Giffords TBI Media Coverage in 2011

It has been just over a year since US Congress Representative Gabrielle Giffords experienced a traumatic brain injury as a result of a shooting in Tucson, AZ. While Traumatic Brain Injury (TBI) is now estimated to affect over 1.5 million Americans each year, with many of those wounded from the Iraq and Afghanistan wars, Giffords case has helped shed some new light on the way the media is focusing on TBI.

A variety of stories were in the media after the January 2011 shooting focusing on Giffords recovery, sometimes quoted as “remarkable.” Her yearlong treatment has come through a mixture of the services of Memorial Hermann Medical Center in Houston, home based therapy, and an intensive therapy program based in Ashville, NC. These programs involved traditional therapy approaches common after a TBI such as occupational, physical, & speech therapy, as well as music and animal based therapy programs. Approximately 4 months after Giffords injury, her doctors placed her in the top 5th percentile for patients recovering from similar injuries.

At a recent vigil to honor the other victims of the Tucson shooting, which killed 6 and left 12 others injured, Gabrielle Giffords recited the Pledge of Allegiance in front of hundreds of people, as they quietly chanted “Gabby, Gabby” in encouragement. In a CBS interview with Diane Sawyer she was asked about her intentions to run for reelection this fall; her reply indicated that she will continue to focus on her recovery. In other interviews her husband, Captain Kelly, has been attributed to saying that some days he thinks she could do it; other days it seems it would just be too much.

Giffords’s ordeal has contributed to an already growing awareness about the need for treatment after experiencing a TBI. Many of the stories over 2011 have pointed out that most individuals do not have access to the same type of intensive recovery program as Giffords. While research in recent years has proved that these treatment programs are valuable in recovery after a TBI, insurance companies still rarely cover these services. “Cognitive rehabilitation services designed to improve cognitive functioning after a brain injury are not supported by reliable scientific evidence of efficacy,” according to a 2008 Tricare coverage manual.

Other aspects of recovery after TBI have been exemplified in the media using Giffords as a model, such as the effects of TBI on marriage, returning to work after a TBI, and generalizations made of persons who have experienced TBI.

While the January 2011 shooting was an awful tragedy which affects the lives of many, a positive side has emerged out of it; more people are becoming aware of how seriously TBI affects not just an individual but a family. Giffords case represents that having more programs to intensely focus on an individual’s recovery yields positive results, and that better funding gives more people hope that they will be able to return to a better quality of life after TBI. Hopefully Giffords example can continue to shed light on how TBI affects so many people each year, and can continue to push for better programs and funding for recovery.

Former NHL Linesman Pat Dapuzzo Talks about Post-Concussion Depression

Former NHL linesman Pat Dapuzzo is just one of a number of hockey players who have been in multiple collisions and have sustained multiple concussions as a result. He is also among the number for whom the consequences of those injuries are ongoing.

Dapuzzo, retired from active play and now a scout for the Toronto Maple Leafs, has battled depression post-concussion. He has made a commitment to donate his brain and spinal cord to the Boston University Center for the Study of Traumatic Encephalopathy.

Read the article “Recovery Doesn’t Stop After Injuries Heal” at nytimes.com.

Gabrielle Giffords on ABC’s 20/20

More than ten months after she was shot in the head last January, Representative Gabrielle Giffords is able to walk and is regaining her ability to speak, owing in large part to prolonged, intensive therapy.

The need for treatment is ongoing:  At this stage of her recovery, Ms. Giffords still has difficulty speaking in sentences and receives two hours of therapy daily.

Shortly after the shooting, Ms. Giffords’s husband, Mark Kelly, began making videos documenting the stages of her recovery.  Ms. Giffords and Mr. Kelly spoke with Dianne Sawyer on ABC’s 20/20 about the process and shared some of the videos.

Watch the episode.

Paul and the Just-Right Challenge

Rancho Los Amigos Hospital Ward 904

Tuesday, May 5, 1970

Paul was big for a 15-year-old and protested with loud profanity as Mrs. G. and I pushed him strapped to his wheelchair out of Ward 904, the pediatric wing for rehabilitation of children with brain injuries, to the Music Room for our first therapy session. His abusive language upset most of the nurses and doctors, but I had grown up on the streets and playgrounds of South Central Los Angeles and Mrs. G. was from another planet.

A few weeks before, Paul had been stabbed in his head during a gang fight. The knife had penetrated just above his hairline on the right side of his skull and into his brain. He had lost many of his normal inhibitions as well as the ability to use much of the left side of his body. In the general hospital he had been kept in “soft restraints” since regaining consciousness because he was combative and threatened the staff. However, in the pediatrics pavilion at Rancho Los Amigos Hospital restraints were not acceptable to Mrs. G. and Dr. Elizabeth Eberle, the head nurse and pediatrician for teenagers with brain injuries. Children, even those who were violent, were guided and encouraged, rather than controlled. Paul challenged those values.

Paul had come in by ambulance from the general hospital the day before, accompanied by his mother and grandmother who obviously loved him in spite of his unceasing verbal abuse and threatening gestures. Anticipating the fear and distaste that Paul’s behavior would create in the otherwise caring staff, they had pleaded with us to give their boy a chance, but after praying at his bedside while he fell asleep the night before, they had gone home sad and discouraged.

