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.
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
Veterans With PTSD Win Review of Their Rejected Benefit Claims
Veterans of the wars in Iraq and Afghanistan, whose claims for benefits based on post-traumatic stress disorder (PTSD) were rejected, will have another chance to get relief. For the full story, see http://www.military.com/news/article/vets-with-ptsd-may-get-benefits-upgrade.html
The military has agreed to do an expedited review of the claims due to a judge’s order, which stemmed from a class-action lawsuit filed by seven combat veterans who were discharged for PTSD. Those vets claim they were illegally denied health care and other benefits that they were entitled to with their disability.
One of the original plaintiffs was ex-Army Sgt. Juan Perez, who suffers from PTSD and has problems with migraines and his eye resulting from a head injury he sustained during two tours in Iraq.
The Pentagon mandates that soldiers who leave the military due at least in part to PTSD must receive a disability rating of at least 50 percent to get full benefits, according to the National Veteran Legal Services Group.
But roughly 4,300 former soldiers earned ratings of less than 50 percent, so they were denied benefits. Those veterans will soon receive legal notice that they will be able to have an expedited review of their cases by the military, and that they can “opt in” to a class action lawsuit involving the matter.
The seven ex-soldiers who started the class action suit had disability ratings of 10 percent or less.
After the new review, former soldiers who get ratings of 30 percent or more will become eligible for benefits, according to The New York Times. http://www.nytimes.com/2010/01/26/us/26brfs-BENEFITSELIG_BRF.html
Those applications can be found at ptsdlawsuit.com.
Lawyers for the veterans expect that the reviews will result in ex-soldiers getting millions of dollars.
http://www.wsmv.com/news/22338751/detail.html
The higher disability rating will translate to lifelong monthly disability payments, and free health care for the veteran, his or her spouse and their minor children.
The military has agreed to do an expedited review of the claims due to a judge’s order, which stemmed from a class-action lawsuit filed by seven combat veterans who were discharged for PTSD. Those vets claim they were illegally denied health care and other benefits that they were entitled to with their disability.
One of the original plaintiffs was ex-Army Sgt. Juan Perez, who suffers from PTSD and has problems with migraines and his eye resulting from a head injury he sustained during two tours in Iraq.
The Pentagon mandates that soldiers who leave the military due at least in part to PTSD must receive a disability rating of at least 50 percent to get full benefits, according to the National Veteran Legal Services Group.
But roughly 4,300 former soldiers earned ratings of less than 50 percent, so they were denied benefits. Those veterans will soon receive legal notice that they will be able to have an expedited review of their cases by the military, and that they can “opt in” to a class action lawsuit involving the matter.
The seven ex-soldiers who started the class action suit had disability ratings of 10 percent or less.
After the new review, former soldiers who get ratings of 30 percent or more will become eligible for benefits, according to The New York Times. http://www.nytimes.com/2010/01/26/us/26brfs-BENEFITSELIG_BRF.html
Those applications can be found at ptsdlawsuit.com.
Lawyers for the veterans expect that the reviews will result in ex-soldiers getting millions of dollars.
http://www.wsmv.com/news/22338751/detail.html
The higher disability rating will translate to lifelong monthly disability payments, and free health care for the veteran, his or her spouse and their minor children.
Why Doctors Shouldn’t Be Too Quick To Diagnose a Child With a Concussion Rather than Mild Traumatic Brain Injury
I have been fighting the labels and the distinctions about what you call the subtle damage to the mind as long as I have been an advocate. See my essay “Mind Damage” at http://tbilaw.com/essays.aaname.php Yet, according to new research, the labels make a huge difference in the perception of the severity of the injury.
According to this research, doctors apparently have to choose their words carefully when they’re talking to parents about their children’s head injuries. The study was published online this week by Pediatrics, the journal for the American Academy of Pediatrics. The study received a lot of play in the consumer press, with outlets such as The Los Angeles Times and UPI writing about it. See http://latimesblogs.latimes.com/booster_shots/2010/01/you-say-concussion-i-say-brain-injury-lets-call-the-whole-thing-serious.html
The bottom line of the research was that when a physician uses the term “concussion” rather than “mild traumatic brain injury,” parents don’t seem to believe that their child’s brain has really been damaged.
