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."

The Healthcare Primary -- Why this issue will be big

Slate magazine has an article this week about Barack Obama's health care plan. Obama and all the other candidate will come to the table with health care plans of some sort.



Yet this Slate article -- apparently the first in a series -- is useful because it tells us why healthcare will be a big deal.

The issue of greatest immediacy is the Iraq war, but none of the candidates has a brilliant idea about what to do. Even if he (or she) did have an effective plan, it would still be a crapshoot as to whether he (or she) would implement it if elected...Immigration is the hot issue of the moment, but I presume that by Election Day either it will be resolved or the warring parties will have resolved not to resolve it.That leaves health care.

And the timing for healthcare -- the environment for real change seems right:

The American health-care system is in an advanced state of collapse owing to the failure of an 80-year experiment in market economics. Politically, the problem has grown more urgent because rising health-care premiums and diminishing coverage are starting to cause serious problems for the middle class. Health insurance costs more and more and covers less and less. Per capita health-care costs are about twice what they were when Hillary Clinton tried unsuccessfully to reform the system in 1994, and the ranks of the uninsured have increased by 13 percent. Universal health insurance, which has eluded the political system at least as far back as 1912, when former president Teddy Roosevelt endorsed it in his failed Bull Moose bid, is starting to look inevitable. Even insurance companies think so, according to a May 30 article by Jackie Calmes in the Wall Street Journal. According to the Journal, the insurers have given up blocking universal health care, "Harry and Louise"-style, and are now redirecting their energies toward co-opting it.

So what is Obama proposing -- required health insurance on the individual level coupled with a number of much needed reforms in the vein signed by Mitt Romney. That said, the best part would be a public health insurance program with comprehensive benefits, limits on premiums, co-payments and other protections.

The bad news about Obamacare's (shhh!) socialized-medicine component is that it would be offered only to the self-employed, to employees of small businesses, and to people whose employers didn't give them health insurance. But this last group is growing larger every day, and the mere existence of a public health-insurance program would likely cause businesses to drop out of their private health-insurance plans in droves. That would be fine by me, provided the public health-insurance plan were a decent one. Eventually, all the other parts of Obama's plan might well wither away, leaving only this one.

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Learning from the states...

One of the main topics of this blog will be the search for universal healthcare. I believe we will have the critical mass the in the next few years to achieve that goal -- particularly now that people are realizing that our current system is a drain on the economy. Of course a few brave states are out there trying to lead the way. While simply scaling up a state program to a national level is not wise. If we're smart, we'll learn from their mistakes.

Front page of the New York Times is an example. Maine's program has stalled ....

The story of Maine’s health program — which tries to control hospital costs, improve the quality of health care and offer subsidized insurance to low-income people — harbors lessons for the country, as covering the uninsured takes center stage. States, including California, Massachusetts and Pennsylvania, have unveiled programs of their own, seeking to balance the needs and interests of individuals, employers, insurers and health care providers.

But as Maine tries to reform its reforms, it faces some particular challenges: It has large rural, poor and elderly populations with significant health needs. It has many mom-and-pop businesses and part-time or seasonal workers, and few employers large enough to voluntarily offer employees insurance. And most insurers here no longer find it profitable to sell individual coverage, leaving one carrier, Anthem Blue Cross Blue Shield, with a majority of the market, a landscape that some economists said could make it harder to provide broad choices and competitive prices.

Aged, Frail and Screwed by Insurance...

Bad news if you've been paying into long term care insurance. Your company may be planning to stiff you in the end.

From the New York Times:

"Interviews by The New York Times and confidential depositions indicate that some long-term-care insurers have developed procedures that make it difficult — if not impossible — for policyholders to get paid. A review of more than 400 of the thousands of grievances and lawsuits filed in recent years shows elderly policyholders confronting unnecessary delays and overwhelming bureaucracies. In California alone, nearly one in every four long-term-care claims was denied in 2005, according to the state."

Cancer fight in Campaign Spotlight

Presidential Candidate John Edwards' wife has cancer again.

"Mrs. Edwards’s doctor said at the news conference that she had metastatic, or Stage 4, breast cancer, meaning that it is in an advanced stage that has spread beyond the breast and lymph nodes, in her case to the bone.

According to statistics from the American Cancer Society, only 26.1 percent of patients with Stage 4 breast cancer live five years or more, but those figures are by nature outdated and do not reflect recent medical advances."

Edwards has already done a lot to raise awareness of breast cancer. Now her fight will be even more high profile. Edwards by the way, thus far has the most coherent Health Care plan of the campaign.