 |
|
|
|
|
February 18th, 2011
12:13 PM ET
Inside Giffords' rehab: Hard work, hard questionsWhen I walked into TIRR Memorial Hermann hospital, I had a few things on my mind. I would get to see firsthand the type of therapy Congresswoman Gabby Giffords was receiving after being shot in the head in early January. I also realized that, despite sending hundreds of my own neurosurgery patients for rehabilitation, I had not spent extended time learning all the various therapies currently available and how they work together to restore function. Finally, I reflected on a conversation I had with T. Christian Miller from ProPublica, about TriCare (the Pentagon’s health plan for the armed forces) and how it won’t pay to cover cognitive therapy for brain injured soldiers. Gifford’s doctor, Gerard Francisco, greeted me and showed me a white board of a therapy schedule he tailored for me. On this day, I was playing the patient. An intensive, exhaustive seven-hour schedule was presented, full of physical therapy, speech, recreational, occupational and my personal favorite – music therapy. The mantra of Julie Welch, my physical therapist, was “do not neglect your weak side.” While some patients may be inclined to overcompensate with the left side of the body if the right side is weak – my therapy focused on just the opposite. Giffords was shot in the left brain, and it would be her right side of the body that would be affected. Electrodes were hooked up to the muscles on my right leg, and then I was asked to ride a stationary bike. If my right leg wasn’t performing as well, small shocks stimulated the appropriate muscle during my pedaling, and also sent a message to the brain that this muscle was being ignored or neglected. Francisco explained that “it was part of the re-wiring process that takes place.” We know the brain can tell a muscle what to do – such as lift your right leg. With these stimulations, the muscle is now also telling the brain what to do. During speech therapy, my therapist, Shap Shadravan worked on what she called apraxia of speech. This is the difficulty to say words correctly and consistently. It is not due to weakness of speech muscles, or discoordination, but rather caused specifically by an injury to the brain. Think of it as saying “len” whenever you wanted to say “when.” We practiced making movements with my lips and tongue and re-learning sounds made at the front, middle and rear of the mouth. Given the congresswoman’s tracheotomy, we also learned how to speak with this tube in your throat, using a special valve to force air over the vocal cords. Near the end of the day, I sat with Maegan Morrow, my music therapist, and filled in words to well-known songs. Everything from "Twinkle, Twinkle, Little Star" to "Maneater" by Hall and Oates. While it may have looked like simple and fun singing, Megan was constantly using strategies to externally cue me. I realized through music, she was working on developing my attention, memory and overall executive function. In fact, most of the therapy I received at TIRR overlapped, and so much of it focused on cognition. Francisco is convinced this type of approach rapidly expedites a brain-injured person’s recovery, and he has plenty of evidence to back him up. Certainly spending a day going through the therapy as I did allowed me to see that evidence for myself. All of this, of course, got me thinking about T. Christian Miller, his report about TriCare, and the more than 200,000 service members that have suffered a brain injury since 2000. Giffords is currently receiving proven and effective therapy at one of the premier rehabilitation centers in the country – and, very deservedly so. Question is: After considering all of this, why don’t tens of thousands of brain-injured troops have that same care available to them? |
  About this blog
Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.
 |
|
|
|
Every soldier who has suffered a brain injury should be allowed to have the same care available to them. If it is more funds they need, then I can think of many areas to cut in our gov. waste that would pay for this. For starters, let's start with all the welfare fraud that takes place and in other areas of gov. where waste is an ongoing occurrence. There are many people out there who are on gov. assistance that are able bodied to work. Just ask the cashiers in grocery stores. They see this everyday.....
I agree! We could even cut the salaries of the Senators and Congressmen and women. They chose to be public servants-fight for lower taxes etc. but they get paid way too much. im sure they can live on a 100,000 dollar salary as opposed to a 200,000 dollar plus salary. they can use that for the Soldiers or pay the defict down instead of cutting education benfits.
I hope with all my heart that all soldiers are afforded the great treatment that this lady is getting. I can't think that this is not what is happening in the great US of A.
As usual, CNN uses Dr. Gupta as a shill for advancing their political agenda.
