The 8th Annual State of the Art Medical and Rehabilitative Care in Brain Injury: Clinical and Legal Implications Conference was held at the Silverado Resort in Napa, California on November 16-17, with a fundraising Golf Tournament on November 18th. The conference was hosted in collaboration with the Scarlett Law Group.

Conference attendees and speakers traveled to Napa from as far as the east coast and Hawaii to be part of what has been called “the best educational conference for medical and legal professionals” that provide services to individuals with brain injury. Mr. Randall Scarlett participants were treated to a wine tasting by and Dr. Claude Monday founded the concept the Frank Family Vineyards, Elyse Winery, of medical and legal professionals joining and Falcor Wines, and had the opportunity to together to provide the latest and greatest bid on a variety of items donated to CALBIA updates in their respective fields. At the for the Silent Auction, which provided addibeginning of the conference, Dr. Claude Mun-tional funds for CALBIA. day received an award from CALBIA in recognition of his many years of service to The success of the conference could not persons with brain injury, and for his partici-have been achieved without the many sponpation and leadership on the various boards he sors, exhibitors, speakers that donated their sits on, and his committee work. time and travel expenses, and the work of Following the conference on Friday evening, the planning committee, recognized below:

SPONSORS:
High Impact Litigation Law Cash Paradigm Management Services Jones, Clifford, Johnson & Johnson, LLP Malone Law Office Delano Farms Company San Joaquin Bank Contrabande Control Specialists, Inc. Centre for Neuro Skills Scarlett Law Group Doehrman Chamberlain The Veen Firm, P.C. Law Offices of Michael B. Moore Bostwick & Associates Marcus & Regaldo Newton Medical Group Charles Guy Monnett III Brown & McDevitt Gwilliam, Ivary, Chiosso, Cavalli & Brewer Shea & Shea Frank Family Vineyards Elyse Winery Falcor Wines Chalone Vineyard Kim Battuello Buehler Vineyards Far Niente Winery Freemark Abbey Winery Green & Red Vineyard Crgich Hills Cellar Heitz Wine Cellars Hess Collection Winery Honig Vineyard & Winery Milat Vineyards Winery Peju Province Winery Raymond Vineyard & Cellar Rubicon Estate Rutherford Grove Winery Shafer Vineyards Spottswoode Winery Trefethen Vineyards & Winery Trinchero Family Estates V. Sattui Winery ZD Wines Knights Jewlers

EXHIBITORS:
Care Meridian Casa Colina Centers for Rehabilitation Centre for Neuro Skills High Impact Litigation Juris Productions, Inc. Kentfield Rehabilitation & Specialty Hospital Learning Services Corporation Medtronic Neuromodulation Rehab Without Walls Santa Clara Valley Medical Center Dave Woodruff, Susan Connors, Dr. David Hovda, Lee Woodruff and Dr. Douglas Smith

SPEAKERS:
Dave Woodruff Thomas Malone, J.D. Douglas C. Smith, Ph.D. David Hovda, Ph.D. Michael Shea, Jr., J.D. Sharon Grandinette John Romano, J.D. Frank Branson, J.D. Bruce Stern, J.D. Mark D’Esposito, M.D. Bill Smith, J.D. R. J. Waldsmith, J.D. Daniel Kelly, M.D. Geoffrey Manley, M.D., Ph.D. Susan Connors, B.S. Rick Rollens Randall H. Scarlett, J.D. Deborah Doherty, M.D. Daniel Davis, M.D.

CONFERENCE PLANNING COMMITTEE:
Mark J. Ashley, Sc.D. Paula Daoutis Deborah Doherty, M.D. Sharon Grandinette, M.A. Amanda Helvie Tina Horn Patrick Johnson Steve Katomski Lisa Kreber, Ph.D. Claude Munday, Ph.D. Bruce Nelson Randall H. Scarlett, J.D. Kavie Von Husen

Special thanks to:
Anna Gregory Helen Nelson

NEW YORK (CNN) — It’s been described as the closest thing to being buried alive — complete paralysis of the body, except for controlled movement of the eyes.

That’s how 24-year-old Erik Ramsey has spent the last eight years of his life. He suffered a brain stem stroke after a car accident when he was 16, leaving him with “locked-in” syndrome.

This condition is not the same as other forms of paralysis where you feel nothing in the affected areas. Ramsey has 100 percent sensation all over his body. An itch can become excruciating with no way to communicate that he needs it scratched. He has frequent muscle spasms as well, which can be painful.

“Even sweat rolling down his skin or something, there’s nothing he can do about it,” said Eddie Ramsey, 57, Erik’s father. “So he feels everything in the environment, but there is really just nothing he could do about it.”

Doctors told the Ramseys that their son has no chance of getting better.

“There’s always hope, but a large portion of it is in the category of miracles,” said Eddie Ramsey.

But new research may give Erik Ramsey the miracle he has been waiting for. Dr. Phil Kennedy, chief scientist at Neural Signals Inc., a company he founded to conduct research on the brain and communication. He came up with a revolutionary idea that he believed could turn Ramsey’s thoughts into speech.

He invented an electrode that detects the neural signals in the speech motor area of Ramsey’s brain. In December 2004, the electrode was implanted, and Kennedy, along with four independent labs, began decoding the signals in Ramsey’s brain. The researchers asked him to think of specific vowel sounds, then mapped his brain activity. By knowing what his brain looked like when he thought each specific sound, scientists could translate the activity into a language that a voice synthesizer could read.

Dr. Frank Guenther, associate professor of cognitive and neural systems at Boston University, said his lab, one of three others pursuing neural signal translation, had a breakthrough recently: They were able to hear the sounds Ramsey was trying to say using the decoder they built.

“That was a very exciting moment, where we knew this process of taking neural signals and driving a synthesizer was going to work,” Guenther said.

In the next two months, researchers will hook up the synthesizer. Ramsey will produce his first vowel sounds then. The next phase is getting him to produce consonants, which are much harder to synthesize. Conversations, they say, are still about two years away.

For Ramsey, this will mean expressing himself beyond just one word answers. The only way he can indicate what he wants is by moving his eyes up for “yes” and down for “no.” But even this method only goes so far. He gets so tired that he can answer only about six questions before he has to stop.

