Pain Management: Complex Regional Pain Syndrome
Complex regional pain syndrome (CRPS), also called reflex sympathetic dystrophy syndrome, is a chronic pain condition in which high levels of nerve impulses are sent to an affected site. Experts believe that CRPS occurs as a result of dysfunction in the central or peripheral nervous systems.
CRPS is most common in people aged 20-35. The syndrome also can occur in children; it affects women more often than men.
There is no cure for CRPS.
What Causes Complex Regional Pain Syndrome?
CRPS most likely does not have a single cause but rather results from multiple causes that produce similar symptoms. Some theories suggest that pain receptors in the affected part of the body become responsive to catecholamines, a group of nervous system messengers. In cases of injury-related CRPS, the syndrome may be caused by a triggering of the immune response which may lead to the inflammatory symptoms of redness, warmth, and swelling in the affected area. For this reason, it is believed that CRPS may represent a disruption of the healing process.
What Are the Symptoms of Complex Regional Pain Syndrome?
The symptoms of CRPS vary in their severity and length. One symptom of CRPS is continuous, intense pain that gets worse rather than better over time. If CRPS occurs after an injury, it may seem out of proportion to the severity of the injury. Even in cases involving an injury only to a finger or toe, pain can spread to include the entire arm or leg. In some cases, pain can even travel to the opposite extremity. Other symptoms of CRPS include:
- "Burning" pain
- Swelling and stiffness in affected joints
- Motor disability, with decreased ability to move the affected body part
- Changes in nail and hair growth patterns. There may be rapid hair growth or no hair growth.
- Skin changes. CRPS involves changes in skin temperature -- skin on one extremity can feel warmer or cooler compared to the opposite extremity. Skin color changes also are apparent as the skin is often blotchy, pale, purple or red. The texture of skin also can change, becoming shiny and thin. People with syndrome may have skin that sometimes is excessively sweaty.
CRPS may be heightened by emotional stress.
How Is Complex Regional Pain Syndrome Diagnosed?
There is no specific diagnostic test for CRPS, but some testing can rule out other conditions. Triple-phase bone scans can be used to identify changes in the bone and in blood circulation. Some health care providers may apply a stimulus (for example, heat, touch, cold) to determine whether there is pain in a specific area.
Making a firm diagnosis of CRPS may be difficult early in the course of the disorder when symptoms are few or mild. CRPS is diagnosed primarily through observation of the following symptoms:
- The presence of an initial injury
- A higher-than-expected amount of pain from an injury
- A change in appearance of an affected area
- The presence of no other cause of pain or altered appearance
How Is Complex Regional Pain Syndrome Treated?
Since there is no cure for CRPS, the goal of treatment is to relieve painful symptoms associated with the disorder. Therapies used include psychotherapy, physical therapy, and drug treatment, such as topical analgesics, narcotics, corticosteroids, antidepressants and anti-seizure drugs.
Other treatments include:
* Sympathetic nerve blocks: These blocks, which are done in a variety of ways, can provide significant pain relief for some people. One kind of block involves placing an anesthetic next to the spine to directly block the sympathetic nerves.
* Surgical sympathectomy: This controversial technique destroys the nerves involved in CRPS. Some experts believe it has a favorable outcome, while others feel it makes CRPS worse. The technique should be considered only for people whose pain is dramatically but temporarily relieved by selective sympathetic blocks.
* Intrathecal drug pumps: Pumps and implanted catheters are used to send pain-relieving medication into the spinal fluid.
* Spinal cord stimulation: This technique, in which electrodes are placed next to the spinal cord, offers relief for many people with the condition.
Reviewed by the doctors at The Cleveland Clinic Pain Management Department.
POSTED BY ATTORNEY RENE G. GARCIA:
- CRPS is a very serious condition that has been experienced by some of our clients after a serious trauma. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD.
Conversion disorder is classified as one of the somatoform disorders in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, Fourth Edition, Text Revision (DSM-IV-TR).[1] Although defined as a condition that presents as an alteration or loss of a physical function suggestive of a physical disorder, conversion disorder is presumed to be the expression of an underlying psychological conflict or need.
