With concern over concussions a hot issue now, potential National Football League draft picks will have to undergo a brain test and face questions about their brain-injury history, according to the Associated Press.
http://www.latimes.com/sports/football/nfl/wire/sns-ap-fbn-nfl-combine-concussions,0,5717019.story
The 329 players coming to a scouting combine in Indianapolis this week will have to take the ImPACT test, a baseline brain activity examination – a first for the NFL.
Doctors can use the information gathered from the test to create a standard way to evaluation players, and to possibly track data on concussions.
The NFL has already made changes to its rules regarding players returning to play after hitting their heads.
The NFL’s competition committee this week saw demonstrations of new helmets that purportedly would be protective against head injuries.
Friday the NFL players’ union will conduct a Player Safety and Welfare Summit in Indianapolis, where companies can come to discuss any gear or services they offer that are supposed to make football safer.
That night, team doctors will meet to talk about new treatment for players. That meeting will include a discussion of head injuries.
Skier C.R. Johnson Dies In Ski Accident After Striking His Head
Not all sport brain injuries happen in competition. And they are not all routine concussions. Some, like Natasha Richardson’ and now C.R. Johnson, can be fatal.
Johnson, a skier and leader in halfpipe skiing, died in an accident Wednesday when he hit his head against a rock in Squaw Valley, Calif.
http://www.fanhouse.com/2010/02/24/c-r-johnson-killed-in-skiing-accident/
The 26-year-old, who had sustained traumatic brain injury earlier in his career, was skiing on Light Towers with friends when he reportedly fell down face first, twisted around and hit the back of his head on rocks. Johnson was wearing a helmet, which was damaged in the accident.
Johnson had been in the superpipe and halfpipe competitions at the X Games.
Back in 2005, another skier landed on Johnson in an accident in Utah. Johnson, who suffered traumatic brain damage, was put in a coma for 10 days. But he was soon back skiing after spending some time in a rehabilitation facilty, where he had to learn how to talk again.
Some “return to play” decision are just ridiculous. Anyone who suffers a severe brain injury (a coma) should frankly be disqualified from balance, instant decision making, perfectly coordinated activities where there is any risk of further brain injury. Despite what the team doctors might have wanted to believe, or Johnson himself believe, a brain injury severe enough to put someone in a coma, will not have a complete recovery. The goal is a satisfactory recovery, but that doesn’t mean that a finely tuned athlete will ever be able to do all the things again that it takes to excel, or in Johnson’s case, even survive.
If a doctor released Johnson for skiing, that doctor should be answering for his death.
Johnson, a skier and leader in halfpipe skiing, died in an accident Wednesday when he hit his head against a rock in Squaw Valley, Calif.
http://www.fanhouse.com/2010/02/24/c-r-johnson-killed-in-skiing-accident/
The 26-year-old, who had sustained traumatic brain injury earlier in his career, was skiing on Light Towers with friends when he reportedly fell down face first, twisted around and hit the back of his head on rocks. Johnson was wearing a helmet, which was damaged in the accident.
Johnson had been in the superpipe and halfpipe competitions at the X Games.
Back in 2005, another skier landed on Johnson in an accident in Utah. Johnson, who suffered traumatic brain damage, was put in a coma for 10 days. But he was soon back skiing after spending some time in a rehabilitation facilty, where he had to learn how to talk again.
Some “return to play” decision are just ridiculous. Anyone who suffers a severe brain injury (a coma) should frankly be disqualified from balance, instant decision making, perfectly coordinated activities where there is any risk of further brain injury. Despite what the team doctors might have wanted to believe, or Johnson himself believe, a brain injury severe enough to put someone in a coma, will not have a complete recovery. The goal is a satisfactory recovery, but that doesn’t mean that a finely tuned athlete will ever be able to do all the things again that it takes to excel, or in Johnson’s case, even survive.
If a doctor released Johnson for skiing, that doctor should be answering for his death.
Details On Measures the NFL Is Looking At To Limit Concussions
No more three point stance? That will be the acid test as to whether the NFL is willing to put player safety first. Eliminate the three point stance and you change the nature of football. Oddly, the running game would likely be the biggest benefactor, which is a complete contrast to the direction the league has been going. It is hard to imagine a traditional defense without line men digging in to stop the run. Will the NFL force such an organic change in the way the game is played for player safety? I doubt it. Frankly, I am not even sure that such change would make a biomechanical difference.
But eliminating the three point stance is one of the rule changes being considered by the NFL and its players are considering rule changes to ward off concussions, according to a detailed account in The Washington Post.
http://www.washingtonpost.com/wp-dyn/content/article/2010/02/19/AR2010021902973.html Some of the other measures being discussed are barring helmet-to-helmet hits on all ball carriers; limiting off-season practice; and exemptions for players recovering from concussions.