Former Elle magazine editor Jean-Dominque Bauby suffered from the same syndrome and was also able to communicate using only one eye. He wrote about the horror of having locked-in syndrome in his book “The Diving Bell and the Butterfly,” which was made into a film released November 30.

Bauby’s writing was an exceedingly slow process. He dictated the book by blinking his left eye when the correct letter was presented to him. He described his mind as a butterfly flying freely inside a diving bell — a chamber that is placed underwater, trapping the air inside.

His descriptions of life as a man who is paralyzed and mute gave Eddie Ramsey the first detailed account of what it must be for his son to live with locked-in syndrome.

“He had to blink that book with one eye,” Eddie Ramsey said tearfully. “Had he never done that, no one would ever understand what locked-in means.”

Asked if ever wanted to end his life, Erik Ramsey looked up, his way of saying yes. Asked if he still felt that way, he looked up again.

But he hasn’t lost all hope. Asked if he believes Kennedy’s research will allow him to communicate again, he answered “yes.”

Eddie Ramsey thinks so too.

“Dr. Kennedy said he believes Erik will be able to speak again either through a voice synthesizer or through some other means. I believe him and I agree with him,” he said.

It may do the same for tens of thousands of people living with Lou Gehrig’s disease, muscular dystrophy or even Alzheimer’s who have lost their ability to speak.

Rehabilitation

Chronic stroke patients benefit from robotic upper-limb rehabilitation,

Intense, short-term, upper-limb robotic therapy improved motor outcomes among chronic stroke patients. Investigators enrolled 30 patients with upper-limb impairment due to stroke. Over 3 weeks, 18 sessions of robot-assisted therapy were delivered with the use of a robotic exercise device. Significant improvements were observed for severely impaired participants, which indicates that improvement is not limited to individuals with moderate impairments. Moderately and severely impaired patients tolerated intense, frequent, and repetitive treatment. This information is useful for determining the optimal target population, intensity, and duration of robotic therapy and the necessary sample size for a larger trial.

Robotics and functional neuromuscular stimulation improve arm/hand use following stroke,

Stroke patients improved functional use of their impaired arms and hands by participating in robotics plus motor learning or neuromuscular stimulation plus motor learning. Investigators randomly assigned patients with chronic stroke to one of two treatment groups: robotics with motor learning (ROB-ML) or functional neuromuscular stimulation with motor learning (FNS-ML). All participants received treatment 5 hours a day, 5 days a week for 12 weeks. Results showed that ROB-ML participants had gains in functional tasks, accuracy, and smoothness of movement. FNS-ML participants had gains in upper-limb coordination and hand/wrist function.
Narrative discourse evaluation identifies subtle changes in language poststroke

Researchers used narrative discourse to identify patients experiencing language difficulties poststroke. A cohort of individuals who had experienced a left-hemisphere stroke and had not been diagnosed with a language disorder were evaluated for narrative discourse cohesiveness at 1, 6, and 12 months poststroke. Data indicate that during the first year poststroke, the average number of cohesive ties in narrative discourse remained constant, while the percentage of correct use of cohesive ties increased significantly during. These findings suggest that subtle disruptions in expressive language can be present initially but are recovered naturally over time.

Coping resources improve quality of life for caregivers of stroke survivors,

Coping ability is the most important influence on the quality of life for stroke caregivers. Investigators examined data collected at 1 and 6 months poststroke to determine the influence of stroke survivor and caregiver characteristics on quality of life (QOL) for stroke caregivers. At both time points, the most influential factor was sense of coherence (SOC). SOC is the caregiver’s ability to mobilize coping resources during periods of stress. Caregivers who effectively mobilized these resources experienced less burden and fewer symptoms of depression.

Walking increases bone density following stroke,

Daily walking and ground reaction forces can potentially modulate bone loss in stroke survivors with impaired walking ability. Demographics, functional outcomes, bone mineral density (BMD), and gait-related parameters were evaluated in 33 volunteers with poststroke walking deficits. BMD at the hip was significantly lower on the impaired side. Investigators also found a relationship between BMD and a newly developed gait-related parameter that incorporates the number of steps per day and ground reaction force (the reaction to the force the body exerts on the ground). These findings stress that walking is an important component of rehabilitation for maintaining lower-limb bone density in persons with poststroke walking deficits.

Constraint-induced movement therapy improves recovery of upper-limb function following traumatic brain injury,

Constraint-induced therapy may improve upper-limb motor function following chronic traumatic brain injury. A group of 22 participants with chronic traumatic brain injury and upper-limb paralysis participated in constraint-induced movement therapy for 2 weeks. Treatments included massed practice, shaping of the more-affected upper limb, behavioral contracts, and other behavioral techniques for affecting transfer to a real-world setting. Significant improvement was seen in participants’ use of the more affected upper limb to accomplish activities of daily living.

Multidisciplinary treatment program improves long-term outcomes of individuals with Parkinson’s disease,

Over 75 percent of patients with Parkinson’s disease (PD) enrolled in a multidisciplinary rehabilitation program demonstrated stable or improved motor function scores up to 3 years following treatment. Patients’ disease progression was measured at baseline and 1, 2, or 3 years follow-up with the motor subscale of the Unified Parkinson’s Disease Rating Scale. Multidisciplinary interventions included neurology, physiatry, nursing, psychology, medication changes, rehabilitation therapies, functional diagnostic testing, support group, home exercise instruction, and disease and wellness education. This is the first long-range study to assess the efficacy of a multidisciplinary clinical program in management of PD patients.

Muscle vibration may enhance controlled movement in people with central motor disorders,

This study examined whether muscle vibration enhances the brain’s ability to control voluntary movement. Sixteen healthy men and women participated in studies involving the application of 15 or 30 minutes of vibration to the wrist extensor muscle. Fifteen minutes of vibration significantly increased muscle twitch responses, which indicates increased output to the muscles. The effects of muscle vibration were not sustained after 20 minutes. These data provide a basis for exploring the effectiveness of muscle vibration in improving muscle function in people with central motor disorders such as stroke.

