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?
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.
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.
Recovery is a journey. It is a journey of heart and spirit as much as it is of body and mind. It is a journey not only foisted upon the ill or injured, but it becomes a journey for all those connected to them. And journeys - whether they are joyful or painful - are not complete nor fulfilled unless they are shared.
CaringBridges was created to make that sharing a little easier, and to ease the burden of the sometimes emotionally exhausting task of informing one’s concerned circle about an ill, injured or recovering loved one.
This is a free web-based service where anyone can quickly and easily create a personal web site that then serves as a hub of communication and support for both the patient and the family.
Each web site has a “journal” for communications from the patient or caregivers, as well as a message board for friends and family to post messages. Each site has a photo gallery that also serves to help visitors stay connected to the family and loved one.
CaringBridges was founded by Sona Mehring in 1997 when she was faced with task of spreading the word about the premature birth of her dear friends’ baby. She hit upon the idea of creating a web site as a method to keep their social circle informed during the difficult days ahead. Sona created her web site the day the baby was born, and it since has blossomed into CaringBridges and has enabled more than100,000 individual web sites, each created by people facing their own short and long-term life journeys.
While CaringBridges has mostly health-related web pages, a recent story in Delta Airline’s Sky Magazine cites couples creating a web page at CaringBridges to keep friends informed of their international adoption proceedings, and a displaced nursing home that created pages for all of its residents right after the Hurricane Katrina crisis.
Not only do these sites serve as a central communication point, they relieve some of the emotional stress for caregivers of delivering news while at the same time being a lifeline of support and encouragement.
CaringBridges is being embraced by healthcare organizations and non-profits serving health-related issues as a way of serving their constituents. St. Francis Hospital in Minnesota, or example, has gone so far as to put a computer for accessing the site in their Acute Care family waiting room.
CaringBridges has grown to be the largest charitable non-profit website in the world. More than 100 sites are being created there each day, and it averages three people each minute coming to register to visit them. Visitors from 40 different countries have left over 15 million messages of hope and encouragement. CaringBridges is supported solely by donations - 90% of them from individuals and families who use the service.
We hope you will stop by the CaringBridges web site and support them by spreading the word.
“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.
“…on the morning of December 10 1996 I woke up to discover that I had a brain disorder of my own. A blood vessel exploded in the left half of my brain. And in the course of four hours I watched my 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 essentially became an infant in a woman's body.”
On that morning brain researcher and neuroanatomist Dr. Jill Bolte Taylor suffered a hemorrhage in the left hemisphere of her brain. Twelve years later she was on the stage of the TED conference providing us with the powerful story of her experience as she - a brain researcher - meticulously observed herself going through it.
In spite of the fact her brain functions were slipping away one by one due to the massive stroke, she remembered every moment. From waking up with pain, to floating between right and left brain functions and the brain “chatter”; from her paralysis to her inability to communicate – and to the moment when she felt her spirit surrender.
Watch her talk (or read the transcript). Hear her tell us in a lighthearted, yet deeply moving way about how our brains define us and how they also connect us to the world and to one another.
This is a story so powerful you will remember it long after you hear it – and you will want to share it.
Inside our warm, home-like (yet highly specialized rehabilitation) Fresno CareMeridian facility, we’re proudly caring for some of our country’s veterans.
About one year ago, the Veteran’s Administration contacted us to assist them in caring for some of their most medically complex veteran patients. We of course welcomed this opportunity to serve with open arms. Plus, it made such perfect sense.
The VA approached us because CareMeridian has in place the knowledge
and high quality medical care programs for the very specialized care
that their brain injury, spinal cord injury, tracheotomy, and
ventilator-dependant patients require.
The VA is treating more than 200,000 patients from the wars in Afghanistan and Iraq alone. Many of these are brain-injured – a class of injury about which the VA is admittedly struggling to become more knowledgeable. CareMeridian has a long history of exactly the type of specialized, long-term care such catastrophically injured patients require.
The VA hospitals are top-notch in acute care. They also excel at all aspects of limb injuries, rehabilitation and prosthetics. This is because, until very recently, these have been a major source of injury for vets. The VA over the years has perfected their ability to provide these types of treatments. But today, with the impressive advances in immediate post-injury and acute care, soldiers are surviving injuries they may not have just a few years ago – and that can mean some soldiers require very specialized long-term care that the VA is now working hard to be able to provide on a broader basis.
