The Traumapedia is a glossary of terms and procedures commonly used in brain injury cases.
It is best to prevent chronic pain through effective treatment of acute pain. This involves the proper use of medication to fight the physical aspects of pain. The goal is to get rid of the pain. It is also important to look at psychological and environmental factors related to the pain that need to be fixed. Improving mood, relationships, and stressors can make it easier to cope with pain.
Antianxiety medication otherwise known as anxiolytics are drugs prescribed for the treatment of symptoms of anxiety. Some anxiolytics have been shown to be useful in the treatment of anxiety disorders as have antidepressants such as the class of selective serotonin reuptake inhibitors (SSRIs).
Anticonvulsant sometimes also called antiepileptics, belong to a diverse group of pharmaceuticals used in prevention of the occurrence of epileptic seizures. The goal of an anticonvulsant is to suppress the rapid and excessive firing of neurons that start a seizure. Failing this, a good anticonvulsant would prevent the spread of the seizure within the brain and offer protection against possible excitotoxic effects that may result in brain damage.
Some of the medications in this category include phenytoin, carbamazepine, valproic acid, clonazepam, gabapentin, and lamotrigine. Although these medications were made to control seizures, many are effective for use in chronic pain patients. They may be particularly helpful for lancinating (sharp, shooting) pain because they act by calming nerve firing activity.
Antidepressant medication is taken to alleviate clinical depression or dysthymia ('milder' depression). Several groups of drugs are particularly associated with the term, notably MAOIs and tricyclics as well as SSRIs and more recent variations developed by pharmaceutical companies. These medications are now amongst the most commonly prescribed by psychiatrists and general practitioners, and their effectiveness and adverse effects are the subject of many studies and competing claims.
Antidepressants commonly used for pain treatment include Selective Serotonin Reuptake Inhibitors (SSRIs; e.g., citalopram, paroxetine, sertraline, fluoxetine), Tricyclic antidepressants (e.g., amitriptyline, doxepin, imipramine, nortiptyline, desipramine), and Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRIs; e.g., venlafaxine, duloxetine). Although not designed to treat pain, antidepressants are often prescribed for chronic pain patients, with or without depression. These drugs work by increasing chemicals that prevent pain signals from reaching the brain. These medications are usually prescribed at a lower dose than would be used to treat depression. They also need some time to build up in the body before they are effective. Sedation, although considered a side effect, can be helpful for those with chronic pain that suffer from sleep problems.
Attending physicians have completed their residency and possibly fellowship training and practice medicine without supervision. This term applies to medical doctors (MDs) who practice internal medicine, surgery, psychiatry or any other field of medicine. Because they have completed a residency program, they are “board eligible” and if they have passed the qualifying examination(s), they are “board certified.”The term “attending” is also used in hospitals to refer to the physician who is ultimately responsible for a particular patient’s care. Legally, attending physicians have final responsibility for patient care, even when many decisions are being executed by other health care professionals such as nurses, physician assistants, medical residents, and medical students.
Behavioral therapy involves using techniques to reduce or stop the undesired behavior associated with these disorders. For example, one approach involves training patients in relaxation and deep breathing techniques to counteract the agitation and hyperventilation (rapid, shallow breathing) that accompany certain anxiety disorders. Exposure-based behavioral therapy has been used for many years to treat specific phobias. The person gradually encounters the object or situation that is feared, perhaps at first only through pictures or tapes, then later face-to-face. Often the therapist will accompany the person to a feared situation to provide support and guidance.
Benzodiazepines minor tranquilizers that are a class of drugs with sedative, hypnotic, anxiolytic, anticonvulsant, amnestic and muscle relaxant properties. Benzodiazepines are often used for short-term relief of severe, disabling anxiety or insomnia. Long-term use can be problematic due to the development of tolerance and physiological and psychological dependency. They are believed to act on the GABA receptor GABAA, the activation of which dampens higher neuronal activity. They began to be widely prescribed for stress-related ailments in the 1960s and 1970s. Their chemical structure is based upon diazepine and phenyl groups.
Beta Blockers a class of drugs typically used to decrease blood pressure and also prescribed to ease physical symptoms of anxiety associated with social phobia
Another type of depression is bipolar disorder, otherwise known as manic-depressive illness. Occurring less frequently than major depressive disorder, bipolar disorder is distinguished by cycling mood changes: profound highs (mania) and lows (depression). Sometimes shifts in mood are pronounced and rapid, but typically they occur gradually. When experiencing the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic stage, the individual may experience physical and emotional agitation, exhibit pressured speech, and have an overabundance of energy. Mania often distorts thinking, judgment, and social behavior in manners causing distress and embarrassment. Examples include feelings of elation, which can be expressed as risky business decisions or erratic romantic and sexual encounters. If left untreated, mania can deteriorate to a psychotic state.
Symptoms of depression in bipolar disorder mimic those experienced in major depressive disorder. Manic symptoms will be experienced to varying degrees depending on the individual; therefore, some individuals will experience greater symptom frequency, intensity, and duration than others.
Signs & Symptoms of Mania:
Bipolar disorder appears to have a strong genetic component; therefore it typically is found among family members. Research studying the prevalence of bipolar disorder across generations found that family members diagnosed with the disorder had a slightly different genetic makeup than those who do not get ill. Conversely, they found not all individuals with a genetic predisposition to bipolar disorder developed the illness. Therefore, additional triggers including familial, occupational, and educational stressors may be related to onset
The lifetime prevalence of bipolar disorder has varied from 0.4% to 1.6% in the population. There is minimal evidence to suggest differing incidence rates dependent upon race or ethnicity. Average age of onset is twenty and it is equally found among women and men.
Blocks are usually done by a specially trained physician. The blocks may be diagnostic, prognostic, or therapeutic. Diagnostic blocks are done to help find the source of the pain and the pathway involved. Prognostic blocks are done before more invasive procedures to predict how they might work.
The purpose of therapeutic blocks is to relieve pain. Blocks and trigger point injections can help interrupt the negative cycle of pain-muscle tension-pain that occurs in the body. Blocks may be done in one session or in series. The most common blocks used in the diagnosis and treatment of pain are sympathetic, intravenous (IV) regional and somatic nerve blocks.
Sympathetic blocks may provide permanent or short-term relief of pain. This type of block can help determine if part of the pain is being caused by a problem with the sympathetic nervous system. In addition, a physician gets information about how well other treatments may work based on the patient’s response to the sympathetic block. A sympathetic block of the upper extremity is called a stellate ganglia block. A sympathetic block of the lower extremity is called a lumbar sympathetic block.
Intravenous regional blocks, or Bier blocks, use a tourniquet to keep the injected drug in one area.
Nerve blocks may also be used for diagnostic and treatment purposes. An anesthetic is injected directly into, or near, specific nerves. The anesthetic helps block the pain signal to the brain.
An epidural block can be used to treat pain in the lower part of the body. An epidural catheter is placed in the spinal column to administer a local anesthetic. This treatment may cause weakness in the legs, which makes walking dangerous.
Trigger point injections involve the injection of a local anesthetic into various point-tender spots in the muscles (trigger points). Trigger points usually occur around the area of the muscle where the nerves are sending the most intense pain signals.
Brain death is a complete and permanent cessation of brain activity. For someone who is brain dead one would expect to see a cessation of functions, such as breathing and heartbeat. A brain dead person also feels no pain and has a loss of reflexes. Brain death should not be confused with being a in a vegetative state, where wakefulness is present but awareness is absent.
A Case Manager is a professional, usually a social worker or nurse, who serves as a point of contact for individuals with disabilities and family members. This person coordinates the process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs. Case managers consult with key service providers to ensure that the health care plan is developed appropriately and monitored for effective service based on specified and desired outcomes. Case managers are expected to maintain quality in service provision for individual clients and the wider target population.
Responsibilities and Duties include:
A case manager usually has a Bachelors degree from an accredited college or university with major coursework in nursing.
Bruising of the brain. This can occur beneath a skull fracture. It can also be a result of a blow to the head that has caused the brain to shift and bounce against the skull.
Cerebral hypoxia refers to a condition in which there is decreased oxygen supply to the brain even though there is good blood flow. The more common causes of hypoxia or anoxia (no oxygen to the brain) are head trauma, complications of general anesthesia (medication to put a person to sleep) and cardiac arrest. Brain cells are extremely sensitive to the lack of oxygen and can begin to die within five minutes after the oxygen supply has been cut off. When hypoxia (too little oxygen to the brain) lasts for longer periods of time, it can cause coma, seizures, and even brain death. During recovery the patient may experience forgetfulness, personality changes, and hallucinations (seeing things that are not present); the longer a patient remains unconscious the greater the risk of poor functional recovery.Patients with severe brain damage due to the lack of oxygen have a limited amount of recovery and will present in one of these states:
Coma (Unconscious): a condition in which the person appears to be sleeping, but is unable to be aroused.
Vegetative state: wakeful unresponsiveness,” a person who is neither in a coma nor conscious. MBR>
Conscious: a person is awake and able to interact with the environment.
As with any trauma patient the medical staff will provide the best possible care for every patient. However, in severe anoxic or hypoxic head injury patients the doctor and healthcare team will discuss, in detail, the realistic future of the patient’s quality of life.
A chaplain is typically a member of the clergy serving a group of people or institution, such as a hospital, who are not organized as a mission or church. Chaplains are clinically trained health care professionals that are certified by a national pastoral care organization. They provide spiritual and emotional support and care to all patients, their families, and staff employed by the organization.Chaplains can be attached to emergency services agencies, educational institutions like universities and colleges, private clubs, scout troops, ships, hospitals, prisons, the military and on occasion private companies and corporations. Chaplains also serve in hospice programs and retirement centers.
Many hospitals and hospices employ chaplains to assist with the spiritual needs of patients, families and staff. In the United States, healthcare chaplains are typically educated through the Association for Clinical Pastoral Education and may be certified by one of the following organizations: International Chaplains Association, The Association of Professional Chaplains, The National Association of Catholic Chaplains, or The National Association of Jewish Chaplains.
As pain becomes more chronic medications may continue to be useful, but other strategies should also be examined. Psychological care, physical therapy, blocks, surgical procedures, and implantable devices may be more useful for long-term pain problems. At this point the goal is to reduce pain and improve function. The most useful strategies can be used by the patient at home. Required attendance at a medical facility on a regular basis may be stressful and make pain worse. At-home techniques include relaxation, stress management, stretching, exercise, and use of implantable devices.
American Pain Foundation: Pain Notebook
Clinical laboratory technologists also referred to as clinical laboratory scientists or medical technologists are health care personnel that examine and analyze blood and other body fluids. They look for bacteria, parasites, and other microorganisms; analyze the chemical content of fluids; match blood for transfusions; and test for drug levels in the blood to show how a patient is responding to treatment. Technologists also prepare specimens for examination, count cells, and look for abnormal cells in blood and body fluids.The usual requirement for an entry-level position as a clinical laboratory technologist is a bachelor’s degree with a major in medical technology or in one of the life sciences; although it is possible to qualify through a combination of education, on-the-job, and specialized training. Universities and hospitals offer medical technology programs.