The critical psychological conflict or stress may not be apparent initially, but it becomes evident in the course of obtaining a patient’s history: ideally, it is a psychological factor related symbolically and temporally to symptom onset. Conversion symptoms are presumed to result from an unconscious process. (Conscious/intentional production of physical symptoms is classified as factitious disorder or malingering.) Conversion symptoms are not considered to be under voluntary control, and, should not be explained by any physical disorder or known pathological mechanism (after appropriate medical evaluation).
Though classified with somatoform disorders including hypochondriasis and body dysmorphic disorder in DSM-III and DSM-IV, conversion disorder is classified as a dissociative disorder in ICD-10, keeping its long association with hysteria (Dissociative Disorders in DSM-IV).[2, 3] Clinical descriptions of conversion disorder date to almost 4000 years ago; the Egyptians attributed symptoms to a "wandering uterus." In the 19th century, Paul Briquet described the disorder as a dysfunction of the CNS.[4, 5] Freud first used the term conversion to refer to the development of a somatic symptom to help bind anxiety around a repressed conflict.[6]
POSTED BY: Attorney Rene G. Garcia
- Conversion Disorder is a very serious Psychiatric sickness that can be experienced after a serious trauma. The Garcia Law Firm, P.C. has successfully handled these types of cases. Please call us at 212-725-1313 for a free consultation.
PARIS (AP) - A large study in older veterans raises fresh concern about mild brain injuries that hundreds of thousands of troops have suffered from explosions in recent wars. Even concussions seem to raise the risk of developing Alzheimer's disease or other dementia later in life, researchers found.
Closed-head, traumatic brain injuries are a legacy of the Afghanistan and Iraq wars. Body armor is helping troops survive bomb blasts, but the long-term effects of their head injuries are unknown.
Other research found a possibly high rate of mild cognitive impairment, or "pre-Alzheimer's," in some retired pro-football players, who take many hits to the head in their careers.
The studies, reported Monday at the Alzheimer's Association International Conference in France, challenge the current view that only moderate or severe brain injuries predispose people to dementia.
"Even a concussion or a mild brain injury can put you at risk," said Laurie Ryan, a neuropsychiatrist who used to work at Walter Reed Army Medical Center and now oversees Alzheimer's grants at the U.S. National Institute on Aging.
Don't panic - this doesn't mean that every soldier or student athlete who has had a concussion is in danger. Pro-football players and boxers "are almost a different species from us" in terms of the repeated blows they take to the head, said William Thies, the Alzheimer's Association's scientific director.
It does mean you should try to avoid one, by fall-proofing your home and wearing helmets and seat belts, he said. About 1.7 million brain injuries occur each year in the U.S.
Troops also need to prevent any further harm, said Dr. David Cifu, national director of physical medicine and rehabilitation for the Veterans Health Administration.
"What the people who have had a head injury and read this should do is to exercise and eat right and take their medicines and take their aspirin and do meditation to reduce stress - reduce risk factors that are modifiable," he said. The new study is "a great start," but limitations in its methods mean that it can't prove a brain injury-dementia link, he said. More definitive studies are starting now but will take many years to give results.
The veterans study was led by Dr. Kristine Yaffe, a University of California professor and director of the Memory Disorders Clinic at the San Francisco VA Medical Center. The Department of Defense and the National Institutes of Health paid for the work.
"It's by far the largest" study of brain injury and dementia risk, she said. "It's never been looked at in veterans specifically."
Researchers reviewed medical records on 281,540 veterans who got care at Veterans Health Administration hospitals from 1997 to 2000 and had at least one follow-up visit from 2001-2007. All were at least 55 and none had been diagnosed with dementia when the study began. This older group was chosen because dementia grows more common with age, and researchers needed enough cases to compare those with and without brain injuries.
Records showed that 4,902 of the veterans had suffered a traumatic brain injury, or TBI, ranging from concussions to skull fractures. Researchers don't know how long ago the injuries occurred. Many participants were Vietnam War vets and their injuries were during active duty. None were due to strokes - those cases were weeded out.
Over the next seven years, more than 15 percent of those who had suffered a brain injury were diagnosed with dementia versus only 7 percent of the others - a more than doubled risk. Severity of the injury made no difference in the odds of developing dementia.
