Jan 5, 2019

Doctors Were Stumped Till Now on Treatment of TBI?

New methods used by doctors like this to care for brains
Doctors finally have a chance to treat brain injury.

Quite comforting it must be when you imagine your doctors know everything.  And in most cases, our doctors do know everything they need to know. But a few examples exist where they don’t have the best information or expertise.

In the case of treating TBI, they had been somewhat stumped for years. Especially true was the case when they were posed with broad questions. The brain is just so complex. But repairing the brain is the main goal of all healers.

The Black Box?

David Ryser takes care of Intermountain Medical Center Neuro-Specialty Rehabilitation Unit in Murry. He acts as a medical director. Of note, he has used the term “black box” when defining the practice of various clinicians when it comes to rehab for patients with brain injuries.

Thus, he says that you will hear the clinicians say that recovery worked for a patient. But according to him, this information remains sparse. A lot of stuff remains hidden underneath that term. And it cannot yet be answered precisely.

So the problem for researchers is finding the exact process among hundreds of operations. So the key remains finding out the goings-on as part of the cure.

The Evolution of Practice-Based Evidence in Diagnosing and Curing Brain Injury

A significant research project started seven years back. Further, it initiated by professors of biomedical informatics at the University of Utah. Their names are Susan Horn and David Ryser. Susan Horn gained fame for prioritizing “practice-based evidence.” The study, published in a medical journal, showed 2000 subjects as part of the research. These topics' researched located around ten rehab centers in various regions.

Also, rehab centers included in the study were not only in the US but in Canada too. One of those patients was Greg Nordfelt. So he had been a great motorcyclist in Salt Lake. Now Greg works as a banker at 53 years of age. Having a bad stomach one day, Greg fell off his Harley Davidson in Idaho. He suffered injuries to his skull and his left brain. So his normal life stopped right there.

Intermountain Medical Center was the place where he was brought after his accident. In addition to the brain injury, he had received serious injuries to his legs. Greg recalls that the first thing he did when he came to his senses. Mind you; this was after two weeks of being on the bed unconscious.

What he did was to follow the instructions of the staff. The people at the center for therapy gave him tasks. The patient received immediate physical therapy. The client also received occupational and speech therapy. He went through several processes just like any other patient like him does.

The Butterfly Puzzle Example of Success.

He recalls receiving a puzzle of just four pieces. When you joined all the parts of the puzzle together, it was a butterfly. He remembers this incident and cries with tears. Then he explains that he could not put such a simple piece of the puzzle together for so long. Finally, he was able to put the pieces together.

He had found out that it was a butterfly. However, it was even more shocking for him when he could not tell the doctors what he saw on the completed puzzle – a butterfly.

50,000 TBI Deaths Per Year.

Traumatic brain injuries are a huge problem for the country. Because they caused 50,000 deaths in just one year in 2010 shows their dangers. Also, as stated by several experts from CDC, more studies are sought after. So the argument is that all the things are missing in the previous studies or not answered.

These can be answered with more data. The health effects of traumatic brain injuries are many. So this includes physical, cognitive and mental. And these effects may change entirely from one patient to another.

The Many Factors Involved in TBI Treatment

Why it remains nearly impossible to pinpoint the working factors in a rehab involves hundreds of factors. Think about the elements that make one patient different from another:

  • His age when he received brain injury,
  • The intensity of the impact,
  • The damages of the brain injury,
  • Treatments he is receiving etc.

Horn explains the question about rehab. He says when you ask this question the person who should answer is clueless. The answerer thinks that it was impossible to pinpoint. Horn noted that practice-based evidence might be the only thing that works.

It could allow clinicians to answer such questions. He said that using practice-based evidence means collecting loads of data. Knowing more about the remedy of patients while working on them remains critical.

Statistical Based Research on Brain Injury Treatment

After collecting the data, the modern statistical techniques become invaluable. Also, this helps to find out the most effective processes. Nordfelt was one of the many patients who went through therapy and recovery. He did so immediately after the brain injury. So his treatment provided every dot of the information about his recovery. This information was key to researchers.

Thus, these researchers kept records of everything that he was going through. So from his speech therapy hours to the type of food he got through tubes, researched derived.

  • One thousand clinicians produced notes and records.
  • Records about sessions amounted to a total of 350,000.

Also, such large amounts of data are unprecedented in the past for recovering patients.

The study, in summary, includes 14 papers. According to the main points mentioned in its published version:

The ideal time interval between the injury and rehabilitation should be as small as possible for the best results. So according to Ryser, his team stays in touch with the ICU. Hence, this allows the patients admitted rehab as soon as possible.

The intensity of the therapy achieved higher priority and preference than its length and amount. Also, in the study, doctors taught most of the patients to sit up and move around on the bed only. Such practices help the patients recover faster. Such is the case with cognitive and motor-related troubles.

Researchers deduced that feeding tubes play a considerable role in the fast recovery of the patient. According to Ryser, taking care of feeding tubes is often a troubling task. So for the staff, it proved it mattered a lot.

  • Again, the report mentions a providing diet high in proteins helped the patient a lot.
  • So at least 25% of the total diet during their entire stay ideally is composed of such high protein diet.

Limitations of Brain Injury Studies?

While such studies often such how the patients with severe brain injuries seek treatment, they are not easy to conduct. So this was due to several limitations. So the biggest barrier to such research and studies remains finances.

  • This study cost nearly 7 million dollars funded through grants.

Only serious professionals could conduct such a thorough study again. So Nordfelt has thankful thoughts of the staff there. Also, he remains grateful for the positive dealings with them. Most relevant here, he said that Intermountain and similar centers build appreciation. He feels he got his life back due to their efforts.

Volunteering and Giving Back

Hence, Nordfelt has now volunteered there with his wife. Also, he won't leave any opportunity of giving back. He wants to thank the institution that did so much for him. So Ryser says that after the study and its results, practice-based evidence finally received recognition. And this was well deserved.

He said that brain injury and Psychiatry related rehab are the places where practice-based evidence is the only way to analyze data. Also, it is the best way to reach a result. Contrast this with randomized controlled trials. He says they have not helped much in these cases.

Accepting Practice-Based Evidence

Horn said that NIH has always been reluctant in taking practice-based evidence, but things might change in future. Allegedly, randomized controlled trials have produced the same information over and over.


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