In working with the VA on our partnership, it became clear that even though we provide this care in small, highly staffed (4-1 patient to care-giver ratio), 12-bed facilities for personalized care, CareMeridian was able to deliver these services at about ½ the cost that the VA could provide them.
All in all, this means better care for our vets – and for their families. Certainly our entire focus on caring for such specialized needs in an intimate environment - that allows for including the family in the care day-to-day - is a primary benefit. But, because families may also be faced with certain co-insurance payments, our cost-effective care means their co-payments are less as well. And by placing the appropriate patients within our skilled facilities, the VA in turn has more beds at their facilities to allow for better care for other veteran patients.
We’re proud to be supporting the VA in their efforts by currently providing two types of services for our vets. We’re caring for those that require round-the-clock skilled nursing, such as IV, tracheotomy, ventilator and other catastrophic injury therapies; as well as those needing neuro-behavioral therapies, community integration, and caregiver training.
CareMeridian stands ready to support our troops in our own, very unique way.
The web site has a wealth of information about specific disorders as well as publications and information on clinical studies. In addition to links to non-profit organizations and resources, NINDS also has a contact form for submitting questions. The web site is here. NINDS is part of the National Institutes of Health.
Coaching the Comeback The New York Times published an inspiring story this month focused on occupational therapist, Jody Levin. She works every day to help heal brain-injured patients and this story reminds us how dedicated, caring health care workers encourage recovery miracles. Read the story here.
UCLA Research Finds Nervous Systems Can Rewire Itself A recent UCLA study with mice shows that the central nervous system can reorganize itself after spinal injury by finding new pathways to restore the cellular communication required for movement. The study is shedding new light for doctors who believed that the only way for injured patients to walk again was to regrow the long nerves that link the brain and base of the spinal cord. The discovery could lead to new therapies for the estimated 250,000 Americans who suffer spinal injuries each year.
Interactive Memory Mapping: Learning About the Brain National Geographic Magazine has an interactive feature on their web site explaining memory mapping.
It shows through beautifully design graphics how the brain works in
forming memories, storing them, and forgetting our memories due to age,
injury or illness. Learn more about how our brain works here.
Researchers Link Some Social Problems With Undetected Brain Injury The Wall Street Journal reports that brain researchers are linking some common social problems, such as alcoholism, certain learning disabilities, and chronic homelessness to brain injury - a long-forgotten blow to the head.
Researchers have found high rates of head trauma among various populations in New York schools, addiction programs and in the general population. The research is being conducted by the Brain Injury Research Center at Mount Sinai School of Medicine. The findings are offering new hope to adults coping with the “hidden” effects of brain injury. Read the full article here.
Easter Seals Launches Brain Fitness Program for TBI Vets Easter Seals is launching a new nationwide program to help returning veterans with Traumatic Brain Injury (TBI). Nationwide, health care professionals estimate at least 30% of troops who have been engaged in active combat for four months or more are at risk for some brain injury due to exposure to the percussive effectives of explosive devices.
Easter Seal’s new Brain Fitness Program is a pilot program based on an in-home computer-based software program that helps people who have sustained some types of brain injury think faster, focus better and remember more. TBI is characterized by memory loss, difficulty in concentrating, slowness in thinking, and mood and personality changes. Beyond the computer software, the program includes phone and email support and referral to community resources.
Service members and veterans can enroll now by calling 866.423.4981 or emailing: veterans@easterseals.com to participate.
Five hundred thousand Americans will suffer brain injury this year. Yet, there are many misconceptions surrounding traumatic brain injury. Below we’re tackling a few common myths and hope this proves to reveal a little bit about TBI.
Myth 1: TBI occurs through external trauma to the head. It is true that accidents and blows to the head cause a large percentage of traumatic brain injuries, but TBI can also stem from a stoke, tumor, post-surgical complication or aneurysm. TBI is an umbrella term for any insult to the brain – internal or external.
Myth 2: Traumatic brain injury always causes loss of consciousness. Actually, simple concussions are types of TBI. The person may only be dazed for a brief period. The brain inside the skull is jarred enough however to cause an injury to the brain.
Mild TBI should not be construed as “insignificant.” Any injury to the brain can cause some kind of functional disability.
Myth 3: Brain injury is manifested through specific physical symptoms Traumatic brain injury is sometimes called the “silent epidemic” because the injury is quite often unseen. Physical symptoms are not always present – sometimes the symptoms are emotional, cognitive or behavioral. Of course there are a variety of physical impairments that stem from TBI such as impaired speech, hearing, vision, lack of motor function, or paralysis. But TBI may also manifest itself with cognitive symptoms including memory deficits, inability to concentrate, perceptual difficulties, impaired judgment or confusion.