"It's not just one kind of TBI or super-severe TBI" that poses a danger, Yaffe said.
That worries Ryan Lamke, 26, a medically retired Marine who lives in suburban Washington, D.C. He suffered a traumatic brain injury from multiple blast exposures in 2005 in Iraq. "I'm diagnosed as a moderate (brain injury) but it feels like a mild," said Lamke, who relies on electronic calendars and other gadgets to stay organized. He's a student at Georgetown University and works part-time as a government relations intern for a private firm.
"I have to read for twice as long as my classmates" to accomplish what's needed, he said. "I've not found a doctor so far who can give me a true understanding of what's going to happen 20 or 30 years down the road."
Troops will need close monitoring in the years ahead and treatment for post-traumatic stress, depression and other conditions that can lead to cognitive problems, experts said.
"While we don't want people frightened to think they're going to be permanently impaired, a mild traumatic brain injury does not necessarily mean" no long-term problems, said Dr. Gregory O'Shanick, a psychiatrist and chairman of the board of the advocacy group Brain Injury Association of America.
The other study is follow-up work on nearly 4,000 retired National Football League players surveyed in 2001. New surveys were sent in 2008 to 905 of them who were over 50. Of those who responded, 513 had spouses who could complete the part assessing the players' memory.
"We were surprised that 35 percent of them appeared to have significant cognitive problems," said lead researcher Dr. Christopher Randolph of Loyola University Medical Center in Chicago.
Researchers sent 41 of them to the Center for the Study of Retired Athletes at the University of North Carolina in Chapel Hill. Tests showed they had mild cognitive impairment that resembled a comparison group of much older patients from the general population.
The results are preliminary, and suggest the players have higher rates of impairment than would be expected for their age, but they also have more dementia risk factors, such as obesity, high blood pressure and diabetes, Randolph said.
POSTED BY: RENE GARCIA (ATTORNEY)
Many of our clients have expressed concerns over the long term effects of traumatic brain injury and post concussion syndrome. Unfortunately, this current study doe snot paint a bright picture for the victims of these injuries.
The following is an article by www.time.com, The spinal chord stimulator is giving hope to many accident victims. It can often be performed by a Pain Management specialist. Several of our clients have undergone this procedure with remarkable results.
After being struck by a car in 2006, Rob Summers was given a grim prognosis: paralysis from the chest down and the possibility of never walking again. But five years later, he is able to stand on his own two feet unaided — thanks to an experimental treatment, whose success is giving hope to millions of patients with spinal-cord injuries.
Summers, 25, is the first paralysis patient to undergo a combination of electrical stimulation to the spinal cord — delivered through a surgically implanted stimulation device — combined with intense rehabilitation. As part of a research project at the University of Louisville, Summers first underwent 26 months of intense motor training, in which therapists helped him practice trying to move his legs, before receiving the implant. The Wall Street Journal reports:
Mr. Summers then had surgery to implant a device with 16 electrodes placed on key parts of the spinal cord. With the device delivering constant electrical stimulation, Mr. Summers has been able to stand up using his own leg muscles while holding on to bars for support. He can remain standing, bearing his own weight for up to four minutes at a stretch, and take steps on a treadmill with assistance, according to the researchers.
"I didn't move a toe for four years," said Mr. Summers. "I stood up on the third day they turned the stimulator on," he said. "There are not enough words to describe how I felt."
Although he hasn't regained the full ability to walk — and although the researchers working with him remain cautious, given that his is the only such success in the world — spine-injury experts call the results groundbreaking.
With the stimulators on, doctors helped Summers to practice standing and moving his legs. Now he can pull himself up to standing position on his own, not to mention move his toes, ankles, knees and hips while being stimulated. He has also regained control of his bowels and bladder, and sexual function.
Experts say it's too soon to tell whether the same combination stimulation-rehabilitation program will be able to help other patients (there are four others currently planned to receive it), or whether it will work in patients whose spinal cords have been completely severed. Summers' spine was not. The stimulation from the implanted device (adapted from a device originally FDA-approved to control pain) excites the neurons in his spine, which allows them, even without getting input from the brain, to receive and respond to sensory information from the legs.
