How Can Apps Help People with Brain Injury?

How Can Apps Help People with Brain Injury?


Apps are really important for individuals
with traumatic brain injury and PTSD and other kinds of brain conditions. What I found is that they really allow individuals
to apply cognitive skills in a very practical functional way in a way other than often they
get in more traditional kids of therapies. When an individual has a brain injury they
have difficulty with organization and time management and memory and decision making. And one of the interesting things about apps
is that apps allow them to apply strategies to deal with some of those issues that they
might be facing on an everyday life. But the apps give them immediate feedback
that they can then use in order to sort of determine whether or not they’re on the
right track. Whereas if you’re using something like paper
and pencil it’s not so easy to see the results. The other thing about apps is that they’re
with them every day, all day long. And so they’re able to actually use the
applications throughout the day to ben them and to help them with some of the cognitive
struggles that they have.

Traumatic Brain Injury (TBI): Insights from the National Institute of Nursing Research


MUSIC NARRATOR: The National Institute of Nursing Research,
or NINR, supports the science that improves health and wellness for people at every stage
of life. Research supported by NINR also develops the
science that can lead to better patient care. And the Institute supports tomorrow’s discoveries
by training the next generation of nurse scientists. Dr. Jessica Gill is among those who have benefited
from NINR’s training programs. Her research aims to identify those who are
at risk for ongoing complications from traumatic brain injury. DR JESSICA GILL: The focus of my lab is traumatic brain injuries, or TBIs. These are extremely common in the lives of
Americans. About one-fourth of individuals in America
will have at least one of these injuries during their lifetime. The focus of our work is to understand this
individual variability through looking at biomarkers that we can look at in the blood
to understand how genes and proteins relate to this risk with the idea that if we can
identify these individuals and we can find ways to treat them better, we can prevent the
onset of these symptoms. A big focus of my lab is looking at a protein
called tau which is a microtubule associated protein that is secreted from the brain when
there’s damage following a traumatic brain injury or a concussion. We’ve found that tau elevations relate to
recovery from TBIs. They’ve also been linked to greater risks
for neuro degeneration both from Alzheimer’s disease as well as something called chronic
traumatic encephalopathy or CTE, in which some athletes with multiple sub-concussive
hits and concussions can go on to have Alzheimer’s-like disease risk factors as well as symptoms and
deficits. One of the major limitations in looking at
tau is that it’s in very low concentrations following brain injury. So it’s something like looking for grains
of sand in an Olympic sized swimming pool but what we found is having five grains of
sand versus 50 grains of sand is really important to measure and to link to disability following
TBI’s. So what we’ve done is use an ultra sensitive
technology that’s been developed commercially and we’ve been able to look at tau in very
small quantities in these individuals with more mild related injuries and to be able
to look at it in their blood as well as their sweat and their saliva. One of the big findings from our lab is that
following a sports-related concussion we can see elevations in total tau in the blood relate
to a prolonged return to play. Such that those athletes that need a prolonged
return to play will have elevations in tau within their blood within six hours of the
concussion. What’s really important about this finding
is that if an athlete goes back to play prior to full recovery from that brain injury and
then has another concussion or brain injury they’re at the highest risk to have lasting symptoms
and deficits. So by having a biomarker that helps us make
those very difficult decisions, it helps improve the safety of the athletes. As a nursing scientist I approach research
as a way to address a question, and for me my question came from being an emergency room
nurse. I would see patients coming in acutely with
traumatic brain injuries and concussions. And we’d send them off but many of them would
not get better and we didn’t know why. So I came to the NIH to be able to do additional
training to better understand the reasons why these patients weren’t recovering with
a focus being if we can identify the reason, then we can find an intervention to help those
individuals.

Division of Vocational Rehabilitation Services for Traumatic Brain Injury (TBI)

Division of Vocational Rehabilitation Services for Traumatic Brain Injury (TBI)


[ Music ]>>Interviewer: The Brain Injury
Guide and Resources is a tool for professionals,
community members and family to understand Traumatic
Brain Injury as well as how to promote better living for
those who live with a TBI. In this interview we will
talk with John Harper, assistant director of
mental health services in the Missouri Division of
Vocational Rehabilitation Office of Adult Learning
and Rehabilitation. We’ll be discussing Division of Vocational Rehabilitation
services for TBI survivors. And John, thank you very
much for being with us. We appreciate it.>>John Harper: I’m
glad to be here.>>Interviewer: First of
all, what is the Division of Vocational Rehabilitation
and what are its primary goals?>>John Harper: The Vocational
Rehabilitation is the state agency in Missouri administering
the federal program under the Rehabilitation Act. The Rehabilitation Act is those
services that are provided under the federal law to assist
persons with disabilities with going back to work.>>Interviewer: And what are
the types of services provided by your division
related to education and then also employment?>>John Harper: Certainly. Well, really the focus,
the goal, is going to work from our services, and
if you can imagine any of the related services
that could support going to work, including education. We help people with retraining,
if need be, to go to work, attending college,
junior college courses, certificate training
programs and so forth. We also have some very
specialized services called supported employment. So let’s say an individual
is just interested in going back to work. We help them find a job, and we provide something called
job coaching services to assist that individual with
learning the job again, or having somebody to talk about
the relationships while working, all of those activities that
a lot of us take for granted.>>Interviewer: And does your
agency work with other agencies that might help people
with a TBI?>>John Harper: Certainly. Certainly. That’s one of the keys to the Vocational
Rehabilitation program. Really, administratively as
an agency, a federal agency, we’ve been around oh, I
guess about 85 to 90 years. So we started doing this
just after World War I as an agency federally,and
really had set the routine of collaborating
and coordinating with various agencies
across the country. VR initially was working with
Veterans returning to work, and started reaching out really
into the educational field. And that’s where we’re
located at the federal program.>>Interviewer: And how does a
person with a TBI get involved with your organization?>>John Harper: If an individual
is interested in our services, they merely need to contact
one of our 25 district offices across the state and request
to have an appointment with counselor, and that
counselor will walk them through the eligibility
process and describe to them the services that they
might have available to them to support them to
return to work.>>Interviewer: How successful
is your program, John? Are you able to get
people back to work?>>John Harper: Oh,
we’re highly successful. I’m very proud of
the Missouri program. Typically out of
the 85 VR agencies, the State of Missouri general
program is usually one, number one or number
two, in the country. Our success rate typically
is around 65 percent of the individuals that
we’ve provided services to go back to work. Very oftentimes those that
maybe don’t have a job, they usually return back to us because something is
going on in their lives. They just can’t move forward
yet, so they come back and then we’re successful
with them at a later date.>>Interviewer: So is it
typically maybe some other organization that
refers people to you? Is that how they get to you?>>John Harper: Well, yes. Certainly,it’s not unusual
for individuals that are, especially with Traumatic Brain
Injury, their treatment team to contact a VR counselor
and bring them in to the process
very early just to start creating some
relationship with the survivor and the family to have that
discussion about employment. One of the things that
we very often like to do in the VR agency is try to
help that person go back to the job they had
previously and retain that job. We can do many things working
with the individual as well as the employer to make
that transition back to work more effective.>>Interviewer: What if
the individual is not sure if they can go back
to work, John? Should they still
contact your agency?>>John Harper: Yes, certainly., hey should contact our agency. One of the primary services
we provide is Vocational Rehabilitation Guides
and counseling. Very oftentimes it
becomes a matter of timing for an individual, a survivor
of Traumatic Brain Injury, to make that determination,of
what’s the appropriate point that I need to go back to work, hen should I start
exploring that? Because there are many
factors regarding that, especially fatigue, and
it’s a primary factor.>>Interviewer: All right. John Harper, thanks so
much for being with us. We appreciate it.>>John Harper: Thank
you very much.>>Interviewer: And thank you
for watching this interview on Vocational Rehabilitation
Services After TBI, a service of the Brain
Injury Guide and Resources. [ Music ]

Dr. Peter A. Levine Interview – Somatic Experiencing for Stress Relief Simplified

Dr. Peter A. Levine Interview – Somatic Experiencing for Stress Relief Simplified


