Jump to content
School of Medicine Virginia Commonwealth University VCU Medical Center
School of Medicine discoveries

Main

Clinical breakthroughs archives

21
2014

Tackling Concussions

Awareness, Better Diagnosis and Management are Key

Cade Harris was hit so hard last season that he blacked out for a few seconds. After gathering himself, he walked to the opposing team’s huddle. “The next day, I had a terrible headache,” he says. “It was a little scary.” Doctors confirmed that Cade, a senior at Patrick Henry High School in Hanover, Va., had suffered a concussion, his second in three years.

“There have been thousands of concussions in every war we’ve fought and scores in every football season that’s been played. But for so long there was no awareness. That’s all changing,” says David X. Cifu, M.D., chairman and the Herman J. Flax, M.D. professor in the Department of Physical Medicine and Rehabilitation.

Did you know?• The Centers for Disease Control reports that about 3 million concussions occur each year in the United States.
• Symptoms include headache, difficulty concentrating, dizziness, nausea, sensitivity to light and noise, fatigue and difficulty remembering new information.
• Long-term effects can include dementia and other mental issues.

Cifu is the principal investigator of a $62.2 million federal grant to oversee a national consortium of universities, hospitals and clinics studying what happens to active duty service members and veterans who suffer traumatic brain injuries. And he is working closely with the NFL, NHL, NCAA and high schools to develop better diagnosis and management of concussions. Gone are the days when a coach asks a dazed player how many fingers he is holding up or what day of the week it is.

“Ninety-five percent of all brain injuries are mild concussions – more than half of all people never see a doctor and probably don’t tell their coach or parents,” he says. “But it can take six months or longer for the brain to return to its normal function. We need to test the brain’s ability to perform multiple functions at once before we let an athlete get hit again, give a soldier a gun or let someone drive a car.”

He hopes to release specific findings and guidelines in the next few months. Already, he has helped develop a Concussion Coach app that supports self-management of symptoms for the U.S. Department of Veterans Affairs.

“Concussions are the oldest injury out there, dating back to when cavemen hit each other over the head with animal bones,” he says. “But we are still improving how we diagnose, assess and manage them. We are making great strides to bring about better health for everyone.”

The Concussion Coach App

The Concussion Coach app is a self-help tool for anyone with persistent symptoms after a concussion. The free app is available for iPads and iPods, and it will be available for the Android platform later this year.

This article by Janet Showalter first appeared in the fall issue of 12th & Marshall.

03
2012

VA Chief draws attention to polytrauma rehabilitation

Richmond’s McGuire Veterans Affairs Medical Center has built the reputation as the VA system’s premiere program for treating polytrauma patients, those soldiers who come from the battlefield with multiple disabling injuries including traumatic brain injury.

VA tour

From left to right: Director of the Richmond VA Medical Center Charles E. Sepich, U.S. Secretary of Veterans Affairs Eric K. Shinseki, Virginia Rep. Robert C. “Bobby” Scott, D-3rd, Dean of Medicine Jerome F. Strauss, III, M.D., Ph.D., and network director of the region’s Veterans Integrated Service Network Daniel F. Hoffman.

The polytrauma unit at McGuire tests approaches for these difficult to treat patients and then shares what works throughout the VA system. On February 3, Eric K. Shinseki, the U.S. Secretary of Veterans Affairs, visited McGuire for a first-hand view of the work.

Visits like this do a tremendous amount for patients’ recovery, according to Shane McNamee, M.D., who is medical director of McGuire’s Polytrauma Rehabilitation Center. “The patients are buoyed by seeing their senior leadership on site, caring about them as individuals.”

McNamee led Shinseki on a tour that included meeting patients and test driving a backhoe simulator that prepares patients for real-world jobs. As an assistive technology Center of Excellence, the McGuire VA is among the first to get new equipment that is useful in rehabilitation.

McGuire is one of few VA medical centers in the country that treat active duty service members in addition to veterans. Because of that, they see a large number of patients with recent, acute injuries. Shinseki told the Richmond Times-Dispatch that seeing the service members’ hard won improvement made him proud of the VA’s work.

Like many of the VA’s physicians, McNamee holds a joint appointment in the medical school. Now an assistant professor of physical medicine and rehabilitation, he also completed his housestaff training on the MCV Campus.

