New Study Reveals 1 in 4 Unresponsive Hospital Patients Experience “Covert Awareness”
SevenPonds | By Caitllin Manner
A new study has revealed that approximately 25% of patients with severe brain injuries experience something called Cognitive Motor Dissociation, or “covert awareness.” It’s as scary as it sounds: researchers are just now learning that some patients who were believed to be unaware of their surroundings actually have some level of consciousness, without any observable way to express their presence. This has serious implications for the care of brain-injured patients, and offers some hope for better treatments and prognosis.
Current Practice
When a patient with a brain injury is unresponsive, it is standard procedure for a doctor to perform some basic tests to determine if they might still have some level of awareness. Despite our technological medical advances, these tests are pretty primitive: calling the patient’s name, clapping near their ear or inserting a cotton swab in their nose. If those fail to get a reaction, sometimes a doctor will perform a “sternal rub,” using their knuckles to knead the patient’s sternum (which is surprisingly painful, but won’t cause injury). If the patient still doesn’t respond to any of that stimulus, they are believed to have lost consciousness and are thus unaware of their surroundings.
Once a patient is determined to be unconscious – in a coma or a vegetative state – their treatment is largely focused on caring for their body: trying to reverse whatever caused the brain injury (if possible), providing nutrition and fluids, breathing and circulation support, and preventative care to fight off bedsores, infections or deep vein thrombosis. As it stands right now, much of the mental stimulation is left for caregivers and family members to visit, read to, talk to or play music for the patient. Although this can be helpful, this new study may lead to different medical standards and hospital care in the future.
The Study
The international study, co-led by Weill Cornell Medicine and New York-Presbyterian researchers, was the largest ever investigation of the prevalence of covert awareness. It found that an alarming percentage of patients with severe brain injury can show clear signs of cognitive function on brain scans in response to requests to carry out complex mental work, even when they can’t move or speak.
The study looked at 353 patients who, from the outside, seemed to have lost consciousness due to a brain injury. Of these patients, 241 were diagnosed as being in a coma, a vegetative state, or having only minimal consciousness.
Essentially, researchers repeatedly asked each patient to perform a series of continuous motor tasks (like “keep wiggling your toes”), as well as motor-related cognitive tasks (“keep imagining wiggling your toes”) for multiple bouts of 15-30 seconds while under observation of either electroencephalography readouts and/or functional magnetic resonance imaging scans. (Unlike a standard MRI, which produces 3D images of the brain, a functional MRI measures activity in the brain based on blood flow. When conscious people are told to follow a command, certain areas of the brain become more active, and blood flow to those areas will increase.) The team then compared the results with those of healthy subjects who were asked to perform the same tasks.
The results showed that 25% of the 241 patients who were previously deemed unconscious were able to perform the cognitive tasks, as demonstrated by matching patterns of EEG and/or fMRI-measured brain activity. That means that 1 in 4 brain-injured patients are likely processing their external world without any way to communicate that to anyone.
The Implications of the Study’s Results
Previous, smaller studies estimated that around 10-20% of unresponsive patients could be experiencing covert awareness, but this study alarmed researchers who believe that the number is, in fact, likely much higher. Patients with severe brain injuries have moments throughout the day during which their brain may perform better or worse than usual, referred to as “fluctuations in arousal.” Dr. Nicholas Schiff, a neurologist and author of the study, believes that these fluctuations impacted their results, making 25% a depressingly conservative finding.
Equally alarming is the fact that many hospitals don’t have the technology needed in order to properly assess a patient’s level of consciousness to this degree, making it difficult to ensure they will get the care they need. “They’re going to be treated as if they’re fully unresponsive,” Schiff told Aria Bendix in an article for NBC News. “No one’s going to guess that they’re there.”
The findings do offer some degree of hope, however. The study will likely lead investigators down several new lines of research, such as finding easier methods for detecting CMD, as well as the exploration of CMD’s potential clinical value. Prior studies suggest that patients with some level of covert awareness have a greater chance of recovery compared with those who aren’t able to perform cognitive tasks, so this has massive implications regarding life-support decisions and the degree of engagement of caregivers and family members. In addition, researchers hope it will lead to a better understanding of potential interventions, like brain-computer interfaces, implants or neuromodulation (using electrical currents to alter brain activity). |
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Sandata Technologies Acquired by HHAeXchange
Sandata Technologies
Dear Homecare Association,
We are excited to share that Sandata Technologies has been acquired by HHAeXchange. This is a significant milestone in Sandata’s journey that will benefit our valued customers as well as the greater homecare ecosystem. By uniting two leaders with longstanding commitments to serving all homecare stakeholders, we will drive the transformation of the industry by harnessing advanced technology that empowers payers and providers to deliver the best care in the home.