The Pediatrics article was headlined “My Child Doesn’t Have a Brain Injury, He Only Has a Concussion.” http://pediatrics.aappublications.org/cgi/content/abstract/peds.2008-2720v1
The research, conducted at McMaster Children’s Hospital in Canada by McMaster University, noted that doctors may choose to use “the concussion label” because it’s less alarming than the term mild brain injury. But the word “concussion” seems to imply to the parents that the injury is not serious and will have no long-term consequences for their child, the study found. Yet it’s known that’s not the case.
“Our study suggests that if a child is given a diagnosis of a concussion, the family is less likely to consider it an actual injury to the brain,” the study’s lead author, Carol DeMatteo, said in a press release on the research. “These children may be sent back to school or allowed to return to activity sooner, and maybe sooner than they should. This just puts them at greater risk for a second injury, poor school performance, and wondering what is wrong with them.”
Children diagnosed with a concussion were released earlier from the hospital, and returned to school quicker, according to the study. Yet it’s known that concussions can have serious after effects, including depression, memory issues and headaches. And returning to former activities, such as sports, before the brain damage of a concussion has healed can lead to dire health problems.
The concussion diagnosis was “significantly more likely” when the computed-tomography results were normal and the child had lost consciousness, according to the study.
The takeaway has to be that physicians should not be too quick to label a child as having a concussion, even if it is a less worrisome term than mile TBI.
According to this research, doctors apparently have to choose their words carefully when they’re talking to parents about their children’s head injuries. The study was published online this week by Pediatrics, the journal for the American Academy of Pediatrics. The study received a lot of play in the consumer press, with outlets such as The Los Angeles Times and UPI writing about it. See http://latimesblogs.latimes.com/booster_shots/2010/01/you-say-concussion-i-say-brain-injury-lets-call-the-whole-thing-serious.html
The bottom line of the research was that when a physician uses the term “concussion” rather than “mild traumatic brain injury,” parents don’t seem to believe that their child’s brain has really been damaged.
The Pediatrics article was headlined “My Child Doesn’t Have a Brain Injury, He Only Has a Concussion.” http://pediatrics.aappublications.org/cgi/content/abstract/peds.2008-2720v1
The research, conducted at McMaster Children’s Hospital in Canada by McMaster University, noted that doctors may choose to use “the concussion label” because it’s less alarming than the term mild brain injury. But the word “concussion” seems to imply to the parents that the injury is not serious and will have no long-term consequences for their child, the study found. Yet it’s known that’s not the case.
“Our study suggests that if a child is given a diagnosis of a concussion, the family is less likely to consider it an actual injury to the brain,” the study’s lead author, Carol DeMatteo, said in a press release on the research. “These children may be sent back to school or allowed to return to activity sooner, and maybe sooner than they should. This just puts them at greater risk for a second injury, poor school performance, and wondering what is wrong with them.”
Children diagnosed with a concussion were released earlier from the hospital, and returned to school quicker, according to the study. Yet it’s known that concussions can have serious after effects, including depression, memory issues and headaches. And returning to former activities, such as sports, before the brain damage of a concussion has healed can lead to dire health problems.
The concussion diagnosis was “significantly more likely” when the computed-tomography results were normal and the child had lost consciousness, according to the study.
The takeaway has to be that physicians should not be too quick to label a child as having a concussion, even if it is a less worrisome term than mile TBI.
University of Cincinnati Study to Test Progesterone Effectiveness in Severely Brain Injured Individuals
Editors Note: The greatest advancements in the treatment of brain injury have been in the area of increasing the number of people who survive the severest injuries. Helicopters, CT scans and ICP monitors account for the biggest chunk of that improvement. The press release below from the University of Cincinnati details a new study that is being proposed for 100 severely brain injured people to see what benefit administration of the hormone progesterone will have on outcomes.
Such research is extremely important and the double blind method is critical for research to have any scientific validity. My only concern with this study is that we don’t know how progesterone is supposed to help. If the projected improvement rate is 5%, that may be a lot of effort for what may not be a statistically significant result. But that is what scientific research is there to determine. And if you were one of the 5% who got better that would be significant to you and your family.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
http://subtlebraininjury.com
http://car-accident-rain.com
http://tbilaw.com
https://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
©Attorney Gordon S. Johnson, Jr. 2010
(Media-Newswire.com) – CINCINNATI–Neurotrauma experts at the University of Cincinnati Neuroscience Institute at University Hospital are seeking public input before launching federally funded research aimed at improving outcomes for patients who suffer traumatic brain injury ( TBI ).