Clinical nurse specialists (CNSs) or advanced practice nurses (APNs) are Registered Nurses with advanced education, knowledge, skills, and scope of practice. Most CNSs possess a master's or doctoral degree in nursing and may also sit for additional certification examinations. They perform primary health care, provide mental health services, diagnose, prescribe, carry out nursing research, and educate the public and other professionals.
Cognitive-behavioral therapy (CBT) is very useful in treating anxiety disorders. The cognitive part helps people change the thinking patterns that support their fears, and the behavioral part helps people change the way they react to anxiety-provoking situations. For example, CBT can help people with panic disorder learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them. When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties.
People with OCD who fear dirt and germs are encouraged to get their hands dirty and wait increasing amounts of time before washing them. The therapist helps the person cope with the anxiety that waiting produces; after the exercise has been repeated a number of times, the anxiety diminishes. People with social phobia may be encouraged to spend time in feared social situations without giving in to the temptation to flee and to make small social blunders and observe how people respond to them. Since the response is usually far less harsh than the person fears, these anxieties are lessened. People with PTSD may be supported through recalling their traumatic event in a safe situation, which helps reduce the fear it produces. CBT therapists also teach deep breathing and other types of exercises to relieve anxiety and encourage relaxation.
CBT is undertaken when people decide they are ready for it and with their permission and cooperation. To be effective, the therapy must be directed at the person's specific anxieties and must be tailored to his or her needs. There are no side effects other than the discomfort of temporarily increased anxiety.
It is very important to understand that treatments for anxiety disorders do not work instantly. Many patients will begin to notice improvement in their anxiety symptoms within eight to ten sessions of psychotherapy, especially those who carefully follow the outlined treatment plan. CBT and behavioral therapy are typically concluded within 12 weeks. The patient should be comfortable from the outset with the general treatment being proposed and with the therapist with whom he or she is working. The patient's cooperation is crucial, and there must be a strong sense that the patient and therapist are collaborating as a team to remedy the anxiety disorder. No one plan works well for all patients. Treatment needs to be tailored to the needs of the patient and to the type of disorder, or disorders, from which the individual suffers. For example, there is some evidence that the benefits of CBT last longer than those of medication for people with panic disorder, and the same may be true for OCD, PTSD, and social phobia. If a disorder recurs at a later date, the same therapy can be used to treat it successfully a second time. A therapist and patient should work together to assess whether a treatment plan seems to be on track. Adjustments to the plan sometimes are necessary, since patients respond differently to treatment.
Coma is a state of unconsciousness in which a patient is not able to react to their environment. Coma is different than brain death in that a comatose patient still retains functions such as breathing and heart rate. The patient appears to be sleeping but cannot be awakened, and they fail to respond normally to unpleasant stimuli and light.
Computed tomography (CT) is a method of body imaging in which a thin x-ray beam rotates around the patient. Small detectors measure the amount of x-rays that make it through the patient or particular area of interest.
A computer analyzes the data to construct a cross-sectional image. These images can be stored, viewed on a monitor, or printed on film. In addition, three-dimensional models of organs can be created by stacking the individual images, or "slices."
The patient will be asked to lie on a narrow table that slides into the center of the scanner. Depending on the study being performed, the patient may need to lie on his or her stomach, back, or side. If contrast dye is to be administered, an IV will be placed in a small vein of a hand or arm.
Much like standard photographic cameras, any motion you make causes blurred images in CT. Therefore, the operator will instruct the patient through an intercom on when to hold his or her breath and not move.
As the exam takes place, the table will advance small intervals through the scanner. Modern "spiral" scanners can perform the exam in one continuous motion. Generally, complete scans will only take a few minutes. However, additional contrast-enhanced or higher-resolution scans will add to the scan time. The newest multidetector scanners can image the entire body, head to toe, in less than 30 seconds.
CT provides rapid, detailed cross-sectional imaging of the patient which can then be reconstructed into three-dimensional models, as needed. Intravenous contrast enhanced scans allow for evaluation of vascular structures and further evaluation of masses and tumors.
CT is often utilized in the trauma setting to evaluate the brain, chest, and abdomen. As well, CT can be used to guide interventional procedures, such as biopsies and placement of drainage tubes.
Adapted from the National Library of Medicine.
A brief loss of consciousness following a blow to the head. A CT scan of the head will not show this injury. Concussions may cause confusion or loss of memory about events that caused the injury. More severe concussions can lead to more severe confusion and comatose-like states.
Angiography is a procedure in which a contrast material that can be seen using x-ray equipment is injected into one of the arteries, allowing your health care provider to see the vessel.
How the test is performed
An arteriogram can be used to examine almost any artery, including those of the head, kidneys, heart, or lungs. It is sometimes used as part of a procedure to repair the blood vessels called balloon angioplasty.
First, the doctor will need to insert an intravenous (IV) line into one of the blood vessels in the patient's arm, chest, neck, or groin. A catheter is then inserted through the IV and into the patient's blood vessels using an X-ray machine that produces "live" pictures. Once the catheter is placed into the blood vessel of interest, contrast material is injected and pictures are taken. Sometimes it takes a long time for the doctors to get the catheter into just the right spot. It can be compared to threading a needle for sewing.
Why the test is performed
In general, arteriograms give the best pictures of the body's blood vessels. Arteriograms are used to make specific diagnoses and to help determine what the best treatment is in a particular case. Often, the treatment itself can be performed using the same type of catheters used in the arteriogram, instead of requiring a more extensive surgery in an additional procedure.
The risks for this procedure depend on the type of arteriogram performed.
Other risks may be present as well.
Here is an image of a cardiac arteriogram: Cardiac Arteriogram
Adapted from the National Library of Medicine.
‘Counselor’ is a general term used to describe trained professionals who apply mental health, psychological and human development principles to address wellness, personal growth, career development, and even pathology. Counselors are typically defined by their specialization, which includes (but is not limited to) substance abuse, school, rehabilitation, marriage and family. Social workers can also be considered counselors who focus on the effects that social problems have on individuals, families, organizations, and communities.Counselors apply mental health, psychological or human development principles, through cognitive and behavioral intervention strategies. Specifically, behavioral therapy aims to identify and reduce problematic behaviors. Typically, the counselor will look for patterns of behavior, identify related triggers and consequences, and implement coping strategies accordingly. Cognitive therapy involves recognizing unhelpful or destructive patterns of thinking and reacting, then modifying or replacing these with more realistic or helpful ones. A widely used combination of these two approaches, known as Cognitive Behavioral Therapy (CBT), is based on the idea that how we think (cognition), how we feel (emotion) and how we act (behavior) all interact together. Specifically, our thoughts determine our feelings and our behavior. Therefore, negative and unrealistic thoughts can cause us distress and result in problems. CBT interventions seek to identify the connections between thoughts, feelings, and behaviors, and teach appropriate coping strategies.
Counselors may engage client’s in various modes of therapy, including individual, group, and family counseling. Individual therapy establishes a one on one relationship between counselor and client, and focuses on how the client can best attain their goals given their current needs and level of functioning. In group therapy the interactions between the members of the group and the therapist(s) become the material with which the therapy is conducted, alongside past experiences and experiences outside the therapeutic group. Family therapy, also referred to as couples therapy or family systems therapy, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view these in terms of the systems of interaction between family members and further emphasizes family relationships as an important factor in psychological health.
The master's degree in counselor education is now considered the entry-level preparation for qualification as a professional practitioner. It qualifies the counselor to work, under supervision in some states and without supervision in others, and to apply the skills of assessment and clinical intervention in various settings (schools, agencies, universities) and with different modalities (individual, group, and family counseling). Most programs require a minimum of 2 years full-time study or 3 to 5 years part-time study.
Go to the American Counseling Association’s weblink: Definition of Professional Counseling
Some of the medications used for the treatment of pain can lead to dependency. Working closely with a medical provider to track your drug use reduces that risk. Addiction is often confused with physical dependence or tolerance. Physical dependence means there will be withdrawal symptoms if the drug is suddenly stopped. Tolerance means that the initial dose of medication no longer works as well, or a bigger dose is needed to get the same results as before. Addiction means that the person wants more of the drug and keeps using it regardless of negative consequences. Most people who take pain medications as prescribed by their doctor will not have a problem with addiction. Those with a family history or past problem with addiction may be more at risk.
For more information: http://www.webmd.com/content/article/100/105622.htm
Major depression is evidenced by a cluster of symptoms that noticeably impede work performance, study habits, sleep patterns, eating, and the ability to enjoy pleasurable activities. This type of interference can be limited to one lifetime occurrence, but typically is experienced several times throughout an individual’s life.
The following outline lists common symptoms of a major depressive episode. The number of symptoms experienced varies by individual. Therefore, some depressed people may experience more symptoms than others; the severity and duration of each symptom can also vary.
To meet criteria for depression as outlined by the Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition, Text Revision (DSM-IV-TR) the individual must experience five or more of the following symptoms within a 2-week period.
At least one of the sypmtoms must be present:
1) depressed mood or
2) loss of interest or pleasure
These feelings must further evidence a change from previous functioning. For example:
According to the DSM-IV-TR, Major Depressive Disorder can be marked by a single major depressive episode, or is considered Recurrent if two or more episodes occur (with a symptom free two month period in between). Both types are qualified as Mild, Moderate, or Severe (with or without psychotic symptoms). Likewise, if an individual experiences some but not all symptoms required, the depression is said to by either in Partial Remission or in Full Remission. Lastly, the pattern of depressive symptoms can be described as Longitudinal (describes the period between two depressive episodes) or Seasonal (onset of symptoms coincides with specific annual time-periods).
Some types of depression are similarly experienced among family members, suggesting an inheritable genetic vulnerability. In some instances, major depression can be traced across generations. However, it can also occur in people with no family history of depression. Whether inherited or not, major depressive disorder is often associated with changes in brain structures or brain function.
Risk factors for the development of depression can also include personality characteristics, such as low self-esteem, a pessimistic view of oneself and the world, and vulnerability to stress. It is currently unclear whether these triggers represent a form of psychological predisposition or rather an early appearance of the illness. Furthermore, profound loss, strained relationships, financial difficulties, or any stressful (unwelcome or even desired) modifications to daily life can trigger a depressive episode.
Recently, researchers have illustrated that physical changes in the body can be accompanied by mental change as well. Medical afflictions such as stroke, a heart attack, cancer, Parkinson's disease, and hormonal disorders can lead to the development of a depressive episode(s), often perpetuating feelings of indifference and hopelessness, thus lengthening the recovery process.
Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder. Once a single depressive episode is experienced, subsequent episodes can be readily triggered by only mild stressors or none at all.