Or victims of TBI may have behavioral symptoms, such as mood swings, depression, lack of emotional control, inability to cope, agitation or difficulty in relating to others.
The various types of symptoms of TBI are not mutually exclusive, and often patients with TBI have a combination of physical, cognitive and emotional symptoms.
Myth 4: Effects of TBI are immediately obvious People with” mild” to “moderate” TBI may, in fact, not exhibit symptoms for days or weeks after the initial injury event. They may begin to have trouble concentrating or working; or they may develop personality changes or other emotional symptoms.
Many symptoms begin to manifest up to 6 to 12 hours after an injury, and others become obvious only after the person attempts to resume their daily activities. Only with the demands of their daily environment do certain symptoms become obvious or more pronounced.
Myth 5: TBI patients with injuries categorized as ‘minor’ recover completely and quickly. Many patients with mild brain injury do recover completely. But, it may not always be quick. Through proper acute care and rehabilitation the odds for recovery are favorable. But, even mild TBI can cause long-lasting effects, and should not be dismissed. Research indicates the importance of early treatment in the long-term prospects for recovery.
We know quite a bit about the brain, as well as its needs and willingness for recovery after injury. But medicine is learning more everyday about how the brain works and how it is repaired after injury or trauma.
Along with the “miracles” of medicine and therapy that we are able to shape, the truth is the brain holds some of its own miracles – and those we can only support.
From time to time we like to share our own joyful testimonials of such miracles.
This summer fifteen-year old Stephanie suffered a hematoma after hitting her head in a diving board accident. She was given little hope of recovering from her brain injuries by the neurology team at the pediatric intensive care unit where she was initially treated.
But that wasn’t the only challenge Stephanie faced in her young life – or for her recovery. At birth she was diagnosed with Downs Syndrome, a congenital heart condition, and digestive disorders.
She was admitted to CareMeridian’s Oxnard facility in July of this year, shortly after her traumatic head injury. Stephanie captured our hearts the first time we laid eyes on her in spite of the fact that when she came to us she was totally unresponsive to any stimuli and in a coma. We just knew she would defy all odds. And she amazed us indeed.
Just a little over three months later, with the diligent efforts of Stephanie and her team of therapists at CareMeridian, she left our care walking and needing only minimal assistance with typical daily living activities. She is currently able to communicate with sign language and is completing puzzles in a matter of seconds.
Although Stephanie has left us to continue her recovery with further rehabilitation, she will always be part of the CareMeridian family and an inspiration to us. We visited her recently at Santa Barbara Rehabilitation Institute where, with her dedicated Mom at her side, she was up and walking and trying her best – as always.
Two stories were in the news recently highlighting the hope and reality surrounding brain injury recovery. We thought you might appreciate the inspiration they provide.
Chris Cook in the UK, tells his story about a head-first fall from a cherry-picker doing minor household maintenance outside his home this summer. Despite the fact doctors did not expect him to survive or even emerge from his 3-week coma, he returned home last week – after 12 weeks of hospitalization and therapy – and is well on the road to a full recovery.
Read Chris’s story in an article in The Press (UK) here and view a video of Chris telling his own amazing recovery story here.
Closer to home in Austin, Texas, 29-year old Ryan is taking lessons in comedy at the famous Improv and doing karate two years after a boating accident that nearly killed him. Although Ryan is still recovering, this is his take on how he’s doing: "I'm glad to be better," Ryan Reitmeyer said. "It only took me two years to do it, but I'm in good shape now. I have a great life ahead of me."
Ryan’s story is here in the Austin American-Statesman.
Ryan’s family was blessed with financial resources many people do not have when faced with traumatic brain injury. But one senator is tackling that issue to bring resources to bear for more people.
State Senator Flanagan of Vermont, himself a survivor of TBI, held a press conference recently specifically to address brain injury and the wide-ranging severity and symptoms of it. He announced that he has initiated a legislative study committee with the goal of highlighting issues that face brain injury survivors – including the need for insurance companies to significantly lengthen the payment period for brain injury rehabilitation. Senator Flanagan said, "I'd like to see insurance companies look at brain injury the same way they look at other chronic care.”
We are watching with interest the results of this initiative because we know here at CareMeridian, some miracles just take a little longer than others.
