USA Hockey May Impose Penalties For Head, Neck Contact

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Posted on 30th January 2011 by Gordon Johnson in Brain Injury

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USA Hockey is considering making it a penalty for young players to make contact to another player’s head or neck, according to The New York Times.

The amateur hockey organization is also weighing whether to ban body checking for boys younger than 13, the Times reported. The way rules stand now, ”there is no penalty for incidental contact to the head or neck,” according to The Times.

There was a summit on ice hockey and concussions held in October and led by Dr. Michael Stuart, who is USA Hockey’s chief medical officer and a professor of orthopedic surgery at the Mayo Clinic in Rochester, Minn.

Studies discussed at the summit found that there were more than three times the rate of bad injuries and concussions in jurisdictions that permitted body checking for “11- and 12-year-olds, as measured against areas where it was allowed for 12- and 13-year-olds,” the Times said.           

The USA Hockey proposal regarding penalties for contact with the head and neck at all ages is similar to the rules that already have been enacted at the Ice Hockey Federation and the NCAA. The National Hockey League permits some checks to the head, accordign to The Times. 

http://www.nytimes.com/2011/01/28/sports/hockey/28checking.html?_r=1&src=me&ref=sports

Brain Injury Victim’s Grueling Recovery May Foretell Gabrielle Giffords’ Rehabilitation

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Posted on 24th January 2011 by Gordon Johnson in Brain Injury

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The New York Times Monday did a profile of a young man who, after being shot through the head, underwent treatment at the same facility where Rep. Gabrielle Giffords will be going: the Institute for Rehabilitation and Research in Houston.

http://www.nytimes.com/2011/01/24/us/24rehab.html?scp=1&sq=mark%20steinhubl&st=cse

Mark Steinhubl, a 20-year-old college student, was shot in the head on Jan. 4, 2009, while he was at his friend’s house. The takeaway from his experience recovering from traumatic brain injury, the same type of brain damage that Giffords sustained when she was shot Jan. 8, is that rehabilitation is grueling and difficult. 

The bullet that struck Steinhubl went through the right side of his brain, The Times reported. Doctors had to take off part of his skull, as they did with Giffords, to relieve the pressure as his brain swelled from the injury. Steinhubl, who ended up losing his right  eye and hearing in his right ear, couldn’t even sit up when he first got to the institute.

Once a top student and athlete, it took time for Steinhubl to be able to sit up in bed. His left arm was paralyzed, and physical therapists worked with him so he could regain control of those muscles, according to The Times. They also taught him to walk again.

Steinhubl also had cognitive problems, and had trouble doing math and remembering things. But he progressed, and left the institute Feb. 28 last year, three months ahead of schedule, according to The Times. He then continued his therapy at an outpatient clinic.

The young man, who still doesn’t have full use of his left hand, is attending A&M in Texas. He is studying chemical engineering, but still isn’t ready to take a full course load.

Giffords will be moved to the institute where Steinhubl underwent  rehab once she is well enough to get out of intensive care at Memorial Hermann-Texas Medical Center in Houston. And no doubt, her journey will be as difficult as Steinhubl’s.   

     

Rep. Gabrielle Giffords Moved To Houston Hospital For Rehabilitation

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Posted on 21st January 2011 by Gordon Johnson in Brain Injury

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U.S. Rep. Gabrielle Giffords Friday was moved from Tucson to Memorial Hermann-Texas Medical Center  in Houston, where she will do what most expect to be a difficult rehabiliation from the gunshot wound she sustained to the head Jan. 8. 

http://www.nytimes.com/2011/01/22/us/22giffords.html?_r=1&hpw

Giffords, who has so far been making a miraculous recovery from her horrific injury, was greeted with crowds on the streets of Tuscon as she was taken by ambulance to Davis-Monthan Air Force base to fly to Houston. According to The New York Times, Giffords was well aware that the people with signs and balloons were wishing her well.

She smiled and she teared up when she heard the applause from the crowd, trauma surgeon Dr. Randall Riese told The Times.

Giffords was transported by private jet to William P. Hobby Airport in Houston and landed at 1:30 p.m. Friday. She was then taken by helicopter to Memorial Hermann.

In Houston Giffords was immediately put in an intensive care unit, where six physicians ran tests on her. The congresswoman, who was shot through the brain, hasn’t spoken yet but is following commands and seems to understand what is said to her.

But it’s not known yet which of the 40-year-old’s cognitive or other abilities were impacted by the bullet that traversed the left side of her brain. The left lobe controls the right side of the body, and Giffords’ muscles on her right side are weak and showing some paralysis, The Times reported.

Giffords will eventually be moved to the Institute for Rehabilitation and Research at Memorial Hermann, which treats patients with brain and spiral injuries.      