The lifetime risk for major depressive disorder has varied across research studies from 10% to 25% for women and 5% to 12% for men. These rates appear to be unrelated to ethnicity, education, income, or marital status. Major depressive disorder may begin at any age, but the average age of onset appears to be mid-twenties. It is twice as common in adolescent and adult females as it is in adolescent and adult males. In children, boys and girls are equally affected.
Dietitians and nutritionists are experts in food and nutrition. They promote good health and prevent and treat illnesses by recommending healthy eating habits and dietary modifications. They also supervise the preparation and service of food, develop modified diets, participate in research, and educate individuals and groups on good nutritional habits.
The majority of dietitians are clinical or therapeutic, dietitians. Clinical dietitians work in hospitals to provide medical nutrition therapy and individual inpatient and outpatient dietary consultations. They also conduct group education for other health workers, patients and the public. Clinical dietitians work as a team with the physicians, physical therapists, occupational therapists, speech therapists, social workers and nurses to provide care to the patients.
Community dietitians apply and distribute knowledge about food and nutrition to specific geographic areas. They coordinate nutritional programs in public health agencies, daycare centers, health clubs, and recreational camps and resorts. Some community dietitians carry out clinical based patient care in the form of home visits for patients who are too ill to physically attend consultation in health facilities. Food service dietitians or managers are responsible for large-scale food planning and service. They coordinate, assess, and plan food service processes in health care facilities, school food service programs, prisons, cafeterias, and restaurants.
There are a few different academic routes to becoming a fully qualified registrable Dietitian: a professional undergraduate Bachelor degree in Dietetics or a Bachelor of Science degree and a Postgraduate diploma in Dietetics or a Bachelor of Science degree and a Masters in Dietetics. Besides academic education, registered dietitians must complete a year long internship before they can sit for the registration examination.
Dietary Assistants or Dietary Aides are responsible for assisting and carrying out the medical nutrition therapy prescribed by Dietitians. They ensure that food preparation for the patients, as instructed by the Dietitians, is carried out correctly. They do this by checking menus against recent diet orders and being physically present in the kitchen at meal hours. Dietary aides in some countries might also carry out a simple initial health screening for newly admitted patients.
Dopamine a chemical naturally produced in the body. In the brain, dopamine functions as a neurotransmitter, activating dopamine receptors. Dopamine is also a neurohormone released by the hypothalamus. Its main function as a hormone is to inhibit the release of prolactin from the anterior lobe of the pituitary. Dopamine can be supplied as a medication that acts on the sympathetic nervous system, producing effects such as increased heart rate and blood pressure. However, since dopamine cannot cross the blood-brain barrier, dopamine given as a drug does not directly affect the central nervous system.
Electroconvulsive therapy (ECT) is useful, particularly for individuals whose depression is severe or life threatening or who cannot take antidepressant medication. ECT often is effective in cases where antidepressant medications do not provide sufficient relief of symptoms. In recent years, ECT has been much improved. A muscle relaxant is given before treatment, which is done under brief anesthesia. Electrodes are placed at precise locations on the head to deliver electrical impulses. The stimulation causes a brief (about 30 seconds) seizure within the brain. The person receiving ECT does not consciously experience the electrical stimulus. For full therapeutic benefit, at least several sessions of ECT, typically given at the rate of three per week, are required.
The Emergency Medical Service (EMS) system is responsible for providing pre-hospital (or out-of-hospital) care by paramedics and emergency medical technicians. The goal of EMS is to provide early treatment to those in need of urgent medical care and ultimately rapid transportation to the Emergency Room (ER). Providing medical care early to patients significantly increases their chances of survival, particularly in the event of a heart attack, diabetic emergency, or severe physical trauma. EMS providers work under the license and in direct supervision of a medical director or board-certified physician who oversees the policies and protocols of a particular EMS system or organization. EMS professionals are trained to follow a formal and carefully designed protocol or standard of care, which has been created and approved by physicians. The emphasis in emergency services is on following correct procedure quickly and accurately rather than on making in-depth diagnoses.National EMS standards are determined by the U.S. Department of Transportation and modified by each state's Department of EMS (usually under its Department of Health), and further altered by Regional Medical Advisory Committees (usually in rural areas) or by other committees.
An Emergency Medical Technician (EMT) is an emergency responder trained to provide emergency medical services to the critically ill and injured. An EMT responds to many types of emergency calls, including medical emergencies, hazardous materials exposure, childbirth, child abuse, fires, rescues, injuries, trauma and psychiatric crises. The goal of EMT intervention is to rapidly evaluate a patient's condition and to maintain a patient's airway, breathing and circulation by CPR and defibrillation. In addition, EMT intervention aims to control external bleeding, prevent shock, and prevent further injury or disability by immobilizing potential spinal or other bone fractures, while expediting the safe and timely transport of the patient to a hospital emergency department for definitive medical care.
In the United States, EMTs are certified according to their level of training. On one end of the spectrum, there are fast track programs that can be very intense often demanding a schedule of 8 to 12 hour days for at least two weeks. On the other side of the spectrum are 3 to 4 month training programs whose popular venue is a local community college. Training consists of a few hours a day, couple days a week of classroom time. In addition, field time is also required, where the student must complete specific rotations in the hospital setting, and also gain experience on the ambulance under the guidance of an EMS preceptor. The number of hours in the field varies depending on the state's requirements and the amount of time it takes the student to show competency in their skills. Individual states set their own standards of certification (or licensure, in some cases).
Epidural hemorrhage is an accumulation of blood between the skull and the dura mater of the brain. It can lead to an accumulation of blood in this space leading to increases in intracranial pressure and formation of hematomas (blood clotting). This condition is considered a medical emergency. Acceleration-deceleration forces or shear forces can cause epidural hemorrhage. It is most commonly caused by blows to the side of the head that rupture the arteries. This type of bleeding is very rapid because it usually occurs from torn arteries, which have a much higher blood pressure than veins. Symptoms of an epidural bleed will occur much more rapidly and they include intense headaches, abnormal posture, abnormal pupilary reflexes, and loss of consciousness. The patient that looses consciousness can have a period of time where they regain consciousness, though after this period they will slip into unconsciousness and rapidly decline. Computed tomography (CT) and magnetic resonance imaging (MRI) scans are used to diagnose this type of hemorrhage and surgical intervention is necessary to correct the damage. The blood can be aspirated via a burr hole in the skull or a craniotomy (skull is opened and the blood clot is removed).
Generalized Anxiety Disorder, GAD, is an anxiety disorder characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it. They anticipate disaster and are overly concerned about health issues, money, family problems, or difficulties at work. Sometimes just the thought of getting through the day produces anxiety.
GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months. People with GAD can't seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They can't relax, startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes. As a result of these physical symptoms, individuals with GAD often seek consistent medical attention before anxiety is identified as the cause of their ailments. When their anxiety level is mild, people with GAD can function socially and hold down a job. Although they don't avoid certain situations as a result of their disorder, people with GAD can have difficulty carrying out the simplest daily activities if their anxiety is severe.
To learn more about the signs and symptoms of GAD, you can take this self-test developed by the Anxiety Disorders Association of America (ADAA): http://www.adaa.org/GettingHelp/SelfHelpTests/selftest_GAD.asp
GAD affects about 6.8 million adult Americans and about twice as many women as men. The disorder comes on gradually and can begin across the life cycle, though the risk is highest between childhood and middle age. It is diagnosed when someone spends at least 6 months worrying excessively about a number of everyday problems. Other anxiety disorders, depression, or substance abuse often accompany GAD, which rarely occurs alone. GAD is commonly treated with medication or cognitive-behavioral therapy, but co-occurring conditions must also be treated using the appropriate therapies.
The Glasgow Coma Scale (GCS) is the most common scoring system used to describe the level of consciousness in a person following a traumatic brain injury. Basically, it is used to help gauge the severity of an acute brain injury. The test is simple, reliable, and correlates well with outcome following severe brain injury.
The GCS is a reliable and objective way of recording the initial and subsequent level of consciousness in a person after a brain injury. It is used by trained staff at the site of an injury like a car crash or sports injury, for example, and in the emergency department and intensive care units.
Home health is health care provided in the patient's home by healthcare professionals or by family and friends as caregivers. Home care enables people to remain at home rather than living in a skilled nursing home. For formal care, the health care professionals most often involved are nurses followed by physical therapists and home care aides. Other health care providers include respiratory and occupational therapists, medical social workers and mental health workers. Home care aids help with daily tasks such as getting up, going to bed, dressing, toileting, personal hygiene, some household tasks, shopping, cooking and supervision of medication
Spinal cord stimulation (SCS) uses implanted electrodes to send out low intensity, impulses to stimulate certain nerve fibers along the spinal cord. The goal is to stop pain messages from being sent to the brain from the spinal cord. SCS produces a tingling sensation that should replace the pain. A trial of SCS should be done before the permanent electrodes are placed to assess potential benefit of the device.
The intrathecal pump provides an opioid medication directly into the spinal fluid. It is meant to produce a selective pain-blocking effect on the spinal cord. This method should have less sedation effects than with opioids taken by mouth. However, many of the other side effects that occur with oral opioids can also be a problem with giving the drug through the spinal cord.
An Intensive Care Unit (ICU) or Critical Care Unit (CCU) is a specialized facility in a hospital that provides comprehensive care for patients who are critically ill and usually need life support or organ support. Patients admitted to the intensive care unit not requiring life or organ support are usually admitted for continuous monitoring after major surgery. Patients may be admitted directly from the emergency room or from a surgical ward. Health care professionals monitor and treat these patients 24 hours a day, seven days a week.The Intensive Care Unit is staffed by physicians who have received specialized medical training through a fellowhip in critical care. In general, there are two types of physicians who practice in the ICU, trauma surgeons and anesthesiologists. Depending upon whether they were on call for trauma, the trauma surgeon may be the same physician that evaluated the trauma patient when they first arrived at the hospital.
ICUs typically limit the number of visitors to the patient's immediate family even during visiting hours. The patient usually has several bedside monitors, catheters, and intravenous lines attached to various parts of their body to monitor heart rate, breathing, blood pressure, and blood oxygen level. Some patients may even require a respirator to breathe for them. Once stabilized, patients are transferred either to an intermediary care unit or a general care unit.
The Journal of American Medicine has a page explaining different parts of the ICU at:
Intensive Care Units
Intermediary care units are designed to provide care for acutely ill patients who need more specialized attention than patients on general care units. Care is usually directed by a registered nurse under the direction of a physician, and patients receive regular nursing assessment, ongoing monitoring and frequent treatment.
An internist, often called a “primary care doctor,” is a physician who has completed a residency in internal medicine and provides medical care to adults. They have had specialty training focusing on the prevention and treatment of adult diseases and treat the whole person. Internists can choose to focus their practice on general internal medicine or may take additional training to "subspecialize" in an area of internal medicine such as cardiology, endocrinology, gastroenterology, hematology, infectious disease, oncology, nephrology, or pulmonology. Subspecialty training, sometimes called a fellowship, usually requires an additional one to three years beyond the standard three year general internal medicine residency.