The randomized clinical trial will assess whether administering the naturally occurring hormone progesterone in patients immediately after a moderate to severe traumatic brain injury will reduce brain damage and swelling and thereby improve the patients’ mental and physical outcomes.
The Cincinnati portion of the study will be led by Jay Johannigman, MD, associate professor and director of the division of trauma and critical care, and Lori Shutter, MD, associate professor of neurosurgery and neurology and director of the neurocritical care program.
“The nation is becoming increasingly aware of the devastation that traumatic brain injury can have on a person’s life,” Shutter says. “Unfortunately, although there have been many efforts, we still do not have an effective treatment for a traumatic injury to the brain. The early information on progesterone for treatment of TBI renews our hopes that we may have something that can improve long-term outcomes.”
The progesterone study, funded by the National Institute of Neurological Disorders and Stroke, is known as ProTECT III, which stands for Progesterone for Traumatic Brain Injury–Experimental Clinical Treatment. The $14.5 million trial will enroll 1,140 patients over a period of three years at 17 medical centers throughout the United States. David Wright, MD, assistant professor of emergency medicine at Emory University in Atlanta, is the multicenter study’s lead investigator.
Public comment is required before the ProTECT study begins because a patient who has suffered a brain injury is unconscious and would not be able to give consent before doctors administer the treatment. In addition, a relative or guardian may not be immediately available to grant consent on the patient’s behalf.
Traumatic brain injury involves sudden damage to the brain caused by an outside force to the head, such as a car crash, a fall or a forceful blow from a heavy object. Roughly 1.5 million to 2 million adults and children suffer a traumatic brain injury in the United States each year. About 50,000 die and another 80,000 are permanently disabled, according to the Centers for Disease Control and Prevention. Traumatic brain injury is the leading cause of death and disability among people aged 1 to 44.
ProTECT III is the third phase of groundbreaking research into the effectiveness of progesterone, which is most commonly recognized as a female hormone but also has “protective” properties. Progesterone receptors are abundant in the brain, and laboratory research suggests that progesterone plays a role in the development of brain cells and in the protection of injured brain tissue.
Emory researchers concluded in an earlier pilot study involving 100 patients that giving progesterone to trauma victims shortly after a brain injury appeared to be safe and effective. Emory researchers also reported a 5 percent reduction in mortality among patients treated with progesterone as well as improved outcomes among patients with moderate injury.
Progesterone is an attractive therapy for several reasons, Shutter says. “It is FDA-approved; it can be administered quickly; it enters the brain quickly; and it is inexpensive.”
The current study, ProTECT III, involves patients aged 18 and over who have suffered a moderate to severe traumatic brain injury and who can begin treatment within four hours of their injury. A qualifying patient will be randomly assigned to one of two groups. One group will receive an IV mixture that contains progesterone ( the study medicine ). The other group will receive an IV mixture that has no progesterone ( a placebo ). The UC team expects to enroll approximately 100 patients over the three-year period at University Hospital.
Federal law established the “waiver of consent” in 1996 so that physicians could begin emergency treatment after any injury before obtaining consent from the patient or from a legal guardian or family member. Under terms of the ProTECT study, if a hospital is unable to reach a family member after 60 minutes of diligent effort, the emergency medicine team is allowed to enroll patients who meet the study’s stringent criteria.
To qualify for the waiver, researchers must first explain the research to the community and gather feedback. UC researchers will discuss the ProTECT trial at community meetings during the next several months, with particular emphasis on demographic groups known to have a statistically elevated risk of severe traumatic brain injury. In addition, UC researchers must assess local residents’ willingness for themselves or a family member to participate in this study. A complete description of the study can be reviewed at www.protectiii.com.
Those who review the study description will be invited to complete a short accompanying survey.
ProTECT III is a project of the Neurological Emergencies Treatment Trials ( NETT ), which was established by NIH in early 2007. NETT is a permanent research network that currently involves 17 university medical centers throughout the United States. UC’s involvement in NETT is overseen by Arthur Pancioli, MD, associate professor of emergency medicine and a member of UCNI.
Individuals who are opposed to being enrolled in a NETT study in the event that they were to suffer a neurological emergency can request an “opt out” bracelet by calling ( 513 ) 558-NETT ( 0095 ).
For more information about ProTECT, please contact Sara Stark at ( 513 ) 558-0095 or sara.stark@uc.edu. For more information about NETT, please visit http://nett.umich.edu/nett/welcome.