hi I’m Michael here with my partner Dannette welcome to the stress relief simplified summit we’re excited to share with you proven practices to calm your mind and body in our overstimulated world each day we will introduce you to a leading thought experts who will share resources information and simple practices to help break the cycle of stress and here with us today is Peter A Levine PhD Peter is Dr Levine is the best-selling author scientists researchers and clinician he’s been called one of the worlds preeminent expert on resolving trauma or more specifically the symptoms of trauma such as ptsd flashbacks anxiety and other conditions he has spent close to half a century understanding the human body and its response to what he calls accumulated stress and unresolved trauma the creator of somatic experiencing approach to resolving trauma and 1984 dr. Levine founded the somatic experiencing training institute an organization that has trained over 25,000 practitioners and therapists worldwide in this approach to healing traumas he’s the author of 11 books including the best-selling waking the tiger in an unspoken voice and trauma and memory and for the past six years dr. Levine has been pioneering a new method for resolving fibromyalgia and related conditions he cowrote a book with one of his students Maggie Phillips titled freedom from pain discover your body’s power to overcome physical pain this captures dr. Levine’s approach helping people with conditions like fibromyalgia and we’re lucky enough to have him with us here today welcome dr. Levine thank you thank you for the warm welcome our pleasure so I would love for you to start off with just an understanding of what is somatic experiencing what is somatic and how the science of how it helps us to relieve trauma and pain gladly gladly you know when I first started developing this was in that 19 in the late 1960s into the 1970s and at that time the definition of trauma is PTSD hadn’t yet happened and also the definition really gave the presented trauma PTSD as a brain disorder that was incurable thankfully I didn’t know about that so I had more freedom and what I discovered is that um that when were perceived that were threatened our bodies do things we stiffen we hold our breath we retract we we tighten our guts these are all things that the body does so when we’re overwhelmed either by continuing accumulated stress and or by trauma when that happens our bodies get stuck now and this is really important if the what goes on in the body the map of what’s going on the body is also sent back from the body into the mind okay so so when we’re we’re tight and we’re bracing or when our guts are all turned that information is going back into the brain and saying the threat still exists and so we then tighten even more and then we get feedback from our body that is even more and so this is what I call a positive feedback loop with negative consequences and and this I really believe is one of the roots of conditions like fibro- myalgia yeah yeah and so the somatic is that map if i understand you correctly the map between the body and the brain and how it overlaps is that what somatics is exactly it’s what it is is about changing that feedback loop you see breaking that that that perpetuating condition breaking the loop and so the body can let go and then have new experiences experiences that contradict those of trauma which are feared their overwhelming helplessness pain yeah yeah my experience in 1996 I suffered traumatic brain injury and and you know it as as my brain trauma started to heal as I was able to find words again and things like that the related effect was I developed severe pain in my body and for me that was even more troublesome than you know forgetting words and which is where I was led to being diagnosed with fibromyalgia and but so thank you for not knowing that the research that it sees things can’t be undone so that was exactly what I found through through yoga and through some of the practices we can actually rewire that I think it’s becoming clear that really the practices that work for trauma and also for chronic pain fibromyalgia that they are those that involve the body the living sensing a live body yes so as it relates to stress you’ve said that there are a couple of ways that we can get stuck in the trauma stress either it’s you know an acute incident or its accumulated over time and I think it’s similar to to you know like fibromyalgia if somebody might have a trauma a car accident and end up with the symptoms or it might have been you know 10 years and in an abusive situation that they then end up with that so can you say more about how the stress relates and and how overlaps these condition yeah well we have to define stress its a big its a big subject exactly it’s a very very very big subject but the example you gave is really a good one somebody who’s in an abusive relationship or in a family you know as a child where there’s a lot of fighting and and and and lack of connection with the children and so forth all of these erode our resilience to meeting rest and my approach is really to restore that that resilience I my work really began in a strange kind of way because you know I I realized that animals in the wild were able to throw off generally the effects of stress or a predator prey but if they’re you know if they if they’re almost caught but they escape they they they somehow shake it off so they’re not burdened with the accumulated stress and trauma and what I believe happens i’m pretty sure what happens is that there are there are innate things that the body does the brain and the body does to shake off our encounters with threat because if animals couldn’t do that then the animal wouldn’t survive probably then nor would the species survive so there has to be built in some kind of an immunity to stress and trauma that actually brings us back to baseline if we can learn not to interfere with it and i found that was the difference between the animal experience in predation and the human experience is that we’re the very sensations actually that destress us or take us out of trauma the very sensations our experience as frightening because we’re unfamiliar with them and because they also have a high charge but in somatic experiencing we help people touch into these experiences one small piece at a time that’s what i call titration so that the energy that’s compressed the stress and the trauma can be released slowly yeah I’ve seen some of your work where you use a slinky to demonstrate that that idea oh yay so let’s just take this image of a cheetah running down a gazelle on the in the Serengeti and just before the the cheetah is making the making the contact with the gazelle or when it has it down on the ground it was it was running to escape like this full-out I mean 65 even 70 miles an hour for this short sprint and so you have this tremendous energy that’s that’s being used for this it’s the same kind of energy that allows an 80-pound mother a 90-pound mother to lift the car off of her trapped child and pull the child out it’s incredible amount of energy that gets locked in the body so if we were to release this energy all at once we would have an explosion of the energy and in doing that we actually would be very often actually reinforcing the stress and the trauma so what what I discovered is that if we have a way that we very very slowly release that energy and let it come to equilibrium and then again release release more and let it come to equilibrium and release release more so we’re not releasing it all at once and that’s the key I feel to any effective approach to work with trauma and and accumulated stress in some ways accumulated stress is a little bit more tricky because when you have something that’s the direct cause it’s easier to work with but the principles are really the same follow-up to that I really believe in the work i do as a yoga therapist that the body starts to almost trust that constricted state that it’s in it’s because of the safety that it apparently in the moment might provide and that in that undoing and even in that gentle you know let’s have that little relief like you said there’s some fear in that expansion that’s right and so the undoing can often be as complicated as seen in it so I just want to know what your thoughts are to that I know there’s a lot of resistance yeah well yeah again I think Yoga is one of the things that’s now been shown demonstrated to be a very important component in working with trauma and also with chronic pain and again this has to be done in a very titrated way in a very gradual gradual way the key again in in sensing and coming out of these traps where the body is reinforcing the minds experience of fear the trick here is to become aware that when we are actually able to experience these sensations while they may feel worse at first they may feel even more contracted that they will then expand and again you might remember the toy that I have for demonstrating this because we are always in a state of either contraction or expansion so in trauma and in chronic pain we get caught in this contraction but when we and we don’t want to feel it because it feels bad many cases it feels horrible but when we’re able to gradually contact it to just touch into it it may feel worse for the moment but then it feels better and then it feels worse contraction and then feels better expansion contraction expansion and that’s how people come out of trauma and out of chronic pain that is my my experience and as I said in working you know working with this for over 45 years oh Lord a long time thank you for that work yes absolutely thank you for that demonstration that helps a lot those of us that are visual Peter you’re currently developing a method for addressing fibromyalgia and related condition can you tell us about this work and what are other related conditions your work will also address okay well as you you probably know that fibromyalgia is often accompanied with other conditions that are related to the fibromyalgia and I actually wrote an article on that and I can probably send copies of that to your audience yeah I would be glad to do that but anyhow the fibromyalgia often is accompanied by irritable bowel migraines urinary issues irritable bowel and migraines sometimes and I see those actually being part of a the same underlying mechanism of a core dis-regulation and so we’ve been working on a program for helping to address these kind of conditions with focusing primarily on fibromyalgia but again knowing that these are followed with these other conditions and we we were in the process of we are in the process of testing it of seeing really how well it works as you know we did a test with a group of 12 people who were suffering from fibromyalgia and these conditions and by enlarged it was a very positive response so we want to really make sure that that we want to test this with more people and tested in a program and a format that people can use at home so forth so we’re going to be continuing research on that and I’m working with an incredible team of it was a man who who is a a philanthropist and entrepreneur and who’s really mission is to help people who are suffering and we met at a lecture that I gave and then we have a person from MIT who is an expert in in computers of human interaction and so forth so we’ve been working together on develop this program and we’re in the process of testing it and for sure if your audience is listening or wanting more information we’ll give you a website and they can sign up there and we’ll give you that information send the article and I thought also a video that might be helpful this marine that I had worked with who is suffering from traumatic brain injury and severe PTSD chronic pain depression and so forth and we see how in a few sessions he really was able to come out of this and engage back into life so we’ll we’ll send them that link as well I think this says real stories where you you see and you hear about the transformation that’s possible are essential and thank you yeah right again you know it’s all theory until you experience it and then when people you know experience that oh my god I don’t have to be caught in this that I’m able to actually move into it and out of it and into it out of it that it no longer keeps us absolutely trapped and and and when that happens the person has gone 50 one percent of the way thats kind of like Richard Miller had mentioned you take these incremental steps and you kind of move from hope to faith to trust and it was kind of like the example you were giving where you release the energy slower or it’s kind of incremental steps yeah with yeah yeah that is the key the incremental steps so again we don’t want to be overwhelmed we don’t want the person to be overwhelmed because in terms of the brain it really can’t tell the difference between being overwhelmed in present time and being overwhelmed in past time so it’s not really helping and I’m I’m very I’m definitely not a fan of some of the treatments for PTSD that have to do with exposure where you have the person relive over and over again the worst part of a traumatic experiencing I think that’s just inflicting unnecessary pain and suffering and that does lead me lead me to my next question for you how does your understanding of fibromyalgia differ from Western medicines understanding right well Western medicine is fantastic for certain things that I am actually seeing and seeing almost 20 20 is a miracle of modern technical medicine i had cataracts and had the surgery and then had lens implanted that’s absolute miraculous you’re in a car crash you’re taken to the hospital emergency medicine miraculous you you have a lung infection and you get an antibiotic and you’re cured the infection medicine is incredible in this realm when people with fibromyalgia comes to see a physician you need people with fibromyalgia see an average of six physicians before they even are diagnosed with fibromyalgia Western medicine really doesn’t have anything to help very much I mean there are a few things that help some people there’s there’s no question about that but really getting at the underlying dynamics of what’s causing the fibromyalgia Western medicine doesn’t doesn’t really understand that doesn’t really have a have a clue and as I described it I see it as a functional disorder not as a pathology not as a disease but the functional disorder again that we get stuck in this condition where our bodies are tight are braced and often at the same time also collapsed and without energy so to work with these kind of functional issues a Western medicine doesn’t really have much to say I mean occasionally they may recommend something like biofeedback which of course in very often it is helpful but basically Western medicine really doesn’t have a clue about working with fibromyalgia indeed many people who see a physician who have fibromyalgia and the other and other condition they may be sent to a Rheumatologist because of the pain and then there may be diagnosed with fibromyalgia they migraines are sent off into a neurologist and by the way of course if somebody has any of these conditions you have to eliminate a possible medical cause and that’s that’s that’s common sense so so anyhow further for gastrointestinal problems for irritable bowel they’re sent to a gastroenterologist the urinary problems to the urologist and so forth and so on and so and then often these these specialists you know report back to the primary care physician we couldn’t find anything so again it’s important to make sure that there’s nothing medically involved but medicine per se doesn’t understand these kind of conditions and therefore unable to work with them effectively hopefully we’ll begin to change this I’ve seen a little bit of change with alternative practices at the VA I get all my health services here in San Diego at the VA okay the VA here they’re really good they have yoga in house now they’ll send you outside the facility for acupuncture that’s right yes there are certain exactly exactly things are opening up yeah acupuncture even the bodywork or massage yeah you know things are happening and I think in 10 years people look quite different than they look right now I think in a way as you gave an example for the VA you know that people were not getting the treatment that they needed it and so then they started to ask the question why and and that’s an example of a forward-thinking organization I I think the subtitle of your book freedom from pain it references your body’s power to overcome physical pain can you speak more to what you mean by the body’s power yes important question this is I spoke a little bit about this before this is about the our innate capacity to rebound from states of stress or threat it’s what allows the animal to shake off its encounters with a predator it’s what I think someone called the instinct to heal and I believe that instinct is profoundly powerful the question is how to tap into it and that for me is about the living knowing the living sensing knowing body that when we allow the body to do what it is meant to do to allow our sensations and feelings to do what they are meant to do then we can begin to overcome the effects of pain and stress and trauma again I see them not as separate but as coexisting conditions so you had said just a few moments ago that the body the mind actually doesn’t understand the difference between a real-time stressor and a stressor from the past am i understanding you correctly that is actually the body is kind of that gateway to differentiate between the two which will then allow the space for healing yeah yeah you i mean you could for sure say that I think that it goes back to again of not wanting to overwhelm the person and that’s really the key so a lot of times are symptoms our physical symptoms are in a way snapshots accumulated snapshots of things that have happened to us in the past and they kind of layer one upon the other and the other and again the key is getting the best touching incident allowing it to complete and to resolve so for example let’s just say the child was uh was was hit by a parent routinely so the first time the child lifts up you know tries to protect themselves from being hit and then they let go and then the parent again start yelling or screaming or hits them and the shoulders go up again this time it doesn’t come down all the way it stays partly up so what what is the shoulder doing the shoulder is actually trying to protect the child against being hit but it gets stuck here so through body awareness through as we do in somatic experiencing the person actually is able to complete this response so they’re able to feel not only the shoulders going up but what the rest of their arms had wanted to do but couldn’t do because they were too small and we’re overwhelmed so we’re completing that stuck response and then that allows it to release it is powerful and when a person first experiences it you see their eyes will open and they look around the room in utter amazement you know and also because they’re seeing things differently they’re seeing things with more color more clear because once we shift from the inside it also shifts on the outside as within so without and then how must that effects all the layers of their life that they no longer have that need to protect which isn’t just showing up in the body it’s showing up on how they relate and respond to the world right exactly exactly because when you’re in that kind of a state you experience even the loving touch from a from a mate as being frightening as being yeah right frightening or as disgusting or something like that because again it’s reactivating reactivating those circuits from the earlier the earlier trauma amazing work that you’re doing that you can understand and are training all these practitioners to help then all the people that they’re touching to undo the effects of this in our bodies and you know I I have believed for very long time that the symptoms I experienced after my traumatic brain injuries were not just the results of this traumatic brain injuries like you know what was my lifestyle leading up to that point not everyone that has a traumatic brain injury ends up debilitated for 13 years by chronic pain right so you understood that mechanism was you know was the trauma was the trauma was actually kinda a gift the traumatic brain injury was kind of the gift that has brought me to an understanding and through through through body work through movements and moving with the breath and then being introduced to your work last year which we so appreciate so so thank you from my perspective and Michael really has similar perspective and I think a lot of times it’s true I’m sorry I just to finish my thought about PTSD in my opinion a lot of people with ptsd likely had some pre-disposition to it before the trauma because of lifestyle or yeah right I I mean it’s the thing that we’re we’re discovering more and more is when there’s neglect or chronic stress in the family that makes the people more susceptible to becoming traumatized later there’s there’s no question but again it is my experience that when we’re able to tap into that innate capacity to heal that we can actually restore re-learn how to be more resilient human beings and as you pointed out beautifully and many people who have trauma have say this you know when they come to the other side when they come back to their bodies they in a way thank the trauma because without that they wouldn’t have made that inner connection also this one thing i forgot i want to just add in that example of where the child is afraid of being hit well think of what happens when this becomes chronic just do that for 20 minutes and you’re going to start feeling significant pain i’m not suggesting people do that right especially people with fibromyalgia again you can see how these input responses can then add up and then the body is just burden with this accumulation of stress and pain yeah so I would love now if we could come back to the practices to to the things that you’re actually doing to help with this rewiring of trauma and can you share with this you know maybe one or two of your proven practices to help with breaking the cycle well there are many many many many but let’s give one that’s deceptively simple and this relates to the what we were talking about before with the contraction and the expansion this is what I call pendulation so when we’re experiencing something even if it feels worse momentarily then it can open and feel better and gradually will open more and more and more so and this also is again is a very simple exercise to take the first step to coming back to the body in a safe way so what I’ll do and by the way if any of these exercises evokes this exercise evokes pain then just don’t do it just observe it or imagine doing but sometimes that can be as effective even more effective than also doing it so let’s just look at your hand our hands and now just put your hands in to a fist and just look at that notice that again just gently gently into a closed fist and then open them again and just looking at that so you’re noticing that now begin to put your mind your awareness into the physical sensations of your hands as they slowly begin to close and again only closing as is comfortable enough moving towards the fist feeling the closed position and then slowly opening again feeling the physical sensations noticing if they spread to other parts of the body if there’s some sense of openness and receptivity and then again if the hands closed do you feel an increase in tension or do you even maybe even experienced something like strength or power again just noticing the sensations of the feelings and once more just allowing the fingers slowly the hands slowly to open and I’m just wondering what you are experiencing Michael and Dannette in doing the exercise yeah so when the first time i was closing slowly there was a moment where it felt a little more comfortable and then it became the constriction I guess I could feel it more as constriction and opening the second time i opened it was it was much more of a release than the first time got it Michael yeah so I think mine was similar the first time I actually clenched my fist a little tighter than I needed to so I certainly felt the tension there but with each time that I did it I felt like I was I was focused obviously that’s important but there was a became calmer and calmer I guess just wow with great each time that i did it again that’s such a simple thing it’s trivial in a way but it gives you again an indication of how powerful the the introceptive sense the felt sense of the body can be in helping us release stress and restore the sense of goodness and wellness which is our true natural state which is exactly which is our natural state and it’s about restoring that natural state I don’t know if you have another practice to share but I want to ask about your experience when we start to restore that natural state what’s the effect on our experience of stress from there versus when we’re in that more diminished state so in other words i’m just going to kind of lead you like are we much more able to cope with stress once we start to restore versus when we’re still stuck in our our traumas sorry what more able to what to restore you so are we able to deal with life’s daily stresses because stress is inevitable from from that restored place that you’re talking about versus before we you know where we’re stuck in our previous trauma right now absolutely absolutely you know I think that’s the really the point of this is that we what when we are more in balance then then the stresses of everyday don’t effect us nearly as much maybe even challenge us in some ways you know one of my intellectual mentors was a man named Hans Selye and he’s the person who coined the term stress and he was working the 1940s 50’s into the sixties I think and basically his idea is that we stress it’s like a bank account you keep withdrawing cash stress and then till you don’t have any left and then you go into the red so he saw this as kind of I guess you could say a zero-sum game we just the stress erodes us erodes us erodes us but I was discovering again something very different and I can I can maybe give this as an example if we have time but that people when they rebound and they meet stress the nervous system is able to to move through the strength into relaxation activation deactivation relaxation the stress doesn’t accumulate so it’s not a linear system like Selye had thought and when I said to my PhD when I finished it I I was in a way critiquing his approach to stress and he sent me this most amazing letter saying that he really sees how important this is and and I was so deeply touched I really was because I didn’t know what his reaction was because it really contradicted his whole whole theory but this is the key that when we are resilient the stresses of everyday life don’t effect us in the same way not to say I mean obviously what we’re talking about refugee Syrian refugees who are in this refugee camps under these horrendous conditions I don’t think you know the Dalai Lama is going to do that well in the conditions like that you know it’s just one thing after another after another although you do find some people again like in the concentration camps that were more resilient you know Viktor Frankl of course is the example of that and that is a number of conditions and other types of situations two colleagues and I are actually going to be probably writing an article on resilience and I when that happens again I’ll be glad to send copies of that too to your group i’ll give you a link before we know before we end and we can get all that information to them well that’s a great cause i know our listeners are going to resonate with you and I know they’re going to want to find you so they can look into your work more further and join you in some of your programs and if you can just quickly mention so many websites where they can find you okay gladly the website where they can sign up to get this information and to get updates on how our project is going how our research is going we will absolutely do that and the website is www.somaticexperiencing.com and then get on the list and we’ll send them send them that information be sure oh and also my assistant said that would I guess it’s kind of a raffle thing and we’re giving away three copies of the book and the additional CD that goes with that also can go with the book on chronic on freedom from pain so we’ll we’ll send those out there i guess to 3 folks yeah wonderful thank you so is there any final wisdom you want to share yes I do i would say trauma and pain is it’s universal but it doesn’t have to be a life if trauma and pain may be a fact of life but it doesn’t have to be a life sentence and another thing that I’ve noticed when people work through their pain and trauma that they become a side effect of this is they become more compassionate more compassionate to themselves and more compassionate to eachother and so I would say that’s a commodity that we could well use more more of in the world today thank you for your compassion your wisdom your time your whole team’s time I you know I look forward to reading the book I haven’t yet but i definitely look forward to it and I know personally my FibroHaven community that you have made a difference and we’ll get you copies of the book thank you for all the work you’re doing with PTSD and those with trauma and for spending the time with us today well and thank you for getting this kind of information out it’s so dearly needed you know education is the first step yeah yeah thank you to our participants tune back in tomorrow we have another amazing thought leader like Dr Levine who will share their wisdom so many different perspectives and approaches to to helping with this so thank you again Dr Levine and we look forward to tomorrow okay Bye!