When the bleeding is occurring inside the brain tissue. This usually occurs when blood vessels deep in the brain are injured.
Licensed practical nurses (LPNs) are health care professionals who have completed twelve months to two years of training in anatomy and physiology, medications, and practical patient care. They have passed state and national boards. LPNs can perform simple as well as complex medical procedures, but must operate under the supervision of either a professional registered nurse (RN) or a physician. They can administer most medications, perform measurements (blood pressure, temperature, etc), and help with patient-care planning, surgery, first aid, and basic care.
MRI is a non-invasive procedure that uses powerful magnets and radio waves to construct pictures of the body.
Unlike conventional radiography and computed tomographic (CT) imaging, which make use of potentially harmful radiation (x-rays), MRI imaging is based on the magnetic properties of atoms. A powerful magnet generates a magnetic field roughly 10,000 times stronger than the natural background magnetism from the earth. A very small percentage of hydrogen atoms within a human body will align with this field.
When focused radio wave pulses are broadcast towards the aligned hydrogen atoms in tissues of interest, they will return a signal. The subtle differences in that signal from various body tissues enables MRI to differentiate organs, and potentially contrast benign and malignant tissue.
Any imaging plane (or slice) can be projected, stored in a computer, or printed on film. MRI can easily be performed through clothing and bones. However, certain types of metal in the area of interest can cause significant errors, called artifacts, in the reconstructed images.
How the test is performed
Since MRI makes use of radio waves very close in frequency to those of ordinary FM radio stations, the scanner must be located within a specially shielded room to avoid outside interference. The patient will be asked to lie on a narrow table which slides into a large tunnel-like tube within the scanner.
In addition, small devices may be placed around the head, arm, or leg, or adjacent to other areas to be studied. These are special body coils which send and receive the radio wave pulses, and are designed to improve the quality of the images. If contrast is to be administered, an IV will be placed, usually in a small vein of the hand or forearm. A technologist will operate the machine and observe you during the entire study from an adjacent room.
Several sets of images are usually required, each taking from 2 to 15 minutes. A complete scan, depending on the organs studied, sequences performed, and need for contrast enhancement may take up to one hour or more. Newer scanners with more powerful magnets utilizing updated software and advanced sequences may complete the process in less time.
How to prepare for the test
No preparatory tests, diets, or medications are usually needed. An MRI can be performed immediately after other imaging studies. Depending on the area of interest, the patient may be asked to fast for 4 - 6 hours prior to the scan.
MRI also should not be used for people with metallic objects in their bodies, such as:
Sheet metal workers, or persons with similar potential exposure to small metal fragments, will first be screened for metal shards within the eyes with x-rays of the skull.
The patient will be asked to sign a consent form confirming that none of the above issues apply before the study will be performed.
An MRI can provide additional imaging information for the clinician based upon its superior tissue contrast resolution. Combined with other imaging methods, a more definitive diagnosis can be given in the work up of a patient's disease.
Sequences performed with intravenous contrast may provide additional data about the blood vessels within masses.
Adapted from the National Library of Medicine.
As a trauma patient or the patient’s family member or friend, you will encounter numerous individuals who will contribute to the trauma patient’s overall care. As a patient, you will most likely first interact with the paramedics at the scene of your injury. However, as a family member or friend, your first interaction is usually with a representative of the hospital, often a social worker or chaplain, who can provide you with basic, general information about your loved ones care and can support you through this difficult time. In the trauma bay, numerous staff stand ready awaiting the patient’s arrival. The brief list includes trauma surgeons and emergency medicine physicians and their residents, nurses, respiratory therapists, x-ray technicians, and operating room staff, including anesthesia personnel. We can assure you; there will be too many people to remember! Their aim, however, is to have all of the resources they could possibly need at your bedside. Nurses will be drawing blood and starting IVs; residents or physicians will be asking several but specific questions and performing their physical exam. Often, multiple x-rays will be taken.
The goal of the team in the trauma bay is to determine all of the injuries the patient has suffered and what is the next best step to address those injuries. Some patients will be taken to the Radiology department for a CT scan; for others, it is “do not pass go” directly to the operating room; some will be taken to the Intensive Care Unit for close observation, IV fluids, blood, and further testing. For family members and friends, time seems like an eternity. Social workers or chaplains are there to explain in general terms what is going on behind the scenes and to provide emotional and spiritual support; however, they may not have specific information about how your loved one is doing. At that moment in time, the patient is best served by having the doctor’s full attention. After the patient is stable, meaning that his or her vital signs are within the normal limits, and after the initial evaluation and studies are complete, the physician will provide family members and friends with an update on the patient’s condition.
Depending upon the patient’s hospital course, he or she may be transferred to the general surgical floor, to the operating room, or to the Intensive Care Unit. In the Intensive Care Unit, nurses are typically assigned to one or two patients due to their complex needs. It is common to see respiratory therapists as many patients require ventilatory support to breath. Often, multiple physicians are involved in a patient’s care. On the general floor, trauma patients will work more heavily with the physical and occupational therapists as they continue to heal and recover. A smaller number of physicians focus on providing the patient’s medical care. Social workers become essential in ensuring that proper care and centers for recovery after the hospital are secured. Whether in the ICU or on the floor, multiple individuals will be asking you questions and visiting throughout the day, it is at times impossible to remember them all. Do not hesitate to ask them who they are and what their job is and if need be, write the information down. Trauma is a complex injury that requires detail-oriented care; involving individuals with multiple areas of specialty ensures that the patient can be on the road to recovery.
A medical fellow is a term used for physicians who have completed three or more years of residency and have chosen to pursue subspecialty training. For example, if you are hospitalized for a traumatic injury, you may see a “trauma fellow.” Fellowship programs usually last for one to three years. The goal of most fellowships is to produce academic and clinical leaders and involve physicians in patient care, research, and education.
A medical intern is a term used for a physician in training who has completed medical school. An intern in the medical field has an M.D. or D.O. degree but does not have a full license to practice medicine unsupervised in the U.S. They are in their first year of residency. A medical residency gives in-depth training within a specific branch of medicine, such as internal medicine, neurology, psychiatry, physical medicine and rehabilitation, and radiology. The field of surgery also has several specialties such as neurosurgery, orthopaedics, and general surgery.This first internship year is also called “PGY-1,” meaning “post-graduate year 1.” They practice under direct supervision of a senior resident and attending physician. Interns are expected to know nearly everything about the patients assigned to them, and they are the first persons called by nurses. Interns generally write orders for all medications, tests, and consultations.
A medical resident is a term used for a physician in training who has completed medical school. A resident in the medical field has an M.D. or D.O. degree but does not have a full license to practice medicine unsupervised in the U.S. They are in their second, third, or fourth year of residency. Some residents can even be in medical training up to 8 years.A medical residency gives in-depth training within a specific branch of medicine, such as internal medicine, neurology, psychiatry, physical medicine and rehabilitation, and radiology.
A Junior resident or PGY-2 is a physician trainee in his or her second year of residency. Junior residents supervise and teach interns and medical students. A Senior resident is a physician trainee in his or her third year of residency or greater. Senior residents supervise and teach interns and medical students and are preparing themselves for independent practice. In some fields, such as surgery, residency can continue beyond three years to a total of eight years. There are also Chief residents in the hospital. These are residents in their final year who take on a leadership role within the residency program. Chief residents serve as an intermediary between the more senior physicians and the hospital administration.
A neuropsychologist specializes in neuropsychology, a branch of psychology and neurology that aims to understand how the structure and function of the brain relate to behavior. Aspects of behavior that interest neuropsychologists include attention, memory, language, and intellectual functions. In practice neuropsychologists tend to work in academia (involved in basic or clinical research), clinical settings, forensic settings (often assessing people for legal reasons or court cases), or industry (often as consultants in product design or in the management of pharmaceutical clinical-trials for drug research).
A neurosurgeon is a surgical specialist who is trained to diagnose, treat, and manage disorders of the nervous system. The nervous system includes the brain, spinal cord, spinal column and peripheral nerves, including their support structures and blood supply. They also evaluate and manage disorders that affect the function of the nervous system and the operative and non-operative management of certain types of pain. Some conditions treated by neurosurgeons include spinal disc herniation, spinal stenosis, head trauma, spinal cord trauma, brain and spinal cord tumors, and some forms of stroke. Pediatric neurosurgeons manage children with head injuries, brain and spinal tumors, vascular malformation, seizures disorders, and hydrocephalus.
Non-steroidal Anti-inflammatory Drugs (NSAIDs) – There are a number of NSAIDs available such as aspirin, ibuprofen, naproxen, and COX-2 inhibitors. NSAIDs are mostly used for mild to moderate acute pain. They may be used for injuries such as strains, sprains, headaches, arthritis, and soft tissue damage. They interfere with the making of pain-producing chemicals in the body. This type of medication may also be used with an opioid drug in order to reduce the required dose of the opioid.
A nurse practitioner (NP) is a registered nurse who has completed advanced education, generally a Master of Science in Nursing, and specializes in a particular field of medical care. NPs are trained in the diagnosis and management of common medical conditions, including chronic illnesses. They provide much of the same care as physicians and can serve as a patient’s regular health care provider. In addition to health care services, NPs conduct research and are often active in patient advocacy activities.
Some nurse practitioner's duties may include the following:
Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety.
People with obsessive-compulsive disorder (OCD) have persistent, upsetting thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce; most of the time, the rituals end up controlling them. For example, if people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. If they develop an obsession with intruders, they may lock and relock their doors many times before going to bed. Being afraid of social embarrassment may prompt people with OCD to comb their hair compulsively in front of a mirror-sometimes they get "caught" in the mirror and can't move away from it. Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts. Other common rituals are a need to repeatedly check things, touch things (especially in a particular sequence), or count things. Some common obsessions include having frequent thoughts of violence and harming loved ones, persistently thinking about performing sexual acts the person dislikes, or having thoughts that are prohibited by religious beliefs. People with OCD may also be preoccupied with order and symmetry, have difficulty throwing things out (so they accumulate), or hoard unneeded items.
The course of the disease is quite varied. Symptoms may come and go, ease over time, or get worse. If OCD becomes severe, it can keep a person from working or carrying out normal responsibilities at home. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves.
There is growing evidence that OCD represents abnormal functioning of brain circuitry, probably involving a part of the brain called the striatum. OCD is not caused by family problems or attitudes learned in childhood, such as an inordinate emphasis on cleanliness, or a belief that certain thoughts are dangerous or unacceptable.
Brain imaging studies using a technique called positron emission tomography (PET) have compared people with and without OCD. Those with OCD have patterns of brain activity that differ from people with other mental illnesses or people with no mental illness at all. In addition, PET scans show that in individuals with OCD, both behavioral therapy and medication produce changes in the striatum. This is graphic evidence that both psychotherapy and medication affect the brain.