Rep. Gabrielle Giffords Slated To Move To Houston Rehabilitation Hospital

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Posted on 19th January 2011 by Gordon Johnson in Brain Injury

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U.S. Rep. Gabrielle Giffords is in fact headed to a Houston rehabilitation hospital to continue her recovery from a gunshot wound in her head following a bloodbath in Tucson Jan. 8.  

http://www.mercurynews.com/nation-world/ci_17137388?nclick_check=1

Unless there are any unexpected medical problems, Giffords will be transferred Friday to the TIRR Memorial Hermann Rehabilitation Hospital in Houston, her family announced Wednesday. It remains to be seen how difficult her recovery will be as a result of the damage her brain sustained when she was shot through the head.

Giffords’ husband, astronaut Mark Kelly, lives in Houston but has been by her side at the Arizona hospital where she is now. He put out statement about Giffords’ condition.

“I am extremely hopeful at the signs of recovery that my wife has made since the shooting,” Kelly said. “The team of doctors and nurses at UMC (University Medical Center in Tucson) has stabilized her to the point of being able to move to the rehabilitation phase.”

TIRR Memorial is affiliated with the University of Texas Health Science Center in Houston, and has 116 beds, according to the Associated Press. AP noted that Buffalo Bills’ tight end Kevin Everett, who was paralyzed from the waist down after sustaining a spinal injury, came to the rehab facility in September 2007 and can now walk.  

Giffords has been improving daily since being shot through the head while meeting with constituents outside a Safeway store in Tucson, squeezing her husband’s hand and even giving him a back rub. Six people were killed and 14 hurt during the rampage where Giffords was shot by the gunman.

Astronaut Kelly has been assigned to command NASA’s space shuttle flight in April. But it’s not known now whether Kelly will still lead that mission. He has more important business at home.       

Rep. Gabrielle Giffords Could Be Moved To A Rehab Center Soon

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Posted on 17th January 2011 by Gordon Johnson in Brain Injury

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U.S. Rep. Gabrielle Giffords is continuing to make what doctors call miraculous progress after being shot in the head, and will be on her way to a rehabilitation facility soon, according to press reports Monday. 

http://online.wsj.com/article/SB10001424052748703396604576088303403067640.html

Giffords’ relatives have already started the hunt for a rehab center for the congresswoman, who was shot in a Jan. 8 massacre at a Tuscon where six people were killed and 14 were injured, her neurosurgeon said during a press conference Monday.

She is doing so well she could be ready to move to a rehab center in anywhere from a few days to a few weeks.

Giffords is continuing to show hopeful signs that her cognitive abilities weren’t destroyed when she was shot through the head by her alleged assailant Jared Loughner. For example, she has smiled at her husband, astronaut Mark Kelly, and even rubbed his back for 10 minutes.     

http://www.washingtonpost.com/wp-dyn/content/article/2011/01/17/AR2011011702542.html?hpid=topnews

During the weekend doctors operated on Giffords’ right eye socket, which was injured when the bullet that went though her skull pushed pieces of bone into that eye. Surgeons mended the right eye by putting titanium mesh in it.

It’s still not known what kind of vision she will have in that eye, just as it isn’t known yet how much her head wounds will be affecting her brain function.

Over the weekend doctors at University Medical Center in Tucson took Giffords off a ventilator and removed a breathing tube from her mouth, replacing it with one that goes right into her windpipe.

On Monday it was also revealed that Arizona has a statute that says if a public official ceases to “discharge the duties of office for the period of three consecutive months”  that office can be considered vacant, to be filled by a special election. But no one knows what are considered “duties” under the law.    

 

Rep. Giffords Opened Eyes For First Time, President Obama Says

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Posted on 13th January 2011 by Gordon Johnson in Brain Injury

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Rep. Gabrielle Giffords opened her eyes Wednesday, President Barack Obama told an overflow audience during his speech at a tribute to her and the others injured or killed during a massacre outside a Tucson supermarket last weekend.

http://www.azcentral.com/news/articles/2011/01/12/20110112giffords-shooting-obama-tucson-speech-brk12-ON.html

Obama unexpectedly delivered the report on Giffords, who was shot through the head in an attempted assassinaton, while speaking at the University of Arizona’s McKale Center Wednesday.

While Giffords’ husband, astronaut husband Mark Kelly, looked on, Obama said that shortly after he left Giffords at University Medical Center, she had opened her eyes for the first time since she was shot. That news brought tears and cheers from the audience.

According to The Arizona Republic, Congresswoman Debbie Wasserman Schultz of Florida told CNN that she was in the hospital room when Giffords opened her eyes.

Schultz told Giffords she had to recover quickly because she wanted her to visit her this summer at her New Hampshire house.