The Brain Injury Rehabilitation Program at Craig Hospital

The Brain Injury Rehabilitation Program at Craig Hospital


– There’s a reason why
thousands of patients like me have walked through the
doors of Craig Hospital every year since 1955. It’s not just because of
Craig’s world class outcomes, or expertise in brain injury, or the remarkable longevity of staff, leading research, peer mentoring, and family housing. It’s not because of the
patient centered treatment, or state-of-the-art facility. When you come to Craig, you’re not just getting
the best care out there. When you come to Craig, you join a family. (light upbeat music) – Craig is more than just a place for brain injury rehabilitation. It’s a place that changes you forever, and helps you return to an independent and meaningful life. – Why we chose Craig was, from the second that
I walked in the doors, in knew it was the right place. Everywhere that I went on the tour, I thought, oh my God, this is amazing, there’s people out and
about doing therapy, everyone looks so happy, felt like there was a camaraderie. – Following a catastrophic brain injury it’s important to understand that you, or your loved one may
need a very specialized, focused brain injury system of care. – This is where you wanna go for a complex traumatic brain injury because of the experience that we have as a collective group of physicians, and therapy, and nursing specialists. So, our specialized approach, and our years of experience and expertise, give us a real unique ability to address needs for the patients. – Knowing that they were
nationally renowned. That they had this
multi-disciplinary care team. They had exceptional patient outcomes, and as evidence that
where I was sending Mike was gonna be amazing. – After our initial assessment, we set up goals, we work everyday, every week, towards those goals. We align with the patient and their family in terms of where they
wanna be when they go home. – When we got there, they set us up, introduced us to our care team. – And the teams consist of the physician, a rehabilitation nurse, a neuropsychologist, a physical therapist, occupational therapist, and speech therapist, but we also have a therapeutic
recreation specialist, a music therapist. – The entire rehabilitation
team needs to understand those interactive dynamics. Personalized, individualized care, taking into account the individual, personal traits with
the injury’s severity, and then as an individual gets better with their injury, you as a team, have to have the experience and wherewithal to keep up
with their changing needs, and keep up with families
changing expectations, and be prepared for community integration, and the next phase of their life. – The other part is
critical of our component, in terms of team planning is, who is this patient? And recognizing this person before injury and where we have to get
them to after injury. – One thing that Craig always said is that we’re not just here for only you, we’re here for your whole family, which is something that made me feel super comfortable while being there because when a brain injury happens, it doesn’t just happen to an individual, it does happen to the entire family. – Craig houses families on the campus. So, right next to us is family housing. Families can be involved in
their loved one’s whole day, from getting up in the morning, to going to bed at night, and I think that’s a
comfort for families, too. – It’s not just a recommendation that families are involved. It’s actually, pretty much, an expectation that families are involved in all of our therapy sessions, in order to learn the skills, to be able to take their
loved one home with them. – I think, as a nurse, I was able to see that the
employees where super happy, and I think that that actually
makes a big difference in the care that you get, and in terms of their outcomes, you can see that. – Our discharge to home rate is very high. So, we’re not only able to
take folks through inpatient, but we’re also able to follow them through our community
reintegration program, and our driving program, and our outpatient program, back out into the community, and help support them to be successful. – The speech therapy, that was the main focus
point being an engineer and getting back at that cognitive level the demands of kinda high
paced work environment. – Speech pathologists and
occupational therapists work together for
augmentative communication. So, helping of patient’s
ability to communicate and then, assistive technology, which also may be, them being able to access technology, or use technology to, again, communicate with kinda the outside world. – What’s really impactful
about therapy here at Craig is maximizing somebody’s independence, bathing, dressing, feeding, homemaking, we have all the adaptive equipment, or adaptive techniques for somebody with limited mobility to be able to participate
in those activities. – When patients come to
Craig this is all new and what we really wanna
provide for them is hope, is opportunity, is really opening the
doors of what’s possible. – Years later, as I look back and we all look in the mirror, how am I in one piece? And I can’t fathom the recovery process going any better on any level, and I get a little smile to my face when I’m going through
the hallways at Craig because I know what I was like, and what Craig did for me. – It’s important to be confident that you’ve chosen the best quality care for yourself, or your loved one. Our patients live healthier, happier, and more independent lives than their peers at other facilities. At Craig, we don’t just provide
the best care out there. We empower lives. So, come to Craig and join our family. Visit craighospital.org to
start your admissions process.

Brain Injury Awareness

Brain Injury Awareness


– [Narrator] Your brain
controls everything you do. (popping) Walking, talking, sense
of taste, vision, balance, just about everything. So when an accident happens
that impacts your brain (honking) It can impact your whole
day or even your whole life. A brain injury can happen
many different ways any one of which fall
under two main categories, acquired, like a stroke or
lack of oxygen to the brain, or traumatic, like a
fall or a car accident. Whether it’s the result of a
mild traumatic brain injury, like a concussion, or the
result of a more serious brain injury, your life
can change forever. No two brains are alike. Symptoms may be different
for different people. After experiencing a brain
injury you may notice that your mood is different. You could get angry quicker, cry more, or laugh at inappropriate times. (laughing) Some of these include cognitive, physical or emotional symptoms. Symptoms can include feeling depressed, disrupted sleeping
patterns, loss of appetite, and lack of balance. You may feel like your
head is in a haze for weeks or your memory just might
not be as sharp as it was. Any of these symptoms can lead to a tremendous sense of social isolation. If you are struggling to
cope with the symptoms from a brain injury, do not
start using drugs and alcohol. Studies show that drugs and alcohol can increase recovery time
and increase brain damage. In addition, since many
substances effect judgment and balance, they also
can lead to a higher risk of obtaining a traumatic brain injury. When it comes to brain injury,
the only amount of alcohol or drugs that is safe to use is none. (popping) Education, support and
referral will help the person minimize long-term effects. If you are struggling with an injury, talk to your health care professionals. You can get help and have
hope for better future days. (light happy electronic music)

Living With A Stranger: My Husband’s Brain Injury

Living With A Stranger: My Husband’s Brain Injury


2 years ago, a stranger came to live in my house. The stranger looked a lot like my husband. But while my husband was warm, funny, and caring… The stranger was cold… humorless… and distant. My husband had always worked hard, taken care of the bills, and fixed the things around the house that needed fixing. But the stranger left that all up to me. He didn’t want to work. He didn’t care how we would pay the rent. Some days he didn’t even get out of bed. I no longer had a partner. And everything fell on MY shoulders. My husband and I were blessed with a beautiful daughter. And it might sound cliché but… she was his world. The stranger simply ignored her. Acted like she didn’t even exist. It seemed like he only cared about himself. And worst of all, the stranger had a terrible temper. He would get angry at the smallest things. Yell at me for hours because I simply asked him how he was feeling. His behavior, frightened and embarrassed our daughter. There were even times I was scared he might hurt me physically. But fortunately, it never came to that. My husband had always been very responsible and social. We enjoyed spending time with each other, and with our friends and family. But the stranger wanted me all to himself. He didn’t want anyone to visit. And he wouldn’t let me go out. I became more and more isolated. It seemed my whole life revolved around trying to hold our lives together. Taking care of our family, and taking care of this… lookalike. It felt like I was a nurse and a parent to a grown man. On the rare occasions I did get to see my friends I’d be desperate for them to ask me how I was feeling, how I was coping. For a shoulder to cry on. But they didn’t see my pain. They only asked me about the stranger. How HE was feeling. How HE was coping. It felt like I was living in a bubble. I wanted to scream. To cry out ‘WHAT ABOUT ME!’ I wanted to run away from it all. But I didn’t. I couldn’t. I kept it all locked up inside and carried on. I hid everything behind a smile and tried to make things as normal as possible for our family. Because the truth is… my husband never left. The man who came to stay is not a stranger. He’s the same man I met and fell in love with. The man I married and the father of our little girl. But 2 years ago, his life… our lives… changed forever. (CRASHING SOUND) My husband is one of the 5.3 million Americans who live with the devastating consequences of traumatic brain injury. And I am one of the millions of Americans who live with a spouse or loved one who has experienced a traumatic brain injury. Overnight I became my husband’s caretaker. His brain injury affected his memory. He forgot how to do simple tasks, making him feel confused and helpless. And for the longest time his feelings were trapped inside. But then one day he finally opened up to me about how he felt. How it seemed like he had an invisible rain cloud that followed him everywhere. And how the rain cloud made everything seem cold and gray. We became involved in the Brain Injury Association. He found support groups, and he got help. I also found a support group where I met others who were going through similar situations in their lives. It really helped to be able to talk to other people who understood what I was going through. We still have ups and downs. And there are still days that I worry about the future. But with patience, love and support, we are learning to adapt to our new lives together. Thank you for listening to my story.

Reducing Severe Traumatic Brain Injury in the U.S.