Oh, seriously... welfare fraud? I hope that's not the best you have. What about the billions that have lined the pockets of Halliburton and 'Xe' or whatever they call themselves.. Clearly you are living in the United States of Amnesia.
Perhaps the cost of medical rehab should be reduced so that all veterans can afford to get needed help and be an eventual asset to our evolving society after literally sacrificing their brains for a war for,.....???
I agree~~~!!! Or how about a ceiling cap on politicians (INCLUDING OUR PRESIDENT) so that they know what it's like to only get paid for the amount of work you do or the hours you put in, while at the same time trying to figure out how to make due with a mediocre monthly wage that barely covers the essentials and having to adjust to rising gas prices, insurance prices and everything else the government can squeeze out of us!
Can't we take money from cancelling unwanted jet engines and items that DoD says aren't need and then put it into getting our brave soldiers back to healing everything, brain and body? Their sacrifice deserves no less.
Migs, well said. It never ceases to amaze me that the Troops are put into harm's way, make unimaginable sacrifices, suffer beyond our understanding, then come home to find that the care their poor injured brains need just isn't there. In what universe is that right and proper?
migs do you goto usuhs by chance? lol
It seems like Senator Boehner from Ohio, who says 'We are broke!", chose not to vote this week on canceling a back up jet engine program for the F-35 that the secretary of defense proposed as unnecessary, because some of that activity occurs in Ohio. Many in the GOP voted for the spare jet engine, despite their message that we must cut spending. But if it were to spend the same 5 billion dollars upscaling care of our brave troops, Boehner would quickly tell us "We are broke!"
Do you know how frustrating is is to see what people of note can get for rehab for a brain injury to someone who gets nothing?
I can't believe that this is happening when someone 'important' is hurt guess what......'we have funding'.
I ABSOLUTELY agree. My best friend of 20 years had a car accident 5 months ago...and we have YET to be able to get him into ANY type of rehab. There is always an excuse. Even the GREAT Hermann Memorial told me they couldnt take him because of his trach, but I just learned that the senator has a trach. Why does she receive special treatment. I wish her well, but I am absolutely appalled by the lack of care my friend has gotten. HE IS IMPORTANT TOO!
Thank you so much for highlighting the important role that Dr. Francisco plays in the rehabilitation of brain injuries. Physical medicine and rehabilitation physicians are not as well known as other medical specialties but those who come into contact with them quickly learn about their expertise in rehabilitating a person after an illness or injury to get them back to as a full a life as possible.
You need to also stress the cost of such rehab and those without insurance or minimal coverage don't receive the same amount of therapy. I know I only have a certain number of weeks allowable in a calendar year of any phyiscal therapy both outpatient and inpatient. I have to agree with Maureen and I work in healthcare.
Migs, Congress can't seem to do that. It seems to me that Congress, the defense contractors and the lobbyists are all in bed together to make money instead of doing right by our injured soldiers. The VA healthcare system is spotty on quality and the healthcare you will get there is just a luck of the draw and how much you can effectively insist on good care. Instead our Congress and the DOD think it is to save money on care for our soldiers and give the money for unwanted defense projects so the lobbyists can make money.
JUst escaped the second bout of Embolisms with my life ! Too many Athletes do not listen to their body and pay the price with their life ! http://www.parrabuddy.blogspot.com has more on this subject and i would appreciate others adding to the blog so that there are less ill informed out there and at risk.
PARRABUDDY HAS ALSO ADDRESSED THE SUBJECT OF MISTREATMENT OF THOSE IN HARM´S WAY !
Paralympic 2012 will be an arena where the world will see Troops of Many Nations returning to fight in a sporting way for their country demonstrating that their new way of life allows them to serve their nation once again !
While this idiot was plying with his new toys, someone who needed it couldn't get access.
I am a nurse and a veteran who receives health care through the VA. Indeed the care is spotty, but since I am unemployed and in grad school I appreciate the care. I have been impressed by the quality of care, both in and out-patient. I do think that I have an advantage to get good care since I know what questions to ask. I do see young veterans who have obviously had traumatic injury and hope that they are able to get the care that they need because they really deserve it. Congress needs to spend money on these young vets or they will be needing to get more intensive and costly care later.
this is morbid and unnecesary and Vedette Drs like gupta should consider other work options
I saw the story on CNN and I thought it was rude of Dr. Gupta to do a story of Rep. Gifford's physical therapy. He has no respect for her privacy.