In response, Giffords opened her eyes. When her husband asked her to to touch him, she started rubbing his arm.

It’s good news about Giffords, but her recovery is still likely to be long and challenging, as The Arizona Republic explained earlier in the day Wednesday.     

http://www.azcentral.com/news/articles/2011/01/12/20110112gabrielle-giffords-arizona-shooting-brain-injury-road-to-recovery.html

Doctors Monitor Congresswoman Giffords’ Brain Swelling

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Posted on 10th January 2011 by Gordon Johnson in Brain Injury

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Rep. Gabrielle Giffords’ condition remained the same Monday, according to the doctors treating her for the gunshot wound in the head she sustained Saturday. 

http://www.latimes.com/news/nationworld/nation/la-na-arizona-shooting-medical-20110111,0,1714259.story

During a press conference at University Medical Center (UMC) in Tucson, physcians said they are waiting to see if Giffords’ brain swells any more. Brain swelling usually peaks on the third day after an injury takes place, according to Dr. Michael Lemole, who UMC’s chief of neurosurgery.

As far as the congresswoman’s condition, Lemole told reporters, “No change is good, and we have no change. She is still following basic commands, and her CAT scans are showing no progression of swelling. Every day that goes by, we are slightly more optimistic.”

Doctors removed much of the left side of Giffords’ skull Saturday to relieve pressure as her brain swelled from the gunshot wound.

The 9-millimeter bullet allegedly shot by suspect Jared Loughner entered the back of Giffords’ skull and came out through the front, missing several important areas of the brain.

Giffords was among those hurt when Loughner, allegedly trying to assassinate her, opened fire at a Safeway in Tucson, killing six people and injuring 14 others.

While Giffords has been responding to commands, on Monday her doctors would not evaluate her mental condition.

“At this point, we can’t measure psychologic function, nor would we try,” Lemole told the press.

Handicapping Brain-Injured Arizona Congresswoman’s Odds For Recovery After Shooting

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Posted on 9th January 2011 by Gordon Johnson in Brain Injury

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Physicians are saying that Rep. Gabrielle Giffords of Arizona is lucky, if you can say that anyone who was shot in the head is “lucky.”

Giffords, who was gunned down Saturday in the Tucson massacre that left six people dead and 13 injured, took a bullet that “luckily” didn’t travel through the center of her brain. And it didn’t go through one brain hemisphere to another. That’s the good news. 

The New York Times offered one of the best accounts of the press conference by the doctors who operated on Giffords at University Medical Center (UMC) in Tucson, explaining her circumstances.

http://www.nytimes.com/2011/01/10/us/politics/10giffords.html?hp

Chief of neurosurgery Dr. G. Michael Lemole Jr., said that the bullet that hit Giffords went through the left side of her brain “from back to front.” It entered the back of her head and came out through the front. So it didn’t  cross from one side of the brain to the other, and it did not go through crucial areas that would hamstrung any recovery.

The left side of the brain governs strength and sensation on the right side of the body, along with speech.

http://www.politicsdaily.com/2011/01/09/doctors-cautiously-optimistic-about-gabrielle-giffords-condit/

UMC’s head of trauma surgery Dr. Peter Rhee told reporters, “Over all, this is about as good as it’s going to get. When you get shot in the head and a bullet goes through your brain, the chances of you living are very small, and the chances of you waking up and actually following commands is even much smaller than that.”

Doctors are being upbeat and “cautiously optimistic” about Giffords, in part because the congresswoman has been able to respond to some simple commands, as Rhee mentioned. But the physicians wouldn’t handicap her odds for a full recovery, and noted that the process could take months to years.

Press reports credit swift action by Giffords’ 20-year-old intern, and the fact that she was in the hospital within 38 minutes, with saving her life.

According to The Arizona Republic, University of Arizona intern Daniel Hernandez applied pressure on Giffords’ head wounds after she was shot and held her upright so she wouldn’t choke on her own blood. Remarkably, he said that Giffords was conscious at this point.  

http://www.azcentral.com/news/articles/2011/01/09/20110109daniel-hernandez-gabrielle-giffords-arizona-shooting.html

When Giffords got to the hospital, doctors took off part of her skull, to alleviate the pressure from brain swelling. They also removed the part of her brain that had been damaged, but it was not very much tissue.

The congresswoman has been put into a medically induced coma, and is being awakened periodically so doctors can monitor her progress.  

Expect a barrage of press stories about Giffords’ prognosis. The Los Angeles Times has already printed one, headlined “Head Trauma is Not a Death Sentence.” That story quoted a trauma neurosurgeon at Cedars-Sinai Medical Center, Dr. Ian Armstrong.

 http://www.latimes.com/news/nationworld/nation/la-na-giffords-head-wound-20110109,0,6568557.story

“I’ve seen every foreign body in the world pass through the brain, and I never cease to be amazed that some seem to survive and do amazingly well,” Armstrong told the Los Angeles Times. 