As you may know, HHAeXchange has served the homecare software space for over 15 years. Their technology has helped thousands of caregivers, homecare providers, state Medicaid programs, and managed care organizations (MCOs) across the country achieve operational efficiency and ensure quality member care.
Sandata and HHAeXchange share an ambitious vision that now is the time to deliver on the promise of the industry, by ensuring homecare stakeholders have the right tools and analytics to meet their compliance, billing, and other operational needs. This step only strengthens our commitment to raising the bar for our customers and leading the market into a new future defined by best-in-class software and a superior experience.
Importantly, we do not expect any disruption to our services or technology. All Sandata customers and programs will continue to use the same software and work with the same team with no change. If you have questions, please visit the following site, https://www.sandata.com/about/faq/.
For more than three decades, we have helped payers and providers work together, guided by a simple mission: to drive better health outcomes with solutions that enable the highest-quality care. That vision remains our top priority as part of HHAeXchange, and we look forward to building on it for years to come.
Best regards,
Akshay Bhandari
President
Sandata Technologies |
Music and Health: What You Need To Know
National Center for Complementary and Integrative Health
Can music be good for you?
Yes, according to a growing body of research. Listening to or making music affects the brain in ways that may help promote health and manage disease symptoms.
Performing or listening to music activates a variety of structures in the brain that are involved in thinking, sensation, movement, and emotion. These brain effects may have physical and psychological benefits. For example, music causes the release of brain chemicals (neurotransmitters and hormones) that can evoke emotional reactions, memories, and feelings and promote social bonds. Music can even affect the structure of the brain. Certain structures in the brain have been found to be larger in musicians than nonmusicians, with particularly noticeable changes in people who started their musical training at an early age.
Increasing evidence suggests that music-based interventions may be helpful for health conditions that occur during childhood, adulthood, or aging. However, because much of the research on music-based interventions is preliminary, few definite conclusions about their effects have been reached. Many reports on the potential benefits of music-based interventions come from observations of individuals or small groups of people. Evidence of this type is valuable for suggesting new ideas, but carefully designed, scientifically rigorous studies of larger numbers of people are needed to provide stronger evidence on whether music-based interventions are effective for specific purposes.
What is music therapy?
Music therapy is a health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs. The term “music therapy” is not a description of a specific type of intervention. Instead, it indicates the education, training, and credentials of the therapist who is delivering the intervention.
Music therapy may involve a variety of different activities, including music improvisation, music listening, song writing, music performance, and learning through music. Music therapists may work in many different settings, such as hospitals, outpatient clinics, nursing homes, senior centers, rehabilitation facilities, or schools.
Some of the music-based interventions described in this fact sheet fit the definition of music therapy, but others do not. For example, music-based interventions that involve listening to recorded music are often delivered by health professionals other than music therapists (such as nurses), and therefore do not fit the definition of music therapy.
You can learn more about music therapy on the website of the American Music Therapy AssociationLink to External Link Policy.
Can music be harmful?
In general, research studies of music-based interventions do not show any negative effects. However, listening to music at too high a volume can contribute to noise-induced hearing loss. You can find out about this type of hearing loss on the National Institute on Deafness and Other Communication Disorders website.
In addition, because music can be associated with strong memories or emotional reactions, some people may be distressed by exposure to specific pieces or types of music. Extensive playing of musical instruments can lead to pain and injury. Music-based interventions that involve exercise or other types of movement could also lead to injury if appropriate safety precautions are not taken.
What does research show about music-based interventions for people with health conditions?
The preliminary research that has been done so far suggests that music-based interventions may be helpful for anxiety, depressive symptoms, and pain associated with a variety of health conditions, as well as for some other symptoms associated with dementia, multiple sclerosis, Parkinson’s disease, and other conditions. |
How to Prepare Yourself for Death When Given a Terminal Diagnosis
Yahool!Life | By Kate Ng
Receiving a terminal diagnosis can be a devastating blow, for the individual and their loved ones. There is no right or wrong way to react to such news, and people respond with all sorts of emotions - from anger and denial, to acceptance and peace.
Having a terminal illness can also give a person new perspective. Recently, beloved BBC Radio 2 DJ Johnnie Walker announced his retirement from his radio career which has spanned nearly 60 years. Walker’s decision to bring his career to an end comes after he was diagnosed with idiopathic pulmonary fibrosis, a terminal illness that has left his lungs scarred and makes it increasingly difficult to breathe.