The possible changes could be in place by next season, according to The Washington Post. The league is trying to put the kibosh on the number of concussions that players suffer.
Thom Mayer, the medical director for the players’ union, is quoted saying that he envisions a 20 percent to 25 percent drop in the number of practices with collisions between players being permitted.
The possible changes will be part of the agenda when the NFL competition committee and union reps are together in Indianapolis next week.
Some safety measures were already implemented by the NFL following congressional hearings in October, which took testimony on player concussions causing long-term memory-related problems.
But eliminating the three point stance is one of the rule changes being considered by the NFL and its players are considering rule changes to ward off concussions, according to a detailed account in The Washington Post.
http://www.washingtonpost.com/wp-dyn/content/article/2010/02/19/AR2010021902973.html Some of the other measures being discussed are barring helmet-to-helmet hits on all ball carriers; limiting off-season practice; and exemptions for players recovering from concussions.
The possible changes could be in place by next season, according to The Washington Post. The league is trying to put the kibosh on the number of concussions that players suffer.
Thom Mayer, the medical director for the players’ union, is quoted saying that he envisions a 20 percent to 25 percent drop in the number of practices with collisions between players being permitted.
The possible changes will be part of the agenda when the NFL competition committee and union reps are together in Indianapolis next week.
Some safety measures were already implemented by the NFL following congressional hearings in October, which took testimony on player concussions causing long-term memory-related problems.
More Than 1,000 Disabled in N.J. Could Lose Benefits From Cash-Strapped Traumatic Brain Injury Fund
Roughly 1,300 disabled people in New Jersey could lose treatment and services because of budget cuts impacting the state’s Traumatic Brain Injury Fund.
http://www.nj.com/news/index.ssf/2010/02/nj_assembly_committee_discuss.html
A New Jersey Assembly committee met Thursday to talk about possible ways to raise more money for the fund. In order to keep within the fund’s yearly $3.4 million budget, some officials have recommended that the fund only serve those who sustained a blow to the head, not those who suffered brain injury from a stroke, tumor or other type of trauma.
If that change were made, 60 percent of the 2,000 people who now get services from the program would be ineligible for it.
One of the solutions being considered is raising the 50-cent surcharge on car registrations that funds the program now.
Recipients who would be cut off from the Traumatic Brain Injury Fund are understandingly upset, as described in this well-done human interest story by The Star-Ledger of Newark, N.J.
http://www.nj.com/news/index.ssf/2010/02/state_brain_injury_fund.html
The story talks about the case of Michael Jankowsky of Toms River, who got stabbed in the heart trying to protect a friend 25 years ago. His brain didn’t get oxygen, and he suffered brain damage. He needs constant care, at age 45.
“He uses a wheelchair, slurs his speech, and struggles to concentrate,” The Ledger writes. “He has made progress over the past few years, his mother says, thanks to New Jersey’s Traumatic Brain Injury Fund, which paid for speech therapy and other treatments not covered by insurance.”
The story goes on, “That could end soon. The Brain Injury Fund is going broke, and the state wants to limit whom it helps to people whose brain damage came from a direct blow to the head.”
This is absurd. The issue is whether the brain is injured, not what mechanism of injury caused it. Some of the most serious of brain injuries don’t involve any blow to the head and as high as 50% of concussions do as well. See http://subtlebraininjury.com for more on the mechanical forces which cause brain injury.
http://www.nj.com/news/index.ssf/2010/02/nj_assembly_committee_discuss.html
A New Jersey Assembly committee met Thursday to talk about possible ways to raise more money for the fund. In order to keep within the fund’s yearly $3.4 million budget, some officials have recommended that the fund only serve those who sustained a blow to the head, not those who suffered brain injury from a stroke, tumor or other type of trauma.
If that change were made, 60 percent of the 2,000 people who now get services from the program would be ineligible for it.
One of the solutions being considered is raising the 50-cent surcharge on car registrations that funds the program now.
Recipients who would be cut off from the Traumatic Brain Injury Fund are understandingly upset, as described in this well-done human interest story by The Star-Ledger of Newark, N.J.
http://www.nj.com/news/index.ssf/2010/02/state_brain_injury_fund.html
The story talks about the case of Michael Jankowsky of Toms River, who got stabbed in the heart trying to protect a friend 25 years ago. His brain didn’t get oxygen, and he suffered brain damage. He needs constant care, at age 45.
