and incredible thing. You cannot beat someone down who wants to triumph."

That is Lee Woodruff speaking - from experience.  She is the wife of Bob Woodruff, the now famous journalist who suffered a traumatic brain injury in 2006 while in Iraq. She and Bob wrote a book last year about their life, their crisis and their recovery as a family.  The book is titled "In an Instant: A Family's Journey of Love and Healing" and it quickly became a best seller and a “best book of 2007.”

When Lee spoke of the strength of the human spirit, she was speaking to an audience of more than 600 people, and as the recipient of the 2008 Woman of Courage Award bestowed upon her by the Domestic Violence Crisis Center in Stamford, CT.  Her connection to domestic violence with brain injury was highlighted in her talk by way of a little known fact: that roughly 11% of the 1.5 million traumatic brain injuries per year are caused by domestic violence.

Ms. Woodruff’s words and this news story really hit us close to home.  We see the triumph of the human spirit every day here. But it isn’t every day one of CareMerdian’s patients also publishes a book about their own journey through TBI.

In his book, Life After Near-Death, Matt Stepien tells his frightening and compelling story of a rare virus that lead to a brain hemorrhage, three weeks in a coma, and a life completely transformed by this crisis.

Matt describes the book as an autobiography detailing the trials and transformations following severe brain injury.  Toni Bethke at our Santiago Canyon facility where Matt was a patient in 2005 describes it as an amazing and heartwarming story of Matthew's courageous efforts and achievements after a near fatal brain hemorrhage.

Matt’s recovery took more than 2 years, but he is now living independently at home much to the joy of his wife, children and six grandchildren. Matt is employed as a civil engineer.  He lives with permanent neurological damage to his right leg and to the center of the brain affecting his balance.  That is the legacy of his brain injury, but as you will see in his book, he is discovering talents he didn’t – and perhaps wouldn’t otherwise - know he had.

Lee Woodruff likely summed up Matt’s feelings as well when she said at that awards luncheon earlier this week,

"How do you get through any crisis without an amazing network of friends who drop everything and will do whatever is needed? To any one of you who thought about my family in Rye, N.Y., or said a prayer, I want to thank you all. Because I firmly believe that you all brought him back to us. It really does take a village in a situation like this.”

Matt congratulations on your book – and most assuredly on your own triumphs.  You inspire those in your “village.”  You have certainly inspired us.

Matt’s book is published by BIGRED and is available for $14.95 on the web here.

Connected Communities Support Those Living With Brain and Spinal Injury

CareMeridian integrates family and loved ones into our patients’ recovery from brain injury, spinal cord injury, or numerous other traumatic or neuromuscular conditions.  We also recognize that those loved ones who support the recovering need a support system of their own to celebrate the good days and to help through the sometimes long and frustrating ones.

Support systems for families extend well beyond our facilities, to be sure, and some of these are new ways to connect with those affected by long-term injury recovery.

Personal online journals called weblogs are both a way to communicate and an important emotional outlet.  Josh’s mom started a personal weblog to chronicle Josh’s recovery from brain injury from a drug overdose.  It is her way of keeping friends and family involved and informed – and a way to share her ever-changing thoughts and feelings along the journey.

Karen’s mom is also periodically updating her online journal called Blessings For Karen. Friends stop by to leave comments and messages of support.

The Paralysis Community is a new online social network gathering together all those who are touched by spinal cord injury and paralysis.  The goal is to bring together experts, families, friends and those living with paralysis to share their stories and experiences.  There are discussions, weblogs and message boards as ways for all community members to meet and share.

Carepages offers free personal, private web pages to help loved ones stay connected and emotionally supported. There are special areas for Mom and Dads, as well as inspiring stories – and places to meet others experiencing similar life and injury circumstances.  The brain injury support center at Carepages offers a newsletter as well.

Apparelyzed is an online peer support site for those with spinal cord injuries. In addition to discussion forums, it has a wealth of information and links on everything from adaptive equipment to health conditions, from sexuality and parenting to statistics and news.  Apparelyzed was created and is maintained by UK resident Simon, who is medically classed as a quadriplegic.