Researchers still need to design a more sophisticated stimulation device specifically for spinal-cord injury, and the current findings need to be replicated in other patients. But experts say the results — if they hold up — may offer new treatment avenues for paralyzed patients. "It opens a whole new set of possibilities for patients, not just those recently injured but those who have been injured for months and years," said study author Susan Harkema of the University of Louisville, at a press conference to announce the results.
The research was supported by the Christopher and Dana Reeve Foundation and is outlined in the journal Lancet.
In a potential breakthrough for the treatment of spinal-cord injuries, a man paralyzed below the chest has regained some ability to move and stand through the use of electrical stimulation coupled with intense physical rehabilitation—a combination previously shown to work only in animals.
his is the first such success in humans, so researchers on the case—from the University of Louisville, the University of California, Los Angeles, and the California Institute of Technology—remain cautious. They say findings must be replicated in many patients, and many technological questions answered, before spinal stimulation could be considered for wider use.
Still, spinal-cord injury experts say the work, if it holds up under further research, opens the door to new therapies that could improve the outlook for paralyzed patients.
Rob Summers, 25 years old, was hit by a car in 2006 and paralyzed below the chest, though he retained some feeling in the area below his injury. As part of a research project at the University of Louisville, he underwent 26 months of locomotor training, a rehabilitative technique in which he was suspended in a harness over a treadmill while therapists moved his legs to make a stepping motion. (That by itself can produce improvements in patients who retain some motor function.)
Mr. Summers then had surgery to implant a device with 16 electrodes placed on key parts of the spinal cord. With the device delivering constant electrical stimulation, Mr. Summers has been able to stand up using his own leg muscles while holding on to bars for support. He can remain standing, bearing his own weight for up to four minutes at a stretch, and take steps on a treadmill with assistance, according to the researchers.
"I didn't move a toe for four years," said Mr. Summers. "I stood up on the third day they turned the stimulator on," he said. "There are not enough words to describe how I felt."
Under stimulation, Mr. Summers is also able to voluntarily move his hips, ankles and toes. And he has gotten back some bladder and sexual function.
"This probably changes the field fairly dramatically," said Ronald Reeves, vice chairman of the department of physical medicine and rehabilitation at the Mayo Clinic in Rochester, Minn., who wasn't involved in the research. "It's the first time that there's compelling scientific evidence that you can, with the electrostimulation of the spinal cord, create a favorable motor response."
As in most spine injuries, Mr. Summers' spinal cord wasn't totally severed, though the damage was severe enough to prevent the brain from signaling the spinal cord to initiate movement.
The research, published Thursday by The Lancet, suggests using electrical stimulation to stand in for the signals the brain usually sends to the spinal cord is enough to produce at least basic movement. The stimulation primes nerve cells that, even without the brain, can receive sensory information and act on it.
"Not only can they sense and feel what's happening, they know what to do next. If you're standing on one leg and your joints are in a certain position, that's a sign you're getting ready to step," said study co-author Reggie Edgerton, of the department of integrative biology and comparative physiology at UCLA.
One unknown: whether the stimulation could produce movement in patients whose spinal cords were completely severed.
Further research is also needed on more-sophisticated stimulation devices—the current one is normally used in pain control—and on the possibility of adding drugs to further sensitize neural circuits in the spinal cord, said study co-author Susan Harkema, rehabilitation-research director at the Kentucky Spinal Cord Injury Research Center at the University of Louisville.
The research was supported by the Christopher & Dana Reeve Foundation and the National Institutes of Health.
Posted by: Rene G. Garcia (Attorney)
This article is an example of a relatively new procedure that has benefited several of our clients and has significantly improved their lives.
Complex Regional Pain Syndrome (CRPS)
http://www.webmd.com/pain-management/guide/crps
Pain Management: Complex Regional Pain Syndrome
Complex regional pain syndrome (CRPS), also called reflex sympathetic dystrophy syndrome, is a chronic pain condition in which high levels of nerve impulses are sent to an affected site. Experts believe that CRPS occurs as a result of dysfunction in the central or peripheral nervous systems.