Such research is extremely important and the double blind method is critical for research to have any scientific validity. My only concern with this study is that we don’t know how progesterone is supposed to help. If the projected improvement rate is 5%, that may be a lot of effort for what may not be a statistically significant result. But that is what scientific research is there to determine. And if you were one of the 5% who got better that would be significant to you and your family.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
http://subtlebraininjury.com
http://car-accident-rain.com
http://tbilaw.com
https://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
©Attorney Gordon S. Johnson, Jr. 2010
(Media-Newswire.com) – CINCINNATI–Neurotrauma experts at the University of Cincinnati Neuroscience Institute at University Hospital are seeking public input before launching federally funded research aimed at improving outcomes for patients who suffer traumatic brain injury ( TBI ).
The randomized clinical trial will assess whether administering the naturally occurring hormone progesterone in patients immediately after a moderate to severe traumatic brain injury will reduce brain damage and swelling and thereby improve the patients’ mental and physical outcomes.
The Cincinnati portion of the study will be led by Jay Johannigman, MD, associate professor and director of the division of trauma and critical care, and Lori Shutter, MD, associate professor of neurosurgery and neurology and director of the neurocritical care program.
“The nation is becoming increasingly aware of the devastation that traumatic brain injury can have on a person’s life,” Shutter says. “Unfortunately, although there have been many efforts, we still do not have an effective treatment for a traumatic injury to the brain. The early information on progesterone for treatment of TBI renews our hopes that we may have something that can improve long-term outcomes.”
The progesterone study, funded by the National Institute of Neurological Disorders and Stroke, is known as ProTECT III, which stands for Progesterone for Traumatic Brain Injury–Experimental Clinical Treatment. The $14.5 million trial will enroll 1,140 patients over a period of three years at 17 medical centers throughout the United States. David Wright, MD, assistant professor of emergency medicine at Emory University in Atlanta, is the multicenter study’s lead investigator.
Public comment is required before the ProTECT study begins because a patient who has suffered a brain injury is unconscious and would not be able to give consent before doctors administer the treatment. In addition, a relative or guardian may not be immediately available to grant consent on the patient’s behalf.
Traumatic brain injury involves sudden damage to the brain caused by an outside force to the head, such as a car crash, a fall or a forceful blow from a heavy object. Roughly 1.5 million to 2 million adults and children suffer a traumatic brain injury in the United States each year. About 50,000 die and another 80,000 are permanently disabled, according to the Centers for Disease Control and Prevention. Traumatic brain injury is the leading cause of death and disability among people aged 1 to 44.
ProTECT III is the third phase of groundbreaking research into the effectiveness of progesterone, which is most commonly recognized as a female hormone but also has “protective” properties. Progesterone receptors are abundant in the brain, and laboratory research suggests that progesterone plays a role in the development of brain cells and in the protection of injured brain tissue.
Emory researchers concluded in an earlier pilot study involving 100 patients that giving progesterone to trauma victims shortly after a brain injury appeared to be safe and effective. Emory researchers also reported a 5 percent reduction in mortality among patients treated with progesterone as well as improved outcomes among patients with moderate injury.
Progesterone is an attractive therapy for several reasons, Shutter says. “It is FDA-approved; it can be administered quickly; it enters the brain quickly; and it is inexpensive.”
The current study, ProTECT III, involves patients aged 18 and over who have suffered a moderate to severe traumatic brain injury and who can begin treatment within four hours of their injury. A qualifying patient will be randomly assigned to one of two groups. One group will receive an IV mixture that contains progesterone ( the study medicine ). The other group will receive an IV mixture that has no progesterone ( a placebo ). The UC team expects to enroll approximately 100 patients over the three-year period at University Hospital.
Federal law established the “waiver of consent” in 1996 so that physicians could begin emergency treatment after any injury before obtaining consent from the patient or from a legal guardian or family member. Under terms of the ProTECT study, if a hospital is unable to reach a family member after 60 minutes of diligent effort, the emergency medicine team is allowed to enroll patients who meet the study’s stringent criteria.
To qualify for the waiver, researchers must first explain the research to the community and gather feedback. UC researchers will discuss the ProTECT trial at community meetings during the next several months, with particular emphasis on demographic groups known to have a statistically elevated risk of severe traumatic brain injury. In addition, UC researchers must assess local residents’ willingness for themselves or a family member to participate in this study. A complete description of the study can be reviewed at www.protectiii.com.
Those who review the study description will be invited to complete a short accompanying survey.