The medical school’s longstanding partnership with the nearby McGuire VA was spotlighted by the Jan. 11 visit of First Lady Michelle Obama when she came to Richmond to announce the Joining Forces initiative.

Dean of Medicine Jerry Strauss, M.D., Ph.D., toured the unit with Shinseki and was reminded of the importance of the VA’s relationship to the medical school and its faculty. “When we visited the unit, we met a number of polytrauma patients who are working hard on their recovery. They have earned our country’s gratitude, and I was impressed to see the team approach to world-class care that the polytrauma program provides for our service men and women.”

Photo courtesy of the McGuire Veterans Affairs Medical Center

LINKS:
Read the Richmond Times-Dispatch coverage of Shinseki’s visit.

02
2009

The day the NBC Nightly News reported on House Calls’ potential to reduce health care costs.

"If we can keep these people from riding in ambulances to emergency rooms and hospitals, we’ll save the Medicare program perhaps as much in a year’s time as $50 billion," Peter Boling, M.D., told NBC Nightly News.

In today’s ongoing health care reform debates, House Calls are being discussed as an option that has the potential to save costs as well as improve care for those patients who have great difficulty in getting to a doctor’s office. Internal Medicine Professor Boling helped craft language for the Independence at Home Act (S. 1131/HR. 2560) that advocates home-delivered care for individuals with functional impairment, high costs and multiple illnesses.

Watch the NBC Nightly News segment.

Boling’s House Calls program has also received coverage by ABC News, CBS News and the LA Times.

29
2009

The day the AP reported on a return to House Calls as an answer in the health care reform debate.

In today’s ongoing health care reform debates, House Calls are being discussed as an option that has the potential to save costs as well as improve care for those patients who have great difficulty in getting to a doctor’s office.

Internal Medicine Professor Peter Boling, M.D., helped craft language for the Independence at Home Act (S. 1131/HR. 2560) that advocates home-delivered care for individuals with functional impairment, high costs and multiple illnesses. The Associated Press visited the MCV Campus to learn more about the program, reporting in its resulting story that “Where other proposals have divided lawmakers, the house-calls idea is winning support from Republicans and Democrats alike.”

The story “House calls as cost-saver in health care reform?” already has been picked up by nearly 100 AP-member news organizations including National Public Radio, CBS News Online, ABC News Online and Yahoo News.

For more information see:

25
2009

The day Dr. Boling’s House Calls Program garnered media coverage.

Twenty-five years ago, Internal Medicine Professor Peter Boling, M.D., started his house calls program for elderly patients who had difficulty getting to their appointments at the medical center. Some saw it as a throw-back to the days when physicians drove a horse and buggy to visit their patients instead of the other way around.

In today’s ongoing health care reform debates, house calls are being discussed as an option that has the potential to save costs as well as improve care. In fact, Boling helped craft language for the Independence at Home Act (S. 1131/HR.2560) that advocates home-delivered care for individuals with functional impairment, high costs and multiple illnesses.

The August 25, 2009 edition of the Los Angeles Times details Boling’s house calls program and includes data from a study by the medical center that looks at recently discharged patients who are seen in the program. The news article reports… “the house call program helped cut in half the number of days these patients spent in the hospital, saving the medical center as much as $2 million.”

Read about the work of Boling’s team in “Getting cheaper, better healthcare at home?

The Los Angeles Times’ story has been picked up by the Chicago Tribune and was the top story in their Tuesday, August 25 e-mail blast from America’s Health Insurance Plans to health plan executives.

29
2009

The day that Lexi undergoes a rare brain surgery

Seven-year-old Lexi suffers with kernicterus, a type of brain damage that was caused by excessive jaundice after she was born. A story that appeared in the Sunday, July 26, 2009 edition of the Charlotte Observer chronicles her struggles as well as her family’s hopes that a rare brain surgery may allow her to talk or even walk.

Professor of Neurology Steven Shapiro, M.D., an expert in kernicterus, diagnosed Lexi in July 2004. Five years later, Lexi is prepping for a surgery at the VCU Medical Center that will place electrodes deep inside her brain. A week later, a battery-operated generator will be placed in her abdomen, and on August 24 , 2009, the generators will be turned on

This kind of deep brain stimulation has been used to treat other types of movement disorders but, to Dr. Shapiro’s knowledge, it has not yet been tried on someone with kernicterus.

Read more about Lexi’s story at: