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MORNING EVERYBODY, WHICH CAMERA?

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THIS CAMERA.

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THANK YOU FOR JOINING. 

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WE ARE DAY 2 OF THE NATIONAL

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ADVISORY BOARD FOR MEDICAL

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REHABILITATION RESEARCH AT NIERK

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CHD.

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IME TERESA CRUZ, I'M THE

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DIRECTOR, I WANT TO THANK YOU

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FOR JOINING US TODAY.

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WE HAD AN INCREDIBLE DAY

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YESTERDAY, I THINK AND IF YOU

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MISSED ANY OF IT, IT'LL BE ON

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THE NIH VIDEOCAST AND I WOULD

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ENCOURAGE YOU TO GO BACK AND

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TAKE A LOOK PARTICULARLY IN THE

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AFTERNOON.

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YOU CAN SKIP ALL THE

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BUREAUCRATIC STUFF IN THE

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MORNING BUT THE AFTERNOON

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SESSIONS WERE REALLY JUST

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INCREDIBLE, POWERFUL DISCUSSIONS

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OF THE LIVED EXPERIENCE AND THE

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NEED FOR INCLUSION OF PEOPLE

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WITH DISABILITIES IN THE EFFORTS

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THAT WE SUPPORT.

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TODAY WE WILL SHIFT THE TONE A

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LITTLE BIT AND DIG INTO SOME

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MORE SCIENCE.

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SO WE HAVE 4 GREAT SPEAKERS

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LINED UP.

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AND I DON'T WANT TO TAKE AWAY

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BARBARA SUNNEDDER WITH THE

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INTRODUCTIONS BUT WE AGAIN,

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BEFORE WE WRAP AROUND NOON

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TODAY, WE ARE GOING TO ASK FOR

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TOPICS FOR OUR MAY MEETING.

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SO KEEP IN MIND AS YOU'RE

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LISTENING TO THESE TALKS OR

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OTHER THINGS THAT WOULD BE

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HELPFUL TO YOU ALL TO HEAR WHEN

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WE MEET AGAIN IT MAY.

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NAND CAN I ALSO ADD THAT IT'S

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NOT JUST THIS LITTLE WINDOW BUT

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IT'S DURING THE COURSE OF YOUR

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CAREERS, DURING THE OTHER

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MONTHS, FEEL FREE TO KEEP

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ENGAGING US ON TOPICS YOU WANT

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TO BRING TO THE BOARD.

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SO ANYWAY ISSUES IT'S MY

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PLEASURE TO INTRODUCE 1 OF OUR

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FELLOW BOARD MEMBERS

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DR. FLORA HAM OND IS A BOARD

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CERTIFIED PHYSICIAN MEDICINE AND

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REHAB PATHWAY GIVES SESSION AND

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PROFESSOR AND CHAIR OF PHYSICAL

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MEDICINE AND REHABILITATION AT

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INDIANA UNIVERSITY SCHOOL OF

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MEDICINE EMPLOY SHE'S A PROJECT

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DIRECTOR AT THE INDIANA

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TRAUMATIC BRAIN INJURY MODEL

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SYSTEMS AND MODEL ITS' COMMITTEE

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A PROMINENT RESEARCHER IN THE

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FIELD OF TBI AND WE WILL LIKE TO

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HAVE HER SHARE HER PASSIONS AND

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SCIENTIFIC BACKGROUND WITH US AT

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THIS MEETING.

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SO FLORA, WE TURN IT OVER TO

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YOU. 

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>> THANK YOU.

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GREAT.

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THANK YOU.

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FIRST RALPH ASKED ME FOR A TITLE

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AND I HAD A VISION OF WEAVING

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TOGETHER ALL THE THINGS I

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LEARNED SO FAR IN MY CAREER AND

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THEN COULDN'T REALLY FIGURE OUT

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HOW TO CREATIVELY WEAVE THAT SO

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I DECIDED TO FOCUS ON SOMETHING

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THAT REALLY TAKE WHAT IS WE HAVE

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FOUND TO CREATE A MOVEMENT IN

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CHANGING OUTCOMES FOR PEOPLE

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WITH BRAIN INJURY SO THAT'S WHAT

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I WILL TALK TO YOU ABOUT TODAY.

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SO AS AN OVERVIEW OF WHAT I WILL

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COVER, FIRST I'M GOING TO GO

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OVER A CHANGE IN THINKING ABOUT

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BRAIN INJURY AS A CHRONIC COP

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DITION AND THE DATA THAT LAID

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THAT OUT FOR US OR AT LEAST A

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GLIMPSE OF THAT AND THAT IT'S

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ACTUALLY REALLY A DYNAMIC

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CONDITION, NOT JUST CHRONIC.

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AND THEN TALK TO YOU BRIEFLY

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ABOUT HOW OTHER CONDITIONS HAVE

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MANAGED TO USE A CHRONIC DISEASE

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MODELS TO IMPROVE OUTCOMES, AND

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THEN LASTLY AN EFFORT UNDER FOOT

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TO IMRIEWF THE MODEL OF CARE FOR

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BRAIN INJURY.

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SO FIRST FOCUSING ON BRAIN

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INJURY AS A CHRONIC CONDITION

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EMPLOY WE STARTED THINKING ABOUT

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THIS BACK 2009, THE IOM REPORT

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WAS INSTRUMENTAL IN LAYING OUT

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THE EVIDENCE THAT REALLY AS

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CLINICIANS WE'VE KNOWN FOR A

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LONG TIME BUT LAYING OUT THE

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EVIDENT THAT THERE REALLY IS

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SUFFICIENT EVIDENT THAT THERE

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ARE LONG-TERM ISSUES POST TBI,

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SOUNDS PRETTY SIMPLE BUT WE

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REALLY NEEDED THAT EVIDENT

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CONSOLIDATED TO TELL THE STORY. 

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AND THEN NEXT, DR. MAZAOU, AND

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DR. DEWIT POSITED THAT BRAIN

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INJURY WAS REALLY A DISEASE AND

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NOT AN EVENT AND POINTED THAT

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THAT MANY CARING FOR BRAIN

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INJURY AND THE MODEL AT THE TIME

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WAS A LOT OF THAT RECESSITATION

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AND THEN REALLY FORGETTING

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PEOPLE AND THINKING THAT EITHER

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THERE WEREN'T LONG-TERM ISSUES

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OR IF THERE WERE, THERE WAS

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NOTHING TO BE DONE ABOUT IT.

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AND THEN DR. CORRIGAN AND I WITH

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THE EFFORTS FROM GALVESTON BRAIN

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INJURY CONFERENCE PUBLISHED A

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PAPER THAT SAID WE CAN DO

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BETTER.

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BRAIN YOUR IS A CHRONIC AND

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DYNAMIC CONDITION AND THAT BEING

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PROACTIVE AND WITH SURVEILLANCE

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THAT WE CAN DO A BETTER JOB AND

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WE NEED TO FIGURE THAT OUT.

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IT WAS A CALL TO ACTION AND SO

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THAT WAS BACK IN 2013, WE NOW

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ARE CONSIDERING REVISITING THAT

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AND GIVING AN UPDATE TO WHERE WE

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ARE BECAUSE CERTAINLY WE KNOW

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MORE NOW ABOUT HOW WOE CAN HAVE

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AN EFFECTIVE CALL TO ACTION

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EMPLOY SO THE--IN THAT 2013

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ARTICLE WE PRESENTED THE

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FOLLOWING DATA JUST TO TELL THE

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PICTURE, I JUST UPDATED THIS

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SLIDE SO NOW IT GOES FURTHER OUT

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POST INJURY BUT IT'S THE

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SAMEULAR FINDINGS FOR BACK TO

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2013.

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SO BASICALLY, THE TBI MODEL

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SYSTEM SYSTEM DATA WHERE WE HAVE

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FOLLOWED PEOPLE OUT TO AT LEAST

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30 YEARS POST INJURY. 

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THIS SLIDE USES THE GLASGOW

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OUTCOME SCALE EXTENDED.

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WHAT WE DID IS WE LOOKED AT DID

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PEOPLE CHANGE IN THEIR DPLAS GOW

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OUTCOME SCALE FROM 1 TIME TO THE

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NEXT AND BY HOW MUCH AND WHAT

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YOU WILL SEE HERE IS THE VERY

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FIRST COLUMN.

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YOU SEE THAT'S A COMPARISON OF

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HOW PEOPLE WERE ON THEIR GOSE

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FROM YEAR 1 TO YEAR 2.

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THE NEXT COLUMN IS A COMPARISON

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OF YEAR 2 TO 5, 5 TO 10, 15-20,

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20-25, AND 25-30 AND YOU CAN SEE

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THE SAMPLE HAS DECREASED

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OVERTIME AS WE HAVE MANY MORE

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THAT WE'RE FOLLOWING IN THE

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DATABASE THAT WERE EARLIER FROM

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POST INJURY.

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THE COLOR IS BLUE MEANS THEY DID

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NOT CHANGE FROM 1 EPIC TO THE

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NEXT IN REGARDS TO THEIR GSE

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SCORE.

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THE PEOPLE WHO DIDN'T CHANGE AT

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ALL, THAT'S ABOUT 41-49%

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DEPENDING ON WHICH EPIC, SO MORE

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PEOPLE ARE CHANGING THAN ARE NOT

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CHANGING.

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THE GREEN, MEANS THEY IMPROVED. 

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SO DETENDING--DEPENDING ON THE

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CONDITIONS.

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SO A CONDITION  WHERE WE USED TO

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THINK WELL, YOU GOT WAYOU GOT

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AND YOU WILL NONAPOPTOTIC THE

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HAVE ANY CHANGE.

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THESE ARE PEOPLE THAT ARE

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IMPROVING AND IN FACT, THEY ARE

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IMPROVING WITH THAT ATTITUDE

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EMPLOY YOU WILL SEE EVEN THE

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PEOPLE YEARS POST INJURY ARE

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CONTINUING TO IMPROVE.

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THE OTHER SIDE OF THAT, WE OFTEN

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WORRY ABOUT DECLINE OVER TIME,

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THE RED PINK COLOR IS DECLINED

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AND YOU WILL SEE THE 23-37%

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DECLINED EITHER 1 OR MORE

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POINTS.

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SO THIS SLIDE DOES INCLUDE

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DEATHS.

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THE DATA LOOKS SIMILAR IF YOU

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WERE TO TAKE OUT DEATHS.

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CERTAINLY THESE ARE ALL

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DIFFERENT CAUSES, IT MAY NOT BE

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RELATED TO THEIR BRAIN YOUR OR

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IT MAY BE.

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SO I MENTIONED THE GALVESTON

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BRAIN INJURY CONFERENCE, THE

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GALVESTON BRAIN INJURY

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CONFERENCE IS A THINK TANK THAT

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CONVENES ABOUT 40 PEOPLE,

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EXPERTS IN THE FIELD AND HAS

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TACKLED DIFFICULT ISSUES IF I

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REMEMBER CORRECTLY IT STARTED

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AROUND 2000 AND FROM 2011-2014

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WE CONVENED ON THE TOPIC OF

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BRAIN INJURIES OR CHRONIC

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CONDITION AND WHAT CAN WE DO

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ABOUT IT.

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2011 WAS JUST GETTING OUR HEAD

225
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AROUND THE CONCEPT AND ALL

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GETTING ON THE SAME PAGE,

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TALKING ABOUT COULD THIS BE A

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NEGATIVE THING SOME SIGMA, ET

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CETERA, AND THEN CONVENING IN

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2012, WE CAME UP WITH A

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STRATEGIC PLAN.

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WE CREATED A DEFINITION TR

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CHRONIC BRAIN INJURY EMPLOY THE

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DEFINITION WE CREATED AT THAT

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TIME WAS INJURY TO THE BANE CAN

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EVOLVE INTEREST A LIFE LONG

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HEALTH CONDITION, TERMED CHRONIC

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BRAIN INJURY.

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CHRONIC BRAIN INJURY IMPAIRS THE

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BRAIN AND OTHER ORGAN SYSTEMS

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AND MAY PERSIST OR PROGRESS OVER

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AN INDIVIDUAL'S LIFE SPAN.

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AND THE OTHER THING WE DID THAT

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YEAR IS WE CREATED A VISION

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WHICH HAS THEN MOVED US FORWARD

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FROM THERE, BRAIN INJURY SHOULD

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BE IDENTIFIED AND PROACTIVELY

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MANAGED AS A LIFE LONG DISEASE

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WHICH WILL RESULT IN

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IMPROVEMENTS IN LONGEVITY,

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LEVELS OF DISABILITY, EVENTS IN

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SOCIETY AND QUALITY OF LIFE.

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SO THAT'S QUITE A VISION AND

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WHAT WE'RE REALIZING IS REALLY

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THE BRIDGE, REALLY WE'VE GOT THE

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INITIAL PART OF THE BRIDGE

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BUILT, EXCELLENT ACUTE CARE, AND

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THEN REALLY WE NEED SOME

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INFRASTRUCTURE BUILT TO TAKE

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CARE OF THE REST SO WE CAN

261
00:10:49,290 --> 00:10:50,191
ACHIEVE OPTIMAL LIVING AFTER

262
00:10:50,191 --> 00:10:52,227
BRAIN INJURY.

263
00:10:52,227 --> 00:10:56,564
SO THE TYPICAL PATH POST TBI,

264
00:10:56,564 --> 00:10:59,634
VARIABLE AND LIMITED ACCESS TO

265
00:10:59,634 --> 00:11:01,069
SPECIALIZED PROGRAMS.

266
00:11:01,069 --> 00:11:02,937
WE HAVE LIMITED PROVIDERS,

267
00:11:02,937 --> 00:11:05,407
EXPERTS IN BRAIN INJURY, ARE

268
00:11:05,407 --> 00:11:09,077
HARD TO FIND AND NOT ENOUGH, SO

269
00:11:09,077 --> 00:11:13,014
THE CARE THAT 1 GETS IS VERY--IT

270
00:11:13,014 --> 00:11:14,282
VARIES FROM 1 PLACE TO THE NEXT

271
00:11:14,282 --> 00:11:16,551
EVEN WITHIN A STATE.

272
00:11:16,551 --> 00:11:19,954
THE CARE YOU GET IS REACTIVE AND

273
00:11:19,954 --> 00:11:23,224
VERY AIMED AT SIGNS AND

274
00:11:23,224 --> 00:11:24,359
SYMPTOMS, LESS PROACTIVE.

275
00:11:24,359 --> 00:11:30,799
THE FOLLOW UP 1 GET SYSTEM

276
00:11:30,799 --> 00:11:32,434
BRIEF, REACTIVE, INFREQUENT,

277
00:11:32,434 --> 00:11:33,468
IT'S OFTEN PATIENT-INITIATED AND

278
00:11:33,468 --> 00:11:34,769
IT'S VERY COMMON FOR PEOPLE TO

279
00:11:34,769 --> 00:11:37,072
BE DROPPED FROM A BRAIN INJURY

280
00:11:37,072 --> 00:11:37,305
CLINIC.

281
00:11:37,305 --> 00:11:42,277
YOU KNOW YOU'RE DOING FINE NOW,

282
00:11:42,277 --> 00:11:44,045
WE NEED NEED TO SEE YOU ANYMORE.

283
00:11:44,045 --> 00:11:45,213
SO USUALLY WITHIN THE FIRST

284
00:11:45,213 --> 00:11:46,748
COUPLE YEARS YOU CAN BE DROPPED

285
00:11:46,748 --> 00:11:49,050
FOR FOLLOW UP AS A LACK OF

286
00:11:49,050 --> 00:11:52,454
VISION OF WHAT COULD HAPPEN.

287
00:11:52,454 --> 00:11:55,190
AND THE INTENSITY OF SERVICE IS

288
00:11:55,190 --> 00:11:58,059
GENERALLY LOW, A LOT OF SERVICES

289
00:11:58,059 --> 00:12:01,229
EARLY ON AND THEN THE THOUGHT

290
00:12:01,229 --> 00:12:02,730
THAT YOU'VE STABILIZED AND A

291
00:12:02,730 --> 00:12:05,800
LACK OF ATTENTION TO SERVICES

292
00:12:05,800 --> 00:12:07,268
LATER POST INJURY.

293
00:12:07,268 --> 00:12:11,306
THE DIDACTIC, THE EDUCATION IS

294
00:12:11,306 --> 00:12:12,006
VERY BRIEF.

295
00:12:12,006 --> 00:12:15,310
LIMITED TO NO ACCORD NATION OF

296
00:12:15,310 --> 00:12:21,049
THE CARE, LIMITED NAVIGATION OF

297
00:12:21,049 --> 00:12:23,184
SERVICES AND COMMUNICATION AND

298
00:12:23,184 --> 00:12:24,686
LIMITED CASE MANAGE AM

299
00:12:24,686 --> 00:12:26,654
AVAILABILITY, THERE IS SOMETHING

300
00:12:26,654 --> 00:12:27,922
CALLED RESOURCE FACILITATION

301
00:12:27,922 --> 00:12:30,758
THAT HAS BEEN GAINING STEAM OVER

302
00:12:30,758 --> 00:12:34,529
THE PAST DECADE, LIMITED

303
00:12:34,529 --> 00:12:36,231
ATTENTION, AND SOLUTIONS TO

304
00:12:36,231 --> 00:12:37,499
CHALLENGES IN SOCIAL

305
00:12:37,499 --> 00:12:39,033
DETERMINANTS OF HEALTH AND

306
00:12:39,033 --> 00:12:41,269
COMMUNITY BARRIERS AS WELL AS

307
00:12:41,269 --> 00:12:43,338
MEDICAL BARRIERS AND VERY LITTLE

308
00:12:43,338 --> 00:12:46,007
ATTENTION TO WHAT CAN BE DONE

309
00:12:46,007 --> 00:12:46,908
FOR CAREGIVERS.

310
00:12:46,908 --> 00:12:49,244
SO, WITH ALL THAT IN MIND, WE

311
00:12:49,244 --> 00:12:50,645
WERE THINKING WELL, WHAT HAVE

312
00:12:50,645 --> 00:12:52,614
OTHER CONDITIONS DONE TO ADDRESS

313
00:12:52,614 --> 00:12:56,017
THIS, CERTAINLY WE KNOW THAT

314
00:12:56,017 --> 00:12:58,052
CHRONIC CONDITIONS USE MORE

315
00:12:58,052 --> 00:12:58,853
HEALTHCARE SERVICES AND WITH

316
00:12:58,853 --> 00:13:03,191
THAT AS A HUGE COST AND SO OVER

317
00:13:03,191 --> 00:13:04,392
THE PAST COUPLE DECADES

318
00:13:04,392 --> 00:13:06,127
HEALTHCARE PLANS HAVE DESIGNED

319
00:13:06,127 --> 00:13:07,228
CHRONIC DISEASE MANAGEMENT

320
00:13:07,228 --> 00:13:08,997
APPROACHES TO IMPROVE THE CARE

321
00:13:08,997 --> 00:13:13,468
AND REDUCE THE COST AND

322
00:13:13,468 --> 00:13:14,169
DECREASED RESOURCE UTILIZATION.

323
00:13:14,169 --> 00:13:15,537
SO EXCELLENT EXAMPLES ARE WHAT'S

324
00:13:15,537 --> 00:13:20,642
BEEN DONE FOR DIABETES, COPD,

325
00:13:20,642 --> 00:13:22,744
ASTHMA, CONGESTIVE HEART

326
00:13:22,744 --> 00:13:25,079
FAILURE, RENAL DISEASE, YOU CAN

327
00:13:25,079 --> 00:13:26,214
PROBABLY--THINGS HAVE COME TO

328
00:13:26,214 --> 00:13:27,715
YOUR MIND OF WHAT'S BEEN DONE

329
00:13:27,715 --> 00:13:31,352
OVER THE PAST COUPLE DECADES.

330
00:13:31,352 --> 00:13:33,755
FOR EXAMPLE WITH CONGESTIVE

331
00:13:33,755 --> 00:13:35,390
HEART FAILURE THERE'S A WHOLE

332
00:13:35,390 --> 00:13:36,824
PROTOCOL OF WHAT CAN BE DONE TO

333
00:13:36,824 --> 00:13:40,161
TRY TO KEEP PEOPLE FROM

334
00:13:40,161 --> 00:13:40,862
NEEDING--GOING INTO AN

335
00:13:40,862 --> 00:13:41,696
EXACERBATION AND NEEDING TO END

336
00:13:41,696 --> 00:13:43,965
UP IN THE HOSPITAL.

337
00:13:43,965 --> 00:13:45,033
SO, WAYS THEY'VE DONE THAT,

338
00:13:45,033 --> 00:13:47,468
THERE HAVE BEEN A LOT OF

339
00:13:47,468 --> 00:13:48,069
DIFFERENT APPROACHES,

340
00:13:48,069 --> 00:13:50,805
COLLABORATIVE CARE MODEL IS 1,

341
00:13:50,805 --> 00:13:52,340
THE WAGNER INTEGRATED CARE MODEL

342
00:13:52,340 --> 00:13:54,209
OR THE CHRONIC CARE MODEL IS

343
00:13:54,209 --> 00:13:54,576
ANOTHER.

344
00:13:54,576 --> 00:13:56,344
I'M GOING TO FOCUS ON TALKING A

345
00:13:56,344 --> 00:13:58,513
LITTLE BIT ABOUT THE WAGNER

346
00:13:58,513 --> 00:13:59,514
MODEL.

347
00:13:59,514 --> 00:14:02,217
SO HERE IS A DEPICTION OF THE

348
00:14:02,217 --> 00:14:04,252
WAGNER MODEL, HE LAID OUT THAT

349
00:14:04,252 --> 00:14:07,755
THERE'S THE HEALTH SYSTEMS AND

350
00:14:07,755 --> 00:14:08,356
THE COMMUNITY.

351
00:14:08,356 --> 00:14:09,891
AND WITHIN THE HELT SYSTEMS

352
00:14:09,891 --> 00:14:12,160
THERE'S THE DELIVERY SYSTEM,

353
00:14:12,160 --> 00:14:14,329
DECISION SUPPORT ISSUES

354
00:14:14,329 --> 00:14:15,196
SELF-MANAGEMENT AND CLINICAL

355
00:14:15,196 --> 00:14:17,098
INFORMATION SYSTEMS, WHERE IN

356
00:14:17,098 --> 00:14:19,968
THE COMMUNITY, IT'S PUBLIC

357
00:14:19,968 --> 00:14:22,403
POLICY AND RESOURCES, AND

358
00:14:22,403 --> 00:14:23,705
SUPPORTIVE ENVIRONMENT.

359
00:14:23,705 --> 00:14:30,178
SO WHAT DOES ALL THAT MEAN ?

360
00:14:30,178 --> 00:14:31,746
DELIVERY SYSTEM, AT RISK CASE

361
00:14:31,746 --> 00:14:32,814
MANAGEMENT, SO CASE MANAGEMENT

362
00:14:32,814 --> 00:14:34,415
FOR THOSE WHO ARE AT GREATEST

363
00:14:34,415 --> 00:14:35,917
NEED, BEING ABLE TO IDENTIFY

364
00:14:35,917 --> 00:14:37,552
WHAT THAT NEED IS AND HAVING A

365
00:14:37,552 --> 00:14:41,189
PLAN IN PLACE TO ADDRESS

366
00:14:41,189 --> 00:14:41,556
 THOSENY

367
00:14:41,556 --> 00:14:44,759
NEEDS AND EDUCATED ACTIVATED

368
00:14:44,759 --> 00:14:47,028
CLINICAL TEAMS, DECISION SUPPORT

369
00:14:47,028 --> 00:14:49,864
IS GUIDE LINES, SEMINARS, TO

370
00:14:49,864 --> 00:14:54,168
HELP HAVE THE TEAM AT THE TOP OF

371
00:14:54,168 --> 00:14:57,672
THEIR KNOWLEDGE BASE CAPACITY

372
00:14:57,672 --> 00:14:59,307
BUILDING, AND WORKING HAND IN

373
00:14:59,307 --> 00:15:02,377
HAND WITH CONSULTANTS WITH THAT

374
00:15:02,377 --> 00:15:04,112
EXTRA EXPERTISE.

375
00:15:04,112 --> 00:15:04,912
CLINICAL INFORMATION SYSTEMS

376
00:15:04,912 --> 00:15:09,150
INCLUDE THINGS LIKE REGISTRIES,

377
00:15:09,150 --> 00:15:12,553
AND PERFORMANCE METRICS,

378
00:15:12,553 --> 00:15:13,154
SUPPORTED SELF-MANAGEMENT.

379
00:15:13,154 --> 00:15:14,422
AND I'M GOING TO GO INTO THAT A

380
00:15:14,422 --> 00:15:16,891
LITTLE BIT IN THE NEXT SLIDE.

381
00:15:16,891 --> 00:15:18,293
IT'S A VERY IMPORTANT KEY

382
00:15:18,293 --> 00:15:21,996
FEATURE TO THE CHRONIC CARE

383
00:15:21,996 --> 00:15:23,531
MODEL AND SUPPORTIVE ENVIRONMENT

384
00:15:23,531 --> 00:15:29,370
AND PUBLIC POLICY RESOURCES.

385
00:15:29,370 --> 00:15:31,439
SO OFFENSE TIMES PIECES OF THE

386
00:15:31,439 --> 00:15:32,640
CHRONIC CARE MODEL ARE

387
00:15:32,640 --> 00:15:34,142
IMPLEMENTED RATHER THAN THE

388
00:15:34,142 --> 00:15:37,078
ENTIRE CHRONIC CARE MODEL.

389
00:15:37,078 --> 00:15:38,279
THIS SYSTEMATIC REVIEW I THOUGHT

390
00:15:38,279 --> 00:15:42,784
WAS HELPFUL IN SHOWING HOW OFTEN

391
00:15:42,784 --> 00:15:45,286
THE DIFFERENT PIECES ARE

392
00:15:45,286 --> 00:15:49,957
IMPLEMENTED AND YOU SEE HERE

393
00:15:49,957 --> 00:15:51,259
THAT MOST OFTEN IT'S

394
00:15:51,259 --> 00:15:55,263
SELF-MANAGEMENT THAT IS

395
00:15:55,263 --> 00:15:55,963
IMPLEMENTED.