Rigid pylons as effective as shock-absorbing pylons for absorbing gait impact,

Shock-absorbing pylons (SAP) are as effective as rigid pylons for people with below-the-knee amputations. In this study, a commonly prescribed SAP is compared to a conventional rigid pylon. The pylons were assessed for effect on gait mechanics, transmitted accelerations, and functional outcomes using step counts and questionnaires. The only statistically significant finding was for the prosthetic-side knee angle at initial contact. Volunteers displayed an average of 2.6° more flexion with the rigid pylon than the SAP while walking at a controlled speed. This result indicates that individuals with below-the-knee amputations can adjust the stiffness of their residual limb in response to changes in prosthetic component stiffness.

Foot and ankle ligament geometry,

Little is known about how conditions such as diabetes affect the ligaments of the foot and ankle. In this study, researchers developed a new technique to determine the cross-sectional ligament area for a broad range of foot and ankle ligament sizes and shapes. The technique detailed in this study, together with its baseline data, will expand knowledge of foot ligament properties and foot function, and contribute to the development of a model that can be used in studies of conditions associated with foot deformity.

New insight may help avoid unnecessary hand surgery in elderly,

Motor nerve conduction is a common clinical test used to diagnose nerve problems such as carpal tunnel syndrome. Current techniques use a single recording site over a superficial muscle. This approach does not take into account the electrical contributions from the other muscles innervated by the nerve being stimulated. This study recorded 15 sites over the thenar eminence (muscles at the base of the thumb) during motor nerve conduction studies. Data suggest that standard nerve conduction studies in elderly patients with a common arthritic change in the thumb may result in unnecessary hand surgery.

Neurocognitive enhancement therapy improves work outcomes for people with schizophrenia,

In a recent study, neurocognitive enhancement therapy (NET) significantly improved work outcomes in 145 volunteers with schizophrenia or schizoaffective disorder. Study patients were randomly assigned to 6 months of paid work therapy (WT) or to NET plus WT. Volunteers receiving NET along with WT worked more hours than volunteers receiving WT only. These differences emerged after rehabilitation. Volunteers assigned to the NET plus WT group worked the most during follow-up and tended to have more competitive-wage employment.

New hearing loss test cuts clinical evaluation by half,

Investigators developed a test that quickly measures speech understanding in background noise. An established 70-word hearing test was reduced to 35 words, which cut testing time in half. A shorter word list will help clinicians rapidly evaluate patients’ abilities and address their needs (e.g., hearing aids with directional microphones, FM technology, or digital signal-processing noise-reduction algorithms).

Wheelchair durability and user satisfaction,

A pilot study found that users of wheelchairs are generally satisfied with their mobility devices. A convenience sample of 130 participants who use wheelchairs as their primary means of mobility was recruited. Participants completed a questionnaire about their wheelchair, its maintenance and repair history, and their satisfaction levels. Results showed that 26 percent of participants had completed wheelchair repairs in the past 6 months, 16 percent had completed general maintenance, and 27 percent had completed tire repairs. Neither hours of wheelchair use nor wheelchair age affected repair or maintenance frequency. Better understanding of wheelchair maintenance and repair issues will guide improvements in wheelchair design and enhance the community participation of individuals who use wheelchairs.

Source: http://www.eurekalert.org/pub_releases/2006-05/vrcs-jtf050906.php

A professor at the University of Houston and his research students are working with physicians and scientists at the Methodist Neurological Institute on new technology to help identify which brain aneurysms are at highest risk of rupture and could cause a stroke.

Improving treatment of cerebral aneurysms, which are ballooning weak spots in the wall of a blood vessel in the brain, is at the center of this joint research. The goal of their study is to develop a fully-integrated computational medical tool that will be useful in helping to select patients for treatment whose aneurysms are most likely to rupture.

Ralph Metcalfe, a mechanical engineering professor at UH and deputy director of the UH biomedical engineering program and his graduate student, Aishwarya Mantha, work on this project with a Methodist team consisting of Drs. Charles Strother and Goetz Benndorf, interventional neuroradiologists, and Christof Karmonik, a researcher at the Methodist Hospital Research Institute.

Using computer simulations of blood flow in realistic geometric models of aneurysms, some blood flow characteristics have been identified that may contribute to aneurysm formation. These findings are described in a paper titled “Hemodynamics in a Cerebral Artery Before and After the Formation of an Aneurysm,” appearing in the May issue of the American Journal of Neuroradiology, a scientific journal that publishes original articles dealing with the clinical imaging, endovascular therapy and basic science of the central and peripheral nervous system.

“According to the American Association of Neurological Surgeons, cerebral aneurysms affect up to six percent of the U.S. adult population,” Metcalfe said. “Most aneurysms don’t rupture, but if they do, the results are fatal in about 50 percent of the cases. The question is how to predict who is most at risk.”

Since treatment of aneurysms is associated with some risk, Metcalfe’s group and his Methodist colleagues are trying to develop a better method of identifying which aneurysms are most vulnerable for rupture. Once these patients are identified, physicians can then determine the best course of medical treatment, using existing technologies and best medical practices.

“One of the key points is that aneurysms don’t seem to form randomly,” Metcalfe said. “They do seem to form at locations that are associated with the fluctuations in the flow of blood, leading to the question of what it is about the flow of blood that tends to correlate with the formation of aneurysms.”

The Methodist researchers acquire 3-D images of the intracranial vascular system by injecting dye into the vessels and rotating an X-ray tube around the patient’s head, a technique that has become a standard for high-quality vascular imaging in this institution.

By using this geometric and blood flow data taken from a specific patient’s clinical profile, Metcalfe’s team can perform simulations in their computers of blood flow in that patient’s arteries using existing computational fluid dynamics programs in novel applications. This is similar to the way that an aeronautical engineer would study the design of an airplane on a computer or in a wind tunnel. Strother and his colleagues at Methodist anticipate that this process will help researchers better understand how aneurysms form and ultimately discover ways to prevent strokes and death from this common disorder.

“We can’t look at a person and tell the likelihood that an aneurysm will rupture,” Strother said. “But we do know that force and stresses created by blood flow produces aneurysms. Our hope is that this study will help us learn enough to predict which ones are at high risk of rupture so that treatment can be offered before they become harmful.”

This work has two potential applications. The first is as a research tool, with Metcalfe’s team performing simulations of specific aneurysms. Using a technique employed by Karmonik to simulate removal of an aneurysm on the computer, they analyze how the blood behaves as it flows near the aneurysm site and determine if that can be correlated to a certain type of behavior of the blood at potential sites where aneurysms form. Very accurate simulations are done for a complete description of the flow fields, studying all the fluid dynamic variables in great detail, such as the wall shear stresses, the pressures and the velocity.