>>>GOOD AFTERNOON AND WELCOME TO THE CDC PUBLIC HEALTH
GRAND ROUNDS. THERE WILL BE A SIGNUP SHEET. SO THOSE FROM THE CENTER WHO ARE
NOT HERE IN PERSON, WE’LL HAVE A DISCUSSION ABOUT THAT LATER. BUT THOSE OF YOU WHO ARE HERE,
VERY GOOD TO SEE YOU. I ALSO WOULD LIKE TO WELCOME
MANY OF THOSE WHO ARE JOINING US BY INTERNET AND HERE ARE THE WEB
PAGE WHERE PEOPLE CAN WATCH US BASICALLY THROUGH YOUTUBE. TODAY’S TOPIC IS DRAMATIC BRAIN
INJURY. BEFORE WE LAUNCH INTO THE
SESSION, I WOULD LIKE TO TAKE A COUPLE OF MINUTES AND HAVE A
PERSONAL STORY OF A YOUNG GIRL WHO HAS EXPERIENCED TRAUMATIC
BRAIN INJURY BEING SHARED WITH YOU.>>IT WAS JANUARY 10th, 2005. I WAS 17 YEARS OLD AND MY HIGH
SCHOOL BASKETBALL TEAM WAS PLAYING A VARSITY GAME. AND IT WAS AROUND THE SECOND
QUARTER AND I WAS GOING UP FOR A REBOUND AND AS I CAME DOWN, THE
BACK OF MY HEAD COLLIDED WITH THE TOP OF ANOTHER GIRL’S HEAD. THE NEXT DAY, AFTER THE DAY I
GOT HIT, I WENT TO SCHOOL AND I WAS REALLY SICK. I KNOW I HAD A CONCUSSION
BECAUSE I SUFFERED THROUGH A CONCUSSION ANY SEVENTH GRADE
YEAR. I HAD ALL THE SYMPTOMS, DIZZY,
NAUSEOUS, I COULDN’T FOCUS IN SCHOOL. I CONTINUED TO PLAY A SECOND
GAME AFTER THAT AND I HAD PASSED OUT AFTER THE SECOND GAME IN THE
LOCKER ROOM. BASICALLY, I WAS BED RIDDEN IN
MY HOUSE FOR ABOUT SIX MONTHS STRAIGHT. I SLEPT ON THE COUCH BECAUSE OF
THE LIGHT. WE HAD TO PUT DARK SHEETS OVER
THE WINDOWS. MY MOM AND MY SISTER HAD TO HELP
ME WALK AROUND. I LOST MY BALANCE. I COULDN’T REALLY GET THAT BACK
FOR QUITE A WHILE. I DIDN’T KNOW IT COULD GET THIS
BAD. ALL ATHLETES HAVE A STRONG WILL
AND SINCE WE’RE YOUNG, WE KNOW THAT WE HAVE TO SUCK IT UP, SUCK
THINGS UP, WHETHER, YOU KNOW, YOU SPRAIN YOUR ANKLE OR YOU
HURT YOUR FINGER, YOU JUST GO IN THE GAME AND YOU SHAKE IT OFF
AND YOU DON’T COMPLAIN, YOU DON’T CRY. BUT THIS IS THE BRAIN AND HEAD
WE’RE TALKING ABOUT AND YOU CAN’T SUCK IT UP. SO UNFORTUNATELY INSTEAD OF
MISSING A GAME, I MISSED THE SEASON, I MISSED SPORTS FOR THE
REST OF MY LIFE AND I MISS OUT ON A GREAT LIFE THAT I COULD
HAVE HAD. ATHLETES NEED TO KNOW, IF YOU
THINK YOU HAVE A CONCUSSION, DON’T HIDE IT, REPORT IT. IT’S BETTER TO MISS ONE GAME
THAN THE ENTIRE SEASON.>>SPEAKERS, WE ACTUALLY HAVE
ONLY THREE SPEAKERS TODAY, BUT THEY CERTAINLY MAKE UP IN
QUALITY FOR THE FIVE OR FOUR THAT WE NORMALLY HAVE. OUR OWN DR. LISA McGUIRE, DR. DAVID WRIGHT FROM THE EMORY UNIVERSITY AND DR. ART KELLERMANN FROM RAND CORPORATION. EACH ONE OF THEM WILL TALK ABOUT
DIFFERENT ASPECTS OF HOW WE ARE DEALING WITH TRAUMATIC BRAIN
INJURY. THIS IS A COURSE THAT QUALIFIES
FOR THE CONTINUING EDUCATION CREDIT AND FOR THE FIRST TIME
NOW, WE ARE GOING TO BE HAVING Q&A SESSIONS AFTER YOU LISTEN TO
THE SESSION. YOU SHOULD GO TO THE WEB PAGE,
ANSWER FOUR OF THE FIVE QUESTIONS TO BE ABLE TO GET THE
CREDIT FOR THIS SESSION. SO JUST SITTING AND LISTENING IS
NOT ENOUGH ANY MORE. I WOULD ALSO LIKE TO POINT OUT
THAT, AS ALWAYS, WE ARE COORDINATING SLIDE CLIPS WITH
THE TOPIC OF OUR GRAND ROUNDS AND I WOULD LIKE TO THANK OUR
COLLEAGUES FROM THE INJURY CENTER WHO HAVE MADE THE
SELECTION FOR THIS WEEK. FINALLY, THIS IS A GROUP OF
PEOPLE THAT, AS ALWAYS, HAD TO DO SOME TEAM WORK. SO IN THIS TERM, DAVID CALL A
CALL AT THE EMORY AND WE ALL DEALT TO SEE HOW THE PATIENTS
DEAL WITH THESE REALLY SERIOUS AND LIFE THREATENING ISSUES AND
NURSE TONYA OR NURSE JACKIE WAS WATCHING ASIDE AND HAD TO GIVE
AN ENORMOUS AMOUNT OF CREDIT FOR THESE UNBELIEVABLY PROFESSIONALS
WHO HAVE WORKED WITH ME AND TOLERATED A LOT OF LITTLE DO
THIS, DON’T DO THIS TO MAKE THIS WHAT I HOPE IS GOING TO BE,
AGAIN, AN OUTSTANDING SESSION. I’D LIKE TO BRAG ABOUT THE
NUMBER OF PEOPLE THAT COME AND VIEW THIS SESSION BECAUSE IT’S
REALLY NOT JUST THE NUMBER OF PEOPLE IN THE AUDITORIUM. IT’S THOUSANDS OF PEOPLE, AS YOU
CAN SEE FROM THIS CHART, WHO HAVE BEEN WATCHING US LIVE. AND TO BE VERY SPECIFIC IN THE
PAST COUPLE OF YEARS THAT WE HAVE BEEN DOING THIS, WE HAVE
HAD 329,751 PEOPLE WHO HAVE WATCHED US ELECTRONICALLY. IN SOME WAY, WHETHER IT’S LIVE
OR DOWNLOADED OUR SESSIONS. THAT’S A HUGE NUMBER OF PEOPLE
FOR A PUBLIC HEALTH TOPIC. TO ASSURE THAT WE ACTUALLY
CONTINUE WITH THE QUALITY AND WITH THE INTEREST THAT WE HAVE
GOTTEN SO FAR, WE ARE GOING TO BE TAKING A BREAK. AND AFTER TWO YEARS OF DOING
THIS MONTH AFTER MONTH, WHAT WE WOULD LIKE TO DO IS WE WOULD
LIKE TO DO A LITTLE BIT OF REASSESSMENT, WHAT IS IT THAT
WORKS VERY WELL, WHAT IS IT THAT NEEDS TO BE IMPROVED? WE WOULD LIKE TO CONTINUE MAKING
THIS ABOUT SCIENCE AS THE FOUNDATION OF WHAT WE DO, AS THE
FOUNDATION OF DECISIONS THAT ARE BEING MADE AND RECOMMENDATIONS
THAT STEM FROM A LOT OF THESE DECISIONS. WE ALSO WOULD LIKE TO KEEP
EVERYTHING ABOUT PRACTICE AND THE EXCITEMENT OF PUTTING SOME
OF THESE INTERVENTIONS IN PRACTICE, BUT IN THE END, IT
REALLY IS ALL ABOUT YOU, THOSE OF YOU WHO ARE EITHER COMING
HERE IN PERPENDICULAR OR WHO ARE WATCHING US THROUGHOUT THE
COUNTRY AND WORLDWIDE AS THIS POINT, WHAT IS IT THAT MOTIVATES
YOU TO COME HERE, TO LISTEN TO THESE SESSIONS AND WHAT IS IT
THAT YOU TAKE BACK FROM THEM THAT IS USEFUL FOR YOU IN YOUR
WORK? SO WITH THAT, JUST TO GIVE YOU A
SENSE OF WHAT IS COMING IN THE NEXT NINE TO TEN MONTHS — LIKE
I SAID, WE WILL BE TAKING A BREAK IN OCTOBER AND NOVEMBER. THEN WE HAVE ROUND UP ANOTHER
SERIES OF WHAT I THINK YOU WILL FIND EXTREMELY INTERESTING
TOPICS AS I HAVE LISTED HERE. AS IT HAPPENS, WE TRIED TO
COORDINATE A LOT OF EVENTS AND TRIED TO POINT OUT EVENTS THAT
HAPPENED AT THE SAME TIME AS OUR GRAND ROUNDS. SO JUST TODAY, IN OUR NEW
SECTION, WE HAVE A YEAR OF ASSESSMENT OF WHAT IS IT THAT
HAS BEEN DONE IN A BATTLE SESSION, AS YOU KNOW, MOTOR
VEHICLE CRASHES ARE ONE OF CDC’S WINNABLE BATTLES. I’M GOING TO READ TO YOU ONE
SENTENCE FROM THAT ARTICLE THAT CAME TODAY. IN 2009, ABOUT 12,000 MORE
INJURIES WOULD HAVE BEEN PREVENTED AND ABOUT 450 MORE
LIVES SAVED IF ALL STATES HAD PRIMARY ENFORCEMENT SEAT BELT
LAWS. AND YOU WILL SEE THAT SEAT BELT
LAWS, MOTOR VEHICLE CRASHES AND TRAUMATIC BRAIN INJURIES ARE
VERY MUCH INTERTWINED. BEFORE WE MOVE TO OUR
SPECTACULAR SPEAKERS, WE ARE GOING TO MOVE TO OUR SPECTACULAR
CDC DIRECTOR, WHO IS NOT HERE TODAY, BUT IS GOING TO PROVIDE
HIS COMMENTS THAT HE HAS VIDEOTAPED.>>ABOUT 1.7 MILLION AMERICANS
HAVE A TRAUMATIC BRAIN INJURY EACH YEAR. TBIs ARE CAUSED BY FALLS, MOTOR
VEHICLE CRASHES, FIREARMS AND BLAST INJURIES. THE RESULTS CAN RANGE FROM MILD
TO SEVERE. SOME CAN RESULT IN LIFELONG
COGNITIVE IMPAIRMENT OR EVEN DEATH. SEVERE TBIs AFFECT FAMILIES AND
COMMUNITIES AND THEY’RE PREVENTABLE WITH PRIMARY
PREVENTION STRATEGIES, INCLUDING HELMETS AND SEAT BELT USE LAWS. WHEN TBIs OCCUR, EARLY
IDENTIFICATION AND MANAGEMENT ARE KEY TO MINIMIZING SECONDARY
BRAIN INJURY WHILE REHABILITATION IS KEY TO REGAIN
FUNCTION AND MINIMIZE PERMANENT DISABILITY. IMPLEMENTING PREVENTION
STRATEGIES AND RESPONDING TO TBIs IS COMPLICATED BY THE
COMPLEX NATURE OF TBI. NO ONE STRATEGY WILL ADDRESS ALL
RISKS OR CONSEQUENCES OF TBI. WE NEED STRONGER INJURY
SURVEILLANCE, MORE USE OF EXISTING PRIMARY PREVENTION
STRATEGIES AND RESEARCH TO EXPAND OUR EVIDENCE BASE FOR
PREVENTION. THE RULE OF PUBLIC HEALTH AND
REDUCING TBIs INCLUDES KEY ACTIVITIES SUCH AS SUPPORTING
SURVEILLANCE, IDENTIFYING BEST PRACTICES, IMPLEMENTING AND
DISSEMINATING RESPECTIVE INTERVENTION AND RIGOROUSLY
EVALUATING INTERACTION TO SEE IF WE HAVE THE INTENDED IMPACT. THIS SESSION WILL DISCUSS TBIs,
PROMSING TO PREVENT AND TREATMENT THEM AND MANY OF THE
CHALLENGES WE FACE MOVING FORWARD. THANK YOU.>>>GOOD AFTERNOON I’M LISA McGUIRE FROM CDC’S
NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL. I’M GOING TO TALK TO YOU THIS
AFTERNOON ABOUT THE THE PUBLIC HEALTH ROLE IN SEVERE TRAUMATIC
BRAIN INJURY OR TBI. THE CDC DEFINES A TBI AS A BRAIN
INJURY THAT DISRUPTS THE NORMAL FUNCTIONING OF THE BRAIN. IT CAN BE CAUSED BY A BUMP, A
BLOW OR A JOLT TO THE HEAD OR ALSO A PENETRATING HEAD INJURY. THERE ARE AT LEAST 1 MILLION
TBIs SUSTAINED IN THE UNITED STATES EVERY YEAR. THESE NUMBERS UNDERESTIMATE THE
TRUE BURDEN OF TBIs. THEY DO NOT INCLUDE TBIs TREATED
IN NONHOSPITAL BASED BEDDING, SUCH AS A DOCTOR’S OFFICE OR
OUTPATIENT CLINIC. THEY ALSO DO NOT INCLUDE TBIs
THAT WERE SUSTAINED BY MILITARY PERSONNEL THAT HAVE BEEN TREATED
IN EITHER A MILITARY OR VETERAN’S ADMINISTRATION MEDICAL
SETTING. TO ILLUSTRATE THE MAGNITUDE OF
TBI IN THE MILITARY, THE DEPARTMENT OF DEFENSE REPORTED
THAT MORE THAN 31,000 U.S. MILITARY PERSONNEL WERE
DIAGNOSED WITH A TBI IN 2010. FINALLY, TBIs OFTEN GO
UNDIAGNOSED IN THE PRESENCE OF OTHER LIFE THREATENING
CONDITIONS. AT LEAST ONE PERSON SUSTAINS A
TBI EVERY THREE MINUTES IN THE UNITED STATES. MALES ARE MORE LIKELY TO SUSTAIN
A TBI THAN FEMALES AND WHEN MALES DO SUSTAIN A TBI, THEY’RE
THREE TIMES MORE LIKELY TO DIE FROM THAT TBI THAN FEMALES ARE. CDC HAS ESTIMATED THAT 5.3
MILLION PEOPLE LIVE WITH A LONG-TERM COGNITIVE AND
PSYCHOLOGICAL IMPAIRMENT OR OTHER LONG-TERM CONSEQUENCES
ASSOCIATED WITH A TBI. USING LIFETIME ESTIMATES OF COST
OF TBI IN THE U.S. FOR THE YEAR 2000 AND AJUSTING FOR INFLATION,
WE ESTIMATE THAT THE 2010 COST FOR TBIs WERE $76.3 BILLION. OF THAT, $11.5 BILLION WERE DUE
TO DIRECT MEDICAL COSTS AND $64.8 BILLION ARE DUE TO
INDIRECT COSTS SUCH AS LOST WAGES, PRODUCTIVITY LOSS AND
NONMEDICAL RELATED EXPENDITURE. NOW LET’S DISCUSS THE CAUSES OF
TBI. FALLS ARE THE OVERALL LEADING
CAUSE OF TBI AMONG CIVILIAN POPULATIONS. FOR EXAMPLE, ACTRESS NATASHA
RICHARDSON FELL WHILE SKIING. THIS RESULTED IN AN EPIDURAL
HEMATOMA THAT CAUSED HER DEATH. MOTOR VEHICLE CRASHES ARE THE
SECOND LEADING CAUSE OF TBI AND THEY’RE THE LEADING CAUSE OF TBI
RELATED DEATHS. TBIs ACCOUNT FOR NEARLY
ONE-THIRD OF ALL INJURY RELATED DEATHS IN THE U.S. IT’S ALSO IMPORTANT TO KNOW THAT
TBIs DO NOT OCCUR IN ISOLATION. THEY MAY OCCUR IN COMBINATION
WITH OTHER INJURIES WHICH MAY BE SERIOUS OR LIFE THREATENING. WE WILL NOW LOOK AT THE RATES OF
TBI BY AGE AND CAUSE. FALLS ARE THE LEADING CAUSE OF
TBIs. THE RATES ARE HIGHEST IN
CHILDREN AND OLDER ADULTS. FALLS COST APPROXIMATELY 50% OF
THE TBIs IN CHILDREN AGE ZERO TO 14 YEARS AND A LITTLE MORE THAN
60% OF THE TBIs IN ADULTS AGE 65 YEARS OLD AND OLDER. MOTOR VEHICLE CRASHES ARE THE
SECOND LEADING CAUSE OF TBIs. HOWEVER, MOTOR VEHICLE CRASHES
ARE THE LEADING CAUSE OF TBI FOR TEENS AND ADULTS 15 TO 34 YEARS
OLD. MALES AGE 5 TO 24 YEARS OLD AND
ANYBODY WHO IS AGE 85 YEARS OLD AND OLDER HAVE THE HIGHEST RATES
OF TBI DEATH FROM MOTOR VEHICLE CRASHES. TBI SEVERITY IS CLASSIFIED AS
MILD, MODERATE OR SEVERE. FOLLOWING AN INJURY,
CLASSIFICATION MAY BE BASED ON THE LENGTH AND DEPTH OF COMA OR
ALTERED CONSCIOUSNESS. IT ALSO CAN BE BASED ON THE
ANATOMICAL DESCRIPTION OF THE INJURY OR THE FUNCTIONAL
OUTCOME. DR. WRIGHT WILL TELL US A LITTLE
BIT MORE ABOUT THIS IN HIS PRESENTATION. WHY FOCUS ON THIS IN SEVERE TBI? MANY TBI SURVIVORS, PRIMARILY
THOSE WITH SEVERE TBI CAN FACE LONG-TERM DISABILITY. ONE STUDY ESTIMATED THAT
NATIONWIDE 43% OF TBI SURVIVORS WHO HAD BEEN HOSPITALIZED HAD
TBI RELATED DISABILITIES REMAINING ONE YEAR AFTER THEIR
INJURY. ADDITIONALLY, THE COST OF FATAL
TBIs AND TBIs REQUIRING HOSPITALIZATION, MANY OF WHICH
ARE SEVERE, ACCOUNT FOR APPROXIMATELY 90% OF THE TOTAL
TBI MEDICAL COSTS. I WILL NOW DISCUSS NONFATAL TBIs
AND HOW TO REDUCE THE CONSEQUENCES. HERE ARE SOME POTENTIAL
CONSEQUENCES, LET ME HIGHLIGHT JUST ONE, COGNITIVE IMPAIRMENT. COGNITIVE IMPAIRMENT OR DEFICIT
CAN INCLUDE MEMORY LOT LOSS AND DIFFICULTIES AND PLANNING OR
PROBLEM SOLVING. THIS CAN AFFECT THE PERSON’S
ABILITY TO PERFORM EVEN VERY SIMPLE TASKS, SUCH AS