Occupational therapists are healthcare professionals who work with people who have a permanent or temporary impairment in their physical, mental, or social functioning. The aim of occupational therapy is to help the client perform daily tasks in their living and working environments and to assist them in developing the skills to live independent, satisfying, and productive lives.
Occupational therapy usually involves the use of purposeful activities, which have some meaning and relevance to a client (these are also called 'occupations' and include routine behaviors associated with work, leisure and self care). Another important area of intervention is by means of environmental manipulation to maximize ability (such as environments for wheelchair users) or afford the desired behaviors (e.g. set up the environment so that it contains cues to compensate for memory impairment).
Occupational therapists might work in a hospital, skilled nursing facility, school, outpatient clinic, or in the client's home as in home health. Some occupational therapists also conduct research to assess new techniques, rate the effectiveness of existing services, and investigate other areas into which occupational therapy might be beneficial. Additionally, there are some non-traditional roles such as consulting with lawmakers and doing home accessibility modification and ergonomic assessments of work environments.
Opioid drugs include morphine, codeine, oxycodone, hydromorphone, and methadone. These drugs are generally used for severe forms of acute pain. They may also be used for chronic pain conditions after other appropriate therapies have failed. Opioids act through several groups of receptors in the body, which is why they can have such a large and varied effect. There are guidelines for opioid therapy that should be followed to reduce risk of tolerance or addiction.
An orthotist is an allied health professional who is specifically trained and educated to provide or manage the provision of a custom-designed, fabricated, modified, and fitted external orthosis, based on a clinical assessment and a physician’s prescription. An orthosis is a device that is applied to a part of the body to correct deformity, improve function, or relieve symptoms of a disease.
Practitioners who successfully complete the education, experience, and examination requirements prescribed by the American Board of Certification in Orthotics and Prosthetics, Inc. (ABC) are conferred the credentials of Certified Orthotist (CO). The credentials of Certified Prosthetist-Orthotist (CPO) is conferred to practitioners whose responsibilities conform to those of both orthotist and prosthetist and who successfully fulfill all of the requirements in both disciplines
A clinic or outpatient clinic is a medical facility that provides health care for ambulatory patients - as opposed to patients eho have been admitted to a hospital. Oupatient clinics may be located within or on the same campus as a hospital; they may also be free standing. Most clinics are run by one or more general practitioners, but there are clinics operated by private corporations, government organizations or hospitals. The function of clinics will differ from place to place. For instance, a local general practice will provide primary health care while a rehabilitation clinic may provide physical and/or occupational therapy.Some clinics function as a place for people with injuries or illnesses to come and be seen by medical professionals. In these clinics, the injury or illness is not serious enough to warrant a visit to an emergency room. Treatment at these clinics is often much less expensive than it would be at an acute care hospital. These clinics often have access to diagnostic equipment such as X-ray machines, especially if the clinic is part of a larger facility. Doctors at such clinics can often refer patients to specialists if the need arises.
Injuries following trauma can result in severe, acute pain to the individual. Trauma patients will often experience more than one type of pain in the days and months following a severe injury. The pain may be either short-term or chronic in nature. Several models have been proposed over the years to help us better understand pain. Each is useful in certain situations. The most common model used by doctors, and the easiest to understand is the medical (physical or biological) model of pain. The medical model focuses totally on the physical injury (or disease) as the only source causing pain and primarily emphasizes traditional medicine techniques and pain medications to diagnose and treat pain.
This model is the main method used for understanding and treating short-term pain, the type of pain that is most likely a result of acute traumatic injuries. One of the earliest medical models, or theories, to explain pain was proposed by the French philosopher Descartes in the year 1664. He described pain as simply a biological phenomenon. Something that causes local tissue damage, such as heat, a sharp cut, or a blow to a body region causes special sensory nerves to recognize the tissue damage and send a signal directly to the brain. The brain immediately detects this signal as pain. The larger the tissue damage, the bigger the signal; and, presumably as the signal increases, the amount of pain detected by the brain will also proportionately increase.
We now know that pain is not that simple. Even acute pain can be of several types, and can be perceived at very different levels of severity by different individuals. The pain caused by acute injury is generally explained by the physiology and interaction of the peripheral and the central nervous system. This is explained in greater detail below under the Physiology section. The biopsychosocial model is another theory that may be useful in understanding and treating pain, particularly chronic pain.
This model is more a philosophy, first proposed by George Engel in 1977, to help patients and doctors understand that illness and injury, and their associated symptoms, are affected by multiple levels of organization. In other words, pain is not simply a physical or biological phenomenon. Pain is closely associated with the individual's social background and psychological makeup. In chronic pain syndromes, fear of worsening the chronic pain can lead to inactivity, decreased social interactions, avoiding work, and reducing the usual recreational activities. This behavior in turn can lead to anxiety and depression, which can actually make the chronic pain more intense. The biopsychosocial model focuses on the way a person’s biology (medical condition), psychology, and social environment are all related to the pain experience. To really understand and treat chronic pain it is important to examine all three of these areas.
Panic disorder is an anxiety disorder and is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.
Panic disorder is a real illness that can be successfully treated. It is characterized by sudden attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain, or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control.
A fear of one's own unexplained physical symptoms is also a symptom of panic disorder. People having panic attacks sometimes believe they are having heart attacks, losing their minds, or on the verge of death. They can't predict when or where an attack will occur, and between episodes many worry intensely and dread the next attack.
The AADA offers a self-test for individuals who believe they may be suffering from Panic Disorder: http://www.adaa.org/GettingHelp/SelfHelpTests/selftest_Panic.asp
Panic attacks can occur at any time, even during sleep. An attack usually peaks within 10 minutes, but some symptoms may last much longer. Panic disorder affects about 6 million American adults and is twice as common in women as men. Panic attacks often begin in late adolescence or early adulthood, but not everyone who experiences panic attacks will develop panic disorder. Many people have just one attack and never have another. Panic disorder is often accompanied by other serious problems, such as depression, drug abuse, or alcoholism.
The tendency to develop panic attacks appears to be inherited. Specifically, heredity, other biological factors, stressful life events, and thinking in a way that exaggerates relatively normal bodily reactions are all believed to play a role in the onset of panic disorder. The exact cause or causes of panic disorder are unknown and are the subject of intense scientific investigation.
Studies in animals and humans have focused on pinpointing the specific brain areas and circuits involved in anxiety and fear, which underlie anxiety disorders, such as panic disorder. Fear, an emotion that evolved to deal with danger, causes an automatic, rapid protective response that occurs without the need for conscious thought. It has been found that the body's fear response is coordinated by a small structure deep inside the brain, called the amygdala.
The amygdala, although relatively small, is a very complicated structure, and recent research suggests that anxiety disorders may be associated with abnormal activation in the amygdala. One aim of research is to use such basic scientific knowledge to develop new therapies.
A paramedic is an Emergency Medical Technician certified to the highest level of training and responds to medical and trauma emergencies for the purpose of stabilizing a patient's condition before and during transportation to an appropriate medical facility, usually by ambulance. Paramedics administer a variety of emergency medications and elective medications such as those which relieve pain or decrease nausea and vomiting. Unlike most other health care providers, paramedics typically are not directly supervised by physicians. Rather, paramedics provide care under protocols written by physicians, which guide clinical decisions. In certain cases paramedics in the field may contact an emergency physician to seek permission to perform certain uncommon procedures, administer certain medications, or discuss the appropriate treatment for a complicated situation. However, the paramedic, based on the patient's physical exam and history, decides which treatment protocol is most appropriate or if additional information/advice is needed from an emergency physician.
Patient Care Technicians (PCTs) are certified nursing assistants who work with doctors, nurses and other healthcare professional to provide direct patient care in a variety of healthcare environments. PCTs often have more contact with the patient than any other health care member including doctors and nurses. PCTs are an important factor in a patient’s recovery by detecting signs of developing problems.
PCTs work under the supervision of nursing or medical staff to provide basic patient care, such as:
Hospitals often use a patient-controlled intravenous analgesia (PCA) system for acute pain following surgery. The patient is given a control button, which delivers a dose of pain reliever when pushed. Although the dose is smaller than would be used with injected drugs, relief occurs right away because the medication is released directly into the bloodstream. Many studies on pain management support this method of treatment. Pain is usually better controlled with less medication when compared to scheduled (every 4 hours as needed) pain control.
A peer mentor is generally an influential, experienced individual in a certain topic or someone who is a ‘veteran’ of an experience such as a traumatic injury who can help others ‘new’ to the experience to adjust. A mentor has also been described as a trusted counselor or guide. Mentors provide support and guidance and actively help ‘new’ individuals reach their goals. Peer mentoring programs have been developed specifically for individuals coping with a variety of medical conditions and physical disabilities.There are two types of mentoring relationships: informal and formal. Informal relationships develop on their own between two people. Formal mentoring, on the other hand, refers to assigned relationships, often associated with organizational mentoring programs. In well-designed formal mentoring programs, there are program goals, schedules, training (for mentors and mentorees), and evaluation.
Pharmacists are health professionals who distribute drugs prescribed by physicians and other health practitioners and provide information to patients about medications and their use. They advise physicians and other health practitioners on the selection, dosages, interactions, and side effects of medications. Pharmacists also monitor the health and progress of patients in response to drug therapy to ensure the safe and effective use of medication. Pharmacists must understand the use, clinical effects, and composition of drugs, including their chemical, biological, and physical properties. Most pharmacists work in a community setting, such as a retail drugstore, or in a health care facility, such as a hospital, nursing home, mental health institution, or neighborhood health clinic.
Pharmacists in community and retail pharmacies counsel patients and answer questions about prescription drugs, including questions regarding possible side effects or interactions among various drugs. They provide information about over-the-counter drugs and make recommendations after talking with the patient. They also may give advice about the patient’s diet, exercise, or stress management or about durable medical equipment and home health care supplies. In addition, they also may complete third-party insurance forms and other paperwork. Some community pharmacists provide specialized services to help patients manage conditions such as diabetes, asthma, smoking cessation, or high blood pressure. Some community pharmacists also are trained to administer vaccinations.
Pharmacists must first complete undergraduate coursework in basic and advanced sciences. Then a student will complete a four year pharmacy program and will be awarded the Doctor of Pharmacy (PharmD) degree upon graduation. A pharmacy graduate may choose to complete an optional post-graduate residency (one to three years) or enter directly into pharmacy practice. Pharmacy school graduates must complete internship requirements and pass the North American Pharmacist Licensure Examination, or NAPLEX, and an additional state exam before they can acquire a license to practice pharmacy in that state.