396
00:15:55,963 --> 00:16:00,234
IN THIS STUDY, THEY FOUND 46% OF

397
00:16:00,234 --> 00:16:03,971
THE STUDIES USED SELF-MANAGEMENT

398
00:16:03,971 --> 00:16:06,274
AND NEXT WAS DELIVERY SYSTEM

399
00:16:06,274 --> 00:16:07,875
DESIGNS FOLLOWED BY DECISION

400
00:16:07,875 --> 00:16:09,177
SUPPORT, AND CLINICAL

401
00:16:09,177 --> 00:16:11,946
INFORMATION SYSTEMS AND WHAT YOU

402
00:16:11,946 --> 00:16:15,183
SEE HERE IS ALMOST NEVER A USE

403
00:16:15,183 --> 00:16:25,593
OF COMMUNITY RESOURCES.

404
00:16:26,294 --> 00:16:27,729
SO SELF-MANAGEMENT IS THE COMMON

405
00:16:27,729 --> 00:16:28,796
KEY ELMETROPOLITAN OF THIS MODEL

406
00:16:28,796 --> 00:16:30,865
AND VERY IMPORTANT FOR HELPING

407
00:16:30,865 --> 00:16:33,201
PEOPLE LIVE WITH THEIR INJURY OR

408
00:16:33,201 --> 00:16:33,434
ILLNESS.

409
00:16:33,434 --> 00:16:34,268
MOST PEOPLE SPEND VERY LITTLE

410
00:16:34,268 --> 00:16:36,671
TIME IN FRONT OF A HELT CARE

411
00:16:36,671 --> 00:16:40,108
PROVIDER SO YOU CAN SEE HOW

412
00:16:40,108 --> 00:16:42,377
SELF-MANAGEMENT BECOMES REALLY

413
00:16:42,377 --> 00:16:44,078
IMPORTANT TO MANAGING AND NOT

414
00:16:44,078 --> 00:16:50,385
BEING DEPENDENT ON THE MEDICAL

415
00:16:50,385 --> 00:16:50,618
SYSTEM.

416
00:16:50,618 --> 00:16:51,986
SO SELF-MANAGEMENT, AND THE GOAL

417
00:16:51,986 --> 00:16:56,624
IS TO IMPROVE SELF-EFFICACY

418
00:16:56,624 --> 00:17:01,596
THROUGH GOAL ATTAINMENT BY

419
00:17:01,596 --> 00:17:02,363
PERSUASION, PHYSICAL ACTIVITY

420
00:17:02,363 --> 00:17:04,699
LINKED TO PHYSICAL AS WELL AS

421
00:17:04,699 --> 00:17:05,299
CERTAINLY--CERTAINLY MOTIONAL

422
00:17:05,299 --> 00:17:05,600
STATUS.

423
00:17:05,600 --> 00:17:06,801
FOR EXAMPLE, DIABETES AND BLOOD

424
00:17:06,801 --> 00:17:10,638
SUGAR AND BEING ABLE TO

425
00:17:10,638 --> 00:17:12,473
RECOGNIZE WHEN YOU'VE GOT A

426
00:17:12,473 --> 00:17:13,841
MARKER, THE BLOOD SUGAR IS HIGH

427
00:17:13,841 --> 00:17:20,748
AND WHAT TO DO AND HOW TO MANAGE

428
00:17:20,748 --> 00:17:21,582
THAT IT REQUIRES THAT THE PERSON

429
00:17:21,582 --> 00:17:23,217
WITH THE INJURY OR ILLNESS

430
00:17:23,217 --> 00:17:28,423
RECOGNIZE THE ISSUE AND THEN

431
00:17:28,423 --> 00:17:30,258
ALSO, INVOLVES ABILITY TO HAVE

432
00:17:30,258 --> 00:17:32,994
GOAL SETTING, HAVE SUPPORT TO

433
00:17:32,994 --> 00:17:38,499
HELP IN ADJUSTING THOSE GOALS

434
00:17:38,499 --> 00:17:39,500
AND SELF-MONITORING.

435
00:17:39,500 --> 00:17:42,303
IT'S TOUTED THAT THERE ARE 6

436
00:17:42,303 --> 00:17:51,779
CORE SKILLS, PROBLEM SOLVING

437
00:17:51,779 --> 00:17:54,215
SKILLS, SELF-TAYLORRING AND YOU

438
00:17:54,215 --> 00:17:55,583
THINK ABOUT APPLYING THIS TO

439
00:17:55,583 --> 00:17:56,651
BRAIN INJURY, YOU REALIZE THERE

440
00:17:56,651 --> 00:17:59,287
ARE OTHER SKILLS THAT COME TO

441
00:17:59,287 --> 00:18:02,457
MIND FOR EXAMPLE, SELF-AWARENESS

442
00:18:02,457 --> 00:18:02,857
AND INITIATION.

443
00:18:02,857 --> 00:18:05,359
IN THINKING ABOUT THE NEEDS OF

444
00:18:05,359 --> 00:18:06,227
APPLYING SELF-MANAGEMENT TO

445
00:18:06,227 --> 00:18:11,032
PEOPLE WITH BRAIN INJURY, THERE

446
00:18:11,032 --> 00:18:12,667
ARE MODELS OUT THERE THAT

447
00:18:12,667 --> 00:18:13,601
ADDRESS ISSUES THAT PEOPLE WITH

448
00:18:13,601 --> 00:18:15,303
BREAN INJURY MAY HAVE, PEOPLE

449
00:18:15,303 --> 00:18:17,638
WITH BRAIN INJURY MAY OFTEN HAVE

450
00:18:17,638 --> 00:18:19,440
ISSUES WITH SUBSTANCE AND

451
00:18:19,440 --> 00:18:21,642
ALCOHOL USE, DIABETES, CHRONIC

452
00:18:21,642 --> 00:18:25,379
ILLNESS AND GENERAL, DEPRESSION,

453
00:18:25,379 --> 00:18:25,613
PAIN.

454
00:18:25,613 --> 00:18:27,014
THERE ARE ALREADY QUITE A BIT OF

455
00:18:27,014 --> 00:18:31,953
WORK ON THOSE SYMPTOMS AND

456
00:18:31,953 --> 00:18:33,588
ILLNESSES THAT WE CAN TAP INTO

457
00:18:33,588 --> 00:18:34,255
AND LEARN FROM.

458
00:18:34,255 --> 00:18:35,690
WE ARE IN THE PROCESS OF TRYING

459
00:18:35,690 --> 00:18:37,558
TO LEARN HOW MUCH THAT MID NEED

460
00:18:37,558 --> 00:18:39,727
TO BE MODIFIED TO HELP PEOPLE

461
00:18:39,727 --> 00:18:40,661
WITH BRAIN INJURY.

462
00:18:40,661 --> 00:18:42,063
THE OTHER IMPORTANT PIECE OF A

463
00:18:42,063 --> 00:18:43,231
CHRONIC DISEASE MODEL IS TO

464
00:18:43,231 --> 00:18:47,268
FIGURE OUT WHO NEEDS WHAT SO

465
00:18:47,268 --> 00:18:48,703
THAT YOU CAN FIGURE--YOU'RE

466
00:18:48,703 --> 00:18:49,971
GETTING THE RIGHT SERVICES TO

467
00:18:49,971 --> 00:18:51,706
THE RIGHT PEOPLE, SPENDING THE

468
00:18:51,706 --> 00:18:53,574
RIGHT RESOURCES.

469
00:18:53,574 --> 00:18:57,879
AND SO, THIS IS A DIAGRAM THAT

470
00:18:57,879 --> 00:19:00,915
SHOWS, AND MOST CHRONIC DISEASES

471
00:19:00,915 --> 00:19:05,887
THAT 70-80% ARE AT LOW RISK AND

472
00:19:05,887 --> 00:19:07,288
THOSE AT LOW RISK WOULD MORE

473
00:19:07,288 --> 00:19:09,223
THAN LIKELY NEED SUPPORTED

474
00:19:09,223 --> 00:19:11,959
SELF-MANAGEMENT APPROACH WITH A

475
00:19:11,959 --> 00:19:18,366
SMALL SLIVER PERCENTAGE NEEDING

476
00:19:18,366 --> 00:19:19,333
MORE PROFESSIONAL MANAGEMENT.

477
00:19:19,333 --> 00:19:21,869
AND AT THE NEXT LEVEL UP IS THAT

478
00:19:21,869 --> 00:19:22,803
THE MODERATE RISK WOULD NEED

479
00:19:22,803 --> 00:19:25,006
MORE OF A DISEASE MANAGEMENT

480
00:19:25,006 --> 00:19:28,643
APPROACH AND THEN FINALLY, THOSE

481
00:19:28,643 --> 00:19:30,478
AT HIGHEST NEED, THE MOST

482
00:19:30,478 --> 00:19:32,947
COMPLEX, WOULD REQUIRE CASE

483
00:19:32,947 --> 00:19:33,381
MANAGEMENT.

484
00:19:33,381 --> 00:19:35,316
SO REALLY WHEN WE'RE TALKING

485
00:19:35,316 --> 00:19:36,851
ABOUT THIS MODEL, WE'RE NOT

486
00:19:36,851 --> 00:19:39,620
TALKING ABOUT ALL UNDER THE

487
00:19:39,620 --> 00:19:40,221
RESOURCES OF EVERYONE, WE'RE

488
00:19:40,221 --> 00:19:42,523
TRYING TO FIGURE OUT WHO NEEDS

489
00:19:42,523 --> 00:19:43,524
WHAT.

490
00:19:43,524 --> 00:19:45,760
SO TO FOCUS NOW ON WHAT ARE WE

491
00:19:45,760 --> 00:19:48,930
DOING FOR TRYING TO IMPROVE CARE

492
00:19:48,930 --> 00:19:51,899
FOR THE LIFE LONG LIVING WITH

493
00:19:51,899 --> 00:19:52,600
BRAIN INJURY.

494
00:19:52,600 --> 00:19:55,803
WE ARE FORTUNATE IN 2020 TO

495
00:19:55,803 --> 00:20:00,141
RECEIVE FUNDING FOR NIDLR, TO

496
00:20:00,141 --> 00:20:01,642
CREATE A MODEL FOR PEOPLE WITH

497
00:20:01,642 --> 00:20:03,644
BRAIN INJURY TO LIVE WITH, LIVE

498
00:20:03,644 --> 00:20:04,545
WITH BRAIN INJURY.

499
00:20:04,545 --> 00:20:06,414
SO THE OVERALL GOAL OF THE GRANT

500
00:20:06,414 --> 00:20:08,916
WAS TO DEVELOP A CHRONIC DISEASE

501
00:20:08,916 --> 00:20:11,586
MODEL FOR BRAIN YOUR WITH

502
00:20:11,586 --> 00:20:13,688
DIVISION OF CREATING ACCESSIBLE

503
00:20:13,688 --> 00:20:15,389
AND INTEGRATED CONFIDENT AND

504
00:20:15,389 --> 00:20:16,457
PATIENT HAVED CHRONIC DISEASE

505
00:20:16,457 --> 00:20:18,159
MANAGEMENT FOR AN INDIVIDUAL

506
00:20:18,159 --> 00:20:20,861
WITH PERSISTING EFFECTS OF BRAIN

507
00:20:20,861 --> 00:20:21,095
INJURY.

508
00:20:21,095 --> 00:20:24,632
AND TO THE RIGHT, YOU SIMPLY SEE

509
00:20:24,632 --> 00:20:25,933
KIND OF THE STRUCTURE OF THE

510
00:20:25,933 --> 00:20:28,169
GRANT IS THAT FOR THE FIRST 12

511
00:20:28,169 --> 00:20:29,136
MONTHS WE REVIEWED THE

512
00:20:29,136 --> 00:20:30,938
LITERATURE AND TRIED TO LEARN

513
00:20:30,938 --> 00:20:34,275
FROM OTHER DISEASE PROCESSES IN

514
00:20:34,275 --> 00:20:40,915
REGARDS TO THE STRUCTURE, THE

515
00:20:40,915 --> 00:20:42,216
DIFFERENT CLINICAL ISSUES, AND

516
00:20:42,216 --> 00:20:45,820
REGARDS TO SELF-MANAGEMENT IN

517
00:20:45,820 --> 00:20:46,454
THIS AREA.

518
00:20:46,454 --> 00:20:48,889
SO WITHIN THE NEXT 18 MONTHS,

519
00:20:48,889 --> 00:20:50,992
TRYING TO REFINE THE MODEL THAT

520
00:20:50,992 --> 00:20:53,961
WE HAD ORIGINALLY PROPOSED AND

521
00:20:53,961 --> 00:20:56,397
THEN IN THIS LADDER PHASE, NOW,

522
00:20:56,397 --> 00:20:58,566
WE ARE CONDUCTING FEASIBILITY

523
00:20:58,566 --> 00:21:00,368
PROJECTS TO TEST OUT DIFFERENT

524
00:21:00,368 --> 00:21:02,803
PROJECTS, DIFFERENT ASPECTS OF

525
00:21:02,803 --> 00:21:06,774
THE MODEL AND THEN FROM THERE

526
00:21:06,774 --> 00:21:12,747
INTEGRATING THOSE FINDINGS INTO

527
00:21:12,747 --> 00:21:13,314
A FINAL MODEL.