REMEMBERING WHERE THEIR KEYS ARE OR FINDING THEIR WAY HOME AT THE
END OF THE DAY. TBIs AFFECT THE FAMILIES, THE
COMMUNITY AND THE SOCIETY AS A WHOLE. FOR EXAMPLE, FAMILY MEMBERS MAY
NEED TO ADJUST THEIR ROLE WITHIN THE FAMILY IN ORDER TO PROVIDE
CARE. A PRIMARY BREAD WINNER MAY NO
LONGER BE ABLE TO WORK AT THE SAME JOB WITH THE SAME INTENSITY
OR EVEN WORK TODD. AT ALL. SOCIETAL FACTORS MAY INCLUDE
ECONOMIC STRESS, PRODUCTIVITY LOSS, INCREASED DEPEND YANTANCE
ON SOCIAL PROGRAMS OR SUPPORT. THERE ARE THREE WAYS TO REDUCE
THE SEVERE TBI AND ITS CONSEQUENCES. PRIMARY PREVENTION, EARLY
MANAGEMENT AND THE COMPREHENSIVE APPROACH TO REHABILITATION AND
REINTEGRATION. I WILL START WITH HIRING
PREVENTION. THE OPTIMAL WAY TO REDUCE
MORBIDITY, MORTALITY, AND ECONOMIC CONSEQUENCES OF
INJURIES IS TO PREVENT THEIR OCCURRENCE. THERE ARE SEVERAL AVENUES FOR
PREVENTION, INTERVENTION PRESENTED HERE. FALLS ARE THE NUMBER ONE CAUSE
OF TBI. TO REDUCE FALLS, EXERCISE AND
BALANCE TRAINING HAVE BEEN SHOWN TO BE EFFECTIVE. ONE OF THE CHALLENGES WITH
PRIMARY PREVENTION IS ENSURING STRATEGIES ARE BROADLY ADOPTED. MANY ARE BEST IMPLEMENTED
THROUGH POLICY. AND, DOCTOR KELLERMANN WILL
ADDRESS THESE. WHEN TBIs DO OCCUR, RAPID
TRANSPORTATION TO APPROPRIATE TRAUMA CARE IS NECESSARY. CDC SUPPORTED RESEARCH
DEMONSTRATED THAT THE RISK FOR DEATH FOR SEVERELY INJURED
PATIENTS WAS 25% LOWER WHEN THE PATIENT RECEIVED CARE AT A LEVEL
ONE TRAUMA CENTER. THE GUIDELINES FOR FIELD TRIAGE
OF INJURED PATIENTS PROVIDES EMERGENCY MEDICAL SERVICE
PROVIDERS OR EMS WITH THE ABILITY TO IDENTIFY SEVERELY
INJURED PATIENTS. THEN TO RAPIDLY TRANSPORT THEM
TO THE HIGHEST LEVELS OF CARE WITHIN THE TRAUMA SYSTEM. UNFORTUNATELY, NEARLY 45 MILLION
AMERICANS DO NOT HAVE ACCESS TO A LEVEL ONE OR A LEVEL TWO
TRAUMA CENTER WITHIN ONE HOUR EITHER BY GROUND OR AIR
TRANSPORT. THESE FACILITIES HAVE THE
RESOURCES TO TREAT PATIENTS WITH THE MOST LIFE THREATENING
INJURIES. THE BRAIN TRAUMA FOUNDATION
GUIDELINES PROIT PROVIDE HEALTH CARE PROFESSIONALS WITH EVIDENCE
BASED PATIENT CARE TREATMENT RECOMMENDATIONS. SOME EXAMPLES ARE LISTED HERE. CDC RECOMMENDS THE WIDESPREAD
ADOPTION OF THESE GUIDELINES. DR. WRIGHT WILL DISCUSS THIS, AS
WELL. EACH PATIENT NEEDS AN
INDIVIDUALIZED COMPREHENSIVE APPROACH TO REHABILITATION AND
REINTEGRATION. THIS WILL HELP TO ENSURE THE
PATIENT REACHES THEIR MAXIMUM FUNCTIONAL POTENTIAL AND LEARNS
TO ADAPT TO THEIR DISABILITY. U.S. CONGRESSWOMAN GABRIEL
GIFFORDS, AS YOU KNOW, WAS SHOT IN THE HEAD EARLIER THIS YEAR. SHE SUSTAINED A SEVERE TBI. HER ABILITY TO OBTAIN
COMPREHENSIVE REHABILITATION SERVICES IS ONE FACTOR THAT’S
LED TO HER RECOVERY. REHABILITATION REQUIRES A
COMPLEX MIX OF SERVICES. UNFORTUNATELY, NOT EVERY PERSON
IS ABLE TO OBTAIN THESE NEEDED SERVICES. FOR EXAMPLE, SOME SERVICES ARE
NOT PROVIDED IN EVERY GEOGRAPHICAL AREA. AND EVEN WHEN THOSE SERVICES ARE
AVAILABLE, HEALTH INSURANCE CAN LIMIT THE AMOUNT OF TYPE OF
SERVICES THAT A PERSON MIGHT RECEIVE. FINALLY, THE DEVELOPMENT AND
VAEBLGZ OF NEW REHABILITATION INTERVENTION, INCLUDING THE
LENGTH OF TIME FOR RECOVERY MUST INCORPORATE THE GROWING EVIDENCE
OF NEURAL PALACE ADVERTISE TYUR NEURAL PLASTICITY. OUR GOAL IS TO IMPROVEMENT THE
MANAGEMENT OF TBI WHEN IT HAPPENS. KEY ACTIVITIES IN THIS EFFORT
ARE SURVEILLANCE, IDENTIFICATION OF EVIDENCE BASED STRATEGIES AND
DISSEMINATION AND IMPLEMENTATION OF THOSE STRATEGIES. SURVEILLANCE IS IMPORTANT TO ALL
STAGES OF THE PREVENTION RESPONSE. WE AT PUBLIC HEALTH DO HAVE A
ROLE. MANY CURRENT DATA SOURCES DO NOT
PROVIDE THE LEVEL OF DETAIL NEEDED TO FULLY UNDERSTAND THE
EPIDEMIOLOGY AND LONG-TERM CONSEQUENCES AND OUTCOMES OF
TBI. THE DEVELOPMENT OF A STANDARD
DEFINITION FOR TBI, IN ADDITION TO A TRUE NATIONAL INJURY
SURVEILLANCE SYSTEM WILL INFORM PREVENTION EFFORTS. LONGITUDINAL OR FOLLOW-UP
STUDIES WILL HELP US EVALUATE INTERVENTION FOR THEIR
EFFECTIVENESS. WE HAVE A ROLE IN DEVELOPING,
IDENTIFYING, AND DISSEMINATING EVIDENCE-BASED PRIMARY
PREVENTION STRATEGIES. MANY OF THESE STRATEGIES
RECOMMENDED BY CDC’S GUIDE TO COMMUNITY PREVENTIVE SERVICES
ARE BEING IMPLEMENTED ACROSS THE U.S. WE KNOW THAT NOT ONE SIZE FITS
ALL. THE MULTIPLE POTENTIAL CAUSES OF
TBI REQUIRE MULTIPLE INTERVENTION WITH ACTION ON ALL
LEVELS. MOVING FORWARD, WE NEED TO
TAILOR INTERVENTION FOR HIGH RISK POPULATIONS AND TO EVALUATE
PROGRAMS AND POLICIES IN ORDER TO IMPROVE IMPLEMENTATION. THROUGH RESEARCH, PUBLIC HEALTH
CAN ADDRESS GAPS IN EXISTING POLICIES AND WITH STATE ASK
LOCAL COMMUNITIES CAN FULLY IMPLEMENT EFFECTIVE
INTERVENTION. WE HAVE A ROLE IN THE
IDENTIFICATION DISSEMINATION OF EARLY MANAGEMENT STRATEGIES FOR
TBI. ESPECIALLY THROUGH THE
IMPROVEMENT OF GUIDELINES OF FIELD TRIAGE AND TRAUMA SYSTEMS
DEVELOPMENT. ACCESS TO TRAUMA CARE IS CRUCIAL
TO MINIMIZING LONG-TERM CONSEQUENCES OF TBI. HOWEVER, THIS ACCESS IS NOT
AVAILABLE IN ALL AREAS. WE CAN ALSO SUPPORT THE
DEVELOPMENT OF TRAUMA SYSTEMS INTEGRATED WITHIN PUBLIC HEALTH
ACROSS THE UNITED STATES. WE HAVE A ROLE IN SUPPORTING THE
REHABILITATION AND REINTEGRATION OF INDIVIDUALS BACK INTO THEIR
COMMUNITY. THE CURRENT EVIDENCE SHOWS THAT
A COMPREHENSIVE PROGRAM OF REHABILITATION IS THE MOST
EFFECTIVE WAY OF MINIMIZING NEGATIVE CONSEQUENCES. IN ORDER TO SUPPORT THIS, WE
NEED TO WORK WITH PARTNERS TO IDENTIFY MECHANISMS FOR
REIMBURSEMENT THAT ALLOW FOR INCREASED ACCESS TO
COMPREHENSIVE CARE. FURTHER, WE NEED TO COLLABORATE
WITH THE CLINICAL COMMUNITY TO BUILD THE EVIDENCE BASED FOR
COMPREHENSIVE REHABILITATION, INCLUDING LINKAGES TO PUBLIC
HEALTH PREVENTION, INCIDENT HER VENGZ TO SUPPORT LIFELONG
HEALTH. PARTNERSHIPS ARE THE ENGINE THAT
DRIVES PROGRESS TO PREVENT AND TREATMENT TRAUMATIC BRAIN
INJURY. FOR EXAMPLE, ONE COMMON
DEFINITION OF TBI CAN OHM BE REACHED IF ALL PARTNERS AGREE TO
IMPLEMENT IT WITHIN THEIR SURVEILLANCE SYSTEM. ADDITIONALLY, SHARING THE
FINDINGS BETWEEN THE MILITARY AND CIVILIAN MEDICAL COMMUNITIES
CAN ENCOURAGE REHABILITATION ACTIVITY. FEDERAL AGENCIES, STATE AND
LOCAL HEALTH DEPARTMENTS AND NATIONAL AND COMMUNITY
ORGANIZATIONS CAN COOPERATE TO IDENTIFY AND IMPLEMENT EFFECTIVE
PREVENTION STRATEGIES. PUBLIC HEALTH DOES HAVE A ROLE. OUR NEXT SPEAKER THIS AFTERNOON
IS DR. DAVID WRIGHT.>>GOOD AFTERNOON. THANK YOU, LISA. MY NAME IS DAVID WRIGHT. I AM THE DIRECTOR OF EMERGENCY
NEUROSCIENCES AT EMORY UNIVERSITY AT THE DEPARTMENT OF
MEDICINE AND I’M A PRACTICING PHYSICIAN AT GRADY MEMORIAL
HOSPITAL, ARGUABLY, ONE OF THE BUSIEST TRAUMA CENTERS IN THE
NATION. SO TODAY WE ARE GOING TO TALK
ABOUT OR DISCUSS, RATHER, THE IMPORTANCE OF THE FOUNDATION
GUIDELINES AND ALSO KIND OF REVIEW THE EXISTING RESEARCH
GAPS FOR HOPES OF OPPORTUNITIES IN CHANGE AND IMPROVEMENT AND
INTRODUCE WHAT I’M EXCITED ABOUT, A NOVEL AND POTENTIAL
TREATMENT FOR TRAUMATIC BRAIN INJURY. FIRST, I WANT TO COVER A LITTLE
BIT ABOUT WHAT GOES ON AFTER A BRAIN INJURY OCCURS. THE INITIAL TRAUMA IS REALLY
ONLY THE FIRST PHASE OF INJURY. IT’S THE SECONDARY PHASE THAT’S
CHARACTERIZED BY ACTIVATION OVER A WHOLE HOST OF NEUROTOXIC
EVENTS AND ACTIVATION OF PATHWAYS THAT CAUSE PROBABLY
MOST OF THE MORBIDITY AND MORTALITY AFTER SURVIVABLE
INJURIES. THIS SECONDARY INJURY BEGINS
IMMEDIATELY AT THE TIME OF THE ACCIDENT AND THEN CONTINUES TO
OCCUR FOR MONTHS, EVEN UP TO A YEAR AFTER THE INJURY. NOW, THE EARLIEST MECHANISMS
DISCOVERED WERE THE RELEASE OF NEUROTRANSMITTERS, THE INFLUX OF
HUGE AMOUNTS OF CALCIUM INTO THE CELL AND OTHER IONS WHICH
OVERWHELM THE CELL AND CAUSED EVENTUAL NECROSIS AND CELL
DEATH. HOWEVER, I THINK THIS SLIDE IS
PRETTY OBVIOUS TO EVERYONE, RIGHT? WE KNOW IT TO BE MUCH MORE
COMPLICATED THAN THAT. IN FACT, THERE ARE MULTIPLE
PATHWAYS THAT ARE ACTIVATED. IN THIS SLIDE, YOU CAN BEGIN TO
SEE MANY OF THOSE PATHWAYS THAT ARE ACTIVATED, INCLUDING THE
RELEASE OF INFLAMMATORY CYTOKINES, EDEMA AND EVEN
SELF-SUICIDE, SOMETHING CALLED APOTOSIS. SO IT’S IMPORTANT TO RECOGNIZE
THE COMPLEXITY OF BRAIN INJURY AND WHAT’S GOING ON AFTERWARDS
SO THAT WE CAN BETTER INFORM DRUG DISCOVERY AND ALSO DEVELOP
SUCCESSFUL TREATMENT STRATEGIES. HOWEVER, EVEN WITH A CLEARER
UNDERSTANDING OF THE PATH OF PHYSIOLOGY AT TBI AND OVER 150
DIFFERENT TARGETS AVAILABLE FOR US, WE HAVE YET TO FIND A
TREATMENT THAT CAN IMPROVE THE FUNCTIONAL OUTCOME. WHERE ARE WE CURRENTLY TODAY? THERE ARE FLEEMTS AVAILABLE THAT
TARGET THE SECONDARY CASCADE AND IMPROVE FUNCTIONAL OUTCOME. THIS HAS LED EXPERTS AROUND THE
COUNTRY TO EXAMINE WHY IS THIS? WHAT ARE THE RESEARCH GAPS? WHAT ARE THE REASONS FOR
CLINICAL FAILURES? WELL, THE MOST OBVIOUS RESEARCH
GAP IS THE VERY DEFINITION AND CLASSIFICATION OF TRAUMATIC
BRAIN INJURY. WE CURRENTLY — OR OUR CURRENT
APPROACH IS BASED SOLELY ON AN INDIVIDUAL’S RESPONSE TO THE
ENVIRONMENT. HOW AWAKE ARE THEY? THIS CATEGORIZATION OR SCALE
DIVIDES PATIENTS INTO MILD, MODERATE AND SEVERE. THIS IS CRUDE, OKAY? OVEN CONTAMINATED BY ALCOHOL,
OTHER DRUGS, SUCH AS A DRUG THAT WE GIVE THEM, AND IT LACKS, MOST
IMPORTANTLY, ANY PATHOLOGICAL LINK. IT TELLS YOU NOTHING ABOUT
WHAT’S GOING ON IN THE BRAIN AT THE TIME OF THE INJURY. THIS DOES A DECIDES SERVICE TO
THE INJURY AND OUR ABILITY TO ASSESS THE PATIENTS. THIS IS AN EXAMPLE. THIS IS SIX DIFFERENT PATIENTS. EACH OF THESE PATIENTS HAVE A
SCALE OF SIX. NONE OF THEM HAVE THE SAME TYPE
OF INJURY. NONE OF THEM WILL HAVE THE SAME
PROGNOSIS. SO THE LACK OF A GOOD
CLASSIFICATION SYSTEM HAS REALLY IMPACTED BOTH OUR ABILITY TO
ASSESS AND MANAGE PATIENTS, BUT ALSO HAMMERED OUR CLINICAL
TRAUMAS. WE NEED A BETTER CLASSIFICATION
SYSTEM. ANOTHER GAP IS OUR MECHANICISTIC
APPROACH TO DRAMATIC BRAIN INJURY, THAT MAGIC BULLET. SINGLE ION CHANNEL BLOCKERS SUCH
AS CALCIUM CHANNEL BLOCKERS AND OTHER THINGS HAVE BEEN TRIED AND
THEY ACTUALLY WORK IN ANIMALS. WHEN THEY TAKE THEM TO THE
CLINICAL TRIAL, THEY DON’T WORK ANY MORE. SO THESE SINGLE, SINGLE PATHWAY
APPROACHES ARE NOT LIKELY TO BE ROBUST ENOUGH TO WORK IN A HUMAN
MODEL. WHAT WE REALLY NEED IS A MULTI
DIMENSIONAL APPROACH, EITHER DRUGS THAT ARE PLEOTROPIC OR
MULTIPLE DRUGS AT ONE TIME. FORTUNATELY THE NIH IS NOW
EXPLORING MULTIPLE DRUG THERAPIES IN THEIR GRANT
PROGRAM. HOWEVER, TO ME, THE ELEPHANT IN
THE ROOM IS OUR CURRENT THERAPY. AND THE VERY ABILITY CAUSED BY
IT. THE DIFFERENCES IN MORTALITY IN
TRAUMATIC BRAIN INJURY PATIENTS ACROSS THIS COUNTRY IS HUGE,
SOMEWHERE AROUND 20% TO 65% MORTALITY DEPENDING ON WHAT
HOSPITAL YOU GO TO. IT REALLY DOES MATTER WHERE YOU
GO FOR CARE IN THE UNITED STATES. THIS BACKGROUND VARIABILITY IS
UNACCEPTABLE, OKAY? IT IS LIKELY RESPONSIBLE FOR
DROWNING OUT MULTIPLE OR RATHER DROWNING OUT ANY TREATMENT
EFFECT OF OUR PREVIOUSLY PROMISING THERAPIES IN CLINICAL
TRIALS. HERE WE GO. SO, INDEED, THE BETTER
IMPROVEMENT AND OUTCOME THAT 20% IS LINKED ACTUALLY TO FOLLOWING
A SET OF SIMPLE BRAIN TRAUMA FOUNDATION GUIDELINES. NOW, THERE’S CLEAR EVIDENCE THAT
THESE GUIDELINES IMPROVE CARE AND SAVE LIVES. YET THE ADOPTION RATE OF THESE
ARE UNBELIEVABLY ONLY ABOUT 65% IN THE U.S. SO CONSEQUENTLY, THERE’S STILL A
LOT OF VARIABILITY IN A MORTALITY AND MORBIDITY OF
TRAUMATIC BRAIN INJURY PATIENTS. IT’S ESTIMATED THAT IF WE
ADOPTED THESE WIDELY OR UNIVERSALLY, THAT WE WOULD SAVE
SOMEWHERE AROUND $262 MILLION IN MEDICAL CARE COSTS, 43 MILLION
IN REHABILITATION COSTS AND ALMOST 4 BILLION IN LIFETIME
SOCIETAL COSTS EVERY YEAR. SO, AFTER DECADES OF FAILURE IN
THE SEARCH FOR AN EFFECTIVE DRUG TREATMENT, THERE IS HOPE. IN 1991, DR. DONALD STEIN, ONE
OF THE WORLD’S TOP NEUROSCIENTISTS AND A COLLEAGUE
OF MINE HERE AT EMORY SUSPECTED THAT PROGESTERONE MIGHT HAVE