A phlebotomist is an individual trained to draw blood, either for laboratory tests or for blood donations. The certified phlebotomist helps to reduce the workload of doctors and nurses by focusing exclusively on blood collection, particularly in hospitals and blood drives. Phlebotomists sometimes perform other tasks as required such as urine collection and testing.Most phlebotomists in the United States train approximately four months in a career center or trade school or one year in a community college. This training includes a clinical rotation in a hospital. They are usually required to be certified in cardiopulmonary resuscitation (CPR). Phlebotomists can be certified upon examination by a number of agencies, including the American Society of Clinical Pathologists (ASCP), the American Medical Technologists (AMT), and the American Association of Medical Personnel (AAMP). The National Healthcareer Association (NHA) offers a National certification for Phlebotomist's (CPT) as well as certificates for Clinical Medical Assistants (CMA), and Patient Care Technicians (CPT).
A physiatrist specializes in physical medicine and rehabilitation (PM&R), a branch of medicine dealing with functional restoration for persons affected by physical disability and chronic pain. Emphasis is placed on the optimization of function through the combined use of medications, physical and occupational therapy, and experiential training approaches. Common conditions that are treated by physiatrists include amputation, spinal cord injury, sports injury, stroke, musculoskletal pain syndromes such as low back pain, fibromyalgia, and traumatic brain injury.
According to the American Physical Therapy Association (2006), physical therapists (PTs) are health care professionals who diagnose and treat people of all ages who have medical conditions that limit their abilities to move and perform functional activities in their daily lives. PTs also help prevent conditions associated with loss of mobility through fitness and wellness programs. PTs develop plans using treatment techniques that promote the ability to move, reduce pain, restore function, and prevent disability. They provide care in hospitals, clinics, schools, sports facilities, and more. PTs must have a graduate degree from an accredited physical therapy program before taking the national licensure examination. The minimum educational requirement is a master's degree, yet most educational programs now offer the doctor of physical therapy (DPT) degree. Licensure is required in each state in which a physical therapist practices.
A pysician assistant (PA) is licensed to practice medicine with a physician's supervision. This supervision, in most cases, need not be direct or on site, and many PAs practice in remote or underserved areas in satellite clinics. Physician assistants perform medical histories and examinations, order treatments, diagnose acute and chronic illnesses, prescribe medication, interpret diagnostic tests, perform invasive and noninvasive procedures, refer patients to specialists when appropriate and first assist in surgery. The education of a physician assistant is a generalist approach, modeled after the medical school curriculum. Their scope of practice and autonomy are only limited by their supervising physician and their clinical experience, allowing PA's to work in any area of medicine, surgery, or research. PAs work in hospitals, outpatient clinics, public health clinics, nursing homes, schools, prisons, and home health care agencies.
In the past, pain was regarded as a simple stimulus-response relationship. In other words, an injury occurred (stimulus) and a message was sent to the brain to respond. This theory did not explain why pain sometimes continues after the initial damage had healed, or why two people respond differently to the same type of injury with different levels of pain.
More recent research has shown that there are many pathways that can send a pain signal to the brain. There are multiple interacting peripheral (spinal cord, trigeminal nerve) and central (brain) mechanisms involved with pain perception. The detection of pain first requires activation of one or more tiny sensory organs (called nociceptors) located throughout our skin, muscles, and within our organs. The nociceptor converts the painful stimulation into an electrical signal that is sent to the spinal cord (for skin, muscle, joints, organs, and meninges) or to the trigeminal nerve ganglion (head, mouth, neck). From there the signal is transmitted to the brain where the pain is perceived. If the painful stimulus continues, the threshold for activating the nociceptor becomes less, and painful stimulation becomes easier. In other words, if the pain continues, it becomes easier to experience the same amount of pain with less of a stimulus.
This increase in sensitivity to pain is called peripheral sensitization, or primary hyperalgesia. There are also a complex array of descending (from the brain to the spinal cord) pain pathways that contribute significantly to altering the painful signals. These pathways can cause either a reduction or an increase in pain perception within the brain. This is where previous psychological problems (depression, anxiety) and prior painful experiences may play an important role in how much pain an individual patient experiences. Alterations in an individual patient's ability to modulate pain via these descending pathways may convert an acute pain problem into a chronic pain state. It is believed that chronic pain may travel along larger, slower nerve fibers and is characterized by dull and aching sensations. Although research is still being done to understand these pathways, it seems that the brain uses them to send chemical substances and nerve impulses to combat the pain signals being sent to the brain.
The Gate Control Theory, developed by Melzack and Wall, is one theory about how pain signals are sent in the body. It states that there are “gates” on the nerve fibers of the spinal cord that can either allow a pain signal through or close off to stop the pain signal. The gates can be closed off when there is enough alternative stimulation or a signal from the brain. When the gates are open, pain signals get through more easily and pain can be intense. When the gates close, pain messages are stopped from reaching the brain and may not even be noticed. For example, rubbing your arm after you bump it creates a fast pain signal that crowds out the slower transmission of sharp pain from the bump. Gate control theory also takes into account the psychological factors that are related to pain and how they can impact the pain response.
Positron emission tomography (PET) a nuclear medicine medical imaging technique which produces a three-dimensional image or map of functional processes in the body. PET is both a medical and research tool. It is used heavily in clinical oncology (medical imaging of tumors and the search for metastases), and for clinical diagnosis of certain diffuse brain diseases such as those causing various types of dementias. PET is also an important research tool to map normal human brain and heart function.
Post-Traumatic Stress Disorder, PTSD, is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.
Post-traumatic stress disorder (PTSD) develops after a terrifying ordeal that involved physical harm or the threat of physical harm. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers.
PTSD was first brought to public attention in relation to war veterans, but it can result from a variety of traumatic incidents, such as mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as floods or earthquakes.
People with PTSD may startle easily, become emotionally numb (especially in relation to people with whom they used to be close), lose interest in things they used to enjoy, have trouble feeling affectionate, be irritable, become more aggressive, or even become violent. They avoid situations that remind them of the original incident, and anniversaries of the incident are often very difficult. PTSD symptoms seem to be worse if the event that triggered them was deliberately initiated by another person, as in a mugging or a kidnapping. Most people with PTSD repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells, or feelings, and are often triggered by ordinary occurrences, such as a door slamming or a car backfiring on the street. A person having a flashback may lose touch with reality and believe that the traumatic incident is happening all over again.
Not every traumatized person develops full-blown or even minor PTSD. Symptoms usually begin within 3 months of the incident but occasionally emerge years afterward. They must last more than a month to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.
Research is continuing to reveal factors that may lead to PTSD. People who have been abused as children or who have had other previous traumatic experiences are more likely to develop the disorder. In addition, it used to be believed that people who tend to be emotionally numb after a trauma were showing a healthy response; but now some researchers suspect that people who experience this emotional distancing may be more prone to PTSD.
Studies in animals and humans have focused on pinpointing the specific brain areas and circuits involved in anxiety and fear, which are important for understanding anxiety disorders such as PTSD. Fear, an emotion that evolved to deal with danger, causes an automatic, rapid protective response in many systems of the body. It has been found that the fear response is coordinated by a small structure deep inside the brain, called the amygdala. The amygdala, although relatively small, is a very complicated structure, and recent research suggests that different anxiety disorders may be associated with abnormal activation of the amygdala.
People with PTSD tend to have abnormal levels of key hormones involved in response to stress. When people are in danger, they produce high levels of natural opiates, which can temporarily mask pain. Scientists have found that people with PTSD continue to produce those higher levels even after the danger has passed; this may lead to the blunted emotions associated with the condition.
Some studies have shown that cortisol levels are lower than normal and epinephrine and norepinephrine are higher than normal. Norepinephrine is a neurotransmitter released during stress, and one of its functions is to activate the hippocampus, the brain structure involved with organizing and storing information for long-term memory. This action of norepinephrine is thought to be one reason why people generally can remember emotionally arousing events better than other situations. Under the extreme stress of trauma, norepinephrine may act longer or more intensely on the hippocampus, leading to the formation of abnormally strong memories that are then experienced as flashbacks or intrusions. Since cortisol normally limits norepinephrine activation, low cortisol levels may represent a significant risk factor for developing PTSD.
Research to understand these neurotransmitter systems involved in memories of emotionally charged events may lead to the discovery of drugs or psychosocial interventions that, if given early, could block the development of PTSD symptoms.
PTSD affects about 7.7 million American adults, but it can occur at any age, including childhood. Women are more likely to develop PTSD than men, and there is some evidence that susceptibility to the disorder may run in families. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.
Stressors tend to make pain worse. Pain is both a physical and mental stressor. Pain can interfere with work, relationships, and sleep. Anger, depression, and anxiety are often found in people with pain. These problems are even more common for those with chronic pain. Psychological treatment is aimed at reducing stress and improving your ability to cope with the problems related to pain. Education is one of the main parts of this treatment. Other strategies include talk therapy, relaxation training, stress management, and coping skills training. Stress management techniques include deep breathing and muscle relaxation. They help decrease pain and provide a sense of control over the pain. Problem solving can also help manage stress, which may decrease pain. Another strategy involves replacing negative thoughts and beliefs related to pain with more positive, helpful thoughts. This technique is based on research that shows that how we think affects how we feel. Generating more positive thoughts can make us feel better and improve our ability to cope with pain.
Making use of available support (family, friends) and resources can also boost coping skills through positive changes in the social environment.
A psychologist is a highly trained mental health professional whom specializes in human behavior, assessment, diagnosis, treatment, and behavior change. They teach individuals how to manage unhealthy feelings and attitudes by forming and implementing healthy and more effective behaviors. Otherwise known as psychotherapy, this treatment approach is a collaborative effort agreed upon by the psychologist and the client. Psychologists strive to create a supportive environment, in which the client feels they can speak openly and honestly about their concerns, feelings, behaviors, and goals. They seek to foster this atmosphere by considering confidentiality a foremost priority, and answering questions regarding occasional limits to confidentiality early in the treatment phase. Psychologists are also uniquely qualified to provide psychological and neuropsychological assessment for individuals seeking formalized testing for a variety of impairments.The most recognizable difference between psychologists and other mental health professionals lies in the type and length of training they receive. After graduating college, psychologists receive an average of seven years educational and research training before receiving their doctorate. A general psychologist may obtain either a Doctorate of Philosophy (Ph.D.) or a Doctorate of Psychology (Psy.D.). The former degree typically emphasizes research and primarily prepares the individual to work in academic settings, whereas the latter focuses on training the individual to do psychotherapy and to work with clients in applied settings. Before becoming a fully licensed psychologist, the professional must complete a supervised clinical internship in a hospital or organized health facility, in addition to at least one year of supervised post-doctoral training.
