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Sudden Impact

Chris Hartlove

Sudden Impact (continued)

Stephen Wegener, a psychologist in Johns Hopkins' Physical Medicine and Rehabilitation Department, says LEAP was a case of the right messenger with the right message. He says trauma surgeons might have been less responsive to calls from mental health professionals to ramp up psychological services for trauma victims. Having that missive come instead from a recognized public health researcher deeply familiar with the demands and realities of trauma orthopedics proved far more effective.

Wegener, who began collaborating on several projects with MacKenzie post-LEAP, likens LEAP's findings to identifying an infectious disease for which an effective treatment already exists. "The results of the study came at a critical time; the Institute of Medicine had just issued its report ["Crossing the Quality Chasm"] calling for patient-centered care focusing on the psychosocial needs of patients and families," he says. "The psychological community had developed cognitive behavioral interventions that have potential benefit for the problems identified in LEAP. And there are interventions on the psychopharmacology side to work with PTSD, depression and pain."

Ellen MacKenzie and her team had defined the problem. Now they had to deliver solutions.

JR Black is healing, and he's not alone.

In the still room, his voice fills the air with a tale of pain and perspective. And ultimately, hope. 

Seated around the conference table deep in a corner of University of Maryland's downtown medical campus are five other trauma survivors. Their faces register recognition, and appreciation as well, as Black discusses his physical travails—the day and a half of surgery after he was helicoptered to Shock Trauma, the fog of the medically induced coma, the shocking realization that every one of his extremities had been broken, the exhausting physical therapy that took his right knee from a virtually useless 28-degree range of motion to a nearly normal 123 degrees. His terrible thirst, unquenched for days because ventilators and liquids simply don't mix. As he shares his story, heads bob emphatically around the table. They've all been there, done that.

"I was ready to jump the guy watering the plants," recalls one of Black's young tablemates, whose body was decimated in a motorcycle crash. The line elicits a huge laugh from everyone including Black, but the room quickly turns somber again as he hits upon a universal truth for the assembled.

"I had some dark times after I got out of the hospital," Black tells his fellow survivors. "They don't tell you the easy part is when you're in the hospital. When I got out and was home, you have a lot of time alone with your thoughts and your 'new' body, looking different, covered in scars. There's something that plays on your mind. It's hard to have open wounds for such a long time. You feel like a leper."

For Black and the others around the table, sharing and overcoming those feelings is part of what the Trauma Survivors Network (TSN), which organized the meeting, is all about. MacKenzie's team helped the American Trauma Society (ATS) develop and launch TSN in 2006. From 2006 to 2009, MacKenzie was ATS president.

A CDC grant is allowing MacKenzie to evaluate TSN's implementation at the Shock Trauma Center. At its core, TSN connects survivors and their families with those who've suffered a similar fate, providing support along with resources so trauma victims can rebuild their lives.

A vital aspect of TSN is called "NextSteps." The self-management program grew from a similar amputee-targeted program called PALS ("Promoting Amputee Life Skills") that MacKenzie developed with Wegener. The programs share a belief that patients are the central players in their recovery, which can be enhanced by learning self-management skills. LEAP found that greater self-confidence is a major predictor of good outcomes; PALS and NextSteps are designed to teach participants how to take charge of their lives and their recovery.

A randomized trial showed that the eight-week PALS self-management program, which educates patients about their condition and allows them to track their symptoms and progress, reduced depression and improved function and outlook for those who received the training, with an important caveat: timing. "We found that people who were less than a year out from losing their limb did significantly better than those who started the program much later," says MacKenzie, now the Fred and Julie Soper Professor and Chair of the Department of Health Policy and Management.


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Thriving Post-Trauma

Thriving Post-Trauma

Trauma survivor Ryan Major and researcher Ellen MacKenzie explore the personal and scientific sides of injury recovery.

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