Robots For STroke Patients

There are two lines of research that could lead to the use of more robots in long term rehabilatative care. The first is pioneered by Japan -- the idea that robots will serve as helpers for the elderly as fewer young people are available to do the task. This thinking has largely driven humanoid robotic development by Honda and others.

The other line I find interesting is the use of robotic aids for rehab and assistance to the disabled. This can take the form of Dean Kamen's fantastic IBOT system -- a wheel chair that allows patients to climb stairs and look eye to eye with people standing. Another example is a robotic brace that sense weak muscle reflexes and amplifies them so stroke patients can relearn and perform simple tasks. Such relearning can restore function to limbs, and help patients regain independence, according to the New York Times.

"This is an area that’s exploding,” said Hermano Igo Krebs, a principal research scientist at M.I.T. and one of the first scientists to envision robot-assisted therapy for stroke patients and others with brain injuries and neurological disorders. “There are now a hundred groups around the world working on this. In 5 to 10 years, I expect we’ll see these kinds of devices in all major clinics and rehab hospitals in the developed world, and even in patients’ homes.” ...

A small study of the Myomo device and associated treatment, conducted with Spaulding Rehabilitation Hospital in Massachusetts and published in April in The American Journal of Physical Medicine and Rehabilitation, found that patients who exercised with the arm brace for 18 hours over about six weeks experienced a 23 percent improvement in upper extremity function. The device has been approved by the Food and Drug Administration and is expected to reach the market in the next few months.

Dr. Krebs notes that for stroke patients, a large body of evidence now suggests that repeated practice with an impaired limb can foster plastic changes in the brain. In other words, it can help the brain forge new connections between neurons or strengthen existing ones. For patients whose strokes have damaged part of the motor cortex and subcortex, this means that movement therapy may help the brain to use other, nearby neurons — or even neurons in the opposite brain hemisphere — to complete a movement.

It is not yet clear whether movement therapy using a surface-controlled device like the Myomo brace will benefit these patients, said Dr. Irene M. Estores, a specialist in spinal cord injury and in physical medicine and rehabilitation at that hospital. But in the long run, the device (and others like it) could also prove useful as a “power assist” that patients wear every day.

A renewed ability to flex and extend at the elbow would be especially important to patients who also cannot walk and who may otherwise have to rely on a mouth stick to move their wheelchairs, Dr. Estores added.

Tough Pill to Swallow

It seems there is growing momentum for universal coverage. The states are diving in and trying new approaches, Michael Moore's generating the outrage and Presidential Candidates are talking about their health care plans on the stump. However, as the New York Times reports this morning, getting universal can be a bitter pill to swallow. Costs have to be contained and that means somebody's profits will go down. Penn Gov. Ed Rendell ran on health care reform last fall...

“Prescription for Pennsylvania” included a ban on smoking in public places, a reduction in the rate of hospitalization for chronic diseases and an expansion of the role nurses play in treating patients. He even framed his proposal to provide universal access as “a form of cost containment,” emphasizing that 6.5 percent of every health-insurance premium in Pennsylvania went to subsidizing care for the uninsured, often in emergency rooms.

Mr. Rendell is learning, however, that to contain costs is eventually to pluck dollars from someone’s pocket. His plan has incited protest from hospitals, doctors, insurers and small businesses, each of them finding something to detest. Other big-state governors who are leading a second wave of health care overhaul — after recent expansions of coverage in Maine, Massachusetts, and Vermont — are also making strong comments about runaway costs, as are presidential candidates in both parties.

In Illinois, Gov. Rod R. Blagojevich, a Democrat, is selling his health care plan by forecasting that the savings generated by better management of chronic diseases and expanded use of electronic records will exceed the cost of extending coverage to 1.4 million adults. Mr. Blagojevich is trying to revive his plan after legislators rejected a proposal to pay for extended coverage with a tax on gross business receipts.

“The key is, Can you package the reforms to show what impact it’s going to have on people with insurance so that you can motivate labor and big business?” said Kenneth E. Thorpe, a professor of health policy at Emory University who is advising Mr. Blagojevich. “In Illinois, we showed that every $1 in state spending would yield $2 in savings for people with private health insurance. That refocuses the debate.”

Hipaa made me do it

The New York Times has a great article this morning on how the federal law intended to protect patient's privacy is often over enforced by confused hospital staff.

Hipaa was designed to allow Americans to take their health insurance coverage with them when they changed jobs, with provisions to keep medical information confidential. But new studies have found that some health care providers apply Hipaa regulations overzealously, leaving family members, caretakers, public health and law enforcement authorities stymied in their efforts to get information.

Experts say many providers do not understand the law, have not trained their staff members to apply it judiciously, or are fearful of the threat of fines and jail terms — although no penalty has been levied in four years.

Some reports blame the language of the law itself, which says health care providers may share information with others unless the patient objects, but does not require them to do so. Thus, disclosures are voluntary and health care providers are left with broad discretion.

This spring, the department revised its Web site, www.hhs.gov/ocr/hipaa, in the interest of clarity. But Hipaa continues to baffle even the experts.

Ms. McAndrew explained some of the do’s and don’ts of sharing information in a telephone interview:

Medical professionals can talk freely to family and friends, unless the patient objects. No signed authorization is necessary and the person receiving the information need not have the legal standing of, say, a health care proxy or power of attorney. As for public health authorities or those investigating crimes like child abuse, Hipaa defers to state laws, which often, though not always, require such disclosure. Medical workers may not reveal confidential information about a patient or case to reporters, but they can discuss general health issues.

I know as a reporter, we educated ourselves on exactly what information can be released, but there is widespread confusion -- despite HIPAA training each year -- on how decisions are made. We have a sheet that the patient is supposed to fill out with names of the only people we can release information to. We press people to give specific named even when they say we can update "anyone who calls."