528
00:21:13,314 --> 00:21:17,151
SO THIS IS WHAT WE'VE PROPOSED

529
00:21:17,151 --> 00:21:18,953
FOR OUR MODEL, SO 1 WE DECIDED

530
00:21:18,953 --> 00:21:20,388
THAT WE WOULD TART WITH A

531
00:21:20,388 --> 00:21:22,690
CHRONIC CARE MODEL THAT I SHOWED

532
00:21:22,690 --> 00:21:24,825
YOU EARLIER.

533
00:21:24,825 --> 00:21:27,094
AND THEN, IN TALKING WITH

534
00:21:27,094 --> 00:21:29,964
PEOPLE, WITH THE INJURY, IN

535
00:21:29,964 --> 00:21:31,999
PARTICULAR, AS WELL AS

536
00:21:31,999 --> 00:21:33,401
PROVIDERS, WE FELT LIKE IT'S

537
00:21:33,401 --> 00:21:37,271
VERY IMPORTANT TO ADD A PATIENT

538
00:21:37,271 --> 00:21:38,105
CENTERED APPROACH AND THAT IT

539
00:21:38,105 --> 00:21:42,376
NEEDED TO BE A MULTIDISCIPLINARY

540
00:21:42,376 --> 00:21:43,844
PROGRAM STRUCTURE AND INSTEAD OF

541
00:21:43,844 --> 00:21:45,613
CALLING IT A DELIVERY SYSTEM OR

542
00:21:45,613 --> 00:21:52,486
A CLINIC, WE DECIDED

543
00:21:52,486 --> 00:21:53,854
MULTIDISCIPLINARY PROGRAM

544
00:21:53,854 --> 00:21:54,588
THAT--I SAID MULTIDISCIPLINARY

545
00:21:54,588 --> 00:21:55,923
THAT THERE'S A LOT OF DIFFERENT

546
00:21:55,923 --> 00:21:57,058
EXPERTISE THAT WILL NEED TO BE

547
00:21:57,058 --> 00:21:57,825
AT THE TABLE.

548
00:21:57,825 --> 00:22:00,661
WE DECIDED TO FOCUS ON THE

549
00:22:00,661 --> 00:22:01,762
EXPERTISE RATHER THAN THERE ARE

550
00:22:01,762 --> 00:22:04,365
THE TYPES OF NEEDS RATHER THAN

551
00:22:04,365 --> 00:22:07,535
LABELS, SO, WE DECIDED BRAIN

552
00:22:07,535 --> 00:22:08,569
INJURY MEDICINE SPECIALISTS ARE

553
00:22:08,569 --> 00:22:11,405
AN IMPORTANT PIECE OF THIS AS

554
00:22:11,405 --> 00:22:13,708
ARE PEOPLE WHO HAVE EXPERTISE IN

555
00:22:13,708 --> 00:22:16,210
AFFECT BEHAVIOR AND COGNITION.

556
00:22:16,210 --> 00:22:19,246
THIS WOULD INCLUDE THE ABILITY

557
00:22:19,246 --> 00:22:23,718
TO ADAPT AND SUPPORT

558
00:22:23,718 --> 00:22:27,888
SELF-MANAGEMENT, EXPERTISE IN

559
00:22:27,888 --> 00:22:29,023
MOVEMENT AND EXERCISE, EXPERTISE

560
00:22:29,023 --> 00:22:31,659
WITH SOCIAL AND VOCATIONAL

561
00:22:31,659 --> 00:22:34,228
ENGAGEMENT AND COMMUNITY

562
00:22:34,228 --> 00:22:34,662
RESOURCE NAVIGATION.

563
00:22:34,662 --> 00:22:38,232
ALL OF THAT CREATING OUR

564
00:22:38,232 --> 00:22:44,171
SUPPORTIVE ENVIRONMENT AND ALSO,

565
00:22:44,171 --> 00:22:44,872
CARE COORDINATION.

566
00:22:44,872 --> 00:22:46,841
SO I MENTIONED THE IMPORTANCE OF

567
00:22:46,841 --> 00:22:48,442
RISK STRATIFICATION, SO THAT IS

568
00:22:48,442 --> 00:22:51,178
A KEY PIECE THAT WE'LL NEED TO

569
00:22:51,178 --> 00:22:54,381
FIGURE OUT, IS WHO NEEDS WHAT

570
00:22:54,381 --> 00:22:56,117
AND WE DECIDED THAT AT LEFT AT

571
00:22:56,117 --> 00:22:58,452
THIS POINT, WE THINK THAT THAT

572
00:22:58,452 --> 00:23:00,888
INTENSITY, THAT RISK WOULD BE

573
00:23:00,888 --> 00:23:04,391
BASED ON 3 COMPONENTS, MEDICAL

574
00:23:04,391 --> 00:23:05,693
COMPLEXITY, INDEPENDENT AND

575
00:23:05,693 --> 00:23:07,628
SELF-MANAGEMENT, SO 1'S ABILITY

576
00:23:07,628 --> 00:23:08,362
TO SELF-MANAGE WHETHER IT'S

577
00:23:08,362 --> 00:23:11,732
THEMSELVES OR WITH THE SUPPORT

578
00:23:11,732 --> 00:23:14,401
OF OTHERS, HELPING THEM AND

579
00:23:14,401 --> 00:23:15,903
LASTLY, THEIR COMMUNITY

580
00:23:15,903 --> 00:23:18,105
RESOURCES INCLUDING AN EMPHASIS

581
00:23:18,105 --> 00:23:22,409
ON THEIR SOCIAL DETERMINANTS OF

582
00:23:22,409 --> 00:23:22,643
HEALTH.

583
00:23:22,643 --> 00:23:25,980
AND THEN OF COURSE, PROBABLY THE

584
00:23:25,980 --> 00:23:27,148
HARDEST THING TO TACKLE IS

585
00:23:27,148 --> 00:23:29,416
FUNDING AND TRYING TO FIGURE OUT

586
00:23:29,416 --> 00:23:32,386
HOW THIS WILL BE FUNDED AND

587
00:23:32,386 --> 00:23:35,322
REALIZING THAT FEE FOR SERVICE

588
00:23:35,322 --> 00:23:36,924
ITSELF WILL NOT LIKELY DO THIS

589
00:23:36,924 --> 00:23:39,360
AND SO TIME TO EXPLORE DIFFERENT

590
00:23:39,360 --> 00:23:40,628
WAYS OF FUNDING.

591
00:23:40,628 --> 00:23:44,365
SO ALL OF THIS PUT TOGETHER, OUR

592
00:23:44,365 --> 00:23:46,834
VISION IS HAVE AN OPTIMALLY

593
00:23:46,834 --> 00:23:51,338
INFORMED AND ACTIVATED

594
00:23:51,338 --> 00:23:51,639
PARTICIPANT.

595
00:23:51,639 --> 00:23:55,209
OPTIMALLY INFORMED AND ACTIVE

596
00:23:55,209 --> 00:23:56,477
PARTIC PAINT SERVED BY A PRO

597
00:23:56,477 --> 00:23:57,778
ACTIVE TEAM.

598
00:23:57,778 --> 00:24:02,416
SO OUR CORE PRINCIPALS, PREPARE

599
00:24:02,416 --> 00:24:03,918
PROACTIVE PROVIDERS, INFORMED

600
00:24:03,918 --> 00:24:05,419
AND ACTIVATED AND SUPPORTIVE

601
00:24:05,419 --> 00:24:07,788
PEOPLE WITH TBI AND THEIR

602
00:24:07,788 --> 00:24:09,557
CAREGIVERS, ACTIVE COMMUNITIES

603
00:24:09,557 --> 00:24:10,724
AND PREPARE PROACTIVE COMMUNITY

604
00:24:10,724 --> 00:24:12,493
PARTNERS AND A PERSON CENTERED

605
00:24:12,493 --> 00:24:13,627
IN CULTURALLY HUMBLE APPROACH. 

606
00:24:13,627 --> 00:24:14,895
THIS PIECE ABOUT THE COMMUNITY

607
00:24:14,895 --> 00:24:16,397
IS A REAL OPPORTUNITY FOR PEOPLE

608
00:24:16,397 --> 00:24:17,698
WITH BRAIN INJURY THAT IS REALLY

609
00:24:17,698 --> 00:24:20,000
DIFFERENT THAN A LOT OF THE

610
00:24:20,000 --> 00:24:23,504
CHRONIC CARE MODELS BEFORE US.

611
00:24:23,504 --> 00:24:28,042
SO WE'VE COME UP WITH 9

612
00:24:28,042 --> 00:24:30,411
PRINCIPLES AND COMPONENTS,

613
00:24:30,411 --> 00:24:32,680
EDUCATION AND SUPPORT,

614
00:24:32,680 --> 00:24:35,583
IDENTIFYING AND TREATING

615
00:24:35,583 --> 00:24:38,118
HAZARDS, REMOVING HAZARDS ISSUES

616
00:24:38,118 --> 00:24:39,954
REDUCING POTENTIAL ANDROGEN

617
00:24:39,954 --> 00:24:41,989
ROUGH ATOMIENIC HARM,

618
00:24:41,989 --> 00:24:42,823
PRESCRIBING APPROPRIATE

619
00:24:42,823 --> 00:24:45,025
TREATMENTS, FACILITATING SOCIAL

620
00:24:45,025 --> 00:24:47,094
AND INTELLECTUAL ENGAGEMENT,

621
00:24:47,094 --> 00:24:48,929
ENCOURAGING HEALTHY BEHAVIORS,

622
00:24:48,929 --> 00:24:52,233
REVIEW OF COMORBID CONDITION

623
00:24:52,233 --> 00:24:54,401
ANDS MEDICATIONS, FACILITATING

624
00:24:54,401 --> 00:24:55,202
COMMUNICATION AND EVALUATING

625
00:24:55,202 --> 00:24:58,906
COMMUNITY BARRIERS AND

626
00:24:58,906 --> 00:24:59,240
OPPORTUNITIES.

627
00:24:59,240 --> 00:25:02,776
THE THOUGHT OF THIS WAS TAKING

628
00:25:02,776 --> 00:25:04,879
THE CHRONIC CARE MODEL WITH

629
00:25:04,879 --> 00:25:05,579
ADDING IN COLLABORATIVE

630
00:25:05,579 --> 00:25:07,081
APPROACHES AND THEN ADDING IN

631
00:25:07,081 --> 00:25:12,486
WHAT WE KNOW ABOUT BRAIN HEALTH.

632
00:25:12,486 --> 00:25:15,122
AND THERE'S A MOVEMENT IN

633
00:25:15,122 --> 00:25:18,192
MEDICINE AT THIS TIME, THE LIFE

634
00:25:18,192 --> 00:25:20,327
TILE MEDICINE WHICH MAPS ON TO

635
00:25:20,327 --> 00:25:22,296
BRAIN HEALTH AND SO CERTAINLY

636
00:25:22,296 --> 00:25:24,365
THOSE 6 PILLARS OF LIFESTYLE

637
00:25:24,365 --> 00:25:26,767
MEDICINE APPLY AND HAVE BEEN

638
00:25:26,767 --> 00:25:28,969
INTEGRATED INTO THIS MODEL.

639
00:25:28,969 --> 00:25:31,272
THOSE 6 PILLARS, NUTRITION,

640
00:25:31,272 --> 00:25:32,539
EXERCISE, SLEEP, STRESS MANAGE

641
00:25:32,539 --> 00:25:33,474
AM, RISKY SUBSTANCES AND

642
00:25:33,474 --> 00:25:35,409
RELATIONSHIPS, SO CAN YOU SEE

643
00:25:35,409 --> 00:25:37,511
HOW WE ARE INTEGRATING THAT.

644
00:25:37,511 --> 00:25:39,446
SO THE NEXT 9 SLIDES I WILL JUST

645
00:25:39,446 --> 00:25:46,820
TOUCH ON WHAT THESE 9 COMPONENTS

646
00:25:46,820 --> 00:25:47,054
INCLUDE.

647
00:25:47,054 --> 00:25:49,423
SO EDUCATION AND SUPPORT OF THE

648
00:25:49,423 --> 00:25:51,292
PARTICIPANT AND THEIR CAREGIVER,

649
00:25:51,292 --> 00:25:55,296
THERE'S A LOT THAT'S PACKED INTO

650
00:25:55,296 --> 00:25:56,964
THIS 1 COMPONENT, CERTAINLY ALL

651
00:25:56,964 --> 00:25:59,800
THE DIFFERENT REFERRALS THAT

652
00:25:59,800 --> 00:26:04,238
SOMEBODY NEEDS, INCLUDING

653
00:26:04,238 --> 00:26:05,139
RESOURCES, THERAPY SERVICES,

654
00:26:05,139 --> 00:26:06,607
SPESHIST, VERY IMPORTANT TO BE

655
00:26:06,607 --> 00:26:08,642
CONNECTED TO SUPPORT GROUPS,

656
00:26:08,642 --> 00:26:10,511
EDUCATION AND HAVING EDUCATIONAL

657
00:26:10,511 --> 00:26:12,813
MATERIALS THAT MAP ON TO THE

658
00:26:12,813 --> 00:26:15,416
DIFFERENT ASPECTS OF LIVING WITH

659
00:26:15,416 --> 00:26:16,717
BRAIN INJURY, AND HELPING PEOPLE

660
00:26:16,717 --> 00:26:21,388
HAVE THE EDUCATION THEY NEED TO

661
00:26:21,388 --> 00:26:21,889
OPTIMIZE THEIR OUTCOMES.