That may be so, but recovery from brain injury is usually not easy, even in the best of circumstances. Just surviving is the first, but not the last, of the tough challenges Giffords faces.

And during her recovery, how will Giffords be able to fulfill her duties as a congresswoman representing Arizona in Washington?

 

Arizona Congresswoman Likely Faces Tough Recovery After Being Shot Through The Brain

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Posted on 8th January 2011 by Gordon Johnson in Brain Injury

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The next few days will be crucial for Arizona Rep. Gabrielle Giffords, who was shot through the head Saturday by a gunman who also killed six people, including a judge and a 9-year-old, outside a supermarket in Tucson. We will have to wait to see how much brain trauma she sustained.

http://www.latimes.com/news/nationworld/nation/la-na-gabrielle-giffords-20110109,0,5733898,full.story

Giffords, a 40-year-old Democrat, was conducting a meet-and-greet with constituents when she was felled by a suspect identified as Jared Lee Loughner, 22. A second suspect is being sought.  At least a dozen people were injured in the shooting at a Safeway, with the fatalities including U.S. District Court Judge John Roll.

A team of neurosurgeons performed surgery on Giffords at the University Medical Center in Tuscon Saturday, and her spokesman said that afterward the congresswoman had been responsive to some commands from physicians, according to The Los Angeles Times.

That’s a good sign, but obviously only a preliminary one that doesn’t guarantee much in terms of Giffords’ recovery. 

That spokesman, Mark Kimble, said, “The next three days are going to be very critical as far as swelling of the brain.”

The New York Times quoted Dr. Peter Rhee, who is medical director of the medical center’s trauma and critical care unit, who said that Giffords had been shot “through and through,” with her assailant’s bullet traveling through her brain, and then apparently exiting. 

http://www.nytimes.com/2011/01/09/us/politics/09giffords.html?_r=1&hp

The Los Angeles Times quoted a trauma neurosurgeon as saying it isn’t unusual for victims to survive gunshot wounds to the head. They may survive, but I doubt they live a charmed life afterward. We don’t hear about the consequences of their wounds to their brain and behavior.

Hopefully, Giffords will make a good recovery from her brain injuries.  

   

How Centering Care On Alzheimer’s Patients’ Needs Is Working In Arizona

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Posted on 4th January 2011 by Gordon Johnson in Brain Injury

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Letting Alzheimer’s patients do what they want, within reason, has proven to be a successful treatment strategy for a Phoenix nursing home, according to The New York Times.

http://www.nytimes.com/2011/01/01/health/01care.html?_r=1&hp

The Times on Saturday did a Page One story, with the headline “Giving Alzheimer’s Patients Their Way, Even Doses of Chocolate,” about the Beatitudes nursing home.

Beatitudes follows the relatively new philosophy of patient-centered care for those with Alzheimer’s: In other words, acquiescing to their needs and wants, even if they are out of the norm. There is also an emphasis on preserving the Alzheimer’s patient’s dignity and privacy in patient-centered care.

For example, Alzheimer’s patient Margaret Nance, 96, is permitted to get up and go to sleep whenever she wants to. And why should she have to conform to a schedule set by a nursing home? 

And as  The Times points out, at Beatitudes Nance is allowed to eat what she wants, “including unlimited chocolate,” which a Beatitudes official says is “better than Xanax.”

Letting treatment conform to those with Alzheimer’s, rather than try to force them to follow arbitrary rules like getting up at 7 a.m. every morning, is meant to give those with the dreaded disease a sense of control and a positive emotional experience.

Since there is no cure for Alzheimer’s, there is now an increased focus on improving their caretaking, and making caretakers center on the wants and requests of those with this disease. The idea is to lift the moods, and jog the memories, of these patients.

For example, in order to figure ou the best behavior management for a particular resident, nursing-home staff will do research to find out what that Alzheimer’s patient used to enjoy doing before getting the illness, and then duplicate that activity at the facility. This can help refresh the patient’s memory, or spark the same pleasant emotions that the activity used to for that patient.     

Letting an Alzheimer’s patient eat the foods he or she enjoys, such as chocolate, improves his or her mood, acting as a comfort.

And instead of automatically putting residents in diapers, at Beatitudes staff tries to instead have the residents use the regular toilet.

At  Beatitudes, the philosophy is also to try to take patients off antipsychotic drugs.

Until there is a cure for Alzheimer’s, the Beatitudes approach of patient-centered care seems to be the ticket for improving life for those stricken by this disease.      

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