Family caregivers are often time-challenged.  Connected communities such as these are a lifeline of support that is as close as – and as immediately accessible as – the keyboard.

Our Little CJ

We just must share a joyful update on “our little CJ.”   She’s now at home with her family.  We at CareMeridian had the great privilege of helping her get back there, where she belongs.

You see CJ was just 10 years old when she suffered a stroke.  Such a very rare catastrophic injury in one so young. 

CJ was in a coma, only very minimally responsive to any stimuli. Treating doctors at the hospital gave the family virtually no hope for CJ’s recovery.

CJ’s insurance case manager requested that Children’s’ Hospital Central California contact CareMeridian to evaluate CJ and make recommendations. CareMeridian staff evaluated her while she was in the hospital, and she was soon transferred to our San Martin facility for rehabilitation and home-like care.

During the 2 months CJ was with us we all worked hard; CJ, Mom, family and the entire San Martin team.   With expert care, specialized therapies, dedicated staff and loving support, CJ went from almost no response and no ability to eat, walk or talk, to awareness, managing self care tasks and becoming mobile.

It was a happy day at Care Meridian when we saw CJ headed back to Children’s’ Hospital Central California Acute Rehabilitation Center.  She still had work to do, but she was ready to continue her recovery outside the enveloping shelter of CareMeridian. 

Today, her Mom told us she is growing and continuing to improve.  She is now going to a specialized school and able to feed and dress herself and walk with the help of a brace.

CJ’s mom shared words we love to hear: that she knows the care she received here at CareMeridian was the best anywhere and she credits us with CJ’s recovery. 

We couldn’t be prouder of “our little CJ.”  And, no matter where she goes, she will always be a member of the CareMeridian family.

Research Underscores Hope for Traumatic Brain Injury and Spinal Cord Injuries

Here at CareMeridian we experience everyday the small and progressive miracles the body can produce with proper care and rehabilitation.  Our job is to integrate proven therapies that encourage and support the body’s ability to heal and overcome illness or injury.

The research community is continually informing our mission as it progresses with medical understanding of the healing process.  Almost every day some new piece of the human-body puzzle is discovered; and research is constantly underscoring the hope there is for anyone struck with traumatic brain injury, spinal cord injury or other medically complex condition.

New research for example, shows promise in evolving surgical and pharmacological therapies for spinal cord injury.  Studies indicate that if undertaken immediately after injury, certain therapies may help damaged nervous systems to regenerate. A recent grant from the National Institutes of Health is funding a study on the brain’s natural response to injury, which will help to expand medical knowledge about enhancing the body’s own healing response.  And, Carnegie Mellon scientists are showing in the laboratory that certain parts of the brain are extremely adaptive - even when sensory input has been severely damaged (sight or touch) - and that the brain is flexible in compensating for damage to it.

With more than 12,000 spinal cord injuries every year in the United States and Canada, and an estimated 5.3 million people surviving with traumatic brain injuries, some of the world’s most brilliant minds are committed to finding therapies and designing rehabilitation regimes for improving the outcomes for our patients and your loved ones. 

CareMeridian is on the forefront in keeping abreast of the latest medical findings. We treat the whole patient, physically, psychologically, and personally.  Experience matters, knowledge matters, and hope is an important part of the equation - for the patient and for family members,

The More You Know – Post-Acute Care Links and Resources

There is a lot of information – some would say too much information – out on the Internet about traumatic brain injury, spinal cord injuries and other similar post-acute care challenges. Sorting through and making sense of it all is a Herculean task it itself.

You will find some great information on our site for families, medical professionals and payors. But if you are looking for other resources, here are some links we’d like to share. If you have other sites or sources you would like to share just let us know!

• Brain Injury Association of America

• National Brain Injury Research Treatment and Training Foundation

• North American Brain Injury Society

• CDC TBI website

• Rancho Los Amigos Scale

• National Spinal Cord Injury Association

• Mentor ABI