Go to the American Psychological Association’s weblink for: Choosing a Psychotherapist
If an anxiety disorder is diagnosed, the next step is usually seeing a mental health professional. Therapy can provide support, education, and guidance on how to best manage anxiety symptoms. Choosing a therapist is a crucial step in the process towards healing. The practitioners who are most helpful with anxiety disorders are those who have training in cognitive-behavioral therapy and/or behavioral therapy, and who are open to using medication if it is needed. The ADAA offers resources to help you find a therapist who can treat and teach you to manage your anxiety:
You should feel comfortable talking with the mental health professional you choose. If you do not, you should seek help elsewhere. Once you find a mental health professional with whom you are comfortable, the two of you should work as a team and make a plan to treat your anxiety disorder together.
Remember that once you start on medication, it is important not to stop taking it abruptly. Certain drugs must be tapered off under the supervision of a doctor or bad reactions can occur. Make sure you talk to the doctor who prescribed your medication before you stop taking it. If you are having trouble with side effects, it's possible that they can be eliminated by adjusting how much medication you take and when you take it.
Most insurance plans, including health maintenance organizations (HMOs), will cover treatment for anxiety disorders. Check with your insurance company and find out. If you don't have insurance, the Health and Human Services division of your county government may offer mental health care at a public mental health center that charges people according to how much they are able to pay. If you are on public assistance, you may be able to get care through your state Medicaid plan.
Radiologic technologists and technicians, also referred to as radiographers, produce x-ray films (radiographs) of parts of the human body for use in diagnosing medical problems and helping diagnose and treat illness and injury. They work in hospitals, clinics, medical laboratories, nursing homes, and in private industry.
Radiologic technologists are responsible for both use of the machines and patient care. They are the ones who explain the exam to the patient, get him/her ready, and then perform the exam. They place the equipment at the correct distance and angle from the patient to make the appropriate images for the physician. Radiographers also assist surgeons in the operating room with either portable x-ray or fluoroscopic machines.
Radiologic technologists and technicians must follow physicians’ orders precisely and conform to regulations concerning the use of radiation to protect themselves, their patients, and their coworkers from unnecessary exposure.
A radiologic technologist in the U.S. goes to school for at least 2 years through a program accredited by the American Registry of Radiologic Technologists (ARRT) or through an accredited military program. They must pass a written test, as well as final exams at the place of their clinical education (hands-on learning in a medical setting).
Other imaging modalities such as mammography, ultrasound (sonography), nuclear medicine, MRI and CT scanning may be performed by a radiologic technologist, but only one who has further training and/or accreditation.
A radiologist specializes in radiology or medical imaging technologies to diagnose and sometimes treat diseases. These imaging technologies include x-ray machines, ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). As a medical specialty, radiology can be classified into 5 subfields. Diagnostic radiology is concerned with the use of various imaging modalities to aid in the diagnosis of disease. Interventional radiology uses imaging to guide therapeutic procedures. Neuroradiology is concerned with central nervous system imaging. Interventional Neuroradiology uses imaging to guide therapeutic procedures in the head, neck and spine. Radiation therapy uses radiation to treat diseases such as cancer
Cognition refers to a person’s thinking and memory skills. Cognitive skills include paying attention, being aware of one’s surroundings, organizing, planning, following through on decisions, solving problems, judgment, reasoning, and awareness of problems. Memory skills include the ability to remember things before and after the brain injury. Because of the damage caused by a brain injury, some or all of these skills will be changed.
The Levels of Cognitive Functioning is an evaluation tool used by the rehabilitation team. The eight levels describe the pattern or stages of recovery typically seen after a brain injury. This helps the team understand and focus on the person’s abilities and design an appropriate treatment program. Each person will progress at his or her own rate, depending on a variety of factors, including the severity of the brain damage, the location of the injury in the brain, and length of time since the brain injury. Some individuals will pass through each of the eight levels, while others may progress only to a certain level and no farther.
Recreational therapists, also referred to as therapeutic recreation specialists, provide treatment services and recreation activities to individuals with disabilities or illnesses. Using a variety of techniques, including arts and crafts, animals, sports, games, dance and movement, drama, music, and community outings, therapists treat and maintain the physical, mental, and emotional well-being of their clients. Therapists help individuals reduce depression, stress, and anxiety; recover basic motor functioning and reasoning abilities; build confidence; and socialize effectively so that they can enjoy greater independence. In addition, therapists help integrate people with disabilities into the community by teaching them how to use community resources.
In acute health care settings, such as hospitals and rehabilitation centers, recreational therapists treat and rehabilitate individuals with specific health conditions, usually in conjunction or collaboration with physicians, nurses, psychologists, social workers, and physical and occupational therapists. In long-term and residential care facilities, recreational therapists use leisure activities—especially structured group programs—to improve and maintain their clients’ general health and well-being. They also may provide interventions to prevent the client from suffering further medical problems and complications related to illnesses and disabilities.
Community-based recreational therapists may work in park and recreation departments, special-education programs for school districts, or programs for older adults and people with disabilities. Included in the last group are programs and facilities such as assisted-living, adult day care, and substance abuse rehabilitation centers. In these programs, therapists use interventions to develop specific skills, while providing opportunities for exercise, mental stimulation, creativity, and fun. A college degree in recreation therapy is usually required and individuals need to pass a national board for certification as a therapeutic recreation specialist.
Registered nurses (RNs) are health care professionals who have completed either a two-year college degree, a three year nursing diploma program, or a four-year Bachelor of Science Nursing program. After any one of these three educational routes, a test is required to be considered a registered nurse. The scope of practice for a RN is wider than for a licensed practical nurse (LPN) because of the level and content of education. In the hospital setting, registered nurses are often assigned a supervisory role to oversee tasks performed by LPNs and nursing assistants.
A rehabilitation hospital is a licensed inpatient facility devoted to the recovery of patients with various neurologic, musculoskeletal, orthopaedic and other medical conditions following stabilization of their acute medical issues. Patients, who are not ready to go home, are usually discharged directly from an acute care hospital to a rehabilitation hospital. Rehabilitation care consists of medical, social, educational, and vocational services. A comprehensive rehabilitation program is designed to help individuals with a disability achieve the highest possible functional ability. All care is provided by a team of health care professionals and under the supervision of a staff of physicians and nurses.
A seizure is when abnormal electrical activity takes place in the brain, which may produce a sudden, violent, and uncontrollable contraction of a group of muscles (convulsion). Seizures can also manifest as an alteration in mental status, body sensation, or lack of consciousness. They can be very subtle such as a strange sensation of the body, and visual disturbance, or they can be very violent requiring hospitalization. Some things that can evoke seizures include brain injury, drug usage, drug toxicity, fever, or brain lesions. Seizures are classified by whether or not it is localized within the brain or distributed; these are respectfully called focal and general seizures.
Selective Serotonin Reuptake Inhibitors (SSRIs) are a class of antidepressants used in the treatment of depression, anxiety disorders and some personality disorders. SSRIs increase the extracellular level of the neurotransmitter serotonin by inhibiting its reuptake into the presynaptic cell, increasing the level of serotonin available to bind to the postsynaptic receptor. They have varying degrees of selectivity for the other monoamine transporters, having little binding affinity for the noradrenaline and dopamine transporters.
Sensory integration is the ability to take in information through the senses of touch, movement, smell, taste, vision, and hearing and combine them with prior memories and knowledge already stored in the brain. Dysfunction occurs when a disorder or an injury causes the brain to take in the senses normally but they are perceived or processed abnormally. Sensory integration therapy or sensory re-training is a form of therapy in which special exercises are used to help a person’s under- or over-sensitivity to the sense of touch, movement, sight, or sound and to help a person’s sense of balance (vestibular) and where their body is in space (proprioceptive). These exercises can include various alerting, organizing, and calming techniques.
Sensory re-training has also been shown to improve function following nerve injury or nerve damage following surgery. At the proper time, exercises are introduced to decrease pain associated with hypersensitivity and to improve touch discrimination and touch localization. Touch discrimination involves the ability to tell the difference between varying degrees of softness or roughness and localization is the ability to tell where the sensation is being applied to the body. The improved sensory function helps to improve coordination and function in all activities of daily living.
The following are some signs of sensory integration dysfunction:
A skilled nursing facility (SNF) is a place of residence for people who require 24-hour nursing care and have significant problems with activities of daily living. Residents include the elderly and younger adults with physical disabilities. Adults 18 years or older can stay in a skilled nursing facility to receive physical, occupational, and other rehabilitative therapies following an accident or illness. Hospitals often have arrangements with SNFs to provide follow up care after a patient no longer needs the level of services that an acute care hospital provides.Most SNFs have two basic types of services: skilled medical care and custodial care. Skilled medical care includes services of trained professionals such as a registered nurses and physical, occupational, and speech therapists that are needed for a limited period of time following an injury or illness. Custodial or personal care includes assistance with what are known as the activities of daily living, which includes bathing, dressing, eating, grooming, and toileting.
Private insurance and Medicare pay for nursing home care only for limited time periods following a hospitalization. For Medicare payment, patients must have been hospitalized for at least 3 days and enter the nursing home within 30 days of the hospitalization. Only the first 20 days are 100% covered; after 20 days, there is a daily deductible. There is a 100-day maximum related to any one hospitalization and diagnosis. Patients must be making regular progress as documented by medical professionals. If progress toward independence is no longer occurring, insurance coverage ends.
Cracks or breaks in the skull bones due to either blunt or penetrating trauma. The brain and/or blood vessels below the fracture may also be injured.
Skull fracture is a break of one or more bones of the skull. Isolated skull fractures themselves are often not very serious. However, the presence of one or more fractures may indicate more serious brain damage. Pieces of skull can often cause internal injuries such as ruptured blood vessels, or brain laceration. There are three main types of skull fractures. The Basilar skull fracture is a fracture at the base of the skull and requires a great deal of force. They are often caused by blows to the back of the head or sudden deceleration of the trunk but not the head. Linear skull fractures are the most common type of fracture, here the skull is deviated inward, and are usually caused by diffuse impact with a large surface. Comminuted fractures are those in which the bone shatters. Occasionally, bone fragments can often be driven into the brain causing further injury.
Social Phobia, or Social Anxiety Disorder, is an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. Social phobia can be limited to only one type of situation — such as a fear of speaking in formal or informal situations, or eating or drinking in front of others — or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people.
People with social phobia have an intense, persistent, and chronic fear of being watched and judged by others and of doing things that will embarrass them. They can worry for days or weeks before a dreaded situation. This fear may become so severe that it interferes with work, school, and other ordinary activities, and can make it hard to make and keep friends.
While many people with social phobia realize that their fears about being with people are excessive or unreasonable, they are unable to overcome them. Even if they manage to confront their fears and be around others, they are usually very anxious beforehand, are intensely uncomfortable throughout the encounter, and worry about how they were judged for hours afterward.
Social phobia can be limited to one situation (such as talking to people, eating or drinking, or writing on a blackboard in front of others) or may be so broad (such as in generalized social phobia) that the person experiences anxiety around almost anyone other than the family.
Physical symptoms that often accompany social phobia include blushing, profuse sweating, trembling, nausea, and difficulty talking. When these symptoms occur, people with Social Phobia feel as though all eyes are focused on them.