CRPS is most common in people aged 20-35. The syndrome also can occur in children; it affects women more often than men.
There is no cure for CRPS.
What Causes Complex Regional Pain Syndrome?
CRPS most likely does not have a single cause but rather results from multiple causes that produce similar symptoms. Some theories suggest that pain receptors in the affected part of the body become responsive to catecholamines, a group of nervous system messengers. In cases of injury-related CRPS, the syndrome may be caused by a triggering of the immune response which may lead to the inflammatory symptoms of redness, warmth, and swelling in the affected area. For this reason, it is believed that CRPS may represent a disruption of the healing process.
What Are the Symptoms of Complex Regional Pain Syndrome?
The symptoms of CRPS vary in their severity and length. One symptom of CRPS is continuous, intense pain that gets worse rather than better over time. If CRPS occurs after an injury, it may seem out of proportion to the severity of the injury. Even in cases involving an injury only to a finger or toe, pain can spread to include the entire arm or leg. In some cases, pain can even travel to the opposite extremity. Other symptoms of CRPS include:
- "Burning" pain
- Swelling and stiffness in affected joints
- Motor disability, with decreased ability to move the affected body part
- Changes in nail and hair growth patterns. There may be rapid hair growth or no hair growth.
- Skin changes. CRPS involves changes in skin temperature -- skin on one extremity can feel warmer or cooler compared to the opposite extremity. Skin color changes also are apparent as the skin is often blotchy, pale, purple or red. The texture of skin also can change, becoming shiny and thin. People with syndrome may have skin that sometimes is excessively sweaty.
CRPS may be heightened by emotional stress.
How Is Complex Regional Pain Syndrome Diagnosed?
There is no specific diagnostic test for CRPS, but some testing can rule out other conditions. Triple-phase bone scans can be used to identify changes in the bone and in blood circulation. Some health care providers may apply a stimulus (for example, heat, touch, cold) to determine whether there is pain in a specific area.
Making a firm diagnosis of CRPS may be difficult early in the course of the disorder when symptoms are few or mild. CRPS is diagnosed primarily through observation of the following symptoms:
- The presence of an initial injury
- A higher-than-expected amount of pain from an injury
- A change in appearance of an affected area
- The presence of no other cause of pain or altered appearance
How Is Complex Regional Pain Syndrome Treated?
Since there is no cure for CRPS, the goal of treatment is to relieve painful symptoms associated with the disorder. Therapies used include psychotherapy, physical therapy, and drug treatment, such as topical analgesics, narcotics, corticosteroids, antidepressants and anti-seizure drugs.
Other treatments include:
* Sympathetic nerve blocks: These blocks, which are done in a variety of ways, can provide significant pain relief for some people. One kind of block involves placing an anesthetic next to the spine to directly block the sympathetic nerves.
* Surgical sympathectomy: This controversial technique destroys the nerves involved in CRPS. Some experts believe it has a favorable outcome, while others feel it makes CRPS worse. The technique should be considered only for people whose pain is dramatically but temporarily relieved by selective sympathetic blocks.
* Intrathecal drug pumps: Pumps and implanted catheters are used to send pain-relieving medication into the spinal fluid.
* Spinal cord stimulation: This technique, in which electrodes are placed next to the spinal cord, offers relief for many people with the condition.
Reviewed by the doctors at The Cleveland Clinic Pain Management Department.
POSTED BY ATTORNEY RENE G. GARCIA:
- CRPS is a very serious condition that has been experienced by some of our clients after a serious trauma. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD.
Conversion Disorder in Emergency Medicine
http://emedicine.medscape.com/article/805361-overview
Conversion disorder is classified as one of the somatoform disorders in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, Fourth Edition, Text Revision (DSM-IV-TR).[1] Although defined as a condition that presents as an alteration or loss of a physical function suggestive of a physical disorder, conversion disorder is presumed to be the expression of an underlying psychological conflict or need.
The critical psychological conflict or stress may not be apparent initially, but it becomes evident in the course of obtaining a patient’s history: ideally, it is a psychological factor related symbolically and temporally to symptom onset. Conversion symptoms are presumed to result from an unconscious process. (Conscious/intentional production of physical symptoms is classified as factitious disorder or malingering.) Conversion symptoms are not considered to be under voluntary control, and, should not be explained by any physical disorder or known pathological mechanism (after appropriate medical evaluation).
Though classified with somatoform disorders including hypochondriasis and body dysmorphic disorder in DSM-III and DSM-IV, conversion disorder is classified as a dissociative disorder in ICD-10, keeping its long association with hysteria (Dissociative Disorders in DSM-IV).[2, 3] Clinical descriptions of conversion disorder date to almost 4000 years ago; the Egyptians attributed symptoms to a "wandering uterus." In the 19th century, Paul Briquet described the disorder as a dysfunction of the CNS.[4, 5] Freud first used the term conversion to refer to the development of a somatic symptom to help bind anxiety around a repressed conflict.[6]
POSTED BY: Attorney Rene G. Garcia
- Conversion Disorder is a very serious Psychiatric sickness that can be experienced after a serious trauma. The Garcia Law Firm, P.C. has successfully handled these types of cases. Please call us at 212-725-1313 for a free consultation.
Brain injury raises dementia risk, US study finds.
http://m.apnews.com/ap/db_16026/contentdetail.htm?contentguid=Fi7lPF95
PARIS (AP) - A large study in older veterans raises fresh concern about mild brain injuries that hundreds of thousands of troops have suffered from explosions in recent wars. Even concussions seem to raise the risk of developing Alzheimer's disease or other dementia later in life, researchers found.
Closed-head, traumatic brain injuries are a legacy of the Afghanistan and Iraq wars. Body armor is helping troops survive bomb blasts, but the long-term effects of their head injuries are unknown.
Other research found a possibly high rate of mild cognitive impairment, or "pre-Alzheimer's," in some retired pro-football players, who take many hits to the head in their careers.
The studies, reported Monday at the Alzheimer's Association International Conference in France, challenge the current view that only moderate or severe brain injuries predispose people to dementia.
"Even a concussion or a mild brain injury can put you at risk," said Laurie Ryan, a neuropsychiatrist who used to work at Walter Reed Army Medical Center and now oversees Alzheimer's grants at the U.S. National Institute on Aging.
Don't panic - this doesn't mean that every soldier or student athlete who has had a concussion is in danger. Pro-football players and boxers "are almost a different species from us" in terms of the repeated blows they take to the head, said William Thies, the Alzheimer's Association's scientific director.
It does mean you should try to avoid one, by fall-proofing your home and wearing helmets and seat belts, he said. About 1.7 million brain injuries occur each year in the U.S.
Troops also need to prevent any further harm, said Dr. David Cifu, national director of physical medicine and rehabilitation for the Veterans Health Administration.
"What the people who have had a head injury and read this should do is to exercise and eat right and take their medicines and take their aspirin and do meditation to reduce stress - reduce risk factors that are modifiable," he said. The new study is "a great start," but limitations in its methods mean that it can't prove a brain injury-dementia link, he said. More definitive studies are starting now but will take many years to give results.
The veterans study was led by Dr. Kristine Yaffe, a University of California professor and director of the Memory Disorders Clinic at the San Francisco VA Medical Center. The Department of Defense and the National Institutes of Health paid for the work.
"It's by far the largest" study of brain injury and dementia risk, she said. "It's never been looked at in veterans specifically."
Researchers reviewed medical records on 281,540 veterans who got care at Veterans Health Administration hospitals from 1997 to 2000 and had at least one follow-up visit from 2001-2007. All were at least 55 and none had been diagnosed with dementia when the study began. This older group was chosen because dementia grows more common with age, and researchers needed enough cases to compare those with and without brain injuries.
Records showed that 4,902 of the veterans had suffered a traumatic brain injury, or TBI, ranging from concussions to skull fractures. Researchers don't know how long ago the injuries occurred. Many participants were Vietnam War vets and their injuries were during active duty. None were due to strokes - those cases were weeded out.
Over the next seven years, more than 15 percent of those who had suffered a brain injury were diagnosed with dementia versus only 7 percent of the others - a more than doubled risk. Severity of the injury made no difference in the odds of developing dementia.