“The second application is as a potential clinical tool,” Metcalfe said. “Once we have a reasonable idea of the fluid dynamic variables needed to study and identify a potential problem, we then use a program that provides a detailed, 3-D description of the aneurysms of the real patients.”

Benndorf adds that the potential clinical importance of these computer simulations lies in the future possibility of directly predicting patient-specific blood flow so that patient-specific medical devices can be used in aneurysm treatment. He is studying how stents — small wire mesh tubes that are inserted into the artery to facilitate the occlusion of an aneurysm with small platinum coils — can be tailored to the patient’s individual anatomy and blood flow in order to optimize their therapeutic effect and maximize the possibility of a successful outcome.

When Metcalfe’s group imports a patient’s images into a computer program, they remove some geometric glitches and generate a computational mesh that involves the mapping of hundreds of thousands of tiny elements that represent the area being studied. That mesh is then introduced into a program that actually solves the fluid dynamic equations of motion.

“It takes a lot of computer time to perform these simulations,” Metcalfe said. “There are several hundred thousand elements that are discrete zones within a geometric mesh, and then there are 700 steps representing intervals of time over the cycle of each heart beat.”

Requiring extremely fast computers, the group uses the Beowolf cluster at UH’s Texas Learning and Computation Center (TLC2) to significantly improve the visualizations created by the simulations.

“The critical step here is to make these complicated flows much more accessible to people like medical researchers and physicians,” Metcalfe said. “We’re developing 3-D visualizations so doctors can go inside the virtual artery and actually see what’s happening as the blood cells flow through.”

Halliburton Company supports this joint project by funding the research analysis of the study’s findings, which have the potential for substantial impact in neurology and medical science.

Source: http://www.sciencedaily.com/releases/2006/05/060510091804.htm

Anosmics – those without a sense of smell – miss something often taken for granted.
By Bryan David Finlayson
I was 13 when I lost my sense of smell.

Skateboarding downhill in Santa Barbara, Calif., my stepbrother Christian and I were racing. It was not important where we were going; there was no reward for winning, no punishment for losing.

We were competitive.

Gaining speed, I broke ahead of Christian, who was 17. I remember feeling elated over seizing the road from him.

Then the road disappeared.

Minutes passed before I came to, with Christian carrying me to the curb. My transition into the accident that turned my world upside down, for me, is seamless because I cannot remember. The fall was sudden, resulting in the direct impact of my head on the hard asphalt.

I was not wearing a helmet.

A week later, after I was released from the hospital, Christian described what he had seen.

“When your head hit, your glasses went flying straight up, 10 feet in the air,” he said.

Doctors at the Santa Barbara Cottage Hospital told me that I had received a brain contusion, a more traumatic form of a concussion, involving bruised tissue. When the back side of my head hit the asphalt, the impact caused my brain to first bash into the back of my skull, then ricochet strongly against the front.

The ricochet did the damage.

There was extreme bleeding over my frontal lobe, there was the possibility of blood clots leading to seizures, and pressure was mounting inside my skull from the excess blood and swelling brain tissue.

They would have to drill if the pressure worsened, doctors said. I was given morphine and other medications to prevent seizures and reduce the swelling.

The medication worked, and the swelling subsided. They didn’t have to drill.

Four days later, though dizzy and groggy, I went home from the hospital.

It was over a plate of spaghetti at dinner that I realized I couldn’t smell the food. In fact, since leaving the hospital, I had not smelled anything.

My family dismissed my condition as temporary and said once I was off the anti-swelling medication my sense of smell would come back.

They were wrong.

Weeks later it hadn’t come back. It has been eight years now, and I am still waiting.

My head injury left me with more lasting damage than I or anyone else in my family could have predicted.

After consulting a neurologist, I learned the violent ricocheting of my brain against my skull had severed the nerve endings connecting my olfactory glands to the lower cortex of my brain. I was not regaining my sense of smell because scar tissue had formed over the bone, blocking the nerves from regenerating.

I am among nearly 14 million Americans who are anosmics – people who have lost their sense of smell. For us, there is next to nothing in the way of medical treatment.

The medical community sees anosmia as a minor disability, like the common cold.

Generally, treatment is a choice between a biopsy or Cerefolin, a seizure medication.

Biopsy involves drilling into the skull. Noninvasive recovery with Cerefolin has been limited.

A reality of medical research is that smell is the most understudied and least understood of our five senses. The impact of losing your sense of smell on your physiological well-being is just beginning to be explored.

To an anosmic, there is no difference between smoky air in a pool hall and the fresh air outside, save for a lighter feeling on the skin.

I never smell the cologne or deodorant I apply to myself every day. I have no knowledge of the smell of my girlfriend. At the beach, I used to relish the salty smell of the ocean; now my skin just feels sticky.

Smell is a sentimental sense, and missing it can cause depression in anosmics.

Some of my fondest memories are smells: a rose, fresh-cut grass, the ocean. Smell is a valuable sense that is too often taken for granted and sorely missed when it is gone.

It is frustrating that there isn’t more treatment for anosmia. For now, I must accept that I lost my sense of smell over nothing, a silly race down a hill in California leading nowhere in particular.

That’s what stinks.

Source: http://www.philly.com/mld/inquirer/news/local/states/new_jersey/14384028.htm

Newswire Services
April 17, 2006

MORRO BAY, Calif. – Through the Community Center at Cal Poly, volunteers are heading out to Morro Bay on Sunday, April 23, 2006, to paint a group home operated by OPTIONS Family of Services. Paint and some needed supplies were donated by the Morro Bay Miner’s Ace Hardware Store.

OPTIONS is expecting 20-25 student Week of Welcome (WOW) Team Leaders to pick up a paint brush or roller and paint the exterior of their group home Sunday, during what is one of the largest group and volunteer efforts that Cal Poly puts together throughout the year.

According to Dan Pronsolino, coordinator of The Community Center at Cal Poly, “we expect that approximately 800 students – including Greek organizations, student clubs and other intramural organizations will be participating in projects all throughout the county on Sunday.

“The Community Center sponsors various Days of Service throughout the academic year,” Pronsolino said. “These events are one-day opportunities for students and community members to engage in service that benefits their community.”