“He uses a wheelchair, slurs his speech, and struggles to concentrate,” The Ledger writes. “He has made progress over the past few years, his mother says, thanks to New Jersey’s Traumatic Brain Injury Fund, which paid for speech therapy and other treatments not covered by insurance.”
The story goes on, “That could end soon. The Brain Injury Fund is going broke, and the state wants to limit whom it helps to people whose brain damage came from a direct blow to the head.”
This is absurd. The issue is whether the brain is injured, not what mechanism of injury caused it. Some of the most serious of brain injuries don’t involve any blow to the head and as high as 50% of concussions do as well. See http://subtlebraininjury.com for more on the mechanical forces which cause brain injury.
Vermont Teen Back In School After Head Injury
I have talked about the irony of the miracles in severe brain injury cases and the tragedies of mild for more than a decade. See http://tbilaw.com/essays.mildsevere.php That isn’t to say that every severe brain injury is a tragedy of epic proportions. Yet, the only miracle brain injury stories I know are of the severely brain injured people. This story below seems another such case. Families, keep believing, keep praying and keep talking to your loved one. There is always some hope.
In what some claim is a miracle, a Vermont youth who sustained traumatic brain injury six weeks ago is back in school, the Burlington Free Press reports.
http://www.chron.com/disp/story.mpl/hotstories/6859080.html
The teen, Josh Scaralia of West Rutland, was hit by a car in a Dec. 30 accident. He got a fractured skull and had two blood clots in his brain.
Physicians told Scaralia that he would not be able to go back to Mount St. Joseph Academy and that he would have to put his college plans on hold.
But the school prayed for him everyday, and he was back at school at the academy on Monday.
In what some claim is a miracle, a Vermont youth who sustained traumatic brain injury six weeks ago is back in school, the Burlington Free Press reports.
http://www.chron.com/disp/story.mpl/hotstories/6859080.html
The teen, Josh Scaralia of West Rutland, was hit by a car in a Dec. 30 accident. He got a fractured skull and had two blood clots in his brain.
Physicians told Scaralia that he would not be able to go back to Mount St. Joseph Academy and that he would have to put his college plans on hold.
But the school prayed for him everyday, and he was back at school at the academy on Monday.
Olympics Marred by Luger Death Before The Really Dangerous Sport Kicks Off, Snowboarding
Observers feared that daredevil snowboarders might wind up dead at the Winter Olympics in Vancouver, pounding their skulls while attempting death-defying feats in the competition. But it was the luge sport that right out of the gate turned the games “into a gallows,” as one sportswriter out it.
And Olympic officials appeared more concerned about covering their asses than addressing the why of what happened.
This weekend there were many eloquent stories in the national press about the cowardice of the sports officials who blamed Nodar Kumaritashvili, the Georgian Luger killed at the Vancouver Olympics last week, for causing his own tragic death.
In its five-paragraph statement Friday, the International Luge Federation said that the Kumaritashvili came out of a curve and “did not compensate properly…there was no indication that the accident was caused by deficiencies in the track.”
http://www.vancouver2010.com/olympic-news/n/news/fil-statement-on-mens-luge-competition_274462nE.html
There was no mention of the fact that the steel pillar that the 21-year-old luger slammed his back into at racetrack speeds wasn’t padded, or that Olympic lugers were terrified of the track.
The New York Times did a Page One story Sunday on that topic, headlined “Fast and Risky, Sledding Track Drew Red Flags.”
http://www.nytimes.com/2010/02/14/sports/olympics/14track.html?ref=sports
Also on Sunday, The Times blasted the luge federation for its findings in a story headlined “Quick to Blame in Luge, and Showing No Shame.”
http://www.nytimes.com/2010/02/14/sports/olympics/14longman.html?hp
“Olympic officials treated the death of Nodar Kumaritashvili, the Georgian luge athlete, less as a tragedy than as an inconvenience,”
The Times wrote.
Back injuries aren’t the only thing to anticipate with these luge races. Last week a Romanian, Violeta Stramaturaru was knocked unconscious on Thursday and taken to a hospital after slamming into a wall several times.
http://www.nydailynews.com/sports/more_sports/winter_olympics_2010/2010/02/12/2010-02-12_luger_nodar_kumaritashvili_rushed_to_hospital.html?page=1#ixzz0fYFguzaH
Here’s the best summation we read of the tragedy over the weekend, by New York Daily News sports columnist Filip Bondy.
http://www.nydailynews.com/sports/more_sports/winter_olympics_2010/2010/02/13/2010-02-13_quit_playing_a_risky_game.html
“In the end, it wasn’t the halfpipe or the freestanding aerials that turned the Winter Olympic into a gallows,” he wrote Saturday. “It was as slippery-sloped luge track, designed by someone who didn’t know the sport and nurtured by a system that reward outrageous risk-taking.”