His last Sounds of the 70s show will air on Sunday 27 October and Walker promised he will "make the last three shows as good as I possibly can". He is now being looked after round-the-clock by his wife, Tiggy.
In June, the DJ opened up about the diagnosis during a special Carers Week episode of his and Tiggy’s BBC Sounds podcast, Walker and Walker: Johnnie and Tiggy, and said it has been "a very reflective time for us".
Scottish comedian Janey Godley also recently announced she is receiving end-of-life care after her ovarian cancer spread. On Wednesday 25 September, she shared a video message on X, formerly Twitter, to update her fans.
Godley said: "It is devastating news, to know that I’m facing end of life, but we all come to an end some time. I don’t know how long I’ve got left before anybody asks, I’m not a tick tock, I just want you all to know that I appreciate all the love you’ve given me."
What does it feel like to be diagnosed with a terminal illness?
There is no telling how a person will react if they are diagnosed with a terminal illness, but for many, it can feel like "the ground has been pulled from under one’s feet", says Dr Dr Manpreet Dhuffar-Pottiwal, a chartered psychologist and member of the British Psychological Society.
"The shock, fear, and uncertainty can be overwhelming, making it essential to find effective ways to cope with this life-changing news," she explains, adding that seeing a therapist after a terminal diagnosis can help bring comfort and guidance.
"First and foremost, acknowledging and expressing emotions is crucial. Many people experience a whirlwind of feelings, including anger, sadness, and anxiety. A therapist encourages individuals to let these emotions surface rather than suppress them.
"Talking about fears and concerns with a trusted friend or a mental health professional can provide relief and validation. For example, joining a support group can help individuals connect with others facing similar challenges, fostering a sense of community and shared understanding."
I’ve been diagnosed with a terminal illness. Where can I get support?
Dr Paul Perkins, Chief Medical Director of bereavement charity Sue Ryder, points to three sources of support that terminally ill patients can turn to.
1. Healthcare providers can lend a listening ear and help with managing symptoms such as pain and fatigue. They should also be involved in discussions about care options, which can help individuals know what to expect.
2. Family and friends are also very important for a terminally ill person to lean on during such a difficult time, he says.
3. Charities such as Sue Ryder, Macmillan and Marie Curie also offer support in the form of helplines or webchats for both terminally ill individuals and their grieving loved ones…
Read Full Article |
Help the Care at Home Community Impacted by Hurricane Helene
NAHC Report
Hurricane Helene has severely impacted the southeastern United States, with many lives already lost in the Carolinas, and countless missing with no means of communication. Some of the most hard-hit communities are located in North Carolina and South Carolina. Throughout western North Carolina and the Midlands and Upstate regions of South Carolina the devastation caused by Hurricane Helene is still being assessed. President Biden has now declared 25 Western Counties in NC, plus the Cherokee Nation, as Federal Disaster Areas. President Biden has declared 13 counties in SC Federal Disaster Areas, as well.
The Carolinas Foundation for Hospice & Home Care is accepting donations to distribute directly to hospice and home care employees devastated by this storm. Agencies are facing tremendous challenges, including displacement and/or evacuation of staff and patients, collapsed roads, failing infrastructure, lack of water, and the inability to communicate with downed lines. There is a major need for gas to continue to power generators for oxygen dependent patients both in home settings and hospice inpatient facilities.
The Association staff has been in contact with government agencies to us keep up-to-date on the situation as it unfolds.
The care at home community is comprised of caring, compassionate individuals who help those in need. Please consider donating to the Hurricane Helene Relief Fund to help home care and hospice employees hit the hardest.100% of ALL ADMINISTRATIVE COSTS are being borne by the Association and the Foundation. 100% of your donation (tax-deductible) comes in, and 100% of your donation goes out.
Donations may be individual or corporate, and as a 501(c)3 organization, they are often tax deductible based on an individual’s tax status. Please share this information with anyone you think would like to contribute.
Impacted members can also apply to receive funds through the National Hospice Foundation’s Workforce Emergency Support Fund to assist in needed repairs. Please reach out to [email protected] with any questions.
The Alliance is prepared to help support our members in the path of Hurricane Helene. Members can access the Emergency Preparedness webpage in the Regulatory & Compliance Center for helpful tools and guidance.
All of us at the National Alliance for Care at Home are thinking of all our colleagues, agencies, patients, families, and communities impacted by Hurricane Helene.
GO HERE to donate to a Hurricane Helene Relief Fund for the Carolinas |
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