ProTECT III is a project of the Neurological Emergencies Treatment Trials ( NETT ), which was established by NIH in early 2007. NETT is a permanent research network that currently involves 17 university medical centers throughout the United States. UC’s involvement in NETT is overseen by Arthur Pancioli, MD, associate professor of emergency medicine and a member of UCNI.
Individuals who are opposed to being enrolled in a NETT study in the event that they were to suffer a neurological emergency can request an “opt out” bracelet by calling ( 513 ) 558-NETT ( 0095 ).
For more information about ProTECT, please contact Sara Stark at ( 513 ) 558-0095 or sara.stark@uc.edu. For more information about NETT, please visit http://nett.umich.edu/nett/welcome.
Brain Damage Can Kill Too – Car Pedestrian Collision Kills 104 NY Legend
I know it is a continuing oversight by me, but the reality is that brain damage does not only disable, it can kill. In fact statistically, about the same number of people die each year from brain damage as those who have severe brain injury. Now I could be wrong about that, because that is a statistic I have kept in my mind for over 15 years, and perhaps. we are doing a little better with keeping people alive.
Today, one of the world’s most interesting people died. He survived boxing, acting and old age, to be struck down in the prime of his life, at 104 years old, by a minivan. The New York Times told the story exquisitely well. Reading the story I felt like I reading the first chapter of a great novel. Carnivals, Coney Island and all of that lost colorful history of New York and America when we still believed what is says about welcoming immigrants on the Statue of Liberty.
Anyone who was a fledgling reporter on any newspaper, knows about writing obituaries. Yet when it came time to tell the story of Joe Rollino’s life, Manny Fernandez and Michael S. Schmidt of the NY Times did all Pulitzer Prize hopefuls, proud. The story is and the character they portray such a delight, I don’t even want to quote it hear. I am thankful that there are those like Joe Rollino who make it to 104. I am saddened that a life lived so well, could end so quickly because of brain damage. I am proud of the profession of which I was first trained that the NY Times reporter saw that this was not just a story about who survived Joe, but about the life he lived.
The story is so good I don’t want to even quote from it or sum it up. Read it. It is a great story. http://www.nytimes.com/2010/01/12/nyregion/12ironman.html?hp
Today, one of the world’s most interesting people died. He survived boxing, acting and old age, to be struck down in the prime of his life, at 104 years old, by a minivan. The New York Times told the story exquisitely well. Reading the story I felt like I reading the first chapter of a great novel. Carnivals, Coney Island and all of that lost colorful history of New York and America when we still believed what is says about welcoming immigrants on the Statue of Liberty.
Anyone who was a fledgling reporter on any newspaper, knows about writing obituaries. Yet when it came time to tell the story of Joe Rollino’s life, Manny Fernandez and Michael S. Schmidt of the NY Times did all Pulitzer Prize hopefuls, proud. The story is and the character they portray such a delight, I don’t even want to quote it hear. I am thankful that there are those like Joe Rollino who make it to 104. I am saddened that a life lived so well, could end so quickly because of brain damage. I am proud of the profession of which I was first trained that the NY Times reporter saw that this was not just a story about who survived Joe, but about the life he lived.
The story is so good I don’t want to even quote from it or sum it up. Read it. It is a great story. http://www.nytimes.com/2010/01/12/nyregion/12ironman.html?hp
Experienced Brain Injury Attorney Essential in Severe Brain Injury Cases
One of the frustrations of hearing the multitude of calls we get having one of the leading web resources for brain advocacy is the cries for help from potential clients who it is too late to help. Most of those people hired a lawyer who was not an expert in traumatic brain injury. The problems that are created are typically forensic problems, those that relate to the case itself. Sometimes these can be undone, sometimes not.
But as I reflect on the harm that can come to a brain injured person by not hiring the right lawyer, right away, my biggest concern is for those with severe brain injuries, which one would think would be the easiest cases for a non-TBI lawyer to handle. After all, how hard is it to prove someone has been catastrophically damaged, when they have been catastrophically injured?
We get far fewer calls from survivors of coma injury cases than we do concussion survivors. In a coma case, there is never a shortage of lawyers wanting the case and most times family members have chosen a lawyer while the injured person is in the ICU. In contrast, proof of brain injury and disability is so much more difficult in a concussion case that many brain injured people can’t even get representation.
The difference a TBI lawyer makes however may be most significant in the severe brain injury cases. That is because the legal advocacy that is done at the beginning may not only make the case easier to prove, it may also make a huge difference in the access to acute and sub-acute care, in those first few months after a catastrophic brain injury when it is most needed. Thus I think it is important to reflect on what difference a TBI lawyer can make from the start.
The first thing that must be done from the advocacy standpoint after a severe brain injury occurs, is to have a guardian or conservator appointed. While many family members might wonder why they can’t continue on without a guardian, from a legal standpoint no real decisions can be made until someone is given the authority to make those decisions by a court. Many people are afraid of the word “guardian” because it connotes some type of loss of freedom of choice, but without a guardian, the severely brain injured person is left in a legal no man’s land. Among the things that can’t be done without a guardian is hire a lawyer to represent the brain injured person in a lawsuit.
The second area of advocacy that is critically important during those first few weeks after injury is to make sure that a professional case manager is assigned to the case – someone who does not work for the hospital or treatment center. A case manager is someone who will coordinate and manage the treatment and rehabilitation of the brain injured person. In today’s world, especially if it is a Medicaid payment case, the case manager is an essential advocate to assure that treatment doesn’t get suspended or underprovided because of some red tape.
Often times when a professional guardianship firm is utilized, the guardianship firm will have their own case managers. This can be an advantageous situation for the injured person and one reason I often recommend that professional case guardians be utilized.
The ultimate advantage of having an experienced brain injury advocate comes in the matter of the sub-acute treatment, the treatment in the months after the person has emerged from the coma. Fewer and fewer hospitals have inpatient rehab programs for severely brain injured survivors and it takes professionals to assure that the proper placement occurs. One of the advantages of having a top lawyer is that the potential for litigation proceeds may allow access to long term brain injury treatment facilities that would not be available under insurance or Medicaid reimbursement.
An experience brain injury lawyer can also help to avoid the dreaded nursing home placement where there may be a Catch 22 where no treatment occurs because only the nursing home can be reimbursed for treatment. The problem with that is the nursing home reimbursement is not enough to provide any meaningful rehabilitation. Thus rehabilitation is minimal at best. The only other alternative under the local reimbursement situation may be adult foster care placement with outpatient treatment, but often times the available foster care homes are completely inappropriate for the survivor.
An experienced TBI lawyer in the beginning can open up other options. We got involved in a case in California about three years ago with a severely brain injured person. Rather than a nursing home placement, the survivor was placed in a nationally recognized rehabilitation program. In that program, the client got 24/7 appropriate treatment and supervision. As a result of the ability of the lawyer to negotiate a lien payment option, the care wasn’t terminated at 30 days. The care continued long term. The ultimate result is the best possible care for that individual, which continues to this day. Future payment of treatment cost are assured because the jury awarded the plaintiff $49 million.
But as I reflect on the harm that can come to a brain injured person by not hiring the right lawyer, right away, my biggest concern is for those with severe brain injuries, which one would think would be the easiest cases for a non-TBI lawyer to handle. After all, how hard is it to prove someone has been catastrophically damaged, when they have been catastrophically injured?
We get far fewer calls from survivors of coma injury cases than we do concussion survivors. In a coma case, there is never a shortage of lawyers wanting the case and most times family members have chosen a lawyer while the injured person is in the ICU. In contrast, proof of brain injury and disability is so much more difficult in a concussion case that many brain injured people can’t even get representation.
The difference a TBI lawyer makes however may be most significant in the severe brain injury cases. That is because the legal advocacy that is done at the beginning may not only make the case easier to prove, it may also make a huge difference in the access to acute and sub-acute care, in those first few months after a catastrophic brain injury when it is most needed. Thus I think it is important to reflect on what difference a TBI lawyer can make from the start.
The first thing that must be done from the advocacy standpoint after a severe brain injury occurs, is to have a guardian or conservator appointed. While many family members might wonder why they can’t continue on without a guardian, from a legal standpoint no real decisions can be made until someone is given the authority to make those decisions by a court. Many people are afraid of the word “guardian” because it connotes some type of loss of freedom of choice, but without a guardian, the severely brain injured person is left in a legal no man’s land. Among the things that can’t be done without a guardian is hire a lawyer to represent the brain injured person in a lawsuit.
The second area of advocacy that is critically important during those first few weeks after injury is to make sure that a professional case manager is assigned to the case – someone who does not work for the hospital or treatment center. A case manager is someone who will coordinate and manage the treatment and rehabilitation of the brain injured person. In today’s world, especially if it is a Medicaid payment case, the case manager is an essential advocate to assure that treatment doesn’t get suspended or underprovided because of some red tape.