The New York Times Saturday said in a Page One story that the Georgian’s death “casts a pall” over the Winter games.
http://www.nytimes.com/2010/02/13/sports/olympics/13luge.html?hp
On the sports pages that same day, The Times noted that the Winter Olympics have “had ample adversity and controversy,” from too-little snow “and doping” scandals, “but genuine tragedy has been a rarity.
http://www.nytimes.com/2010/02/13/sports/olympics/13clarey.html?hp
Prompted by last week’s death, Olympics officials have taken steps to make the luge track safer. For example, they have moved the men’s start line farther down the track.
We’ll see if that helps – and hold our breath for when the supposedly really dangerous competition starts: snowboarding.
And Olympic officials appeared more concerned about covering their asses than addressing the why of what happened.
This weekend there were many eloquent stories in the national press about the cowardice of the sports officials who blamed Nodar Kumaritashvili, the Georgian Luger killed at the Vancouver Olympics last week, for causing his own tragic death.
In its five-paragraph statement Friday, the International Luge Federation said that the Kumaritashvili came out of a curve and “did not compensate properly…there was no indication that the accident was caused by deficiencies in the track.”
http://www.vancouver2010.com/olympic-news/n/news/fil-statement-on-mens-luge-competition_274462nE.html
There was no mention of the fact that the steel pillar that the 21-year-old luger slammed his back into at racetrack speeds wasn’t padded, or that Olympic lugers were terrified of the track.
The New York Times did a Page One story Sunday on that topic, headlined “Fast and Risky, Sledding Track Drew Red Flags.”
http://www.nytimes.com/2010/02/14/sports/olympics/14track.html?ref=sports
Also on Sunday, The Times blasted the luge federation for its findings in a story headlined “Quick to Blame in Luge, and Showing No Shame.”
http://www.nytimes.com/2010/02/14/sports/olympics/14longman.html?hp
“Olympic officials treated the death of Nodar Kumaritashvili, the Georgian luge athlete, less as a tragedy than as an inconvenience,”
The Times wrote.
Back injuries aren’t the only thing to anticipate with these luge races. Last week a Romanian, Violeta Stramaturaru was knocked unconscious on Thursday and taken to a hospital after slamming into a wall several times.
http://www.nydailynews.com/sports/more_sports/winter_olympics_2010/2010/02/12/2010-02-12_luger_nodar_kumaritashvili_rushed_to_hospital.html?page=1#ixzz0fYFguzaH
Here’s the best summation we read of the tragedy over the weekend, by New York Daily News sports columnist Filip Bondy.
http://www.nydailynews.com/sports/more_sports/winter_olympics_2010/2010/02/13/2010-02-13_quit_playing_a_risky_game.html
“In the end, it wasn’t the halfpipe or the freestanding aerials that turned the Winter Olympic into a gallows,” he wrote Saturday. “It was as slippery-sloped luge track, designed by someone who didn’t know the sport and nurtured by a system that reward outrageous risk-taking.”
The New York Times Saturday said in a Page One story that the Georgian’s death “casts a pall” over the Winter games.
http://www.nytimes.com/2010/02/13/sports/olympics/13luge.html?hp
On the sports pages that same day, The Times noted that the Winter Olympics have “had ample adversity and controversy,” from too-little snow “and doping” scandals, “but genuine tragedy has been a rarity.
http://www.nytimes.com/2010/02/13/sports/olympics/13clarey.html?hp
Prompted by last week’s death, Olympics officials have taken steps to make the luge track safer. For example, they have moved the men’s start line farther down the track.
We’ll see if that helps – and hold our breath for when the supposedly really dangerous competition starts: snowboarding.
Study To Research Impact of Progesterone on TBI Patients
Ironically, despite a strong recommendation from the authors of the Guidelines for the Management of Severe Traumatic Brain Injury that the use of steroids was NOT recommended for the treatment of severe traumatic brain injury, research in the area continues. The irony is that the Brain Trauma Foundation is supporting such research, despite the fact that they were the publishers of the Guidelines. The Guidelines were published in Journal of Neurotrauma, Volume 24, Supplement 1, 2007. http://www.braintrauma.org/site/PageServer?pagename=Guidelines
The latest guideline said this about steroids:
The majority of available evidence indicates that steroids do not improve outcome or lower ICP in severe TBI. There is strong evidence that steroids are deleterious; thus their use is not recommended for TBI.