Which part is unnecessary exactly? Showing the rehab of Gabby Giffords? If too morbid for you, why did you click on the link?
we as voters need to elect represenatives who support the troops and vote out those who turn their backs on them. The troops are left to suffer because we(the voters) don't pay attention for more than 30 seconds.
Dr. Gupta,
I have to say THANK YOU for your honest and experiental coverage of Rep. Giffords rehabilitation. I am sure you can imagine, but the media recognition of music therapy has had our entire professional community buzzing! I love the recognition you give music therapy as more than just singing. Again, thank you so much!
I actually saw Gupta say on television yesterday that this is the first time he's visited a neuro-rehap center despite being a NeuroSurgeon and having referred patients to the same rehab in the past. My only question being, how the hell is that possible? How is a tour of the rehab center not something on the NeuroSurgeon's agenda? Might want to check out what's going on after you send them there....
Someone said on another board, "Sure wish America's wounded soldiers got the kind of care she is getting."
It's pretty pathetic when Gupta has to bring what really amounts to showing how someone with money and being in Congress gets the special treatment that they get. The everyday person would not be able to or get this privileged treatment. Do you really think the families that lost their loved ones cares one bit about her recovery. Because they would not have received the same treatment she is getting. We really don't need to know every time she blinks. I recently had a stroke and was fortunate enough to not die, but I did not think it was anyone's business outside of my immediate family about my progress. This is all about Gupta once again getting his RATINGS up. I still have problems with some everyday life tasks but I don't put it in the news.
Don't worry TPF, no one wants to hear about you either. Thanks for adding your inane comment. If you didn't want anyone to know about your stroke, why did you just post it on CNN?
I have a son who had a traumatic brain Injury in a form similar to a stroke & had rehab as part of his recovery. I have no problem with someone doing the kind of article that Dr. Gupta did, particularly by a person of his qualifications, because it brings to light the tremendous work done by the rehab people & what it takes to help those in this condition.
It is sad that your TBI soldiers don't get the medical attention they deserve. Our health care system may not be perfect in Canada but at least everyone can get the treatment they require from some of the best doctors & hospitals in the world. Funny how people in your country fight universal medical expense coverage & then complain loudly when someone who has the money to get the best care uses it!
hey gupta, you should pay for all the brain injuries for soldiers.
Huh? Why are you asking that? You don't think TriCare should pay for injured soldiers health care?
I am a nurse, and wanted to say "outstanding" report Dr. Gupta! Oh, and ES Holmes - it's nurses like you that give our profession a bad name.
OK I am sick and tired or everyone saying that we dont work because we are lazy!! I worked 7 years past when my DR. told me to go on disability.I still developed woek for myself fpr another 3 years before I applied for disability benefits.I have multiple diagnosis. My husbend worked from age 45 to age 62 with dimentia and then Alzheimers when he could have been lazy. He has now been diagnosed with parkinsons disease. Are we lazy?? Hardly so –we are raising 2 handicapped children with special needs.Everyone -even "professionals" said it couldn't be done. Wrong!! Difficult-YES painful -Yes! Lazy-NO!! Let me tell you something – no one can live on disability!!!!! I sincerly pray that every human being with so much opinionated hate in their mouths gets to experience this firsthand. In glorius pain and desperation. Hope they enjoy going to those checkouts with little or no food in their carts and experiencing some of the hunger!!! Then they can sot back onf listen to all those knowit alls who say that they are less than human-because they got sick!!!!!!!!!!!!!!!!!!!!!!!!!!!!!remember everything life has given you can be taken away in a mere second!!!!!!!!!!!! your health-home -life!!!
Thank you, Dr Gupta, for such wonderful insight. I was excited to see what you thought about your interaction with the music therapist. I thank you for reflecting so clearly how all of the specialists at TIRR work so hard collaboratively. And, as Natalie shared earlier, music therapists are quite abuzz about your coverage.