POTENT NERVE PROTECTIVE PROPERTIES. AT THE TIME, THIS RESEARCH WAS
THOUGHT TO BE CRAZY. EVERYBODY THOUGHT DON WAS CRAZY. AFTER ALL, EVERYBODY KNOWS THAT
PROGESTERONE IS JUST A FEMALE HORMONE, RIGHT? HOW COULD IT HELP VICTIMS OF
TRAUMATIC BRAIN INJURY? FORTUNATELY, THE CDC PLAYED A
PIVOTAL ROLE IN THIS EARLY RESEARCH. DON PUT IT THIS WAY, AND I
QUOTE, THE CDC WAS THE FIRST FEDERAL AGENCY WILLING TO TAKE A
GAMBLE ON WHAT MANY AT THE TIME THOUGHT WAS PIE IN THE SKY. THEIR INITIAL TWO-YEAR GRANT TO
MY TEAM KICK STARTED IT ALL. WITH A BOOST FROM THE CBC, DON’S
TEAM INITIATED A WHOLE SERIES OF ELEGANT EXPERIMENTS THAT
PROVIDED THE DATA NECESSARY FOR THE NIH. AND TO GET THE NIH’S ATTENTION. THIS STORY ACTUALLY DEMONSTRATES
AN IMPORTANT LINK BETWEEN CLINICAL MEDICINE AND PUBLIC
HEALTH. BOTH DISCIPLINES WANT TO REDUCE
DISEASE AND INJURY BURDEN. CLINICAL MEDICINE CONSIDERS THE
INDIVIDUAL, WHERE PUBLIC HEALTH, OBVIOUSLY, HAS A BROADER VIEW. IN THIS CASE, THE CDC RELATIONED
THAT THIS UNORTHODOX IDEA HAD THE POTENTIAL TO SAVE HUNDREDS
OF THOUSANDS OF LIVES IN THE U.S. AND ACROSS THE WORLD. WHAT DON DISCOVERED WAS THAT HIS
FEMALE RATS WERE PERFORMING BETTER AFTER A HEAD INJURY. INDEED, WHEN THE RATS WERE
EXCEEDINGLY HIGH IN PROGESTERONE LEVELS, SUCH AS IN PREGNANCY,
THEY HAD MUCH BETTER OUTCOMES THAN THEIR MALE COUNTERPARTS AND
THEIR NONPREGNANT COUNTERPARTS. AND EVEN MORE IMPORTANTLY, BY
GETTING PROGESTERONE TO THESE ANIMALS AFTER THE INJURY, IT
IMPROVED OUTCOME IN BOTH MALE AND FEMALE ANIMALS. MORE RECENTLY, THE MECHANISMS
FOR HOW PROGESTERONE WORKS HAVE BEEN FURTHER DELINEATED. AS IT TURNS OUT, PROGESTERONE IS
PLEO TROPIC, LIKE THE DRUG COCKTAIL THAT I WAS SPEAKING
ABOUT BEFORE, WORKING AT MANY DIFFERENT SITES AND PROVIDING
SOME ROBUST NEUROPROTECTION. SO TODAY, THERE’S OVER 180
SUPPORTED PUBLICATIONS FROM MULTIPLE LABORATORIES THAT
CONFIRM DON’S FINDINGS. IT SEEMS DON WASN’T SO CRAZY
AFTER ALL. BUT THE REAL QUESTION IS, WILL
IT WORK IN HUMANS? SO ON THE STRENGTH OF DON’S LAB
SCIENCE AND OTHERS, ART KELLERMANN AND I SECURED AN NIH
GRANT TO RUN A SMALL POLLUP STUDY OF 100 GRANGER PATIENTS. THIS WORK WAS DONE RIGHT HERE. WE WERE ACTUALLY STUNNED AT THE
RESULTS. OUR STUDIES SHOW THAT
PROGESTERONE WAS NOT ONLY SAFE, IT REDUCED MORTALITY ALMOST 50%. IT’S IMPORTANT TO NOTE THAT THIS
IS A SMALL STUDY, OKAY? SO THE FINDINGS HAVE TO BE
INTERPRETED WITH CAUTION. HOWEVER, THAT SAID, A YEAR
LATER, VERY SIMILAR FINDINGS IN 159 PATIENTS WERE DEMONSTRATED
AND SHOWED AN IMPROVEMENT IN THREE AND SIX-MONTH OUTCOMES. COMBINED, THESE FINDINGS WERE
COMPELLING AND THE NIH IS NOW SPONSORING A HUGE PHASE THREE
CLINICAL TRIAL CALLED PROTECT THREE. MY COLLEAGUES AND I HOPE TO
ENROLL 1140 SUBJECTS IN 31 DIFFERENT TRAUMA CENTERS ACROSS
THE COUNTRY IN WHAT’S KNOWN AS THE NEUROLOGIC EMERGENCY
TREATMENT CENTERS NETWORK. THIS TRIAL SHOULD PROVIDE THE
EVIDENCE WE NEED TO DETERMINE WHETHER PROGESTERONE REALLY IS
THAT LONG, SOUGHT AFTER DRUG FOR TRAUMATIC BRAIN INJURY. SO WHAT IS THE PATH FORWARD? WELL, WE NEED TO REALLY URGE
CLING CLINGISHANS ACROSS THE COUNTRY TO PROVIDE THE
FOUNDATIONS FOR CARE. THIS IS CRITICAL FOR NOT ONLY
PATIENTS’ LIVES, BUT FOR IMPROVING CLINICAL TRIALS AND
HAVING THE HOPE THAT WE CAN ACTUALLY SEE A DIFFERENCE WITH
THE DRUG AT THE CLINICAL STYLE STAGE. SECOND, WE NEED TO DEVELOP A
BETTER CLASSIFICATION SYSTEM FOR BRAIN INJURY. THE ONE WE HAVE CLEARLY DOESN’T
WORK. WHETHER THAT BE BIOMARKERS AND
OTHER STRATEGIES, WE NEED ONE. THIRD, WE NEED TO KEEP TRYING. YES, THERE HAVE BEEN A LOT OF
ALTERNATIVES AND THERE ARE OTHER THERAPIES BEING CONSIDERED AT
NIH AND OTHER PROGRAM WEBS DRUGS THAT PLEOTROPIC OR COMBINATION
THERAPIES ARE MORE LIKELY TO BE SUCCESSFUL. AND LASTLY, WE NEED TO
STRENGTHEN OUR PARTNERSHIPS BETWEEN CLINICAL MEDICINE AND
PUBLIC HEALTH TO IMPROVE PREVENTION, PUBLIC AWARENESS AND
OUTCOMES. IT’S VERY IMPORTANT, THIS LINK
BETWEEN CLINICAL MEDICINE AND PUBLIC HEALTH. IT PROVIDES NOT ONLY A
SURVEILLANCE SYSTEM TO KNOW WHETHER OUR INTERVENTIONS ARE
WORKING, BUT ALSO ALLOWS US TO DISSEMINATE AND ENSURE THAT THE
TRAUMA FOUNDATION GUIDELINES ARE WIDELY ACCEPTED AND USED ACROSS
THE COUNTRY. I’D LIKE TO THANK YOU AND NOW
OUR NEXT SPEAKER IS ARTHUR KELLERMANN.>>GOOD AFTERNOON. I’M ART KELLERMANN, DIRECTOR OF
RAND HEALTH. BEFORE I JOINED RAND, I
PRACTICED EMERGENCY MEDICINE. WHEN I STARTED MY CLINICAL
CAREER, MANY PEOPLE THOUGHT IT ODD THAT AN ER DOC WOULD HAVE A
PUBLIC HEALTH DEGREE. BUT IT MAKES SENSE BECAUSE
EMERGENCY PHYSICIANS SEE WHAT HAPPENS WHEN PUBLIC HEALTH
FAILS. RICHARD THINMAN, NOBEL PRIZE
WINNING PHYSICIST ONCE OBSERVED THAT IT TAKES VERY LITTLE ENERGY
TO SCRAMBLE AN EGG AND ALL OF OUR SCIENCE IS INCAPABLE OF
REVERSING THE TRANSACTION. IT TAKES VERY LITTLE INJURY TO
SCRAMBLE A BRAIN, TOO, WITH EQUALLY LASTING EFFECTS. THAT’S WHY IT’S IMPORTANT TO
PREVENT AS MANY BRAIN INJURIES AS POSSIBLE AND LIMIT THE
SEVERITY OF THOSE THAT OCCUR. ONE OF THE MOST POWERFUL WAYS TO
DO THIS IS THROUGH EFFECTIVE PUBLIC POLICIES. TO ILLUSTRATE MY POINT, CONSIDER
THE SPECTACULAR PROGRESS WE’VE MADE IN REDUCING DEATHS AND
INJURIES FROM MOTOR VEHICLE CRASHES. MOTOR VEHICLE CRASHES ARE ONE OF
THE CDC’S WINNABLE BATTLES. THE FOCUS IS JUSTIFIED. IN ADDITION TO BEING A LEADING
CAUSE OF INJURY-RELATED DEATH IN THE UNITED STATES, MOTOR VEHICLE
CRASHES ARE THE LEADING CAUSE OF TRAUMATIC BRAIN INJURY RELATED
DEATH TO AMERICANS LESS THAN 75 YEARS OF AGE. INJURY CONTROLLED EXPERTS SPEAK
OF THE FOUR Es OF INJURY PREVENTION. THEY ARE EDUCATION, ENFORCEMENT
OF SAFETY LAWS AND REGULATIONS, ENGINEERING AND ECONOMIC
INCENTIVES. ALL FOUR STRATEGIES HAVE A
PUBLIC POLICY DIMENSION. LET’S START WITH THE FIRST “E,”
EDUCATION. DRIVERS ED PROGRAMS ARE A
PERENNIAL FAVORITE WITH STATE LEGISLATORS AND MANY PARENTS. UNFORTUNATELY, THEY DON’T WORK. A REVIEW OF THREE WELL-DESIGNED
NATIONAL EVALUATIONS FOUND THAT DRIVERS ED PROGRAMS MAY
PARADOXICALLY INCREASE CRASHES BY LOWERING THE AGE AT WHICH
TEENAGERS BECOME LICENSE WITHOUT MATERIALLY AFFECTING THEIR CRASH
RATES ONCE THEY DO. THE STUDY MOST FAMILIAR IN THE
UNITED STATES TOOK PLACE RIGHT HERE IN DeKALB COUNTY IN THE
LATE 1970s. OVER 16,000 STUDENTS WERE RAB
COMELY ASSIGNED TO THREE GROUPS, STANDARD DRIVERS EDUCATION,
DRIVERS ED PLUS, AN 80-HOUR LONG COURSE INCLUDING CLASSROOM
SIMULATION, DRIVING RANGE AND ON THE ROAD COMPONENTS AND A
CONTROL GROUP THAT RECEIVED NO FORMAL DRIVER EDUCATION. SUBSEQUENT ANALYSIS FOUND NO
MEANINGFUL DIFFERENCES AMONG THE THREE GROUPS IN THEIR SUBSEQUENT
RATE OF CRASHES OR TRAFFIC VIOLATIONS. PUBLIC EDUCATION DOESN’T WORK SO
WELL, EITHER. EARLY PR CAMPAIGNS TO FIX THE
NUT BEHIND THE WHEEL WERE INEFFECTIVE. SO WERE SUBSEQUENT CAMPAIGNS
DESIGNED TO CONVINCE THE PUBLIC TO VOLUNTARILY BUCKLE UP. NEW PASSENGER CARS HAVE HAD SOME
FORM OF SAFETY BELTS SINCE 1964. BUT AS RECENTLY AS 1982,
VOLUNTARY RATES OF USE WERE DISMAL. THE FIRST WIDESPREAD SURVEY
CONDUCTED THAT YEAR FOUND AN OVERALL USE RATE OF 11% AMONG
DRIVERS AND FRONT CEASE PASSENGER SPASS ENG SEAT
PASSENGERS. THINGS BEGAN TO IMPROVE, BUT BY
THE EARLY 1990s, RATES OF BELT USE STAGNATED AT AROUND 66% TO
86%. LAW ENFORCEMENT AGENCIES
LAUNCHED A CAMPAIGN OF CLICK IT OR TICKET. IT BOOSTED SAFETY BELT USE RATES
ABOVE 80%. PUBLIC AWARENESS AND ATTITUDES
CHANGED, AS WELL. PROGRAMS LIKE CLICK IT OR TICKET
WORK BEST IN PRIMARY ENFORCEMENT STATES WHERE AN OFFICER CAN
ISSUE A CITATION UPON OBSERVING AN UNBELTED MOTORIST. IT’S HARDER TO MOTIVATE THE
PUBLIC IN SECONDARY ENFORCEMENT STATES WHERE AN OFFICER MUST
STOP THE VEHICLE FOR SOME OTHER VIOLATION BEFORE A SEAT BELT
CITATION CAN BE ISSUED. TODAY, IT’S WIDELY ACCEPTED THAT
THE BEST WAY TO BOOST SEAT BELT USE ABOVE 83% AND KEEP IT THERE
IS THROUGH HIGH VISIBILITY ENFORCEMENT, PLUS SPECIAL
PROGRAM TOES REACH HIGH RISK GROUPS SUCH AS OCCUPIANTS OF
PICKUP TRUCKS, RESIDENTS OF RURAL COMMUNITIES AND NIGHTTIME
DRIVERS. IN CONTRAST TO THE STEADY
PROGRESS WITH SAFETY BELT USE, ALCOHOL IMPAIRED DRIVING HAS
PROVEN TO BE A TOUGHER NUT TO CRACK. BETWEEN 1982 AND THE ’90s,
PROGRESS WAS MADE. GRASSROOTS ORGANIZATIONS LIKE
MOTHERS AGAINST DRUNK DRIVING PLAYED A ROLE. SO DID HIGH VISIBILITY DUI
ENFORCEMENT AND AGAINST PUBLICITY. PUBLIC POLICIES HELPED, AS WELL. EXAMPLES INCLUDE STATE LAWS
LOWERING THE LEGAL LIMIT OF BLOOD ALCOHOL CONCENTRATION TO
0.8, ADMINISTRATIVE LICENSE REVOCATION FOR DUI AND RAISING
THE MINIMUM DRINKING AGE FROM 18 TO 21. UNFORTUNATE, SINCE THE MID
1990s, RATES OF ALCOHOL IM IMPAIRED DRIVING HAVE PLATEAUED. AS A RESULT, IM BARED DRIVING
STILL CAUSES ONE-THIRD OF FATAL CRASHES AND AN ONGOING TOLL OF
TRAUMATIC BRAIN INJURIES. IN CONTRAST TO DRIVERS ED,
GRADUATED DRIVER’S LICENSING LAWS WORK. GDL IS A THREE-PHASE SYSTEM FOR
BEGINNING DRIVERS. THE LEARNER’S PERMIT ONLY ALLOWS
DRIVING UNDER THE SUPERVISION OF A FULLY LNSD ADULT, TYPICALLY A
PARENT. AN INTERMEDIATE LICENSE FOLLOWS. IT ALLOWS UNSERVICED DRIVING,
BUT WITH CERTAIN SIGNIFICANT RESTRICTIONS. TOGETHER, THESE TWO PHASES ALLOW
A YOUNG DRIVER TO LOG VITAL HOURS OF EXPERIENCE BEHIND THE
WHEEL BEFORE GRADUATING TO A FULL, UNRESTRICTED LANGUAGE. NOW, THE MOST STRINGENT GDL
PROGRAMS, THOSE WITH AT LEAST A SIX-MONTH HOLDING PERIOD DURING
THE LEARNER STAGE, NIGHTTIME RESTRICTIONS BEGINNING NO LATER
THAN 10:00 P.M. AND ONLY ONE TEEN PASSENGER IN THE CAR WERE
ASSOCIATED WITH A 38% REDUCTION IN FATAL CRASHES AND A 40%
REDUCTION IN INJURY CRASHES AMONG 16-YEAR-OLD DRIVERS. NOW, A NEWSPAPER PUBLISHED JUST
LAST WEEK SUGGESTED SOME OF THESE BENEFITS OF GDL MAY BE
OFFSET BY HIGHER RATES OF FATAL CRASHES INVOLVING 18-YEAR-OLD
DRIVERS. PERHAPS THE THINKING GOES THAT
MORE TEENS ARE PUTTING OFF GETTING THEIR DRIVER’S LICENSE
TO AVOID THE HASSLES OF GDL AND ARE, THEREFORE, GETTING ON THE
ROAD AT 18 WITHOUT THE BENEFIT OF THOSE EXTRA HOURS BEHIND THE
WHEEL. NOW, EVEN IF THIS IS TRUE, AND
MORE RESEARCH IS NEEDED, IT DOESN’T DIMINISH THE BENEFITS OF
GRADUATED DRIVERS LICENSING FOR YOUNGER DRIVERS. MOTORCYCLE HELMET LAWS ARE
EFFECTIVE, AS WELL. THE FIRST HELMET LAW WAS ENACTED
AS FAR BACK AS 1966, BUT BY 1975, UNIVERSAL HELMET LAWS ARE
IN PLACE IN 47 STATES IN THE DISTRICT OF COLUMBIA. BUT AFTER FEDERAL PENALTIES WERE
ELIMINATED IN 1975, ABOUT HALF THE STATES REPEALED THEIR
STATUTES. SINCE THEN, SEVERAL STATES HAVE
REENACTED OR REPEALED THEIR HELMET LAWS. BUT ONE THING IS CLEAR. MOTORCYCLE HELMETS PROTECT
BIKERS’ HEADS IN A CRASH. A REVIEW FOUND THAT HELMETS
DECREASED THE RISK OF DEATH IN A CRASH BY 42% AND DECREASED THE
RISK OF HEAD INJURY BY FULLY 69%. STATES THAT ADOPT HELMET LAWS
QUICKLY SEE USAGE RATES CLIMB TO 90% OR HIGHER. CONVERSE
CONVERSELY, STATES THAT REPEAL THEIR LAWS SEE HELMET USE RATES
PLUMMET TO 15%. AND RATES OF FATAL INJURY
CLOSELY TRACK CHANGING RATES OF HELMET USE. SOME OF OUR BIGGEST POLICIES
HAVEN’T COME FROM THE BEHAVIOR OF CHANGING DRIVERS. THEY COME FROM CHANGING THE
BEHAVIOR OF MANUFACTURERS THROUGH REGULATION. THEY HAVE COME FROM ENCOURAGEING
THAT THIRD “E,” ENGINEERING. TODAY, AUTOMOBILES ARE
ENGINEERED TO BE CRASHWORTHY. KEY FEATURES INCLUDE A STRONG
OCCUPANT COMPARTMENT, THE SAFETY CAGE, CRUMBLE ZONES THAT ENFORCE
A SERIOUS CRASH, SIDE ELEMENTS THAT RESIST INTRUSION AND A
STRNG ROOF THAT WON’T COLLAPSE IN A ROLLOVER. INITIALLY, OCCUPANT RESTRAINTS
WERE LIMITED TO SEAT BELTS AND FRONTAL LAYER BACKS. TODAY, SUPPLEMENTAL SIDE AND
CURRENT AIR BAGS PROTECT YOUR HEAD, YOUR CHEST AND OTHER VITAL
ORGANS FROM SIDE IMPACTS. A CAR WITH CURTAIN AIR BAGS, IN
FACT, SAVED MY SON’S LIFE AND HIS SUFFERING A TRAUMATIC BRAIN
INJURY IN A SIDE IMPACT CRASH. NOW, ONCE MANUFACTURERS FOUGHT