Currently there is little enthusiasm for re-examing the use of existing formulations of steroids for treatment of patients with TBI. If new compounds with different mechanisms of action are discovered, further study may be justified.
I guess a lot has changed in less than three years. A nationwide study, named ProTECT, on the use of progesterone to treat moderate to severe brain injury will be conducted at 17 hospitals across the nation, it was announced Wednesday.
http://www.henryfordhealth.org/body.cfm?id=46335&action;=detail&ref;=1057 Progesterone also known is a steroid hormone which is part of the female reproductive cycle.
The study, funded by the National Institute of Neurological Diseases and Stroke, will track 1,100 patients nationally for at least three years. http://www.freep.com/article/20100210/BUSINESS06/100210029/1320/Hospitals-take-part-in-brain-injury-study
The goal of the research is to find out if the hormone progesterone can lessen the disability and death, that can stem from Traumatic Brain Injury, the leading cause of death and disability in those younger than 44 years old, according to the Brain Trauma Foundation.
Research with animals has found that progesterone may lessen brain damage resulting from TBI.
ProTECT is a double-bind study, and will evaluate patients with moderate to severe brain damage. The evaluation must take place within four hours of the injury, and enrolled patients will either be given a placebo or the progesterone intravenously.
The Food and Drug Administration is allowing hospitals to enroll patients without written consent because TBI patients may not be conscious or have the ability to make an informed decision right after their injury.
Four Detroit hospitals will take part in the study, namely Henry Ford Hospital, Detroit-Receiving Hospital, Sinai-Grace Hospital and Beaumont Hospital.
One of the last studies on the use of steroids for TBI was halted mid-trial because of hard evidence that it was doing more harm than good. We hope this one is monitored with extremely tight controls, with no vested stake in continuing the study if things start to go wrong.
The latest guideline said this about steroids:
The majority of available evidence indicates that steroids do not improve outcome or lower ICP in severe TBI. There is strong evidence that steroids are deleterious; thus their use is not recommended for TBI.
Currently there is little enthusiasm for re-examing the use of existing formulations of steroids for treatment of patients with TBI. If new compounds with different mechanisms of action are discovered, further study may be justified.
I guess a lot has changed in less than three years. A nationwide study, named ProTECT, on the use of progesterone to treat moderate to severe brain injury will be conducted at 17 hospitals across the nation, it was announced Wednesday.
http://www.henryfordhealth.org/body.cfm?id=46335&action;=detail&ref;=1057 Progesterone also known is a steroid hormone which is part of the female reproductive cycle.
The study, funded by the National Institute of Neurological Diseases and Stroke, will track 1,100 patients nationally for at least three years. http://www.freep.com/article/20100210/BUSINESS06/100210029/1320/Hospitals-take-part-in-brain-injury-study
The goal of the research is to find out if the hormone progesterone can lessen the disability and death, that can stem from Traumatic Brain Injury, the leading cause of death and disability in those younger than 44 years old, according to the Brain Trauma Foundation.
Research with animals has found that progesterone may lessen brain damage resulting from TBI.
ProTECT is a double-bind study, and will evaluate patients with moderate to severe brain damage. The evaluation must take place within four hours of the injury, and enrolled patients will either be given a placebo or the progesterone intravenously.
The Food and Drug Administration is allowing hospitals to enroll patients without written consent because TBI patients may not be conscious or have the ability to make an informed decision right after their injury.
Four Detroit hospitals will take part in the study, namely Henry Ford Hospital, Detroit-Receiving Hospital, Sinai-Grace Hospital and Beaumont Hospital.
One of the last studies on the use of steroids for TBI was halted mid-trial because of hard evidence that it was doing more harm than good. We hope this one is monitored with extremely tight controls, with no vested stake in continuing the study if things start to go wrong.
Certain Brain Damage Can Impact Spirituality, Study Finds
All that we are is in our brains. Heart break happens in the brain. Love happens in the brain. And yes, if you are “saved”, it is your brain that is saved. The brain is the home of the human soul. The study below is further confirmation.
A new study has found link between brain activity and spirituality by testing patients before and after they had surgery to remove brain tumors. http://www.sciencedaily.com/releases/2010/02/100210124757.htm
The study, published in the Feb. 11 issue of the journal Neuron, focused on the a personality trait, self-transcendence (ST), which is used
as a gauge of spiritual feeling and thinking in individuals. The characteristic is marked by a person feeling like he or she is a part of the larger universe.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WSS-4YC2GXT-5&_user=10&_coverDate=02%2F11%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view;=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5;=e4fb1257622032866d30264bf0a9b724
The research compared ST scores of patients before and after they had brain tumors removed, mapping their brain lesions after surgery.