Fast-forward 27 years. I am testifying in the United States Congress about work rehabilitation. “Paul went on to live the American dream,” I tell the assembled Representatives. “He got a job, married and became a father, and lives with his family in his own home in Southern California.”

But that morning when I was left alone with Paul in the Music Room, I was just beginning to tap into the rehabilitative potential of Paul’s brain and, though my efforts were clumsy, start us both on journeys that continue today.

As Mrs. G. left Paul and me in the Music Room, I had only a vague idea of what to do. Basically, my goal was to get Paul to stop his cursing so that he would not disrupt the staff and the five other teenage boys with brain injuries who shared his room. We only had a few days to change his behavior because the other patients had the right to not be abused or frightened by what appeared to be a crazed and dangerous hoodlum.

The Music Room was soundproof, but I had no doubt that Paul’s abusive shouting was reverberating down Rancho’s white tile halls as I sat down and turned his wheelchair to face me. As I always do when it is possible to be struck, I took off my eyeglasses and spoke quietly to Paul, who continued his shouted curses. I tried to soothe and cajole and calm him, but my words had absolutely no effect. Fortunately, the Music Room was well-lighted and I noticed the telltale nicotine stain on the index finger of Paul’s still-useful right hand. I said quietly, “Would you like a smoke?”

Bam! Paul looked at me and stopped shouting. “Whattt?” he slurred. “Whudd you say?” I repeated myself and now I had his attention. “You can earn a smoke if you do what I say,” I said, and laid out three piles of parts on the table, picked up and put a washer on a small bolt, and threaded a nut onto the bolt. There were enough parts for 30 assemblies. “Paul, each one of these you assemble earns you a penny, and you can buy a smoke for 30 cents.”

Bam! Paul brushed his right arm across the table and scattered parts all over and started shouting again, even louder than before, now with the violent shaking of genuine anger. He reached up and yanked his helmet off his head and threw it at me.

I ducked, collected my wits, and picked Paul’s helmet up off the floor and held it in my lap as I continued to talk quietly to him. “Paul, you know cigarettes aren’t allowed in the hospital.”

More violent and belligerent cursing.

“Well, Paul, I can get a cigarette in here this evening if you want, but they cost 30 cents. You can earn 30 cents today by putting these together.”

Quiet. Wheels obviously turning. One LOUD exclamatory curse!

Quiet once again. “O-O-K-K-K,” he stuttered and settled back into his wheelchair. “Good,” I said. “Now help me pick up these parts. We only have enough for 30 and you need 30 cents to buy a cigarette.”

We spent the next three hours putting together those simple parts and counting out one penny for each one. With one tremulous hand, Paul struggled to complete the task, with help from me at first, and less as we went along. Paul was painfully clumsy and easily frustrated and stopped several times. But he always came back to the task and improved as he went along. He completed the 30 sets just before we broke for lunch.

I told Paul, “I have something that’s more difficult — it has 5 parts, but it pays three cents for each set. Would you like to try that tomorrow? If you can handle it, you might be able to buy more smokes.”

I can still remember his first smile and grunted chuckle 40 years later.

Vert Mooney, MD

Vert Mooney died yesterday afternoon on his way home from work, apparently from a heart attack or stroke.  He was a pioneer in so many aspects of rehabilitation and one of the world’s foremost spine surgeons, a wonderful husband and father, and a friend and mentor whose absence will be deeply felt.

I woke up in the wee hours this morning feeling his absence.  His voice is still fresh for me, “Onward and upward, man!”

I’m certain that there are many aspects of Vert I will miss that will come to mind in the coming days, but the very first that I’ve noticed is how much I value his firm graciousness and his insistence on respect for all opinions.  As a pioneer in medicine, it wasn’t uncommon for him to be attacked by vested interests and by people whose cages he enjoyed rattling.  I recall a scientific meeting many years ago in which we presented several research papers to about 500 orthopedic surgeons and then took questions.  Our work was obviously controversial because we had scientifically demonstrated the efficacy of alternatives to expensive surgical procedures; not exactly what spine surgeons wanted to hear.  One of our group was so concerned about the reception of his paper that he actually fainted at the lectern and had to be revived.  After we presented, Vert was the moderator, taking questions from the floor.  Immediately he was hit with angry “questions” that were really diatribes by angry red-faced surgeons who were used to telling other people what was what.  Vert, with deep roots in the scientific and academic communities and as a founder and past president of all of the major pertinent professional associations simply responded with, “Thank you for your question” and asked for the microphone to be passed.  He was polite and not dismissive, allowing people to have their say, trusting that our findings, based on good research, would stand on its own, which was true.  As the diatribes diminished and actual questions began to surface, he encouraged all of us, but most especially the junior members of our research group to respond, which, with Vert having our back, we were able to do.  That was a very special moment for me and provided a template for how to be a mentor and senior scientist.  Being a pioneer is fun, but it is often difficult and the absolute best way to defuse difficult situations is with grace.  Vert was firm, not backing away from a fight, but always treating everyone in the conversation with grace and respect.

Today, I send prayers to Vert’s family and many friends, for our shared loss and thanking God for his gift of Vert’s presence.  Millions have benefited from his work, many of us directly, and the world is so much better because he led and inspired us.