"It's not just one kind of TBI or super-severe TBI" that poses a danger, Yaffe said.
That worries Ryan Lamke, 26, a medically retired Marine who lives in suburban Washington, D.C. He suffered a traumatic brain injury from multiple blast exposures in 2005 in Iraq. "I'm diagnosed as a moderate (brain injury) but it feels like a mild," said Lamke, who relies on electronic calendars and other gadgets to stay organized. He's a student at Georgetown University and works part-time as a government relations intern for a private firm.
"I have to read for twice as long as my classmates" to accomplish what's needed, he said. "I've not found a doctor so far who can give me a true understanding of what's going to happen 20 or 30 years down the road."
Troops will need close monitoring in the years ahead and treatment for post-traumatic stress, depression and other conditions that can lead to cognitive problems, experts said.
"While we don't want people frightened to think they're going to be permanently impaired, a mild traumatic brain injury does not necessarily mean" no long-term problems, said Dr. Gregory O'Shanick, a psychiatrist and chairman of the board of the advocacy group Brain Injury Association of America.
The other study is follow-up work on nearly 4,000 retired National Football League players surveyed in 2001. New surveys were sent in 2008 to 905 of them who were over 50. Of those who responded, 513 had spouses who could complete the part assessing the players' memory.
"We were surprised that 35 percent of them appeared to have significant cognitive problems," said lead researcher Dr. Christopher Randolph of Loyola University Medical Center in Chicago.
Researchers sent 41 of them to the Center for the Study of Retired Athletes at the University of North Carolina in Chapel Hill. Tests showed they had mild cognitive impairment that resembled a comparison group of much older patients from the general population.
The results are preliminary, and suggest the players have higher rates of impairment than would be expected for their age, but they also have more dementia risk factors, such as obesity, high blood pressure and diabetes, Randolph said.
POSTED BY: RENE GARCIA (ATTORNEY)
Many of our clients have expressed concerns over the long term effects of traumatic brain injury and post concussion syndrome. Unfortunately, this current study doe snot paint a bright picture for the victims of these injuries.
Medical Breakthrough: Paraplegic Man Stands Up
Posted By: Rene Garcia (Attorney)
The following is an article by www.time.com, The spinal chord stimulator is giving hope to many accident victims. It can often be performed by a Pain Management specialist. Several of our clients have undergone this procedure with remarkable results.
http://healthland.time.com/2011/05/20/medical-breakthrough-paraplegic-ma...
After being struck by a car in 2006, Rob Summers was given a grim prognosis: paralysis from the chest down and the possibility of never walking again. But five years later, he is able to stand on his own two feet unaided — thanks to an experimental treatment, whose success is giving hope to millions of patients with spinal-cord injuries.
Summers, 25, is the first paralysis patient to undergo a combination of electrical stimulation to the spinal cord — delivered through a surgically implanted stimulation device — combined with intense rehabilitation. As part of a research project at the University of Louisville, Summers first underwent 26 months of intense motor training, in which therapists helped him practice trying to move his legs, before receiving the implant. The Wall Street Journal reports:
Mr. Summers then had surgery to implant a device with 16 electrodes placed on key parts of the spinal cord. With the device delivering constant electrical stimulation, Mr. Summers has been able to stand up using his own leg muscles while holding on to bars for support. He can remain standing, bearing his own weight for up to four minutes at a stretch, and take steps on a treadmill with assistance, according to the researchers.
"I didn't move a toe for four years," said Mr. Summers. "I stood up on the third day they turned the stimulator on," he said. "There are not enough words to describe how I felt."
Although he hasn't regained the full ability to walk — and although the researchers working with him remain cautious, given that his is the only such success in the world — spine-injury experts call the results groundbreaking.
With the stimulators on, doctors helped Summers to practice standing and moving his legs. Now he can pull himself up to standing position on his own, not to mention move his toes, ankles, knees and hips while being stimulated. He has also regained control of his bowels and bladder, and sexual function.