For a nonprofit organization like OPTIONS, it means being able to complete a time-consuming and costly project in only one day due to the help of these student volunteers and local business donations.

Said Mike Mamot, Chief Executive Officer of OPTIONS, “It’s been close to ten years since we’ve have the manpower and resources to paint this house. Both the residents and the neighbors are looking forward to getting this accomplished.”

OPTIONS is a private non-profit organization providing positive choices for people with developmental disabilities and/or traumatic brain injury. On a daily basis, the organization serves over 200 individuals in northern Santa Barbara and San Luis Obispo counties with a staff of 170.

OPTIONS provides comprehensive services in housing, day centers, and training in independent living skills – from one-on-one support and functional services, to vocational services and assistance with community integration for business, as well as social and recreational needs.

Source: http://www.americanchronicle.com/articles/viewArticle.asp?articleID=8231

South Sound medics in Iraq ensure 96% survival rate at Balad Air Base

SEAN COCKERHAM; The News Tribune
Published: May 7th, 2006 01:00 AM

Balad Air Base, Iraq – Maj. Brett Schlifka of Puyallup was up all night in this tent hospital that nurses describe as “‘M*A*S*H’ on steroids.”

The neurosurgeon from Madigan Army Medical Center had been operating on a U.S. soldier shot through the jaw. The next morning, he was getting ready for surgery on an Iraqi who lost his eye to an improvised explosive device.

Schlifka said he heard the Iraqi might be an insurgent who had fallen victim to his own bomb. That’s one of the tough parts of his job.

“I don’t take care of people who are trying to kill me back in the States,” Schlifka said.

In Iraq, he also faces daily mortar attacks, a never-ending stream of gunshot and blast victims, and the emotional gut punch when the American soldiers he considers family die of their wounds.

Schlifka is among dozens of doctors, nurses and air crews from the Puget Sound area who are links in the medical lifeline for soldiers wounded in Iraq.

Medics from McChord Air Force Base help pick up troops and take them for surgery at the Air Force Theater Hospital at Balad, about 50 miles north of Baghdad.

This is the hub for treating battlefield casualties from across Iraq. All soldiers with head and neck injuries go through here. So do any others whose injuries are so severe they require evacuation to Germany.

“Nowhere in the world do you get the level of injuries you see here,” said Col. Donald Taylor, the hospital commander who comes from Lackland Air Force Base in San Antonio.

A team of McChord medical specialists at Balad prepares the patients for evacuation out of Iraq. Other McChord medics and nurses often go on the life flights.

They are part of a medical airlift system the Defense Department calls unsurpassed in the history of war.

Maj. Ken “Rhino” Winslow, a McChord reservist nurse from Issaquah, helped bring wounded soldiers to Germany over the past several months. Winslow, based in Germany, would ride the planes to Iraq and back.

“From the time you are hurt on the battlefield in Iraq until you get to the continental U.S., it is 24 to 36 hours,” he said. “If you were severely wounded in Vietnam, it was two weeks.”

Winslow works in civilian life as a nurse practitioner in the emergency room at Snoqualmie Valley Hospital. He’s proud of his contribution to the wartime medical airlift.

But like other McChord reservists, he said the duty takes a psychological toll. It has made him a different person. He doesn’t know how to answer when people ask what it was like.

“Let’s see, I was wearing body armor and a helmet and saw kids with arms and legs blown off,” he said. “How do you express that?”

Tears and white knuckles

Master Sgt. J.P. Wirth, an Air Force Reserve flight medic from McChord, travels in C-130 aircraft throughout Iraq to pick up wounded soldiers in regional centers like Mosul and Talil.

“We get fired at when we fly, and we could get shot down,” Wirth said. “But that’s nothing compared to the guy in the ditch.”

Wirth, who’s been away from his job as a Seattle firefighter since 2003, said the focus is on safely moving the patients and managing their pain.

“A large number of guys, they will be denying their pain,” he said. “But they will have tears in their eyes and will be gripping with white knuckles.”

Wirth often takes patients to the hospital at Balad Air Base, a collection of more than 30 connected tents and a few trailers in the heat and dust of a former Iraqi air base.

There is no indoor plumbing. But hospital staff said they can do just about anything a major U.S. hospital can do, except heart transplants.

A bone saw is always buzzing in the tents.

The hospital sees more than 650 emergency patients and performs more than 450 surgeries a month. The wards are mostly filled with Iraqi soldiers, police and civilians.
They lie listlessly in hospital beds, some with horrible burns and abrasions. After treatment and triage, they’re released or sent to Iraqi-run hospitals. They are rarely evacuated on American flights to Germany.

About two-thirds of the patients who come through are U.S. troops, with the occasional Brit or other coalition partner, but the Americans normally spend less than 24 hours here before being evacuated. They often are unconscious the whole time, brought in on helicopters, planes or convoys from the battlefield.

Hospital staff must remove stashes of ammo from the patients – including the single bullet that many soldiers tuck away to shoot themselves with if things get too bad.

Unlike anything in the U.S.

Balad is where ABC News anchorman Bob Woodruff and his cameraman, Doug Vogt, were taken after being severely wounded in a bomb blast near Baghdad in January.

Schlifka, the neurosurgeon who lives in Puyallup, was part of the team that worked on them. He said the journalists got no better or worse treatment than the average GI.

“(We) did not know who these guys were when they came in,” Schlifka said. “I only found out who they were when I spoke with my wife later.”

The surgeons often see multiple penetrating brain injuries a day. They routinely perform craniectomies, in which they remove part of the skull to relieve swelling of the brain. Woodruff, who was hit by a roadside bomb while standing in the hatch of an Iraqi army vehicle, apparently underwent such a procedure.

Schlifka is a burly man whose hospital screen saver has pictures of his beloved mastiffs, Baloo and Thor. He said the surgeons are close-knit, goofing around and playing practical jokes to relieve the constant stress. Little attention is paid to rank.

They kick back at “the Swamp,” a building at the rear of the hospital, where doctors grill, watch movies and smoke cigars when not in surgery.

Nurses said the surgeons working at Balad will lecture at medical schools for years to come on the injuries they saw in Iraq and the innovative ways they put people back together.

An estimated 96 percent of the troops who make it from the battlefield to Balad survive.