662
00:26:21,889 --> 00:26:23,123
AND ATTENTION TO THE CAREGIVER

663
00:26:23,123 --> 00:26:26,760
AND BEING ABLE TO MONITOR AND

664
00:26:26,760 --> 00:26:29,063
SUPPORT THE CAREGIVER IN THEIR

665
00:26:29,063 --> 00:26:30,931
EMOTIONAL AND PHYSICAL HEALTH,

666
00:26:30,931 --> 00:26:32,399
INFORMAL TELEPHONE SUPPORT AND

667
00:26:32,399 --> 00:26:34,802
THEN IN THIS COMPONENT IS WHERE

668
00:26:34,802 --> 00:26:37,471
WE WILL DIG INTO MAKING SURE

669
00:26:37,471 --> 00:26:40,374
THAT SELF-MANAGEMENT IS AN

670
00:26:40,374 --> 00:26:43,711
OPTION INN CLUING TRAINING FOR

671
00:26:43,711 --> 00:26:45,512
SELF-MANAGEMENT, A MANUEL

672
00:26:45,512 --> 00:26:48,415
CONSIDERING IF PEOPLE NEED

673
00:26:48,415 --> 00:26:49,149
COMPENSATORY STRATEGIES IN ABLE

674
00:26:49,149 --> 00:26:53,153
TO BE ABLE TO DO SELF-MANAGEMENT

675
00:26:53,153 --> 00:26:57,191
AND SKILLS EMPOWERMENT IN

676
00:26:57,191 --> 00:26:57,558
 ORDER

677
00:26:57,558 --> 00:26:59,460
TO DO SELF-MANAGE AM.

678
00:26:59,460 --> 00:27:03,864
THE SECOND IS TO IDENTIFY

679
00:27:03,864 --> 00:27:05,532
POTENTIAL HARMS AND REMOVING

680
00:27:05,532 --> 00:27:06,200
THOSE ARMS.

681
00:27:06,200 --> 00:27:08,836
SO XCHS ARE HELPING WITH STRESS

682
00:27:08,836 --> 00:27:12,072
MANAGE AM, DEPRESSION, ANXIETY,

683
00:27:12,072 --> 00:27:12,973
IRRITABILITY, ANGER, AGGRESSION,

684
00:27:12,973 --> 00:27:15,075
SOME OF THE HAZARDS THAT SOMEONE

685
00:27:15,075 --> 00:27:17,578
IS DEALING WITH AFTER BRAIN

686
00:27:17,578 --> 00:27:20,547
INJURY, CERTAINLY SUBSTANCE USE

687
00:27:20,547 --> 00:27:22,616
CAN BE AN ISSUE AN BRAIN INJURY,

688
00:27:22,616 --> 00:27:33,127
AND SO IS REDUCING THE NEED TO

689
00:27:33,694 --> 00:27:34,495
REDUCE FALL RISK.

690
00:27:34,495 --> 00:27:39,199
THE OTHER THING WE TALK ABOUT IS

691
00:27:39,199 --> 00:27:40,634
THAT WE'RE NOT CAUSING HARM.

692
00:27:40,634 --> 00:27:41,969
SO A REVIEW OF MEDICATIONS AND

693
00:27:41,969 --> 00:27:50,177
TREATMENTS TO TRY TO MINIMIZE

694
00:27:50,177 --> 00:27:52,012
IATROJENNIC HARM THROUGH

695
00:27:52,012 --> 00:27:52,312
MEDICATIONS.

696
00:27:52,312 --> 00:27:54,648
AND THEN 1 OF OUR STAKEHOLDERS

697
00:27:54,648 --> 00:28:01,588
POINTED OUT WE WANT TO AVOID

698
00:28:01,588 --> 00:28:04,124
HARM THROUGH GIVING

699
00:28:04,124 --> 00:28:06,427
MISINFORMATION, RIGHT?

700
00:28:06,427 --> 00:28:08,695
THROUGH HAVING POOR EXPECTATIONS

701
00:28:08,695 --> 00:28:10,431
OF WHAT COULD HAPPEN AND SO

702
00:28:10,431 --> 00:28:12,399
WE'RE MEN MYSELFING THE OUTCOME

703
00:28:12,399 --> 00:28:14,935
BECAUSE WE HAVE LOW

704
00:28:14,935 --> 00:28:17,271
EXPECTATIONS. 

705
00:28:17,271 --> 00:28:18,705
SO AVOIDING UNSUBSTANTIATED

706
00:28:18,705 --> 00:28:20,707
PESESIMISM ABOUT FUTURE

707
00:28:20,707 --> 00:28:23,844
OUTCOMES, WHILE ALSO HAVING

708
00:28:23,844 --> 00:28:24,778
REALISTIC AND APPROPRIATE

709
00:28:24,778 --> 00:28:25,312
INFORMATION.

710
00:28:25,312 --> 00:28:30,884
IT'S A FINE BALANCE.

711
00:28:30,884 --> 00:28:32,019
PREKRIEBING TBI APPROPRIATE

712
00:28:32,019 --> 00:28:33,153
TREATMENTS TO AUGMENT FUNCTION

713
00:28:33,153 --> 00:28:34,521
AND RECOVERY, THAT SOUNDS PRETTY

714
00:28:34,521 --> 00:28:37,157
OBVIOUS BUT AS I POINTED OUT,

715
00:28:37,157 --> 00:28:40,327
IT'S VERY COMMON TO ARE A LOT OF

716
00:28:40,327 --> 00:28:42,763
SERVICES UP FRONT AND THEN HAVE

717
00:28:42,763 --> 00:28:45,766
A LOW EXPECTATIONS ON WHAT'S

718
00:28:45,766 --> 00:28:46,433
NEEDED LATER.

719
00:28:46,433 --> 00:28:51,338
SO EANGZ TO PREKRIEBING

720
00:28:51,338 --> 00:28:52,272
APPROPRIATE TREATMENTS THAT

721
00:28:52,272 --> 00:28:53,006
ARENIED THROUGHOUT THE LIFE

722
00:28:53,006 --> 00:28:53,240
SPAN.

723
00:28:53,240 --> 00:28:54,541
THIS IS A VERY IMPORTANT ASPECT,

724
00:28:54,541 --> 00:28:57,845
THIS IS WHERE WE'RE REALLY

725
00:28:57,845 --> 00:29:00,047
STARTING TO PULL IN ASPECTS WE

726
00:29:00,047 --> 00:29:01,014
KNOW ABOUT BRAIN HEALTH.

727
00:29:01,014 --> 00:29:06,620
SO NUMBER 5 IS TO FACILITATE

728
00:29:06,620 --> 00:29:07,688
SOCIAL AND INTELLECTUAL ENGAGE

729
00:29:07,688 --> 00:29:07,921
AM.

730
00:29:07,921 --> 00:29:11,492
SO THE MODEL HAS US REVIEW THE

731
00:29:11,492 --> 00:29:13,227
EXTENT OF SOCIAL INTERACTIONS OF

732
00:29:13,227 --> 00:29:15,062
THE PARTICIPANT AND THEN REVIEW

733
00:29:15,062 --> 00:29:16,430
SOCIAL SUPPORTS AND THEN HELP

734
00:29:16,430 --> 00:29:20,634
DEVELOP A PLAN TO ENGAGE IN

735
00:29:20,634 --> 00:29:21,268
VALUED ACTIVITIES.

736
00:29:21,268 --> 00:29:22,669
SO OFTEN TIMES WE DON'T HAVE A

737
00:29:22,669 --> 00:29:27,841
SOLID PLAN IN PLACE WHEN SOMEONE

738
00:29:27,841 --> 00:29:28,642
LEAVES OUR CLINIC.

739
00:29:28,642 --> 00:29:30,944
ENCOURAGE HEALTHY BRAIN

740
00:29:30,944 --> 00:29:31,879
BEHAVIORS, THIS INCLUDES ALL

741
00:29:31,879 --> 00:29:35,149
SORTS OF DIFFERENT ASPECTS OF

742
00:29:35,149 --> 00:29:38,919
HEALTHY LIVING, INCLUDING SLEEP,

743
00:29:38,919 --> 00:29:42,589
TOBACCO USE, ALCOHOL, MARIJUANA,

744
00:29:42,589 --> 00:29:44,091
PHYSICAL EXERCISE, NUTRITION,

745
00:29:44,091 --> 00:29:46,059
PREVENTING REINJURY, WHICH IS A

746
00:29:46,059 --> 00:29:47,461
REALLY IMPORTANT PART FOR PEOPLE

747
00:29:47,461 --> 00:29:47,928
WITH BRAIN INJURY.

748
00:29:47,928 --> 00:29:50,998
WE REALIZE THIS IS A HUGE TASK

749
00:29:50,998 --> 00:29:52,866
AND CERTAINLY NOT ALL ADDRESSED

750
00:29:52,866 --> 00:29:56,036
IN 1 CLINIC, THIS WOULD REQUIRE

751
00:29:56,036 --> 00:29:58,672
FIRST OF ALL FINDING OUT WHERE

752
00:29:58,672 --> 00:30:01,875
SOMEONE HAS AWARENESS AND DESIRE

753
00:30:01,875 --> 00:30:04,778
AND HAS THE BEST OPPORTUNITY IN

754
00:30:04,778 --> 00:30:09,383
LAYING OUT A PLAN TO GET ON THIS

755
00:30:09,383 --> 00:30:11,251
ROAD TO IMPROVING BRAIN HEALTH

756
00:30:11,251 --> 00:30:15,289
THROUGH THESE ACTIVITIES.

757
00:30:15,289 --> 00:30:18,325
ALSO HOW DO WE MANAGE COMORBID

758
00:30:18,325 --> 00:30:22,829
HEALTH CONDITIONS, SO FIRST OF

759
00:30:22,829 --> 00:30:24,565
ALL IDENTIFYING AND SCREENING

760
00:30:24,565 --> 00:30:25,832
FOR COMORBID HEALTH CONDITIONS

761
00:30:25,832 --> 00:30:27,668
THAT WE KNOW ARE COMMON AND

762
00:30:27,668 --> 00:30:28,302
OFTEN ASSOCIATE WIDE BRAIN

763
00:30:28,302 --> 00:30:30,704
INJURY ASK THEN LAYING OUT,

764
00:30:30,704 --> 00:30:32,072
FIGURING OUT HOW MUCH THEY'RE

765
00:30:32,072 --> 00:30:33,040
IMPACTING THE PERSON WITH YOUR

766
00:30:33,040 --> 00:30:34,908
AND LAYING OUT A PLAN OF HOW

767
00:30:34,908 --> 00:30:36,076
THEY CAN BEST BE MANAGED.

768
00:30:36,076 --> 00:30:38,745
SOME OF THE ISSUES OF COMORBID

769
00:30:38,745 --> 00:30:40,681
CONDITIONS ARE BEST MANAGED BY

770
00:30:40,681 --> 00:30:42,849
PRIMARY CARE BUT MAY NEED SOME

771
00:30:42,849 --> 00:30:44,351
FACILITATION FROM A BRAIN INJURY

772
00:30:44,351 --> 00:30:46,553
SPECIALIST SO THEY CAN PERHAPS

773
00:30:46,553 --> 00:30:47,988
BE MORE SUCCESSFUL IN THEIR

774
00:30:47,988 --> 00:30:50,857
MANAGEMENT, SO FOR EXAMPLE,

775
00:30:50,857 --> 00:30:52,259
DIABETES, HYPERTENSION, HYPER

776
00:30:52,259 --> 00:30:54,361
LIPIDEMIA, WOULD BE ABOUTEST IN

777
00:30:54,361 --> 00:30:55,996
OUR OPINION, MANAGED BY THE

778
00:30:55,996 --> 00:30:57,564
PRIMARY CARE PHYSICIAN, BUT THEY

779
00:30:57,564 --> 00:30:59,299
MAY NOT HAVE A PRIMARY CARE

780
00:30:59,299 --> 00:31:03,870
PHYSICIAN AND THEY MAY NEED HELP

781
00:31:03,870 --> 00:31:05,572
FINDING 1 OR THEY MIGHT NEED

782
00:31:05,572 --> 00:31:06,673
HELP IN ADDRESSING COGNITIVE

783
00:31:06,673 --> 00:31:10,744
ISSUES SO THAT THEY CAN BE

784
00:31:10,744 --> 00:31:14,581
COMPLIANT AND MORE SUCCESSFUL

785
00:31:14,581 --> 00:31:17,718
WITH MANAGING THE PRESCRIBED

786
00:31:17,718 --> 00:31:17,918
CARE.