SAFETY REGULATIONS TOOTH AND NAIL. BUT AT SOME POINT, AUTO EXECS
REALIZED, WAIT A MINUTE, IF THE CAR SACRIFICES ITSELF TO SAVE
YOU, YOU’RE GOING TO NEED TO BUY ANOTHER CAR. MANDATORY CRASH TESTING IS
ANOTHER VALUABLE POLICY, BASED ON DYNAMIC TESTING NEW CARS
TODAY EARN A CRASHWORTHINESS RATING. TODAY, SAFETY SELLS. THANKS TO ORGANIZATIONS LIKE
NITSA, CONSUMER REPORTS AND THE INSURANCE INSTITUTE FOR HIGHWAY
SAFETY, CONSUMERS CAN QUICKLY GET OBJECTIVE INFORMATION ABOUT
A CAR’S SAFETY FEATURES AND CRASHWORTHINESS. NO MATTER HOW GOOD WE GET AT
PREVENTING CRASHES, SOME WILL STILL OCCUR. AND WHEN THEY DO, PROMPT AND
EFFECTIVE TREATMENT MAKES ALL THE DIFFERENCE. TRAUMA CENTERS SAVE LIVES. THAT’S WHY REGIONALIZED TRAUMA
CARE SYSTEMS STRIVE TO GET THE RIGHT PATIENT TO THE RIGHT
HOSPITAL AT THE RIGHT TIME. CDC’S NEW TRAUMA TRIAGE
GUIDELINES WILL HELP. PROPERLY IMPLEMENTED, THEY’LL
SAVE THOUSANDS OF LIVES AND TENS OF MILLIONS OF DOLLARS ANNUALLY. SURVIVING THE IMMEDIATE INJURY
IS ONE THING. FULL RECOVERY IS ANOTHER. REHABILITATION BENEFITS BRAIN
INJURY PATIENTS. NOTABLE POLICY GAPS REMAIN. THEY INCLUDE BETTER EVIDENCE ON
HOW TO EVALUATE SPORTS-RELATED CONCUSSIONS AND WHEN AN INJURY
PARTICIPATAN CAN BE ALLOWED TO RETURN TO PLAY. ACCESS TO CARE IS IMPORTANT, NOT
ONLY FOR DAILY EMERGENCIES, BUT IN DISASTERS. CURRENTLY, ACCESS TO TRAUMA CARE
AND REHABILITATION IS INADEQUATE IN MANY PARTS OF THE UNITED
STATES, PARTICULARLY RURAL AND FRONTIER COMMUNITIES. THE BIGGEST POLICY CHALLENGE IN
REHABILITATION IS THE CURRENT DISCONNECTION BETWEEN WHAT
SCIENCE SAYS IS GOOD CARE AND WHAT IS COVERED BY PUBLIC AND
PRIVATE INSURERS. INSURERS SAY THEY WANT TO FIND
EVIDENCE-BASED TREATMENT, BUT THE EVIDENCE BASE IS THIN ON
SEVERAL IMPORTANT QUESTIONS. PUBLIC POLICY IS NOT STATIC. CONCERNS ABOUT PERSONAL FREEDOM
CAN TRUMP EVEN ROBUST EVIDENCE OF THE BENEFIT OF HELMET AND
SEAT BELT LAWS, PRODUCT SAFETY REGULATIONS AND EVEN LAWS THAT
ENCOURAGE EMBARRASSED DRIVING. FUNDING IS ALSO A PROBLEM. AT A TIME WHEN HEALTH CARE IS
CONSIDERING A GROWING SHARE OF FEDERAL, STATE AND FAMILY
BUDGETS, IT WILL BE HARD TO KWON VINCE POLICYMAKERS TO ADEQUATELY
FUND EMS, TRAUMA CARE AND REHABILITATION. NEVERTHELESS, IT’S IMPORTANT TO
ACKNOWLEDGE HOW FAR WE’VE COME. A LITTLE MORE THAN TEN YEARS
AGO, THE CDC IDENTIFIED MOTOR VEHICLE SAFETY AS ONE OF THE TEN
GREATEST PUBLIC HEALTH ACHIEVEMENTS OF THE 20th
CENTURY. AND EARLIER THIS YEAR, THE CDC
RECOGNIZED MOTOR VEHICLE SAFETY AS ONE OF THE TEN SIGNIFICANT
PUBLIC HEALTH ACHIEVEMENTS OF THE LAST DECADE. THANKS SO SMART PUBLIC HEALTH
POLICIES, HUNDREDS OF THOUSANDS OF PEOPLE, INCLUDING MY SON, ARE
ALIVE AND WELL TODAY. MOTOR VEHICLE INJURIES ARE MORE
THAN A WINNABLE BATTLE. IT’S A BATTLE WE’RE WINNING. THANK YOU VERY MUCH. NOW, WE HAVE A FEW MINUTES FOR
QUESTIONS. AND WHILE I AM TODAY, NOW, OUT
OF TOWNER, I USED TO BE A NEAR NEIGHBOR, I HAVE THE PRIVILEGE
OF MODERATING THIS SESSION. SO AS YOU ARE STREAMING TO THE
MICROPHONES, SO THAT FOLKS AT HOME AND ON THEIR WEBSITE CAN
LISTEN TO YOU, I’M GOING TO MOVE BACK OVER TO THE MICROPHONES. I WOULD ENCOURAGE IF YOU HAVE A
QUESTION OR A BRIEF COMMENT, PLEASE SHARE THEM WITH THE
AUDIENCE. I WILL BE AGGRESSIVE IN
ENFORCING THE ONE QUESTION RULE SO THAT EVERYBODY WHO HAS A
QUESTION HAS A CHANCE TO ASK IT. NOW, I KNOW THAT CDC PEOPLE
AREN’T THAT SHY. BUT BECAUSE YOU ARE, I WILL
START WITH THE FIRST QUESTION. LISA, I WONDER IF YOU COULD JUST
ELABORATE A LITTLE BIT MORE ABOUT THE CDC’S HEADS UP
CAMPAIGN. YOU MENTIONED IT, BUT YOU HAD A
LOT OF CONTENT TO COVER AND I WONDER IF YOU COULD ELABORATE A
BIT, PARTICULARLY GIVEN THE OPENING VIDEO.>>THANK YOU. CDC HAS A HEADS UP CAMPAIGN AND
IT ORIGINALLY STARTED WITH OUR MATERIAL AND YOU SAW TRACY AT
THE BEGINNING IN OUR VIDEO. OUR MATERIALS FOR YOUTH SPORTS
ARE DESIGNED FOR STOOUNT STUDENT ATHLETESES, PARENTS, COACHES,
WE’RE EXPANDED TO TRAINER, SCHOOL PROFESSIONALS SO THE
SCHOOL NURSE OR SCHOOL GUIDANCE COUNSELOR WHO SEES THE STUDENT
ATHLETE GOING FROM ONE SPORT TO THE NEXT, THEY TEND TO BE THE
TBAL PERSON IN THAT STUDENT ATH LEETH’S LIFE. WE ALSO HAVE MATERIAL THROUGH
FALLS PREVENTION THAT WE WORK COLLABORATIVELY WITH OUR
COLLEAGUES AND DIVISION OF UNINTENTIONAL INJURY. WE ALSO HAVE MATERIALS ON SHAKEN
BABY SYNDROME, AS WELL.>>QUESTION AT THE MICROPHONE.>>THIS IS FOR DR. KELLERMANN.>>I’M SORRY, YOU NEED TO
IDENTIFY YOURSELF. THEY ALL KNOW WHO YOU ARE, BUT
FOR DAVID AND ME, IF YOU COULD, IDENTIFY YOURSELF AND FOR PEOPLE
WHO ARE LISTENING IN.>>ARLENE GREENSPAN FROM THE
INJURY CENTER. MY QUESTION IS ONE ABOUT POLICY. WE REALLY UNDERSTAND AND
APPRECIATE N INJURY CENTER THE IMPORTANCE THAT POLICY PLAYS IN
REDUCING MORBIDITY AND MORTALITY. HOWEVER, AS YOU MENTIONED, WE’RE
CURRENTLY IN A CLIMATE THAT IS ANTI-REGULATION,
ANTI-LEGISLATION AND OFTEN WE’RE ACCUSED OF BEING A NANCY STATE
WHEN WE SUGGEST POLICIES THAT ARE PUBLIC HEALTH ORIENTED. CAN YOU GIVE SOME INSIGHTS INTO
WHAT STRATEGIES WE CAN USE TO PROMOTE GOOD PUBLIC HEALTH
POLICY AND HOW WE GO ABOUT CONVINCING PEOPLE THAT THIS IS
NOT PART OF BEING A NANNY STATE, BUT MAKES SENSE FISCALLY AS WELL
AS PUBLIC HEALTHWISE?>>IT’S A GREAT QUESTION. AND IT IS VERY TIMELY, GIVEN THE
CURRENT CLIMATE THAT WE’RE IN. FOR 17 YEARS, I WORKED WITH A
HAND FULL OF COLLEAGUES IN GEORGIA TO DEFENSE GEORGIA’S
MOTORCYCLE HELMET LAW, WHICH WAS NOT POPULAR WITH EVERY SINGLE
CONSTITUENT IN THE STATE, BUT WILDLY POPULAR WITH THE MAJORITY
IN THE STATE. BUT THERE WAS A SMALL AND VOCAL
GROUP THAT FEELS THAT THEIR NEED TO FEEL THE FREEDOM OF WIND
BLOWING THROUGH THEIR HAIR IS MORE IMPORTANT THAN THE NEED TO
WEAR A MOTORCYCLE HELMET. THEY HAD A FOLLOWING AND HAVE A
FOLLOWING AT THE GEORGIA GENERAL ASSEMBLY. I HAD A VERY SIMPLE ANSWER TO
THAT, WHICH WAS I ABSOLUTELY BELIEVE IN PERSONAL FREEDOM AND
PERSONAL CHOICE AND PERSONAL RESPONSIBILITY. I ALSO LIKE TO KEEP MY MONEY IN
MY WALLET. AND WHEN PEOPLE HAVE A SEVERE
BRAIN INJURY AND DON’T DIE OR IF THEY HAVE A SEVERE BRAIN INJURY
AND END UP AT A PUBLIC FUNDED TRAUMA CENTER, THE RESOURCE
CONSUMPTION IS ENORMOUS. THE DISABILITY CHALLENGES ARE
PROFOUND. THEY’RE NOT THE ONLY ONE WHO
SUFFERS FOR THAT MISFORTUNE OR THAT INJURY. THEIR FAMILY SUFFERS, THEIR
EMPLOYER SUFFERS, THEIR CHILDREN SUFFERS, THE LOCAL ECONOMY
SUFFERS, THE STATE’S SYSTEM IS COMPROMISED. SO, IN FACT, WE ALL HAVE AN
INTEREST AS A SOCIETY AND BALANCED AGAINST THAT, THE MINOR
INCONVENIENCE OF HAVING A MUSHY HAIR DO WHEN YOU GET TO WHEREVER
YOU’RE GOING IS A SMALL PRICE TO PAY FOR THE PAYOFF. WE DON’T QUESTION, IN MOST
STATES IN THIS COUNTRY MORE THE NEED TO WEAR A SAFETY BELT. THAT IS A BRILLIANT BRAIN INJURY
STRATEGY FOR A MOTOR VEHICLE. WEARING THE HELMET IS THE SAME
EFFECTIVE STRATEGY ON A MOTORCYCLE. SO MY PERSONAL STRATEGY IS TO
APPEAL TO FISCAL CONSERVATIVEISM. THOSE WHO ARE PARTICULARLY THE
STRONGEST LIBERTARIANS ALSO TEND TO BE PHYSICAL CONSERVATIVES AND
CAN RELATE TO THAT ARGUMENT BETTER THAN SOME OTHERS AND IT
IS A POWERFUL, POWERFUL ARGUMENT.>>BRENDAN JACKSON. I’M REALLY GLAD — I WAS
WONDERING WHAT SITUATION IS LIKE FOR PEDESTRIAN BICYCLE INJURIES
AND IS FATALITIES AND WHAT STEPS ARE EFFECTIVE ONES THAT WE CAN
TAKE?>>I’LL GIVE A BRIEF ANSWER, BUT
I ALSO WANT TO LET ME PANELISTS JOIN IN. PEDESTRIAN INJURIES HAVE BEEN A
VERY, VERY CHALLENGING AREA. WE TYPICALLY, SOCIETY, THE FIRST
THING WE ALWAYS THINK ABOUT IS EDUCATION. AND LEFT RIGHT LEFT AND THOSE
SORTS OF THINGS TO TRAIN PEDESTRIANS OR TO TRAIN KIDS IS
IMPORTANT. BUT BY AND LARGE, THE MOST
EFFECTIVE STRATEGIES FOR PEDESTRIAN SAFETY HAVE COME FROM
BETTER LIGHTING IN POORLY LIT AREAS, RESIDENTIAL DESIGN,
THINGS THAT SEPARATE PEDESTRIANS FROM TRAFFIC FLOW, TRAFFIC
CALMING MEASURES THAT SIMPLY SLOW DOIN’ TRAFFICWN TRAFFIC. WHILE WE HAVE MANY PEOPLE
CALLING IN OR LISTENING IN FROM AROUND THE COUNTRY, THOSE OF YOU
IN THIS PART OF THE COUNTRY KNOW THAT BEAUFORT HIGHWAY IS A VERY
DIFFICULT PLACE FOR PEDESTRIANS. YOU HAVE RETAIL STORES AND
GROCERY STORES ON THE OTHER SIDE OF THE TREAT AND RESIDENTS ON
THE OTHER SIDE AND IT CAN BE A HALF MILE OR A MILE TO A
CROSSWALK. THOSE CHALLENGES ARE VERY
DIFFICULT. FOR BICYCLES, WE HAVE SEEN A
STEADY IMPROVEMENT, BUT A PLATEAUING OF THE USE OF BICYCLE
HELMETS, WHICH ARE MORE EFFECTIVE. WE DO MORE MARKING OF LANES IN
THE UNITED STATES, WHEREAS THE EUROPEANS PHYSICALLY SEPARATE
THEIR BIKE LINES FROM VEHICLES. THAT’S A VERY EFFECTIVE
STRATEGY, BUT A LOST COSTLY ONE ON THE FRONT END. WE KNOW STRATEGIES THAT WORK. WE HAVE TO USE THEM MORE
CONSISTENTLY. ANYONE WANT TO WEIGH IN ON THAT? BUT A GOOD QUESTION. THANK YOU.>>>
I HAVE A QUESTION FOR DR. WRIEFT. DAVID, EARLY ON WHEN WE WERE
DOING THIS WORK WITH PROGESTERONE AND EVERYONE THAT
YOU WILL THOUGHT DON WAS CRAZY, WHENEVER I WOULD TELL ANYONE
THAT WE WERE EXPLORING A THERAPY THAT HAD ALL THESE BENEFICIAL
EFFECTS, SEEMED TO WORK WELL IN EXPERIMENTAL ANIMALS AND WE HAVE
SOME PROVOCATIVE CLINICAL DATA IN HUMANS. THEY WOULD GET REALLY EXCITED
AND THEY WOULD GO, WHAT IS IT? WHAT IS IT? AND I WOULD SAY, IT’S
PROGESTERONE. AND THE NEXT REACTION INVARIABLY
WAS THEY WOULD LAUGH. HAS THAT CHANGED?>>WELL, I STILL FEEL LIKE WE’RE
SWIMMING UPSTREAM. AND YEAH, WE STILL GET GIGGLES,
WE GET LAUGHS, WE GET A LOT OF DISBELIEF. THAT IS WHAT OUR PHASE THREE
MULTI CENTER CLINICAL TRIAL IS HERE TO PROVE. IT’S INTERESTING, IF WE HAD
DISCOVERED PROGESTERONE IN THE BRAIN FIRST, IT IS PRODUCED IN
THE BRAIN, IN FACT, IT’S THE ONLY HORMONE/STEROID PRODUCED IN
THE BRAIN. IF WE DISCOVERED IT THERE FIRST,
WE MAY HAVE A COMPLETELY DIFFERENT PERCEPTION OF WHAT
PROGESTERONE DOES. IT’S MADE IN THE BRAIN BY THE
BRAIN FOR THE BRAIN. AND IT ONLY HAPPENED THAT WE
DISCOVERED IT IN THE OVARIES FIRST AND ITS ROLE IN THE
MENSTRUAL CYCLE. IN
INDIED, IT MAY BE THAT ITS EFFECT IN PREGNANCY IS TO COAT
THE BRAIN DURING FETAL DEVELOPMENT. THAT IS HYPOTHESIZES BY A NUMBER
OF GYN AND NEUROEXPERTS. IT’S IMPORTANT HOW THE BODY USES
DIFFERENT COMPOUNDS IN DIFFERENT PLACES FOR DIFFERENT PURPOSES. IT’S A BEAUTIFUL EXAMPLE OF THE
HUMAN BODY AND HOW IT DOES THAT.>>AS YOU ALL HEARD FROM LISA’S
OPENING REMARKS, INJURY IN JOURNAL IN BRAIN INJURY IN
PARTICULAR SEEMS TO BE LINKED TO THE Y CHROMOSOME. I THINK IT’S A CRUEL TRICK OF
FAITH THAT HAD ONLY TESTOSTERONE BEEN THE OF COURSEIVE TRAUMATIC
BRAIN INJURY, WE WOULD HAVE EVERY PHARMACY AROUND THE
COUNTRY STANDING IN LINE WAITING TO BUY IT. I THINK WE HAVE ONE MORE FOR ONE
QUESTION.>>YOU DISCUSS ALCOHOL AND
DRIVING AND THE EFFECT OF SOME OF THE PRESCRIPTION DRUG ABUSE
THAT IS — THAT IS PREVALENT AS WELL AS THE PRESCRIPTION
APPROXIMATED USED WHILE DRIVING, IS THERE ANY SURVEILLANCE ON THE
CDC?>>WELL, THANK YOU FOR THAT
QUESTION. OUR COLLEAGUES IN THE DIVISION
OF UNINTENTIONAL INJURY DO FOCUS ON MEDICATION USED AND MISUSED
IN THAT AND THEY DO LOOK AT THAT IN RELATIONSHIP TO MOTOR VEHICLE
INCIDENTS. AND I’M NOT SURE IF SOMEONE
WOULD LIKE TO COMMENT SPECIFICALLY ON THE SPECIFICS OF
THAT OR WOULD LIKE TO JUST GET WITH YOU AFTER THE SESSION.>>THANK YOU.>>THAT CONCLUDE THESE SESSION. I WOULD LIKE TO THANK ALL OF YOU
WHO ARE PRESENT IN THE AUDITORIUM AND I’D LIKE TO THANK
ALL WHO TUNED IN ON THE WEB AND OVER THE LINES. THANK YOU FOR PARTICIPATING. BRAIN INJURIES MATTER. THEY CAN BE PREVENTED. WE CAN MAKE A DIFFERENCE AND WE
ARE WINNING THIS BATTLE. THANK YOU.>>AND WE ARE GOING TO ASSESS
WHAT KIND OF CHANGES AND MODIFICATIONS WE ARE GOING TO
MAKE IN THE NEXT — IN THE THIRD YEAR OF THE GRAND ROUNDS, WE ARE
HIRING ARTHUR AS OUR PERMANENT MODERATOR. THANK YOU ALL VERY MUCH.