Lt. Richard Stevens, an intensive-care nurse and a 1987 graduate of Peninsula High School, said this is a medical experience unlike anything he could get in the U.S.

It’s hard, though, to see 20-year-old kids with limbs blown off. Sometimes the insurgents responsible for those injuries are in the hospital’s operating room right next to the soldiers whose lives they shattered.

“For me, those insurgents get the minimum care – nothing special,” Stevens said. “I have an awful hard time taking care of those guys.”

Doctors and nurses at Balad say it’s their duty, like taking care of murderers in hospitals in the U.S. They take some consolation in knowing the insurgents go to prisons like Abu Ghraib after their treatment at Balad.

‘Semper Gumby’

Next door to the theater hospital at Balad is the 446th Aeromedical Evacuation Squadron from McChord. The reserve unit gets patients ready for the airlift from Iraq to Germany. A Washington state flag hangs on a wall.

They arrived in Iraq more than three months ago and have a few weeks left. They landed at 9 a.m. one day and had their first mission the same evening.

The pace hasn’t let up. The unit has adopted the motto “Semper Gumby,” emphasizing the need to always be flexible.

The crew of about 70 from McChord tries to bring some normalcy to the wounded who come straight from the desert battlefield. There are donated civilian clothes, a Playstation 2, television, magazines and books.

The McChord reservists, some of whom are carpenters, even built an outside deck, a basketball court, a fire pit and a barbecue area for the walking patients to use.

“This is like being a mom of the sons I never had,” said Lt. Col. Karen Winter, a nurse from Lakewood.

Winter tries to get the injured soldiers to open up. It can be tough. Last week, she said, a Marine who had just graduated from Lake Washington High School in Kirkland came through. The young man had serious leg damage from a rocket-propelled-grenade attack. His buddy died trying to resuscitate him.

“He said he wanted to cry but just couldn’t,” Winter said of the survivor.

A nurse at Madigan back home, Winter said she loves helping soldiers. But she doesn’t think anyone will leave Iraq without some form of post-traumatic stress disorder. The sound of a truck backing up reminds her of the alarm klaxons that signal incoming mortars at Balad.

“I feel like I want to dive to the ground,” she said.

Maj. Diana Hunt of Seattle, a critical-care nurse who works for Airlift Northwest, said it hits her hard to see how young the wounded soldiers are. Most are between 18 and 25. Hunt said she thinks, “What if this was my kid?”

“I try not to let things get to me,” Hunt said, her voice breaking and tears coming to her eyes. “But some things have gotten to me here.”

Special considerations

The McChord medical team makes sure patients are ready for the 51/2-hour flight from Balad to Germany.

They have to consider the movement of the plane and what altitude it should fly; there can be problems with brain and eye injuries at high altitudes.

Another big consideration is taking care of the pain. The most serious patients are sedated.

“One of the most important things for us is that they don’t remember the experience,” Hunt said. “It’s very stressful and very traumatic.”

One night last week, the McChord crew was getting ready to evacuate one soldier with a spine injury from shrapnel and several with relatively minor ailments.

The patients, other than the one injured in combat, slept on cots in the darkened waiting room until the flight left around 4 a.m. About an hour before the flight, McChord medics drove to the hospital to pick up the soldier with the shrapnel wound.

The soldier was angry and drifting in and out of consciousness. He complained bitterly whenever he was moved and kept asking for “Excedrin Migraine.”

All the patients were quiet as medics loaded them aboard the C-17 for the trip to Germany. Their stretchers barely moved as the jet roared off from the desert war zone toward the sanctuary of Germany.

In-flight nurses stood by in what essentially was a flying hospital, checking the soldiers’ vitals and asking them how they were doing.

Spc. Brandon Lander, evacuated on a stretcher after falling from a guard tower near Muqdadiyah, seemed in awe of the care he was getting. Soldiers are used to being tough and self-reliant.

“I don’t think the Army could do enough to award the medics,” Lander said. “It is just absolutely incredible patient care.”

American, Iraqi use languages to form bond

Balad Air Base, Iraq – Lt. Richard Stevens, an intensive-care nurse who grew up in Gig Harbor, spends a lot of time helping Iraqis hurt in the war.

So Stevens turned to an Iraqi interpreter at the Air Force Theater Hospital here to teach him Arabic.

“I’ve tried to learn a few simple words and phrases from him,” said Stevens, an active-duty nurse normally based in Hawaii. “Like ‘This is going to hurt’ and ‘I’m sorry.’ I say ‘I’m sorry’ a lot.”

“He’s awesome,” said the interpreter named Faraj, a man with a quick smile and ready laugh. “He’s a good student.”

Like most native interpreters who work for coalition forces in Iraq, the interpreter knows that having his identity blown could get him and his family killed. He is taking a huge risk by working for the Americans at Balad Air Base, about 50 miles north of Baghdad.

His family lives in neighboring Balad, a city of about 80,000 on the banks of the Tigris River in the heart of the Sunni Triangle.

He is well aware of the dangers when he leaves the base every month or so to go see his family.

“The bad guys have eyes out there, especially the taxi drivers,” he said. But he said it’s not helpful to dwell on the risk.

“You don’t think,” he said. “You just go.”

He said his interpreting job is the only way to keep up his English, which he studied at an Iraqi university before the war. He’s clearly comfortable and well-liked by the U.S. medical staff.

Stevens knows firsthand the dangers that interpreters face. The nurse used to be stationed in Tikrit in a unit that hired two Iraqi brothers as interpreters. The insurgents kidnapped the men’s sister.

“They got back a body,” Stevens said. “That kind of hardens your resolve.”

Sean Cockerham: 253-597-8603
sean.cockerham@thenewstribune.com

Source: http://www.thenewstribune.com/news/local/story/5721510p-5122545c.html

Invivo Partners With Office of Naval Research to Devise Substantial Improvement in Caring for Casualties From Overseas Combat Zones

LATHAM, N.Y., April 11 /PRNewswire-FirstCall/ — Intermagnetics General Corporation (NASDAQ: IMGC) today announced that its subsidiary, Invivo Corporation, has been awarded a $500,000 Department of Defense grant to develop an integrated hardware and software system that will enable high-resolution magnetic resonance imaging (MRI) of traumatic brain injuries and promote substantially more effective diagnosis and treatment in many difficult cases. Invivo is partnering with the Office of Naval Research on the project.