Sounds good, but never having visited a neuro rehab center is pretty shocking, considering Gupta's a Nero Surgeon.
Hi
The us goverment should be ashamed of the under treatment they give to our vets that need medical attention and help and .should.receive the same as the people.. in washington . Every should be treated equal no matter if you got shot in arizona or iraq. We waste so much money on the wrong things. Help the vets they are the ones protecting our country so we can enjoy our lifes. Let the vets have a good life to.
Bill
You missed occupational therapy. They are most certainly working on cognitive issues and important everyday activiies like dressing herself, bathing, grooming,co-ordination and fine motor activities. It all has to go together.
Agree. OT is an integral part of any inpatient rehab stay and I am positive a big part of Gifford's treatment plan. Disappointed Dr. Gupta does not seem aware of this.
He DID mention OT, did you watch the piece?
I agree, where is occupational therapy as part of her recovery?!!!
throughout the Grifford tradegy coverage I wept for the soldiers who do not get the coverage or have the resources to get the kind of treatment Gabby will receive. It will be the best for her and getting better every day.
I hang my head to think of those who put their lives on the line for all of us, and not deserving the same. Why is this?
Please raise this issue in a public forum and shame those who do not ennact the legistration to right this terrible wrong
Your voice is heard so speak loudly about this unjustice
thanks
Fran Stewart an american living in nova scotia
I agree with 100% but isn't this the same all over....Dr Gupta is getting paid well and isn't he a 'pal' of oprah's...what can I say...what's good for the lady that got shot should be good for ALL....especially for soldiers US and Canada....this whole scenario just breaks my heart......
simple.... money.
it's too darned expensive to give that treatment to our soldiers. as a congressional representative, rep. giffords has a fantastic health plan, one that most americans would love to have. our soldiers are expendable and cheap. compare the settlements that those killed in the 9/11 attacks in nyc vs. those of our soldiers killed on the battlefields subsequently. nyc victims' families scream for more money for having been in the wrong place at the wrong time, no different than being mugged in an alley. our soldiers put their lives on the line daily for a pittance compared to the settlements nyc victims received. it's all about the money. too many soldiers receive brain injuries, the government won't pay for it.
soldiers should receive more for what they give up for the rest of us.
I enjoyed reading your article Sanjay and all the comments. I am a physician assistant in stroke care. I do acute inpatient care. Regardless of insurance our patients receive the same care. At discharge that's where access to care fails. No insurance-no rehab care. No insurance- no outpatient services.
Dr. Gupta,
As noted above, my colleagues in Music Therapy are so grateful for your time and recognition of our work. I'm also glad to be part of an exceptional rehabilitation team, and we send you thanks!
Why aren't brain-injured soldiers getting the same quality of care as Congresswoman Giffords? Simple. They're just soldiers, not attractive blonde congresswomen.
yeah to the OT's who noted that OT was missing in the report.
Did you have no nurses, Dr Gupta?
I was charge nurse responsible for a 14-bed unit in the '80s. We specially trained every member of staff–RNs, LPNs, and nursing assistants in the special techniques involved in rehabilitation. We had an excellent reputation because we worked our butts off, and yet it appears yours passed unnoticed.
We had a sign in our unit that stated 'Most nurses are trained to speak in soft voices and wipe each fevered brow. Rehab nurses speak more like football coaches and make the patient wipe his own brow.' It's a speciality nursing field, and I loved it and our clients. Or did you think your nurses were just meanyheads?
Thank you, Dr Gupta! Our health care system has become a sham of survival of the fittest. If you're not that sick, you'll get all the "care" you want. Sure, insurance companies are thrilled to promote so called "wellness" programs. But if you really have a problem, which requires an expensive remedy, like rehabilitation, transplants, advanced chemotherapy, etc, forget it - you're on your own. Remember, insurance companies make money by DENYING care, not providing care. This is why Tri-Care routinely DENIES care.