1. Introduction and About this Video – Brain Injury 101

1. Introduction and About this Video – Brain Injury 101


>>DR. SALOMONE: Hello, I’m Dr. Jeffery
Salomone, Co-Director of Trauma at Grady Memorial Hospital.
The injury of a loved one or friend is a difficult thing to face and we recognize this is a very
challenging time for you. The goal of this video is to give you a better
understanding of brain injury and the rehabilitation process ahead. Because a serious brain injury affects not
just the individual but the entire family unit as well, this video also focuses on the
important role of family members during the next several weeks and months. The more you can equip yourself with knowledge,
the better your loved one’s outcome may be. We hope this video will help answer many
of the questions you might have about brain injury. Thank you for watching and thank you
for entrusting the care of your loved one to this hospital.>>JUDY FORTIN: Hello, I’m Judy Fortin in
Atlanta, Georgia. I’ll be hosting this video to help you and your family better understand
brain injury and disease. For much of my career I was a reporter covering healthcare at CNN.
It’s important to me to help the public deal with medical and health crisis issues
by bringing them timely, accurate information. That’s the purpose of this video – to
give you and your family helpful information right now so you can prepare yourselves for
the challenges ahead. People with brain injury and their families need to know about and
have access to the right resources and support to make their recovery as good as it can possibly
be. Major injuries like the one you are dealing
with have complex consequences that may involve part or all of the central nervous system.
Since the brain and the spinal cord can both be affected in major injuries, it may be important
that you learn about brain and spinal cord injury. Watch our companion video detailing
spinal cord injury for more information. Throughout both these videos, you’ll hear
from some of the nation’s top neuroscientists, physicians and patient advocates who will
help me share timely information with you. The sponsors of this video hope to give you
a resource that you can return to as often as you like. We’ve organized the information
so you can select the chapters that address the specific needs you may have as the patient
yourself or as a concerned friend or family member. [DVD version continues: The chapters
and sub-chapters within them work just like the items on a movie DVD] – [both versions
continue: You can select the chapters you want to watch and then use the easy onscreen
navigation to skip forward or go back to another section at any time. The chapters on this
program are: Chapter I – Introduction & About this Video
Chapter II – Brain Injury Basics & Anatomy of the Brain
Chapter III – Understanding Traumatic Brain Injury: Its Causes, Effects, Classifications
Chapter IV – Understanding Non-Traumatic Brain Injury: Its Causes, Effects, Classifications
Chapter V – Practical Advice for Coping With Brain Injury>>JUDY FORTIN: At this time, I want to introduce
you to a special guest who understands what you’re going through because she’s had
first-hand experience. Lee Woodruff is a best-selling author and leading advocate for people with
brain injuries. She joins us now.>>LEE WOODRUFF: In January of 2006, my husband
Bob was seriously injured in a bomb blast in Iraq while covering the war for ABC News.
In an instant, the shock of that news turned our family upside down. Bob suffered a traumatic
brain injury, and doctors removed 16 centimeters of his skull to save his life. He also had
major damage to his face and jaw. Right now, you probably feel very uncertain
about what the future holds. In the minutes and hours after getting the news about Bob,
I was in the very same place. Would he live? Would he have permanent brain damage? From
the start I clung to the fact that my husband was alive, and to hope – hope that he would
be okay. My family and friends and Bob’s colleagues soon became my rock, as I quickly
realized that I was not alone in my grief, or my fear. Later, I learned that there are
more than five million people living with the after-effects of brain injury in our country. You are not alone either. Lean on people who’ve
gone through this – call in your friends, relatives, your church, community and your
support groups. And then you have to pull yourself together to help your loved one get
better and either become or find an anchor for your family. There’s plenty of information about brain
injury on the Internet, some of it good and some of it not so good. I encourage you to
use credible resources, like this video and web sites from recognized brain injury organizations.
Don’t try to learn everything at once. I didn’t. Rely on the medical professionals
caring for your loved one to help you know what to focus on next. Do your best to take
things a step at a time, one day at a time, and recognize that even the smallest progress
is positive. You have good days and bad days on the long road ahead, and that’s okay. Today, my husband is a working journalist
and an active father. We were so lucky to have a talented team of U.S. military brain
surgeons and trauma care doctors and nurses take care of Bob after his injury and throughout
his rehabilitation. If your loved one has sustained a serious brain injury, whether
it’s traumatic or caused by an illness or chronic condition, it’s important that they
get specialized treatment as soon as possible. Statistically, it makes a huge difference
in their long-term recovery. First, you want to get the most you can out of your trauma
care stay.>>JUDY FORTIN: It’s important to realize
that being at the trauma care center is an interim step in your loved one’s long-term
recovery. There can be a wide range of possible outcomes down the road. As Lee said, try to
focus first on what’s happening right now. Your loved one was probably stabilized by
paramedics at the site where the accident occurred. If the injury was from a trauma,
the head and neck may be immobilized to prevent further damage to the nervous system, spine
and the brain.>>DAVID W. WRIGHT, MD: In the United States,
we are fortunate to have dependable standards for emergency and trauma care, which establish
milestones for that care. At the trauma center, the first step is to medically stabilize the
patient’s condition. Next, they may be given numerous tests and x-rays, and assessed by
various medical specialists. And finally, they may be moved to the operating room or
a hospital room, depending on their condition. This is bound to be a very hectic time, so
try to stay positive and be confident that you are in good hands at the trauma care facility.>>LEON HALEY, MD: It’s natural to wonder
what you might do right now to help your loved one and the care team.
Initially you may be greeted by a nurse or social worker. Let them help you think of
questions you might ask the doctors you’ll see later. Soon the treatment team will update
you on your loved one’s condition. Ask his or her trauma caregivers to explain the basic
tasks they are performing. And, keep these important tips in mind during the trauma care
or hospital stay: If possible, have one point person gather
all of your family’s questions. Limit visits and the number of visitors at
any given time. Allow yourself or your loved one time to rest
between visits. Have everyone who visits maintain a soft and
calm tone of voice. Assume that your loved one can hear you and
be careful of everything that is said within earshot. Your role right now is to support
their recovery in an encouraging and positive way.
If your loved one is able, encourage him or her to move around as much as their condition
and their medical team will allow. Movement might include coughing to stimulate breathing
muscles, deep breathing, sitting up, or moving around the room.>>JUDY FORTIN: Chapter two is next. We’ll
share some basics about the anatomy of the brain and how it works.