Rep. Cliff Stearns (R-Fla.) is scheduled to formally announce the award during an appearance at Invivo’s Gainesville, Florida facility today at 9:00 AM EDT.

“Brain injury is the second leading cause of battlefield deaths, and this grant is intended to provide a means of diagnosis and treatment that, in many cases, is not totally reliable under current procedures,” Stearns said. “We owe it to our wounded military personnel returning from combat duty to have the best possible care available.”

Tom Schubert, chief technology officer of Invivo, added: “We believe Invivo’s advanced MRI radio frequency coils, which enable highly detailed organ-specific imaging, combined with modifications to our innovative DynaCad computer-aided diagnostic system will provide the solution the military is seeking.

“Currently,” Schubert added, “computed tomography (CT) is the main radiological tool for diagnosing traumatic brain injury patients. Yet every radiologist is aware that CT’s effectiveness in assessing brain trauma is limited to visualizing fractures and significant hematomas but is ineffective in diagnosing more subtle injuries.

“For example, CT does not provide the fine soft tissue discrimination required to localize and investigate small white matter lesions, such as the shear lesions and micro-bleedings that are common in traumatic or concussive brain injury. Nor can CT be used in the investigation of subarachnoidal hemorrhage. Subarachnoidal hemorrhages must be fully investigated in a very timely fashion, or they may lead to extremely dangerous secondary strokes.”

Schubert noted that the Invivo solution would be used in the highest-field MRI systems available, such as those powered by Intermagnetics’ 3.0 Tesla magnets. Invivo, working with the Office of Naval Research, expects to deliver evaluation models of both the advanced imaging hardware and the analysis software this year. Naval neurologists, neurosurgeons, and traumatic brain injury specialists will conduct scientific and clinical evaluation of the prototypes.

Intermagnetics (http://www.intermagnetics.com/) draws on the financial strength, operational excellence and technical leadership in the market of Magnetic Resonance Imaging (MRI), as well as its expanding businesses within Medical Devices that encompass Invivo Diagnostic Imaging (focusing on MRI components & imaging sub-systems) and Invivo Patient Care (focusing on monitoring & other patient care devices). Intermagnetics is also a prominent participant in superconducting applications for Energy Technology. The company has a 35-year history as a successful developer, manufacturer and marketer of superconducting materials, high-field magnets, medical systems & components and other specialized high-value added devices.

Safe Harbor Statement: The statements contained in this press release that are not historical fact are “forward-looking statements” which involve various important assumptions, risks, uncertainties and other factors. These forward-looking statements are based on currently available competitive, financial and economic data and management’s views and assumptions regarding future events. Such forward-looking statements are inherently uncertain and are subject to risks, including but not limited to: the company’s ability to meet the performance, quality and price requirements of our customers, develop new products and maintain gross margin levels through continued production cost reductions and manufacturing efficiencies; the company’s ability to avoid the potential adverse impact of competitive emerging patents; as well as other risks and uncertainties set forth herein and in the company’s Annual Report on Forms 10-K and 10-Q. Except for the company’s continuing obligation to disclose material information under federal securities law, the company is not obligated to update its forward-looking statements even though situations may change in the future. The company qualifies all of its forward-looking statements by these cautionary statements.
Website: http://www.intermagnetics.com/

Source : http://sev.prnewswire.com/computer-electronics/20060411/NYTU02511042006-1.html

At 21 years old Tracy Lussenhop-Caldwell learned to walk, talk, read and write and just about everything else most people take for granted.

Caldwell, studying veterinarian medicine at the University of Illinois, was driving to a part-time job on Nov. 5, 1990 when she crashed her new Mustang GT. It was an accident that would change the course of the rest of her life.

“I assume I was going over the speed limit,” Caldwell said. “My tires hit a puddle and the car was wrapped around a telephone poll.”

The car was equipped with airbags, but the bag exploded, throwing Caldwell into the back of the vehicle. She ended up in a coma at Olympia Fields Hospital.

She underwent the first of five brain surgeries, a tracheotomy and had a feeding tube put in. She later was transferred to Northwestern Memorial Hospital where she underwent more brain surgery.

“My brain was like a ball flattened on the side,” she said. “The left hemisphere was damaged. That has math and science skills, all of your knowledge.”

To add to her troubles her brother died of an accident on the day she awoke from a 20-day coma.

He was just the first member of her family who would die during her years of recovery.
A cousin died in 1993 and her mother died from breast cancer in 1995.

“One year, one month, one day later I get a call from the Richton Park Police that they were looking for my father. Nine days later the Chicago Police found his body.”

A cousin died just two years later, in 1998.

But with all of that, Caldwell had her own recovery to deal with.

Tests at Northwestern after Caldwell came out of the coma showed that her general knowledge was at an eighth-grade level. In college she had been an honor-roll student, but all of that was gone.

“They were able to save my life, but they couldn’t continue my life. I had to learn how to talk, to stand. I had to learn everything again at age 21.

“I was a very physical, a very strong, very active person. I had always been a tomboy,” Caldwell said.

Now, more than 15 years later, Caldwell has come to terms with her injury and the life she has led since.

She suffers from grand mal seizures and severe depression, but at the same time she has tried to use her experiences to help other people.

She is married with two children and still has the love of animals that led her into veterinary medicine in college.

She is preparing to take part in this fall’s Chicago marathon with an eye toward raising money for the Brain Injury Association of America and PAWS (Pets are Worth Saving).

As part of her preparation Caldwell plans to take part Sunday in the Morton Grove Park District’s annual Prairie View 5K Run/Fun Walk.

In addition, she walks between 8 and 10 miles a day with her Saint Bernard Cubby.

On the advice of her doctors, Caldwell’s husband Jim will accompany her on the marathon. It’s something he would likely do anyway.

He’s protective of his wife, coming home from work during an interview and warning her about her doctor’s advice when she says she may try running rather than walking in the Prairie View 5K.

He also is one of her biggest boosters. “I’m very proud of her,” Jim Caldwell said.

As part of her recovery Caldwell has attended a support group for people with brain injuries at Lutheran General Hospital.

She went to her first meeting in December 2002 and more than three years later has “grown into a mentor role,” said Nancy Landre, who leads the Traumatic Brain Injury Support Group.
“She enjoys being in the role where she can give advice and be helpful to others,” Landre said. “She’s always willing to extend herself to other people in the group.”