A self-test to help individuals better determine if they have Social Anxiety Disorder is available from the ADAA: http://www.adaa.org/GettingHelp/SelfHelpTests/selftest_socialpho.asp
Social phobia affects about 15 million American adults. Women and men are equally likely to develop the disorder, which usually begins in childhood or early adolescence. There is some evidence that genetic factors are involved. Social phobia is often accompanied by other anxiety disorders or depression, and substance abuse may develop if people try to self-medicate their anxiety.
Social workers help individuals function the best way they can in their environment, deal with their relationships, and solve personal and family problems. Social workers often see clients who face a life-threatening disease or a social problem, such as unemployment, a serious illness, a disability, or substance abuse. Social workers help people overcome some of life’s most difficult challenges: poverty, discrimination, abuse, addiction, physical illness, divorce, loss, unemployment, educational problems, disability, and mental illness. They help prevent crises and counsel individuals, families, and communities to cope more effectively with the stresses of everyday life.Professional social workers are found in every facet of community life—in schools, hospitals, mental health clinics, senior centers, elected office, private practices, prisons, military, corporations, and in numerous public and private agencies that serve individuals and families in need.
Social workers are highly trained and experienced professionals. Only those who have earned social work degrees at the bachelor’s, masters or doctoral levels, and completed a minimum number of hours in supervised fieldwork, are “professional social workers.”
Speech Therapists or Speech-Language Pathologists (SLPs) are allied health professionals who assess, diagnose, treat, and help to prevent speech, language, swallowing, and other related disorders. Speech-language pathologists work with people who cannot produce speech sounds or cannot produce them clearly; those with speech rhythm and fluency problems, such as stuttering; people with voice disorders, such as inappropriate pitch or harsh voice; those with problems understanding and producing language; and those with cognitive communication impairments, such as attention, memory, and problem solving disorders.
Speech, language, and swallowing difficulties can result from a variety of causes including stroke, brain injury, learning disabilities, voice pathology, hearing loss, or emotional problems. Speech-language pathologists counsel individuals and their families concerning communication disorders and how to cope with the stress and misunderstanding that often accompany them. They also work with family members to recognize and change behavior patterns that impede communication and treatment and show them communication-enhancing techniques to use at home.
In medical facilities, speech therapists may perform their job in conjunction with physicians, social workers, psychologists, and other therapists. While in schools, they collaborate with teachers, special educators, interpreters, other school personnel, and parents to develop and implement individual or group programs, provide counseling, and support classroom activities. Some speech-language pathologists conduct research on how people communicate. Others design and develop equipment or techniques for diagnosing and treating speech problems.
In the United States, speech therapists must complete a master's degree and pass a national examination to practice.
A stroke is a medical emergency whereby the blood supply to the brain is interrupted and some portions of the brain are deprived of oxygen. This loss of oxygen leads to cell death and brain damage. It is the third leading cause of death in the US. Often permanent neurological and functional deficit is seen in the area that was without oxygen. People who suffer minor stroke may only suffer small problems such as weakness of a body part.
A subarachnoid hemorrhage (bleeding) is an abnormal and very dangerous condition in which blood collects beneath the membrane that covers the brain. This area, called the subarachnoid space, normally contains cerebrospinal fluid (fluid around the brain and spinal cord). The immediate danger due to subarachnoid hemorrhage is ischemia (tissue damage caused by blocked blood flow). These areas of the brain that do not receive enough oxygen can suffer permanent injury, leading to lasting brain damage or death. An individual who survives the initial hemorrhage is at risk for a number of difficulties in the following hours, days, and weeks. The most common problem is increased pressure in the brain. A computed tomography (CT) scan is used to diagnose a bleed in the head. In addition to monitoring vital signs and intravenous (IV) fluids, treatment may involve mechanical ventilation (breathing machine), and monitoring of the pressures in the head. Medicines for pain, nausea, and vomiting and sedation are administered as needed. Individuals who are awake have the best prognosis. Disabilities may include partial paralysis, weakened or numbed areas of the body, learning or speech difficulties, and vision problems.
Occurs when a vein on the outside of the brain is injured and bleeds. A blood clot slowly forms and puts pressure on the outside of the brain.
Subdural Hemorrhage is bleeding within the two membranes that surround the brain: the dura mater and the arachnoid mater. This bleeding can often separate these two layers and accumulation of blood can lead to increased intracranial pressure, or pooling and clotting of blood known as a hematoma. When this happens it can be very damaging to brain tissue and is considered a medical emergency. Subdural bleeding is often caused by sudden and violent changes in velocity that can stretch and tear the vessels of the dura and arachnoid mater. Veins are more likely to tear than arteries, resulting in a slower accumulation of blood. This means that symptoms of Subdural hemorrhage can show up anywhere from 24 hours to two weeks after the injury.
The elderly and patients on anticoagulant (prevention of blood clots) medication are at higher risk for this type of injury. Computed tomography (CT) and magnetic resonance imaging (MRI) scans are used to diagnose subdural hemorrhage. Careful monitoring and allowing the body to heal on its own can treat small hemorrhages. Large hemorrhages, however, require a procedure called a craniotomy where the skull is opened and the blood clot is removed from between the dura and arachnoid mater. Acute hemorrhages have high rates of death and permanent injury. Sub acute hemorrhages present fewer problems with people often recovering completely when the blood is cleared.
Often occurs after a TBI. Because the skull cannot change size (get bigger or smaller), there is little room for the brain to expand. When brain tissue swells, blood flow to the brain decreases, putting the brain at risk for damage due to lack of oxygen.
This drug has some similarities to opioids, but also shares some properties of the tricyclic antidepressants.
TENS may also provide some short-term relief from chronic pain. A TENS unit works by sending electrical impulses to the site of pain through electrodes on the surface of the skin. The pulse from the electrodes stimulates the nerves in the area of pain. Then, signals are sent to the brain that interferes with the normal pain perception. The device is usually used several times a day at a level set just for that person. The TENS unit is not painful.
Trauma patients are critically ill, often comatose and sometimes in a state of shock due to blood loss and multiple injuries throughout the body. Injuries that affect multiple organ systems require that patients have instant access to physicians with many different specialties, including orthopedics, neurosurgery, reconstructive surgery, radiology and anesthesia. Also, because life-threatening injuries can occur at any time, it is important that patients have access to quality care 24 hours a day and 365 days a year. Trauma centers have these unique abilities. The trauma infrastructure includes not only an intensive care unit (ICU), but also helicopters for rapid patient transport, operating rooms and a large number of appropriately trained and experienced nurses, technicians and other staff.While all hospitals and emergency departments care for people with minor traumatic injuries, only trauma centers have the capacity, commitment and infrastructure to deliver continuous and consistent high quality trauma care. In the United States, trauma centers are categorized according to the level of trauma care available and are ranked in five categories, from limited care facilities in Level V and IV up to comprehensive care centers in Level I. Since the onset of trauma systems and level I trauma centers, people are now able to survive severe injuries that previously may have proven fatal.
In the United States a Level I trauma center provides the highest level of surgical care to trauma patients. A Level I trauma center is required to have a certain number of surgeons and anesthesiologists on duty 24 hours a day, an education program, and preventive and outreach programs. They must also have a full-time trauma program manager. Key elements include 24-hour in-house coverage by general surgeons and prompt availability of care in specialties such as orthopaedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine and critical care. Also, a trauma surgeon is expected to be in the emergency room within 15 minutes of patient arrival. Hospitals are designated as a Level I trauma center by the American College of Surgeons for a period of three years. Designation is based on performance criteria. To qualify, Level I centers must treat 1200 admissions a year or 240 major trauma patients per year or an average of 35 major trauma patients per surgeon.
In the United States, a Level II trauma center provides comprehensive trauma care either as a supplement to a Level I trauma center in a large urban area or as the lead hospital in a less population-dense area. A Level II trauma center is required to have a certain number of surgeons and anesthesiologists on call 24 hours a day. A trauma surgeon is expected to be in the emergency room within 15 minutes of a patient’s arrival. Level II trauma centers must also have a part-time trauma program manager, but they are not expected to provide leadership in teaching and research. Hospitals are designated as a Level II trauma center by the American College of Surgeons for a period of three years.
In the United States, a Level III trauma center provides emergency medical care to trauma patients who do not currently need the services of a Level I or II trauma center. Level III centers provide prompt assessment, resuscitation, emergency surgery, and stabilization before transfer to a Level I or II center. Level III facilities typically serve communities that do not have immediate access to a Level I or II trauma center. A Level III trauma center is required to have a certain number of surgeons on call 24 hours a day and a trauma surgeon is expected to be in the emergency room within 30 minutes of a patient’s arrival. Hospitals are designated as a Level III trauma center by the American College of Surgeons for a period of three years.
In the United States, a Level IV trauma center provides advanced trauma life support prior to patient transfer in remote areas in which no higher level of care is available. The key role of the Level IV center is to resuscitate and stabilize patients and arrange for their transfer to the closest, most appropriate trauma facility. Hospitals are designated as a Level IV trauma center by the American College of Surgeons for a period of three years. Level V trauma centers are not formally recognized by the American College of Surgeons, but they are used by some states to further categorize hospitals providing life support prior to patient transfer to higher level centers.
Traumatic brain injury occurs when a sudden trauma causes brain damage. Open or closed head wounds can cause this. There are many symptoms of traumatic brain injury including headache, confusion, dizziness, behavior changes, seizures, vomiting, and nausea. This type of injury is most often caused by assault or accidents.
Ultrasound involves the use of high-frequency sound waves to create images of organs and systems within the body.
An ultrasound machine creates images that allow various organs in the body to be examined. The machine sends out high-frequency sound waves, which reflect off body structures. A computer receives these reflected waves and uses them to create a picture. Unlike with an x-ray, there is no ionizing radiation exposure with this test.
The vestibular system controls a person’s ability to maintain posture and coordinate balance. The vestibular organs of the inner ear provide the brain with information about changes in head movement. If the vestibular system is not functioning properly, dizziness, vertigo, imbalance, and spatial disorientation can result.
Additional signs and symptoms also include:
(Asked about life at the helm of Vanderbilt’s trauma program) This is a hard job, but it is a really good job. There are highs and there are lows, and the highs are super high and the lows can be pretty low, but it is the kind of job where you never have to justify getting out of bed in the morning.
The Trauma Survivors Network is a community of patients and families who are looking to connect with one another and rebuild their lives after a serious injury. The American Trauma Society, the leading organization advocating for the injured and their families, in partnership with hospitals around the country, is committed to growing the Trauma Survivors Network by providing the programs and resources patients and families tell us they need to manage their recovery and improve their lives. The underlying goal in all of these programs and resources is helping trauma patients and their families connect and rebuild their lives following a serious injury.
In order to achieve this goal, the American Trauma Society is committed to:
The Trauma Survivors Network offers its services in collaboration with local trauma centers.