I do enjoy reading about how Gabby is doing when there is a new update. Gabby is one amazing woman that really shows that she will fight back against the gunshot to her braine. I do and hope that Gabby make a full recovery from her injury, to be able to return to her job, when she is ready to do so. Please keep bringing more new updates about Gabby. I like hearing about how well she is doing. She is also showing her doctors, that her braine can overcome anything that can happen to her. Gabby inspires everyone around the world that likes reading amazing stories. Please let Gabby know, that she is doing a really good job. I hope to hear more good news about gabby really soon.
It shames me to know I live in a country that doesn't take care of it's soldiers after being wounded fighting to protect our country!! Every time I read a story about how one of soldiers and their family is suffering because they can't get the care or support they need once they return home, makes me wonder what kind of society would do this to our brave mmen and women fighting for what could be a wonderful country!! Shame on all of us for letting this injustice happen!! Pray for all of our soldiers!! Mary!
What is really concerning is that many brain injured persons get in trouble with the law due to the complex behavioural issues involved in brain ijury. They go to court, they go to jail, and the governmet pays for that, when cognitive rehab could have prevented this. While not a veteran my husband is having trouble getting into outpatient cognitive therapy. Most ins says it is not "health related". They will not pay for 'community re-integration'. At least the men and women who risked their lives for us should get rehab!!
how about you mention something about occupational therapy 99% of the time they work in concert with the physical therapist...need more information of what she is doing in rehab, this article was quite void the details!
Where's my previous comment?
I love Dr.Gupta, he's a great reporter.
I just had a subarachroid hemorrhage (or a hemorrhagic stroke) and after 6 days in one hospital and being airlifted to another where I was in the neuro ICU for 8 days and a specialized patient room for 3 days I was informed that I could not get rehab unless I paid $1000 upfront and $153 a day – and that was for a nursing home – because I had not met my $2000 dollar deductible I was readmitted with anoth stroke less than 24 hours after discharge I was readmitted with another stroke – I spent another 3 days in neuro ICU and another 2 days on a specialized patient floor this time I qualified for a true rehab hospital instead of a nursing home. healthcare/ insurance are not patient advocztes until you cost them tooo much money!!!
Yes, too bad there was no mention of the rehab nurses. Patients are in therapy a few hours a day, but it is the rehab nurses who are with them the other 20 hours a day, teaching them to carry over the skills they practice in therapy, into their daily lives, and reassuring the patients and their families, educating them about what to expect, problem solving with them about how to manage their care needs when they get home. And we don't "make the patients wipe their own brow" like a drill sargeant or a football coach–we encourage them to do as much as they can for themselves, but we're right there to help them when they're exhausted or discouraged.
It was a pre-printed sign, not a care plan. We evaluated every patient that was admitted and treated them to their abilities. We did not expect a massive stroke patient to 'wipe his own brow' immediately. That would be bad nursning. But what we did differently from other nurses was to challenge him/her to perform to the limits of their ability, and as they improved, we did less for them *physically*. We treated them with love and compassion, but one is doing no one any favors by not encouraging a client to do as much as possible–and then we did 'possible'. If you don't believe in your patietnts it's hard to see them as human beings, capable of learning and adapting. We believed in ours. It is agonizing to report at a team meeting 'Well, nothing's really changed', but I've done if if it was the truth. But if we, as nurses, don't encourage our patients (as a good coach does) to do as much as they can, we may as well just ship them all off to Sunnydale. Who tells a patient with left neglect 'Look left, Dr. Gupta', PT, OTs, or nurses? I submit we do. We work hard for little pay-off in results so much of the time, so we must do something more than feed 'em and fan 'em; we have to work with them, as they are, and try to make their world easier to manage. The goal is total independence, but we both know that isn't always possible. So for 20 out of 24 hours a day we do what we can to enable them to live in this world they never made but aquired with their injury, stroke, spinal cord damage, orthopedic injury, MS, and God knows whaever else the docs throw at us and, I hope, we both did it to the best of *our* abilities. The point that we are both making is, why didn't Dr.Gupta mention our highly-trained and skilled profession?`
Exactly, why are the brain injured vets NOT getting the cream of the crop treatment? A very interesting question indeed.
Our troops are willing to give 100% to complete their missions. That commitment should be matched by our commitment to provide them the best health care available. Our priorities are seriously out of balance.