Often times when a professional guardianship firm is utilized, the guardianship firm will have their own case managers. This can be an advantageous situation for the injured person and one reason I often recommend that professional case guardians be utilized.
The ultimate advantage of having an experienced brain injury advocate comes in the matter of the sub-acute treatment, the treatment in the months after the person has emerged from the coma. Fewer and fewer hospitals have inpatient rehab programs for severely brain injured survivors and it takes professionals to assure that the proper placement occurs. One of the advantages of having a top lawyer is that the potential for litigation proceeds may allow access to long term brain injury treatment facilities that would not be available under insurance or Medicaid reimbursement.
An experience brain injury lawyer can also help to avoid the dreaded nursing home placement where there may be a Catch 22 where no treatment occurs because only the nursing home can be reimbursed for treatment. The problem with that is the nursing home reimbursement is not enough to provide any meaningful rehabilitation. Thus rehabilitation is minimal at best. The only other alternative under the local reimbursement situation may be adult foster care placement with outpatient treatment, but often times the available foster care homes are completely inappropriate for the survivor.
An experienced TBI lawyer in the beginning can open up other options. We got involved in a case in California about three years ago with a severely brain injured person. Rather than a nursing home placement, the survivor was placed in a nationally recognized rehabilitation program. In that program, the client got 24/7 appropriate treatment and supervision. As a result of the ability of the lawyer to negotiate a lien payment option, the care wasn’t terminated at 30 days. The care continued long term. The ultimate result is the best possible care for that individual, which continues to this day. Future payment of treatment cost are assured because the jury awarded the plaintiff $49 million.
Mike Leach Firing Clearly Justified by Evidence of Abuse of Brain Injured Athlete
Texas Tech has won its bowl game without the Concussion abuser Mike Leach as its head coach. Leach was fired on Thursday, just before his hearing to force reinstatement. The court case was odd, especially since Leach chose to try his case in the media with out of context claims of support from the team doctor and trainer. As reported by the New York Times, neither the trainer nor the team doctor are supporting his treatment of Adam James. See http://www.nytimes.com/2010/01/03/sports/ncaafootball/03leach.html?hp
A Texas Tech athletic trainer said he was told by the fired coach Mike Leach to lock wide receiver Adam James in the dark after doctors determined that he had a concussion, according to an affidavit released Saturday by the university.
According to the NY Times story:
Despite Leach’s media claims, the team doctor did not support the treatment of James, either. According to the NY Times:
A Texas Tech athletic trainer said he was told by the fired coach Mike Leach to lock wide receiver Adam James in the dark after doctors determined that he had a concussion, according to an affidavit released Saturday by the university.
According to the NY Times story:
In a Dec. 21 interview with a university investigative attorney looking into James’s treatment, Steve Pincock, Texas Tech’s head football trainer, said he told James he was sorry about placing him inside an equipment shed on Dec. 17 near the practice field. According to the affidavit, Pincock also said he was not aware that any other player had ever been treated in such a manner.
“I do not agree with this form of treatment for anyone,” Pincock said in the affidavit.
In describing what Leach told him to do, Pincock quoted the coach as using graphic and profane language about locking James in a dark place, according to the affidavit. Pincock also told the investigator that Leach “wanted James to be uncomfortable,” the affidavit said. Pincock did not return a message left on his cellphone or reply to a text message Saturday.
Despite Leach’s media claims, the team doctor did not support the treatment of James, either. According to the NY Times:
In another affidavit released Saturday by the university, the team physician Michael Phy told the investigator on Dec. 22 that James “may not have been harmed,” but that Phy considered “this practice inappropriate.” In the statement announcing Leach’s firing, Texas Tech said Leach’s actions put James “at risk for additional injury.”As I said on one of my other blogs last week, while isolation does not necessarily expose the injured brain to any new physical forces, it can expose the brain to additional stress, which can result in further Post Concussion Syndrome problems. See http://blog.subtlebraininjury.com/2009/12/texas-tech-isolation-for-concussed.html
Last year was a remarkable year for concussion awareness, but we are only scratching the surface of treating the secondary effects of concussion, especially those that involve emotional stressors. I hope the Leach chapter stays in the media focus long enough to get some of the leading thinkers on concussion to educate on this issue further.