Caldwell also has tried to help other people better understand what a severe brain injury means to its victims. She has spoken to Sociology of Family classes at DePaul University and Biology classes at Truman College.

“I do as much as I can for everybody,” Caldwell said.

She also has tried to learn more about herself, spending hours at the Morton Grove Public Library studying about traumatic brain injuries.

“I’m fascinated with the brain and how I became what I am,” Caldwell said. “I just on my own want to learn.”

Family members, as well as victims, often learn of various tests purportedly administered following traumatic brain injury. Whether the tests were administered in a given case, and whether positive results were found, may not conclusively establish, nor rule out, the existence of brain injury. Nonetheless, brief description of common tests follows:

(a) Glasgow Coma Scale. Often times administered by EMT personnel or paramedics during ambulance transport from the scene of an accident, the Glasgow Coma Scale rates (1) a patient’s ability to open his/her eyes; (2) motor responses to verbal/painful stimulus; and (3) verbal responses.

The Glasgow Coma Scale is also used to rate coma victims, and an individual’s response, or lack thereof, may correlate, especially in severe cases, to cognitive deficits:

Eyes ______Score

Open spontaneously 4

Open to verbal command 3

Open to pain 2

No response 1

Best Motor Response to Verbal Command

Obeys verbal command 6

Best Motor Response to Painful Stimulus

Localizes pain 5

Flexion – withdrawal 4

Flexion – abnormal 3

Extension 2

No response 1

Best Verbal Response Oriented and converses 5

Disoriented and converses 4

Inappropriate words 3

Incomprehensive sounds 2

No response 1

Remember, modern definitions of mild traumatic brain injury allow for a Glasgow Coma Scale score of between 13 to 15. Under the Scale itself, a person generally thought to be alert and oriented would be rated 15, while an unresponsive comatose individual would rate as low as 3.

(b) Sophisticated Imaging. Various sophisticated imaging tests may have been performed diagnostically in the hospital or radiology setting. These include:

(1) Skull x-rays;

(2) CT Scans;

(3)MRI Scans; and

(4) EEG studies.

Generally speaking, this imaging is extremely helpful in cases involving skull fractures as well as hematomas, or hemorrhages which may occur at a variety of locations in the brain.

Common hematomas include extradural hematomas involving a collection of blood outside the dura between the inner-table of the skull and the dura; subdural hematomas involving a collection of blood beneath the dura; and intra-cerebral hematomas involving a collection of blood within the brain itself.

These imaging tests may reveal no positive findings, however, in cases involving “mild” traumatic brain injury. Often times, “mild” to “moderate” traumatic brain injury involves diffuse axonal injury caused by shearing forces. Indeed, axonal degeneration is only seen in the traumatized brain. Yet, its direct visualization is not presently technologically feasible except when a large number of clustered neurons are interrupted. Following death, however, neuro-pathological investigation clearly evidences diffuse axonal hearing.

Recently, the development of new, highly sophisticated imaging techniques have helped the diagnostic process, but are still far from conclusive. Such tests include:

(1)brain mapping;

(2)SPECT scans;

(3)PET scans; and

(4) MRA.

While not conclusive, these tests have provided validation for neuropsychological assessments, and in the setting of the courtroom may provide the jurors with a picture of the invisible injury.

(c) The Rancho Los Amigas Cognitive Scale.This scale describes levels of function and is used to evaluate the progress of a patient and rehabilitative development. Victims routinely reflect multiple category symptomology.

(i) No Response. No response to pain, touch, sound or sight. (Patient appears to be in deep sleep.)

(ii) Generalized Response. General reflex response to pain.

(iii)Localized Response. Localized response to pain. (Blinks to strong light, turns toward or away from sound, responds to physical discomfort, inconsistent response to commands.

(iv) Confused/Agitated. Alert, very active, aggressive or bizarre behaviors, performs motor activities, but behavior is non-purposeful, extremely short attention span.

(v) Confused/Non-Agitated. Gross attention to environment, highly distractible, requires continual redirection, difficulty learning new tasks, agitated by too much stimulation. May engage in social conversation but with inappropriate verbalization.

(vi) Confused/Appropriate. Inconsistent orientation to time and place, retention span/recent memory impaired, begins to recall past, consistently follows simple directions, goal-directed behavior with assistance.

(vii) Automatic/Appropriate. Performs daily routine in highly familiar environment in a non-confused but automatic robot-like manner. Skills noticeably deteriorate in unfamiliar environment. Lacks realistic planning for own future.

(viii) Purposeful/Appropriate. Patient is alert and oriented and is able to recall and integrate past and recent events.

(d)Neuropsychological Testing. Neuropsychological testing is the sine qua non for modern diagnostics of brain injury. It is proven reliable, accurate, and unlike other testing and evaluative mechanisms which compare patients with the so-called “normal person”, neuropsychological testing evaluates whether a particular patient has himself/herself changed.

The rationale for this distinction is easily enunciated: As an individual grows and matures, s/he develops and utilizes the most efficient pathways in the brain. When traumatic brain injury occurs, many times those pathways are severed or unable to properly transmit or receive information. Methods of learning and behaving are altered. While this individual may still be within the normal population range, s/he would surely be outside their individual “pre-injury” range.

Neuropsychological testing allows competent professionals to reach the conclusion, to a reasonable degree of scientific probability, that organic brain injury has occurred. It further allows the professionals to pinpoint areas of deficit, be they visual/spacial, memory, recall or other. Simply put, neuropsychological testing is the most important testing most “mild” to “moderate” traumatic brain injury patients will undergo.

Neuropsychological assessment is a method of validation, which measures the ability of the nervous system to perform cognitive functions we minimally need to exist. It measures compromise of functions against pre-morbid capabilities. Neuropsychologists are psychologists with specialized training. Neuropsychological assessment is an interface between science and practice.

Current debate in the field of neuropsychology focuses primarily on approach. Many neuropsychologists advocate the quantitative approach utilizing the so-called “non-flex” Halstead-Reitan battery of testing. Still others advocate the “flexible battery” approach. Statistical accuracy is the issue.

Irrespective of approach, neuropsychological assessment is essential to the proper diagnoses and treatment of most victims of traumatic brain injury.