787
00:31:17,918 --> 00:31:20,354
OR SOME OF THESE MAY BE BEST

788
00:31:20,354 --> 00:31:20,954
ADDRESSED BY REHABILITATION

789
00:31:20,954 --> 00:31:24,691
PROFESSIONAL OR OTHER TYPE OF

790
00:31:24,691 --> 00:31:26,426
PHYSICIAN FOR EXAMPLE,

791
00:31:26,426 --> 00:31:29,463
NEUROENDOCRINE DISORDERS, AND

792
00:31:29,463 --> 00:31:31,999
OTHER EXAMPLES.

793
00:31:31,999 --> 00:31:33,700
FACILITATE COMMUNICATION,

794
00:31:33,700 --> 00:31:35,435
BELIEVING YESTERDAY AND AS THE

795
00:31:35,435 --> 00:31:37,137
DOCTORS POINTED OUT QUITE

796
00:31:37,137 --> 00:31:40,073
CLEARLY THE CHALLENGES OF

797
00:31:40,073 --> 00:31:41,341
COMMUNICATION FROM PROVIDER TO

798
00:31:41,341 --> 00:31:42,843
PROVIEDMANNER WHICH CAN THEN

799
00:31:42,843 --> 00:31:46,346
CREATE A MISSTEP IN SOMEONE'S

800
00:31:46,346 --> 00:31:49,716
OUTCOME AND THEIR CARE AND ALSO

801
00:31:49,716 --> 00:31:50,684
COMMUNICATION BETWEEN

802
00:31:50,684 --> 00:31:51,752
PARTICIPANT AND PROVIDER IS SO

803
00:31:51,752 --> 00:31:58,825
IMPORTANT EMPLOY EMPLOY AND

804
00:31:58,825 --> 00:31:59,626
LASTLY OFFERING COMMUNITY

805
00:31:59,626 --> 00:32:01,194
BARRIERS AND OPPORTUNITIES TO

806
00:32:01,194 --> 00:32:02,696
IMPROVE OUTCOMES SO THAT'S

807
00:32:02,696 --> 00:32:04,665
SCREENING FOR BASIC NEEDS

808
00:32:04,665 --> 00:32:06,900
INCLUDING SOCIAL DETERMINANTS OF

809
00:32:06,900 --> 00:32:07,567
HEALTH AND FACILITATING

810
00:32:07,567 --> 00:32:12,639
CONNECTIONS TO TRY OUR BEST TO

811
00:32:12,639 --> 00:32:13,240
RESOLVE THOSE ISSUES.

812
00:32:13,240 --> 00:32:19,112
SO TO SUM IT UP, THE BE HEALTHY

813
00:32:19,112 --> 00:32:19,880
PATH IS PERSON-CENTERED INTAKE

814
00:32:19,880 --> 00:32:26,153
SO THAT IS THE FIRST LAYER IN

815
00:32:26,153 --> 00:32:30,691
ENCOUNTERING THIS MODEL AND

816
00:32:30,691 --> 00:32:31,625
EVIDENCE INFORMED PROTOCOL

817
00:32:31,625 --> 00:32:34,094
GUIDED CARE, WE ARE WORKING ON

818
00:32:34,094 --> 00:32:37,064
DEFINING THOSE PROTOCOLS,

819
00:32:37,064 --> 00:32:39,333
PROACTIVE KREENING, COORDINATED

820
00:32:39,333 --> 00:32:41,368
BRAIN HEALTH AND LATE POST

821
00:32:41,368 --> 00:32:44,671
INJURY SERVICES AS NEEDED, A

822
00:32:44,671 --> 00:32:48,075
RISK BASED FOLLOW UP AND

823
00:32:48,075 --> 00:32:49,710
INFORMAL TELEPHONE SUPPORT, RISK

824
00:32:49,710 --> 00:32:51,912
INTENSITY ASSESS AM, REMEMBER, I

825
00:32:51,912 --> 00:32:56,283
MENTIONED THE SOCIAL

826
00:32:56,283 --> 00:33:00,620
DETERMINANTS OF HEALTH, THE CASE

827
00:33:00,620 --> 00:33:01,621
MANAGEMENT, THE SUPPORTED MANAGE

828
00:33:01,621 --> 00:33:02,823
AM, THE DISEASE MANAGEMENT AND

829
00:33:02,823 --> 00:33:04,691
CASE MANAGE AM AND THAT WE WOULD

830
00:33:04,691 --> 00:33:06,793
BE DETERMINING THAT BASED ON

831
00:33:06,793 --> 00:33:09,730
SOCIAL DETERMINANTS OF HEALTH,

832
00:33:09,730 --> 00:33:12,933
MEDICAL COMPLEXITY AND ABILITY

833
00:33:12,933 --> 00:33:16,236
TO SELF-MANAGE.

834
00:33:16,236 --> 00:33:17,604
SYSTEMIC COMPREHENSIVE

835
00:33:17,604 --> 00:33:18,205
EDUCATION, SUPPORTED

836
00:33:18,205 --> 00:33:20,040
SELF-MANAGEMENT AND A CASE

837
00:33:20,040 --> 00:33:22,075
MANAGEMENT AND RESOURCE

838
00:33:22,075 --> 00:33:23,343
FACILITATION TO HELP PEOPLE

839
00:33:23,343 --> 00:33:27,748
NAVIGATE THE SYSTEM AND THE

840
00:33:27,748 --> 00:33:28,248
COMMUNITY BARRIERS.

841
00:33:28,248 --> 00:33:30,417
SO AT THIS POINT WE ARE AT THE

842
00:33:30,417 --> 00:33:32,152
POINT OF CREATING OR

843
00:33:32,152 --> 00:33:34,221
IMPLEMENTING THESE FEASIBLE

844
00:33:34,221 --> 00:33:34,488
PROJECTS.

845
00:33:34,488 --> 00:33:36,590
WE HAVE 13 FEASIBILITY PROJECTS,

846
00:33:36,590 --> 00:33:39,092
CLINICALLY, WE ARE DEVELOPING

847
00:33:39,092 --> 00:33:40,327
SOME CLINICAL CARE PROTOCOLS, WE

848
00:33:40,327 --> 00:33:42,629
ARE IN THE PROCESS OF CREATING A

849
00:33:42,629 --> 00:33:44,598
CASE DEFINITION FOR CHRONIC

850
00:33:44,598 --> 00:33:46,032
BRAIN INJURY.

851
00:33:46,032 --> 00:33:49,703
WE ARE TESTING OUT SOME EXISTING

852
00:33:49,703 --> 00:33:51,071
SELF-MANAGEMENT APPROACHES FOR

853
00:33:51,071 --> 00:33:52,439
CHRONIC DECS THAT THEY ALREADY

854
00:33:52,439 --> 00:33:55,575
EXIST BUT WE'RE NOW HAVING

855
00:33:55,575 --> 00:33:59,679
PEOPLE WITH BRAIN INJURY ENGAGED

856
00:33:59,679 --> 00:34:01,281
IN THE STANFORD CHRONIC DEC

857
00:34:01,281 --> 00:34:02,749
SELF-MANAGEMENT PROGRAM AND TO

858
00:34:02,749 --> 00:34:07,521
SEE WHAT KIND OF BARRIERS AND

859
00:34:07,521 --> 00:34:08,121
EXPERIENCE THEY HAVE.

860
00:34:08,121 --> 00:34:11,892
WE ARE LOOKING AT WHAT IT TAKES

861
00:34:11,892 --> 00:34:13,627
TO PERFORM SELF-MANAGEMENT AND

862
00:34:13,627 --> 00:34:15,362
TESTING OUT A MOBILE APP TO SEE

863
00:34:15,362 --> 00:34:25,172
IF THAT MIGHT HELP THEM WITH

864
00:34:25,172 --> 00:34:25,605
SELF-MONITORING.

865
00:34:25,605 --> 00:34:26,606
STRUCTURALLY WE ARE DOING A

866
00:34:26,606 --> 00:34:28,442
SURVEY TO FIND OUT WHAT KIND OF

867
00:34:28,442 --> 00:34:32,045
CARE PEOPLE HAVE IN PLACE, DO

868
00:34:32,045 --> 00:34:33,580
THEY HAVE A PRIMARY CARE

869
00:34:33,580 --> 00:34:34,848
SPECIALIST, OR A BRAIN INJURY

870
00:34:34,848 --> 00:34:36,583
SPECIALIST AND WHY OR WHY NOT?

871
00:34:36,583 --> 00:34:40,253
WHY DO THEY NOT HAVE A BRAIN

872
00:34:40,253 --> 00:34:41,087
INJURY CARE SPECIALIST?

873
00:34:41,087 --> 00:34:43,690
WHY DON'T THEY HAVE A PRIMARY

874
00:34:43,690 --> 00:34:46,226
CARE SPECIALIST SO WE CAN

875
00:34:46,226 --> 00:34:46,726
ANALYZE THOSE OPTIONS.

876
00:34:46,726 --> 00:34:48,895
SO WE ARE ANALYZING DATA FROM

877
00:34:48,895 --> 00:34:50,730
THE VA TO LEARN MORE ABOUT THE

878
00:34:50,730 --> 00:34:55,168
SUCCESSES THE VA HAS HAD IN

879
00:34:55,168 --> 00:34:57,370
THEIR IMPLEMENTATION OF VERY

880
00:34:57,370 --> 00:35:03,410
INTENSE CONTINUITY OF TBI CARE

881
00:35:03,410 --> 00:35:04,478
COMBINED WITH SPECIALTY CARE.

882
00:35:04,478 --> 00:35:07,481
WE ARE USING DATA FROM A PC ORI

883
00:35:07,481 --> 00:35:08,648
STUDY CALLED THE BRIGHT STUDY,

884
00:35:08,648 --> 00:35:11,384
TO LOCK AT SOCIAL DETERMINANTS

885
00:35:11,384 --> 00:35:13,386
OF HEALTH ON HEALTHCARE

886
00:35:13,386 --> 00:35:16,223
UTILIZATION IN THE FIRST 12

887
00:35:16,223 --> 00:35:17,491
MONTHS POST INJURY AND WE'RE

888
00:35:17,491 --> 00:35:18,825
ALSO USING THE BRIGHT STUDY TO

889
00:35:18,825 --> 00:35:21,628
LOOK AT RESOURCES THAT PEOPLE

890
00:35:21,628 --> 00:35:24,064
HAVE USED AND THEIR ACCESS TO

891
00:35:24,064 --> 00:35:28,301
THOSE RESOURCES IN

892
00:35:28,301 --> 00:35:28,735
URBANNIVERSEUS RURAL

893
00:35:28,735 --> 00:35:29,035
POPULATIONS.

894
00:35:29,035 --> 00:35:31,771
AND WE ARE DOING--SCOPING REVIEW

895
00:35:31,771 --> 00:35:33,406
OF THE PREPARE TOOL, THE PREPARE

896
00:35:33,406 --> 00:35:35,642
TOOL IS THE SOCIAL DETERMINANTS

897
00:35:35,642 --> 00:35:37,811
OF HEALTH SURVEY, AND SO WE'RE

898
00:35:37,811 --> 00:35:39,346
LOOKING AT JUST WHAT THE

899
00:35:39,346 --> 00:35:41,414
LITERATURE SHOWS TO SUPPORT THAT

900
00:35:41,414 --> 00:35:43,016
TO SEE IF WE CAN USE THAT AS

901
00:35:43,016 --> 00:35:51,024
PART OF OUR RISK ARK

902
00:35:51,024 --> 00:35:51,458
ASSESSESMENT.

903
00:35:51,458 --> 00:35:56,062
WE NASHA LED BY REBECCA WOLFKILL

904
00:35:56,062 --> 00:35:59,699
IS DOING THE ARK ASSESSESMENT OF

905
00:35:59,699 --> 00:36:00,867
STATE PARTNERSHIPS TO ASSESS

906
00:36:00,867 --> 00:36:01,701
THEIR PARTICIPANTS THAT COME IN

907
00:36:01,701 --> 00:36:05,472
SO WE CAN LEARN FROM FROM THAT,

908
00:36:05,472 --> 00:36:06,640
THEIR INTAKE ASSESSMENTS AND SEE

909
00:36:06,640 --> 00:36:10,710
IF THAT WILL HELP US AND WE HAVE

910
00:36:10,710 --> 00:36:12,712
A MEDICAID MANAGED CARE ORGANIZE

911
00:36:12,712 --> 00:36:14,014
THAT'S WORKING WITH US TO SEE,

912
00:36:14,014 --> 00:36:17,551
WE'RE LOOKING AT THEIR DATA ON

913
00:36:17,551 --> 00:36:20,053
IT SEE THE NUMBERS OF PEOPLE

914
00:36:20,053 --> 00:36:22,122
WITH BRAIN INJURY AND LOOKING AT

915
00:36:22,122 --> 00:36:23,957
TRYING TO HELP IMPLEMENT

916
00:36:23,957 --> 00:36:27,093
SCREENING AND SEEING WHAT THE

917
00:36:27,093 --> 00:36:29,396
FINANCIAL SMLICATIONS WOULD BE

918
00:36:29,396 --> 00:36:37,237
AND IMPLEMENTING SUCH A MODEL.