The study determined that select damage to the left and right posterior parietal regions of the brain increased ST. That has lead researchers to believe that dysfunctional parietal neural activity may cause changed spiritual beliefs and actions.
A new study has found link between brain activity and spirituality by testing patients before and after they had surgery to remove brain tumors. http://www.sciencedaily.com/releases/2010/02/100210124757.htm
The study, published in the Feb. 11 issue of the journal Neuron, focused on the a personality trait, self-transcendence (ST), which is used
as a gauge of spiritual feeling and thinking in individuals. The characteristic is marked by a person feeling like he or she is a part of the larger universe.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WSS-4YC2GXT-5&_user=10&_coverDate=02%2F11%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view;=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5;=e4fb1257622032866d30264bf0a9b724
The research compared ST scores of patients before and after they had brain tumors removed, mapping their brain lesions after surgery.
The study determined that select damage to the left and right posterior parietal regions of the brain increased ST. That has lead researchers to believe that dysfunctional parietal neural activity may cause changed spiritual beliefs and actions.
Vegetative Patients Display Consciousness, Ability To Communicate, New Study Finds
A groundbreaking study, raising troubling medical ethics issues, has found that patients in a vegetative state showed signs of brain activity, indicating not only consciousness but even the ability to communicate.
The study, published online Wednesday by The New England Journal of Medicine, http://content.nejm.org/cgi/content/full/NEJMoa0905370, created an immediate debate about how serious head injuries should be treated, as well as the ethical issue of whether attempts should be made to ask comatose patients what kind of care they want.
In other words, should vegetative patients, once considered unresponsive, now be asked whether they want to live or die?
In the study, 54 patients with vegetative brain injury in England and Belgium were assessed with functional magnetic resonance imaging (MRI), to determine if they could respond to two established imagery tasks. And an additional technique was developed to determine “whether such tasks could be used to communicate yes-or-no answers to simple questions,” according to The New England Journal.
Five patients (five of whom were diagnosed with traumatic brain injury, and four diagnosed as being in a vegetative state) were “willfully able to modulate their brain activity,” the Journal said, “In three of these patients, additional bedside testing revealed some signs of awareness, but in the other two patients, no voluntary behavior could be detected by means of clinical assessment.”
Imaging tests involving one woman showed she had brain activity, in her motor cortex, when she was asked to think about playing tennis, the study found.
One patient was able to answer yes or no questions during the MRI, “however, it remained impossible to establish any form or communications at bedside,” according to the New England Journal article.
The study’s conclusion was that “these results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.”
The study had two goals: The first was to determine whether patients in a vegetative or minimally conscious state retain the capacity for a purposeful response to stimulation, however inconsistent. “Such a capacity, which suggests at least partial awareness, distinguishes minimally conscious patients from those in a vegetative state and therefore has implications for subsequent care and rehabilitation, as well as for legal and ethical decision making,” the New England Journal article said.
The second goal of the study was “to harness and nurture any available response, through intervention, into a form of reproducible communication, however rudimentary. The acquisition of any interactive and functional verbal or nonverbal method of communication is an important milestone. Clinically, consistent and repeatable communication demarcates the upper boundary of a minimally conscious state.”
In introducing the study’s findings, the New England Journal said, “ In recent years, improvements in intensive care have led to an increase in the number of patients who survive severe brain injury. Although some of these patients go on to have a good recovery, others awaken from the acute comatose state but do not show any signs of awareness. If repeated examinations yield no evidence of a sustained, reproducible, purposeful, or voluntary behavioral response to visual, auditory, tactile, or noxious stimuli, a diagnosis of a vegetative state — or “wakefulness without awareness” — is made. Some patients remain in a vegetative state permanently. Others eventually show inconsistent but reproducible signs of awareness, including the ability to follow commands, but they remain unable to communicate interactively.”
That term “minimally conscious state” was used in 2002 by the Aspen Neurobehavioral Conference Work Group to describe the condition of these kinds of patients, “thereby adding a new clinical entity to the spectrum of disorders of consciousness,” the article says.
One of the five patients that showed brain activity, the study found “had the ability to apply the imagery technique in order to answer simple yes-or-no questions accurately. Before the scanning was performed, the patient had undergone repeated evaluations indicating that he was in a vegetative state…the functional MRI approach allowed the patient to establish functional and interactive communication.”