A recent groundbreaking was held near the US Capitol for construction of the American Veterans Disabled for Life Memorial to cost $86 million. Ask any disabled Americanvet whether h/she would rather have a tribve to their sacrifice be rehabilitative therapy or a marble bronze and glass monument they can visit? Ameria, America, God shed His grace on thee..
The lesson is don't join the military if you plan on getting injured in combat.
The ironic part of this whole sad situation is that if Rep. Giffords had been just the spouse of Navy Captain Mark Kelly and not a member of Congress, she wouldn't be receiving the care she is currently receiving. Dependents of Active Duty Military only have available to them the same health coverage as those servicemen and women returning with severe head trauma...military installation health facilities and Tricare. Thoughts anyone?
Everyone is commenting on how the government is wasting money on unneeded things when they could be using that money to treat injured service members. While I agree that there is wasteful spending, and i certainly agree that injured service members deserve the best we offer in care, I think the some blame needs to be placed perhaps on other military personnel. I know that many people who leave the military after 3, 4, 5 years claim medical issues that don't deserve claiming. For instance, IBS from eating chow hall food. They are then awarded 10, 20, 30% disability for the rest of their lives when they've only claimed these issues because they know they'll get money. Perhaps they could give up their undeserved disability for those who really deserve it.
Thank you Dr. Gupta for sharing your experience in rehab. As a music therapist, it is wonderful to know that you had the opportunity to experience MT and that you felt that it was an important part of the process!
Hurray!! for all the music therapists who posted comments and appeared in the segment. However, someone needs to let Dr. Gupta know that his colleagues in the neuroscience community have for decades been studying the scientific basis for the positive effects of music therapy with brain injured patients. There is now very ample data showing exactly how music raises pain thresholds and stimulates the production of new nerve connections that allow the brain to recover cognitive, language, and motor functions lost due to brain damage. It is also much less expensive than drugs and surgery and has been used successfully with head injured soldiers since WW1.
There are resources available that will link up wounded soldiers with therapy resources in their community. Check out VeteranCaregiver.com or contact the American Physical Therapy Association via apta.org for more information.
Thank you, Dr. Gupta for enlightening the world about the many possibilities in Rehab when therapists work together, especially for including a description of how music is processed in the brain and the beneficial use Music Therapy can offer the patient, as demonstrated in Representative Gifford's case. Blessings to her and all in this sacred long process.
Think about the $800 billion we spent so we could take over some "crap" Arab country. Their oil was gonna pay for the war. Too bad that never worked out. Anyone who thinks the "grunts" are gonna get the same care as the VIPs in Washington are crazy.
Giffords deserves this treatment and so does men and women of our armed services and so does my son whose seizure disorder causes childhood apraxia of speech as well as fine motor delays and cognitive delays. It is not Pervasive Developmental Delay as the insurance companies like to think and with the right treatment he does make progress. There are so many children who benefit from this kind of intensive treatment that would go on to lead productive lives. It's the kind of care that should be covered and available to everyone.
While it's great and interesting that Ms. Gifford's is receiving 8 hours of therapy per day, it would also be interesting to know how much therapy the other patients at this rehab hospital (and others) are receiving per day. My assumption is that it is not 8 hours. It is probably closer to 3. While CMS guidelines indicate that patients in inpatient rehab receive "at least" 3 hours of therapy/day, this is probably what most rehab hospitals provide in that staffing and "the bottom line" often come into play.
Dr. Gupta, I am a Physiatrist (a physician specializing in Physical Medicine and Rehabilitation). I have spent my more than twenty years in practice caring for patients with spinal cord injuries, brain injuries, limb amputations etc., helping them recover as much function as possible. I hope that in upcoming coverage on the Congresswoman's recovery you will give your viewers a more balanced picture of inpatient rehabilitation. Physiatrists are responsible for designing and modifying their patients' treatment plans. We work closely with a team of highly trained Physical, Occupational and Speech therapists. A unique characteristic of Rehabilitation is the teamwork and free flow of information between treating disciplines in order to effect maximal recovery for our patients.