919
00:36:37,237 --> 00:36:38,772
SO THAT BRINGS US TO THE NEXT

920
00:36:38,772 --> 00:36:44,110
STEPS THAT WE'RE LOOKING FORWARD

921
00:36:44,110 --> 00:36:44,878
TOWARDS, IMPLEMENTING AND

922
00:36:44,878 --> 00:36:46,479
SUSTAINABILITY, WE HAVE A LOT TO

923
00:36:46,479 --> 00:36:48,114
DO TO IDENTIFY SOME OF THE

924
00:36:48,114 --> 00:36:50,984
OBSTACLES AND SOLUTIONS FOR

925
00:36:50,984 --> 00:36:51,618
HEALTHCARE REIMBURSEMENT, THERE

926
00:36:51,618 --> 00:36:55,355
ARE A LOT OF BARRIERS WE NEED TO

927
00:36:55,355 --> 00:36:57,857
IDENTIFY AND FIGURE OUT

928
00:36:57,857 --> 00:36:59,326
SOLUTIONS FOR AND INTEGRATION

929
00:36:59,326 --> 00:37:01,328
BETWEEN THE MEDICAL COMMUNITY

930
00:37:01,328 --> 00:37:05,532
AND THAT COMMUNITY PIECE THAT IS

931
00:37:05,532 --> 00:37:08,034
SO OFTEN NEGLECTED CONTINUING TO

932
00:37:08,034 --> 00:37:09,536
ENGAGE STAKEHOLDERS AND REALLY

933
00:37:09,536 --> 00:37:11,071
USE THE STAKEHOLDER ANDS HELPING

934
00:37:11,071 --> 00:37:14,374
WITH THE ADVOCACY FOR THIS.

935
00:37:14,374 --> 00:37:16,943
FURTHER DEVELOPMENT OF PROTOCOL

936
00:37:16,943 --> 00:37:17,911
ANDS PROCEDURES TO MAKE THIS

937
00:37:17,911 --> 00:37:19,846
HAPPEN AND OF COURSE WITH ANY

938
00:37:19,846 --> 00:37:23,917
GOOD RESEARCH, YOU NEED MORE

939
00:37:23,917 --> 00:37:25,652
FUNDING TO PURSUE THE PLANNING

940
00:37:25,652 --> 00:37:26,586
OF FUNDING THAT'S NEEDED AND

941
00:37:26,586 --> 00:37:29,222
WE'RE RYING TO FIGURE OUT, AT

942
00:37:29,222 --> 00:37:32,125
FIRST WE THOUGHT IT WILL WILL BE

943
00:37:32,125 --> 00:37:33,159
A PRAGMATIC CLINICAL TRIAL AND

944
00:37:33,159 --> 00:37:34,861
WE'RE REALIZING THAT A WAY AHEAD

945
00:37:34,861 --> 00:37:36,129
FOR US, WE REALLY HAVE MORE THAN

946
00:37:36,129 --> 00:37:40,100
WE NEED TO DO TO ACTUALLY

947
00:37:40,100 --> 00:37:42,335
DEVELOP THIS, SO, TRYING TO

948
00:37:42,335 --> 00:37:44,204
FIGURE OUT THE BEST WAY FORWARD

949
00:37:44,204 --> 00:37:46,740
TO KEEP THIS WORK GOING.

950
00:37:46,740 --> 00:37:48,241
SO IN SUMMARY, CHRONIC CARE

951
00:37:48,241 --> 00:37:51,978
MODELS CERTAINLY HAVE BEEN FOUND

952
00:37:51,978 --> 00:37:55,615
TO BE SUCCESSFUL IN HELPING

953
00:37:55,615 --> 00:37:58,518
OTHER DISEASES AT LOWER COST AND

954
00:37:58,518 --> 00:37:59,786
LOWER THE IMPACT, NEG5 IMPACTS,

955
00:37:59,786 --> 00:38:01,554
AND WE WOULD LOAMACYIC TO DO THE

956
00:38:01,554 --> 00:38:03,289
SAME THING FOR BRINE INJURY.

957
00:38:03,289 --> 00:38:07,027
THERE'S A LOT WE NEED TO DO TO

958
00:38:07,027 --> 00:38:14,200
MAKE THAT HAPPEN IN  ADDITION TO

959
00:38:14,200 --> 00:38:15,068
THE SUSTAINABILITY ISSUES WE

960
00:38:15,068 --> 00:38:18,838
NEED TO ADDRESS, WE ALSO NEAD TO

961
00:38:18,838 --> 00:38:22,909
IDENTIFY HOW TO RISK-STRATIFY

962
00:38:22,909 --> 00:38:24,077
AND HOW TO--1 OF THE OTHER

963
00:38:24,077 --> 00:38:24,978
THINGS THAT IS REALLY IMPORTANT

964
00:38:24,978 --> 00:38:29,449
IN OUR OPINION IS TO GET BRAIN

965
00:38:29,449 --> 00:38:32,986
INJURY TRULY RECOGNIZED AS A

966
00:38:32,986 --> 00:38:35,555
CHRONIC CONDITION, SUCH FOR

967
00:38:35,555 --> 00:38:37,490
EXAMPLE, THAT CMS RECOGNIZES IT

968
00:38:37,490 --> 00:38:40,760
IS A CHRONIC CONDITION TO BE

969
00:38:40,760 --> 00:38:46,066
ABLE TO TAP INTO ACCESS TO DATA

970
00:38:46,066 --> 00:38:48,702
AND SERVICES AND ALSO FOR

971
00:38:48,702 --> 00:38:49,035
SURVEILLANCE.

972
00:38:49,035 --> 00:38:53,273
ALSO THERE'S A LOT OF TALK USING

973
00:38:53,273 --> 00:38:55,542
LEARNING HEALTH SYSTEMS TO HELP

974
00:38:55,542 --> 00:39:00,413
US USE DATA AND INTEGRATED CARE,

975
00:39:00,413 --> 00:39:02,949
AND IN FACT, AT THE NATIONAL

976
00:39:02,949 --> 00:39:04,451
ACADEMY OF SCIENCE ROADMAP

977
00:39:04,451 --> 00:39:06,219
POINTS OUT THE IMPORTANCE OF A

978
00:39:06,219 --> 00:39:07,821
LEARNING HEALTH SYSTEM FOR THE

979
00:39:07,821 --> 00:39:10,523
FUTURE OF BRAIN INJURY, AND THAT

980
00:39:10,523 --> 00:39:11,958
WOULD BE IMPORTANT HERE FOR THIS

981
00:39:11,958 --> 00:39:22,502
CHRONIC CARE MANAGE AM AS WELL.

982
00:39:24,504 --> 00:39:25,839
AND FURTHERING THESE CONNECTIONS

983
00:39:25,839 --> 00:39:27,340
TO RESOURCES IN THE COMMUNITY

984
00:39:27,340 --> 00:39:28,842
AND LASTLY THERE'S A VERY

985
00:39:28,842 --> 00:39:30,043
SHORTAGE OF BRAIN INJURY

986
00:39:30,043 --> 00:39:31,077
PROFESSIONALS, THERE'S A

987
00:39:31,077 --> 00:39:34,781
SHORTAGE OF HELT CARE

988
00:39:34,781 --> 00:39:36,616
PROFESSIONALS PERIOD ACROSS THE

989
00:39:36,616 --> 00:39:37,784
DIFFERENT DISCIPLINES AND IT IS

990
00:39:37,784 --> 00:39:39,519
DEFINITELY THE CASE IN BRAIN

991
00:39:39,519 --> 00:39:39,753
INJURY.

992
00:39:39,753 --> 00:39:43,189
SO NEEDING TO BUILD THAT

993
00:39:43,189 --> 00:39:49,896
CAPACITY. 

994
00:39:49,896 --> 00:39:51,631
THANK YOU.

995
00:39:51,631 --> 00:39:53,333
>> THANKS SO MUCH, FLORA.

996
00:39:53,333 --> 00:39:55,068
QUESTIONS FROM EITHER THE

997
00:39:55,068 --> 00:39:56,903
INDIVIDUALS WHO ARE REMOTE OR

998
00:39:56,903 --> 00:40:02,876
AROUND THE TABLE?

999
00:40:02,876 --> 00:40:03,343
NI'LL TAKE IT.

1000
00:40:03,343 --> 00:40:08,782
THANK YOU FOR A VERY, VERY NICE

1001
00:40:08,782 --> 00:40:10,016
PRESENTATION.

1002
00:40:10,016 --> 00:40:15,789
YOU KNOW THERE'S SOME DATA TO

1003
00:40:15,789 --> 00:40:17,724
SUGGIEST THAT DANCE AND MUSIC

1004
00:40:17,724 --> 00:40:19,459
CAN BE NOT ONLY A FORM OF

1005
00:40:19,459 --> 00:40:23,997
TREATMENT BUT IT ALSO IT CAN

1006
00:40:23,997 --> 00:40:27,600
PROMOTE ENGAGEMENT FOR BEHAVIORS

1007
00:40:27,600 --> 00:40:29,869
AND MIGHT BE A FACTOR HERE AND I

1008
00:40:29,869 --> 00:40:32,071
WONDER WHAT ARE YOUR THOUGHTS ON

1009
00:40:32,071 --> 00:40:39,412
MUSIC AND DANCE AS A PART OF THE

1010
00:40:39,412 --> 00:40:40,213
PROCESS?

1011
00:40:40,213 --> 00:40:43,550
>> YEAH, AND THERE IS A
LOT OF

1012
00:40:43,550 --> 00:40:47,921
RESEARCH ON MUSIC AND DANCE AND

1013
00:40:47,921 --> 00:40:48,555
VARIOUS DIFFERENT HEALTH

1014
00:40:48,555 --> 00:40:49,789
CONDITIONS AND I DON'T

1015
00:40:49,789 --> 00:40:52,826
NECESSARILY KNOW THE LITERATURE,

1016
00:40:52,826 --> 00:40:56,462
BUT CERTAINLY, I THINK THAT NOT

1017
00:40:56,462 --> 00:40:58,198
ONLY MAY IT TAP INTO DIFFERENT

1018
00:40:58,198 --> 00:40:59,866
BENEFITS BUT IT ALSO TAPS INTO A

1019
00:40:59,866 --> 00:41:01,601
LOT OF THESE BRAIN HEALTH,

1020
00:41:01,601 --> 00:41:03,203
RIGHT?

1021
00:41:03,203 --> 00:41:05,872
WE MENTIONED MOVEMENT, EXERCISE,

1022
00:41:05,872 --> 00:41:08,908
SOCIAL ENGAGEMENT, SO I THINK IT

1023
00:41:08,908 --> 00:41:11,344
WOULD BE AN EXCELLENT MEANS OF

1024
00:41:11,344 --> 00:41:16,516
TAPPING BO THE ENGAGEMENT THAT

1025
00:41:16,516 --> 00:41:18,051
WE MENTIONED.

1026
00:41:18,051 --> 00:41:19,853
>> THERE'S AN INCOMING
MEETING

1027
00:41:19,853 --> 00:41:21,754
THIS MONTH ON THIS TOPIC AND WE

1028
00:41:21,754 --> 00:41:24,324
WOULD ENCOURAGE YOU TO

1029
00:41:24,324 --> 00:41:24,657
PARTICIPATE. 

1030
00:41:24,657 --> 00:41:27,927
>> OTHER THOUGHTS IN
THOUGHTS?

1031
00:41:27,927 --> 00:41:30,230
>> FLORA, YOU USED THE
TERM

1032
00:41:30,230 --> 00:41:31,631
ACTIVATED QUITE A FEW TIMES CAN

1033
00:41:31,631 --> 00:41:32,866
I GET A BETTER DEFINITION OF

1034
00:41:32,866 --> 00:41:36,502
THAT, I WANT TO MAKE SUREIME

1035
00:41:36,502 --> 00:41:40,907
UNDERSTANDING THAT RIGHT.

1036
00:41:40,907 --> 00:41:46,946
>> YEAH, SO WE DID. 

1037
00:41:46,946 --> 00:41:50,216
SO ACTIVATED PROFESSIONALS THAT

1038
00:41:50,216 --> 00:41:51,517
WE ARE AWARE, THAT WE KNOW

1039
00:41:51,517 --> 00:41:53,086
WHAT'S IN FRONT OF US SO THAT WE

1040
00:41:53,086 --> 00:41:56,623
CAN RECOGNIZE IT AND THAT WE'RE

1041
00:41:56,623 --> 00:41:57,924
READY TO IDENTIFY AND TREAT

1042
00:41:57,924 --> 00:41:59,859
WHAT'S IN FRONT OF US AND THEN

1043
00:41:59,859 --> 00:42:02,528
I'LL USE THE TERM ACTIVATED FOR

1044
00:42:02,528 --> 00:42:07,600
PARTICIPANTS IN DOING

1045
00:42:07,600 --> 00:42:09,068
SELF-MANAGEMENT.