The article went on, “Indeed, for five of the six questions, the patient had a reliable neural response and was able to provide the correct answer with 100% accuracy. For the remaining question — the last question of the imaging session — the lack of activity within the regions of interest precluded any analysis of the results. Whether the patient fell asleep during this question, did not hear it, simply elected not to answer it, or lost consciousness cannot be determined. Although the functional MRI data provided clear evidence that the patient was aware and able to communicate, it is not known whether either ability was available during earlier evaluations.”
The study received wide coverage in the press, with a Page One story in The New York Times http://www.nytimes.com/2010/02/04/health/04brain.html?hp
and The Star-Ledger of Newark, which ran The Washington Post’s story on the surprising study results, http://www.washingtonpost.com/wp-dyn/content/article/2010/02/03/AR2010020302887.html.
The Wall Street Journal http://online.wsj.com/article/SB10001424052748704259304575043494009308442.html, Los Angeles Times
http://www.latimes.com/news/nationworld/nation/la-sci-vegetative4-2010feb04,0,4078396.story
and the Associated Press also did coverage of the study.
The New York Times wrote, “The experts agreed that the new study exposed the limits of the current bedside test for diagnosing mental state: checking whether patients’ eyes can track objects, and carefully looking for any signs – eye blinks, finger twitches – in response to questions or commands.”
The study, published online Wednesday by The New England Journal of Medicine, http://content.nejm.org/cgi/content/full/NEJMoa0905370, created an immediate debate about how serious head injuries should be treated, as well as the ethical issue of whether attempts should be made to ask comatose patients what kind of care they want.
In other words, should vegetative patients, once considered unresponsive, now be asked whether they want to live or die?
In the study, 54 patients with vegetative brain injury in England and Belgium were assessed with functional magnetic resonance imaging (MRI), to determine if they could respond to two established imagery tasks. And an additional technique was developed to determine “whether such tasks could be used to communicate yes-or-no answers to simple questions,” according to The New England Journal.
Five patients (five of whom were diagnosed with traumatic brain injury, and four diagnosed as being in a vegetative state) were “willfully able to modulate their brain activity,” the Journal said, “In three of these patients, additional bedside testing revealed some signs of awareness, but in the other two patients, no voluntary behavior could be detected by means of clinical assessment.”
Imaging tests involving one woman showed she had brain activity, in her motor cortex, when she was asked to think about playing tennis, the study found.
One patient was able to answer yes or no questions during the MRI, “however, it remained impossible to establish any form or communications at bedside,” according to the New England Journal article.
The study’s conclusion was that “these results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.”
The study had two goals: The first was to determine whether patients in a vegetative or minimally conscious state retain the capacity for a purposeful response to stimulation, however inconsistent. “Such a capacity, which suggests at least partial awareness, distinguishes minimally conscious patients from those in a vegetative state and therefore has implications for subsequent care and rehabilitation, as well as for legal and ethical decision making,” the New England Journal article said.
The second goal of the study was “to harness and nurture any available response, through intervention, into a form of reproducible communication, however rudimentary. The acquisition of any interactive and functional verbal or nonverbal method of communication is an important milestone. Clinically, consistent and repeatable communication demarcates the upper boundary of a minimally conscious state.”
In introducing the study’s findings, the New England Journal said, “ In recent years, improvements in intensive care have led to an increase in the number of patients who survive severe brain injury. Although some of these patients go on to have a good recovery, others awaken from the acute comatose state but do not show any signs of awareness. If repeated examinations yield no evidence of a sustained, reproducible, purposeful, or voluntary behavioral response to visual, auditory, tactile, or noxious stimuli, a diagnosis of a vegetative state — or “wakefulness without awareness” — is made. Some patients remain in a vegetative state permanently. Others eventually show inconsistent but reproducible signs of awareness, including the ability to follow commands, but they remain unable to communicate interactively.”
That term “minimally conscious state” was used in 2002 by the Aspen Neurobehavioral Conference Work Group to describe the condition of these kinds of patients, “thereby adding a new clinical entity to the spectrum of disorders of consciousness,” the article says.
One of the five patients that showed brain activity, the study found “had the ability to apply the imagery technique in order to answer simple yes-or-no questions accurately. Before the scanning was performed, the patient had undergone repeated evaluations indicating that he was in a vegetative state…the functional MRI approach allowed the patient to establish functional and interactive communication.”
The article went on, “Indeed, for five of the six questions, the patient had a reliable neural response and was able to provide the correct answer with 100% accuracy. For the remaining question — the last question of the imaging session — the lack of activity within the regions of interest precluded any analysis of the results. Whether the patient fell asleep during this question, did not hear it, simply elected not to answer it, or lost consciousness cannot be determined. Although the functional MRI data provided clear evidence that the patient was aware and able to communicate, it is not known whether either ability was available during earlier evaluations.”