Primary Care Reimbursement Under Health Care Reform
We have heard much about the size of the new Health Care Reform Act, something nearly 2,000 pages. We have heard very little about what is inside of it except that it will cover more people, provide coverage for those with preexisting conditions and expand the coverage by as much as 30 million people. But how is it going to cut costs? And how will it assure that low income people truly have access to medical care?
One of the provisions included in the Senate plan is to increase the reimbursement rate of primary care doctors who are seeing Medicaid patients. See Health Care Business News at http://www.modernhealthcare.com/article/20091227/REG/312279992/0 In that article they explain:
Our current medical system is built around the concept of a gatekeeper, the primary care or family practice doctor. If you have a problem, it is only through treatment by the family care doctor or referral to a specialist from the primary care doctor that you get treated. Thus it is the gatekeeper who plays the most important role in diagnosis of disease. It is also the gatekeeper who must retain the most overall knowledge of medicine as he must be able to spot a problem across the entire spectrum of medical diagnosis. People think that because they are less specialized they have lower skills. For our system to work properly, that can’t be the case. As capitalist, if we want to attract our best doctors to this role, we have to pay them like our best doctors.
When I look at brain injury diagnosis, I see the enormous role that family doctors have to play. In my model, each concussed person would go back to the Emergency Room the day after his or her injury to be seen by the same doctors who saw them on the day of concussion, to determine if there was continuing or worsening symptoms. That is not what is happening in our current system. What happens in our current system is that the concussed patient is told to follow-up with their family doctor, if they get worse. If the family doctor does not know more about diagnosing a concussion than the average neurologist, then the diagnosis and the documentation of symptomotology that is so important will be missed. The reason that second day documentation is so significant is that without it, it becomes extremely difficult to sort out the issue of whether the symptoms that come later are related to brain injury.
My pet project – had I a lobbyist in my pocket for concussion care reform – would be to require the follow-up visit to the ER. Since I don’t have those kind of connections, this provision to increase access (and compensation to family doctors) is a step in the right direction. Now we must do what we can to educate the primary care doctor that testing for amnesia in the days after the accident will tell us more about the severity of injury and potential for disability than all of the scans that have been or will ever be invented.
One of the provisions included in the Senate plan is to increase the reimbursement rate of primary care doctors who are seeing Medicaid patients. See Health Care Business News at http://www.modernhealthcare.com/article/20091227/REG/312279992/0 In that article they explain:
A key objective of the bill is to bolster the ranks of the primary care workforce. The legislation includes a raft or new funding and measures aimed to encourage doctors to move into primary care . And in a measure to help increase transparency, the legislation requires HHS to develop a “Physician Compare” web site where Medicare beneficiaries can compare measures of physician quality and a patient’s perception of care.This is an important part of the plan. Primary care doctors are in my opinion, the most important doctors in our system and sadly the lowest paid. See http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm
Our current medical system is built around the concept of a gatekeeper, the primary care or family practice doctor. If you have a problem, it is only through treatment by the family care doctor or referral to a specialist from the primary care doctor that you get treated. Thus it is the gatekeeper who plays the most important role in diagnosis of disease. It is also the gatekeeper who must retain the most overall knowledge of medicine as he must be able to spot a problem across the entire spectrum of medical diagnosis. People think that because they are less specialized they have lower skills. For our system to work properly, that can’t be the case. As capitalist, if we want to attract our best doctors to this role, we have to pay them like our best doctors.
When I look at brain injury diagnosis, I see the enormous role that family doctors have to play. In my model, each concussed person would go back to the Emergency Room the day after his or her injury to be seen by the same doctors who saw them on the day of concussion, to determine if there was continuing or worsening symptoms. That is not what is happening in our current system. What happens in our current system is that the concussed patient is told to follow-up with their family doctor, if they get worse. If the family doctor does not know more about diagnosing a concussion than the average neurologist, then the diagnosis and the documentation of symptomotology that is so important will be missed. The reason that second day documentation is so significant is that without it, it becomes extremely difficult to sort out the issue of whether the symptoms that come later are related to brain injury.
My pet project – had I a lobbyist in my pocket for concussion care reform – would be to require the follow-up visit to the ER. Since I don’t have those kind of connections, this provision to increase access (and compensation to family doctors) is a step in the right direction. Now we must do what we can to educate the primary care doctor that testing for amnesia in the days after the accident will tell us more about the severity of injury and potential for disability than all of the scans that have been or will ever be invented.