Experts say it's too soon to tell whether the same combination stimulation-rehabilitation program will be able to help other patients (there are four others currently planned to receive it), or whether it will work in patients whose spinal cords have been completely severed. Summers' spine was not. The stimulation from the implanted device (adapted from a device originally FDA-approved to control pain) excites the neurons in his spine, which allows them, even without getting input from the brain, to receive and respond to sensory information from the legs.
Researchers still need to design a more sophisticated stimulation device specifically for spinal-cord injury, and the current findings need to be replicated in other patients. But experts say the results — if they hold up — may offer new treatment avenues for paralyzed patients. "It opens a whole new set of possibilities for patients, not just those recently injured but those who have been injured for months and years," said study author Susan Harkema of the University of Louisville, at a press conference to announce the results.
The research was supported by the Christopher and Dana Reeve Foundation and is outlined in the journal Lancet.
An Electrical Jolt for Paralysis Research
http://online.wsj.com/article/SB1000142405274870408390457633367281339029...
In a potential breakthrough for the treatment of spinal-cord injuries, a man paralyzed below the chest has regained some ability to move and stand through the use of electrical stimulation coupled with intense physical rehabilitation—a combination previously shown to work only in animals.
his is the first such success in humans, so researchers on the case—from the University of Louisville, the University of California, Los Angeles, and the California Institute of Technology—remain cautious. They say findings must be replicated in many patients, and many technological questions answered, before spinal stimulation could be considered for wider use.
Still, spinal-cord injury experts say the work, if it holds up under further research, opens the door to new therapies that could improve the outlook for paralyzed patients.
Rob Summers, 25 years old, was hit by a car in 2006 and paralyzed below the chest, though he retained some feeling in the area below his injury. As part of a research project at the University of Louisville, he underwent 26 months of locomotor training, a rehabilitative technique in which he was suspended in a harness over a treadmill while therapists moved his legs to make a stepping motion. (That by itself can produce improvements in patients who retain some motor function.)
Mr. Summers then had surgery to implant a device with 16 electrodes placed on key parts of the spinal cord. With the device delivering constant electrical stimulation, Mr. Summers has been able to stand up using his own leg muscles while holding on to bars for support. He can remain standing, bearing his own weight for up to four minutes at a stretch, and take steps on a treadmill with assistance, according to the researchers.
"I didn't move a toe for four years," said Mr. Summers. "I stood up on the third day they turned the stimulator on," he said. "There are not enough words to describe how I felt."
Under stimulation, Mr. Summers is also able to voluntarily move his hips, ankles and toes. And he has gotten back some bladder and sexual function.
"This probably changes the field fairly dramatically," said Ronald Reeves, vice chairman of the department of physical medicine and rehabilitation at the Mayo Clinic in Rochester, Minn., who wasn't involved in the research. "It's the first time that there's compelling scientific evidence that you can, with the electrostimulation of the spinal cord, create a favorable motor response."
As in most spine injuries, Mr. Summers' spinal cord wasn't totally severed, though the damage was severe enough to prevent the brain from signaling the spinal cord to initiate movement.
The research, published Thursday by The Lancet, suggests using electrical stimulation to stand in for the signals the brain usually sends to the spinal cord is enough to produce at least basic movement. The stimulation primes nerve cells that, even without the brain, can receive sensory information and act on it.
"Not only can they sense and feel what's happening, they know what to do next. If you're standing on one leg and your joints are in a certain position, that's a sign you're getting ready to step," said study co-author Reggie Edgerton, of the department of integrative biology and comparative physiology at UCLA.
One unknown: whether the stimulation could produce movement in patients whose spinal cords were completely severed.
Further research is also needed on more-sophisticated stimulation devices—the current one is normally used in pain control—and on the possibility of adding drugs to further sensitize neural circuits in the spinal cord, said study co-author Susan Harkema, rehabilitation-research director at the Kentucky Spinal Cord Injury Research Center at the University of Louisville.
The research was supported by the Christopher & Dana Reeve Foundation and the National Institutes of Health.
Posted by: Rene G. Garcia (Attorney)
This article is an example of a relatively new procedure that has benefited several of our clients and has significantly improved their lives.
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http://lpig.doereport.com/generateexhibit.php?ID=8710&TC=&RF=1