The study received wide coverage in the press, with a Page One story in The New York Times http://www.nytimes.com/2010/02/04/health/04brain.html?hp
and The Star-Ledger of Newark, which ran The Washington Post’s story on the surprising study results, http://www.washingtonpost.com/wp-dyn/content/article/2010/02/03/AR2010020302887.html.
The Wall Street Journal http://online.wsj.com/article/SB10001424052748704259304575043494009308442.html, Los Angeles Times
http://www.latimes.com/news/nationworld/nation/la-sci-vegetative4-2010feb04,0,4078396.story
and the Associated Press also did coverage of the study.
The New York Times wrote, “The experts agreed that the new study exposed the limits of the current bedside test for diagnosing mental state: checking whether patients’ eyes can track objects, and carefully looking for any signs – eye blinks, finger twitches – in response to questions or commands.”
Zackery Lystedt Brain Project To Be Announced at the Super Bowl, New York Times Reports
The Zackery Lystedt Brain Project will be announced at the Super Bowl, The New York Times reported Sunday. http://www.nytimes.com/2010/01/31/sports/31concussions.html?ref=sports
The Lystedt initiative, lead by the Sarah Jane Brain Foundation and the American College of Sports Medicine, will push to convince more states to pass legislation protecting young sports players from concussions and their after effects.
Washington and Oregon enacted the first concussion-specific laws related to concussion protection for school athletes. The law that Washington passed is named after Zackery Lysedt, who sustained serous brain injury in 2006 playing football, according to The Times.
The Washington legislation has become a model for other states. The law requires that coaches be educated on concussions; that players be taken off the field immediately if it’s suspected they’ve sustained a concussion; and that a doctor must clear an athlete before he or she can return to play.
There could be as many as two dozen states that may pass laws related to concussions and youth sports, The Times says. Florida, New Jersey, New York and Massachusetts have bills in the works.
A House Judiciary Committee forum, the third one, will be held Monday, Feb. 1, in Houston to discuss brain injuries in football.
There have been two prior committee meetings, which discussed the poor treatment of concussions by the NFL. The league responded by adopting some new rules, including one that bans players suspected of having a concussion from returning to a game or practice.
Editor’s Note: You cannot tell the difference between a mild concussion and a serious concussion until you wait hours. While there is arguably a cost benefit analysis to returning the quarterback of an NFL team to the game, there is no cost to holding out a scholastic player from that game. This is especially true because there will is no guarantee of a sideline medical professional trained to clear the player. But as brain injury is a process not an event that takes a minimum of 24 hours to fully manifest itself, any return is risky. Sit the injured player and test them the next day, when you can give a sensitive test for amnesia. See http://www.youtube.com/profile?user=braininjuryattorney%22%3Ehttp://youtube.com/profile?user=braininjuryattorney%3C/a#p/u/11/dEWHgwRywtY
The Lystedt initiative, lead by the Sarah Jane Brain Foundation and the American College of Sports Medicine, will push to convince more states to pass legislation protecting young sports players from concussions and their after effects.
Washington and Oregon enacted the first concussion-specific laws related to concussion protection for school athletes. The law that Washington passed is named after Zackery Lysedt, who sustained serous brain injury in 2006 playing football, according to The Times.
The Washington legislation has become a model for other states. The law requires that coaches be educated on concussions; that players be taken off the field immediately if it’s suspected they’ve sustained a concussion; and that a doctor must clear an athlete before he or she can return to play.
There could be as many as two dozen states that may pass laws related to concussions and youth sports, The Times says. Florida, New Jersey, New York and Massachusetts have bills in the works.
A House Judiciary Committee forum, the third one, will be held Monday, Feb. 1, in Houston to discuss brain injuries in football.
There have been two prior committee meetings, which discussed the poor treatment of concussions by the NFL. The league responded by adopting some new rules, including one that bans players suspected of having a concussion from returning to a game or practice.
Editor’s Note: You cannot tell the difference between a mild concussion and a serious concussion until you wait hours. While there is arguably a cost benefit analysis to returning the quarterback of an NFL team to the game, there is no cost to holding out a scholastic player from that game. This is especially true because there will is no guarantee of a sideline medical professional trained to clear the player. But as brain injury is a process not an event that takes a minimum of 24 hours to fully manifest itself, any return is risky. Sit the injured player and test them the next day, when you can give a sensitive test for amnesia. See http://www.youtube.com/profile?user=braininjuryattorney%22%3Ehttp://youtube.com/profile?user=braininjuryattorney%3C/a#p/u/11/dEWHgwRywtY