1046
00:42:09,068 --> 00:42:10,236
THEY NEED TO, BEING ABLE TO KIND

1047
00:42:10,236 --> 00:42:14,641
OF LAY OUT THE STORY FOR THEM

1048
00:42:14,641 --> 00:42:16,276
AND ENGAGE THEM SUCH THAT THEY

1049
00:42:16,276 --> 00:42:18,578
REALIZE WHAT HAY CAN BE WORKING

1050
00:42:18,578 --> 00:42:29,055
ON AND HAVING THEM READY FOR

1051
00:42:31,591 --> 00:42:32,292
CHANGE.

1052
00:42:32,292 --> 00:42:33,459
>> YEAH, THIS SEEMS
REMINISCENT

1053
00:42:33,459 --> 00:42:36,429
OF A LOT OF OTHER CONDITIONS WE

1054
00:42:36,429 --> 00:42:38,364
DEAL WITH WHERE OUR HEALTHCARE

1055
00:42:38,364 --> 00:42:40,033
SYSTEM IS SO FRONT LOADED FOR

1056
00:42:40,033 --> 00:42:41,768
THE ACUTE AND UNDERVALUES THE

1057
00:42:41,768 --> 00:42:43,803
NEED FOR SUPPORT INTO THE

1058
00:42:43,803 --> 00:42:45,838
CHRONIC PHASE BECAUSE PEOPLE

1059
00:42:45,838 --> 00:42:48,775
HAVE SO MANY OFFRAMPS AND YOU

1060
00:42:48,775 --> 00:42:49,909
KNOW OUR HEALTHCARE SYSTEM

1061
00:42:49,909 --> 00:42:50,743
DOESN'T ALWAYS APPRECIATE THE

1062
00:42:50,743 --> 00:42:52,478
IMPORTANCE OF THAT INVESTMENT

1063
00:42:52,478 --> 00:42:56,783
AND ON TOP OF THAT YOU HAVE

1064
00:42:56,783 --> 00:42:59,285
PEOPLE WHOSE VERY ABILITY TO

1065
00:42:59,285 --> 00:42:59,852
ADVOCATE FOR THEMSELVES

1066
00:42:59,852 --> 00:43:01,054
EXECUTIVE FUNCTION CAN OFTEN

1067
00:43:01,054 --> 00:43:04,824
BEING COMPROMISED AS PART OF

1068
00:43:04,824 --> 00:43:07,593
THEIR HEAD  INJURY.

1069
00:43:07,593 --> 00:43:09,195
SO I'M JUST THINKING ABOUT WHEN

1070
00:43:09,195 --> 00:43:10,730
YOU FIRST HAVE MACHINE YOU'RE

1071
00:43:10,730 --> 00:43:11,998
DEALING WITH, A FAMILY, A

1072
00:43:11,998 --> 00:43:14,767
PERSON, HOW WELL CAN YOU PREDICT

1073
00:43:14,767 --> 00:43:16,035
THEIR TRAJECTORY AND SET THEM

1074
00:43:16,035 --> 00:43:19,539
OFF ON THE CORRECT COURSE OR HOW

1075
00:43:19,539 --> 00:43:20,606
MUCH DOES THE THING SURPRISE YOU

1076
00:43:20,606 --> 00:43:22,041
IN THE CLINIC IN TERMS OF THE

1077
00:43:22,041 --> 00:43:23,910
NEED AND SUPPORT FOR PEOPLE?

1078
00:43:23,910 --> 00:43:24,844
BECAUSE IT SEEMS LIKE IT'S SO

1079
00:43:24,844 --> 00:43:28,848
IMPORTANT TO GET THEM TO HAVE

1080
00:43:28,848 --> 00:43:29,949
THAT--YOU KNOW TO ADVOCATE FOR

1081
00:43:29,949 --> 00:43:31,217
THEM AND GET THAT SUPPORT IN THE

1082
00:43:31,217 --> 00:43:32,518
FAMILY AND THE COMMUNITY TO HELP

1083
00:43:32,518 --> 00:43:36,155
THEM NAVIGATE THE SYSTEM WHEN

1084
00:43:36,155 --> 00:43:38,424
THEY'RE VARIABILITY TO ADVOCATE

1085
00:43:38,424 --> 00:43:39,359
IS COMPROMISED.

1086
00:43:39,359 --> 00:43:42,428
>> EXCELLENT POINT AND WE
REALLY

1087
00:43:42,428 --> 00:43:43,730
CAN'T PREDICT THAT OR WE HAVEN'T

1088
00:43:43,730 --> 00:43:45,498
BEEN GOOD AT PREDICTING IT.

1089
00:43:45,498 --> 00:43:49,002
I THINK OFTEN TIMES WHETHER IT'S

1090
00:43:49,002 --> 00:43:51,804
A LACK OF RESOURCES OR A LACK OF

1091
00:43:51,804 --> 00:43:55,375
PREDICTION, PEOPLE LOOK GOOD,

1092
00:43:55,375 --> 00:43:56,876
AND THEY'RE KIND OF JUST SENT

1093
00:43:56,876 --> 00:43:59,612
ALONG THEIR WAY AND MAYBE EVEN

1094
00:43:59,612 --> 00:44:01,981
PEOPLE WITH THE INJURY MAY NOT

1095
00:44:01,981 --> 00:44:03,049
REALIZE, THEY MAY NOT REALIZE

1096
00:44:03,049 --> 00:44:04,317
THAT THEY NEED THAT INFORMATION

1097
00:44:04,317 --> 00:44:06,085
AND SO YOU MAY BE PROVIDING

1098
00:44:06,085 --> 00:44:07,487
INFORMATION BUT NOT AT THE RIGHT

1099
00:44:07,487 --> 00:44:07,687
TIME.

1100
00:44:07,687 --> 00:44:09,355
SO A LOT OF PEOPLE ARE KIND OF

1101
00:44:09,355 --> 00:44:11,691
LIKE, YOU ARE DOING WELL, YOU

1102
00:44:11,691 --> 00:44:12,825
DON'T NEED ANYTHING ELSE AND

1103
00:44:12,825 --> 00:44:15,595
THEN AT THE SAME TIME, SO MANY

1104
00:44:15,595 --> 00:44:17,830
OTHERS ARE GIVEN A PROGNOSEIS

1105
00:44:17,830 --> 00:44:23,403
THAT THERE'S NOTHING WE CAN DO

1106
00:44:23,403 --> 00:44:25,238
AND THEN, LIMITED INFORMATION

1107
00:44:25,238 --> 00:44:26,539
AND RESOURCES FOR THOSE

1108
00:44:26,539 --> 00:44:27,673
INDIVIDUALS AS WELL.

1109
00:44:27,673 --> 00:44:29,776
SO WE ARE REALLY NOT GOOD AT

1110
00:44:29,776 --> 00:44:30,743
PREDICTING AND WHAT WE REALLY

1111
00:44:30,743 --> 00:44:35,782
NEED TO BE DOING IS GIVING AN

1112
00:44:35,782 --> 00:44:36,849
ONRAMP FOR EVERYONE SUCH THAT

1113
00:44:36,849 --> 00:44:41,454
PEOPLE CAN HAVE THE FOLLOW UP

1114
00:44:41,454 --> 00:44:42,855
WHEN THEY'RE READY AND BEING

1115
00:44:42,855 --> 00:44:44,057
NEEDED AND WHEN THEY'RE ABLE TO

1116
00:44:44,057 --> 00:44:48,895
RECOGNIZE WHAT THEY NEED.

1117
00:44:48,895 --> 00:44:53,866
AND LUCKILY A LOT OF WORK FROM

1118
00:44:53,866 --> 00:44:56,636
THE NASEM FORUM IS MAPPING ON TO

1119
00:44:56,636 --> 00:44:57,804
THIS AS WELL.

1120
00:44:57,804 --> 00:45:00,306
>> HI, FLORA.

1121
00:45:00,306 --> 00:45:02,208
THANKS SO--THIS IS GREAT AND A

1122
00:45:02,208 --> 00:45:05,344
LOT OF TERRITORY THAT YOU'RE

1123
00:45:05,344 --> 00:45:07,113
COVERING AND IF I UNDERSTOOD

1124
00:45:07,113 --> 00:45:10,917
CORRECTLY, SO THIS IS THE FOLKS

1125
00:45:10,917 --> 00:45:12,952
WHO HAVE UNFORTUNATELY

1126
00:45:12,952 --> 00:45:14,587
EXPERIENCED NEUROTRAUMA, BRAIN

1127
00:45:14,587 --> 00:45:15,888
TRAUMA AT WHATEVER AGE IN THEIR

1128
00:45:15,888 --> 00:45:20,860
LIFE, SO I'M THINKING ABOUT THE

1129
00:45:20,860 --> 00:45:23,229
YOUNGER POPULATIONS, SCHOOL

1130
00:45:23,229 --> 00:45:25,932
AGED, COLLEGE AGE, HAVE YOU

1131
00:45:25,932 --> 00:45:27,767
THOUGHT ABOUT THAT IDEA OF

1132
00:45:27,767 --> 00:45:29,135
STRATIFYING OR SORT OF A LIST OF

1133
00:45:29,135 --> 00:45:33,306
WHO THE PARTNERS WOULD BE THAT

1134
00:45:33,306 --> 00:45:37,310
CAN ASSIST IN THE CARE, THE

1135
00:45:37,310 --> 00:45:39,679
DEVELOPMENT, THE NEEDS OF FOLKS,

1136
00:45:39,679 --> 00:45:42,215
YOU KNOW WITHIN A SCHOOL SYSTEM

1137
00:45:42,215 --> 00:45:44,917
OR WITHIN A COLLEGE COMMUNITY,

1138
00:45:44,917 --> 00:45:45,685
COMMUNITY COLLEGE ENVIRONMENT

1139
00:45:45,685 --> 00:45:47,320
THAT THERE MIGHT BE DIFFERENT

1140
00:45:47,320 --> 00:45:48,387
PARTNERS THAT MIGHT COME IN TO

1141
00:45:48,387 --> 00:45:50,990
PLAY AND BE HELPFUL DEPENDING ON

1142
00:45:50,990 --> 00:45:55,862
THE AGE OF THE PERSON WHEN THEY

1143
00:45:55,862 --> 00:45:57,730
EXPERIENCE THE NEUROTRAUMA.

1144
00:45:57,730 --> 00:46:01,367
>> GREAT POINT. 

1145
00:46:01,367 --> 00:46:02,668
SO DEFINITELY, IDENTIFYING AND

1146
00:46:02,668 --> 00:46:06,439
ACTIVATING OUR PARTNERS WILL BE

1147
00:46:06,439 --> 00:46:09,075
IMPORTANT. 

1148
00:46:09,075 --> 00:46:10,943
THE--WE HAVEN'T GOTTEN THAT FAR

1149
00:46:10,943 --> 00:46:12,044
BUT OUR PRIORITY IS REALIZING

1150
00:46:12,044 --> 00:46:13,646
THE COMMUNITY AND THE PARTNERS

1151
00:46:13,646 --> 00:46:16,349
HAVE TO BE A PART OF THIS,

1152
00:46:16,349 --> 00:46:17,150
THAT'S WHERE PEOPLE--YOU'RE

1153
00:46:17,150 --> 00:46:18,217
LIVING IN YOUR COMMUNITY AND IT

1154
00:46:18,217 --> 00:46:20,620
CAN'T JUST ALL BE A MEDICAL

1155
00:46:20,620 --> 00:46:22,121
MODEL SO WE HAVEN'T GOTTEN TO,

1156
00:46:22,121 --> 00:46:23,789
YOU KNOW WHO ARE THE PARTNERS

1157
00:46:23,789 --> 00:46:27,960
AND WHAT ARE WE DOING TO CHANGE

1158
00:46:27,960 --> 00:46:30,863
THINGS, BUT WE WILL.

1159
00:46:30,863 --> 00:46:32,265
>> OH, OKAY, SORRY I GOT A

1160
00:46:32,265 --> 00:46:33,666
LITTLE AHEAD OF YOU ON IT

1161
00:46:33,666 --> 00:46:36,102
BECAUSE I'M THINKING WELL ON AN

1162
00:46:36,102 --> 00:46:37,036
ACADEMIC ENVIRONMENT, YOU KNOW

1163
00:46:37,036 --> 00:46:40,840
THERE'S MORE PEOPLE TO BRING TO

1164
00:46:40,840 --> 00:46:42,341
BEAR TO HELPING THAT INDIVIDUAL

1165
00:46:42,341 --> 00:46:46,579
OUT AND I UNDERSTAND THE DEARTH

1166
00:46:46,579 --> 00:46:48,781
OF CARE PROVIDERS OF ALL TIMES

1167
00:46:48,781 --> 00:46:55,621
IN THIS COUNTRY.

1168
00:46:55,621 --> 00:46:57,890
>> KATHLEEN, AND THEN
FRANCISCO.

1169
00:46:57,890 --> 00:46:59,258
>> I LOVE HOW YOU LAID OUT
THE

1170
00:46:59,258 --> 00:47:00,626
STRUCTURE OF THIS BUT WHAT I

1171
00:47:00,626 --> 00:47:04,397
FEEL LIKE I HAVEN'T HEARD YOU

1172
00:47:04,397 --> 00:47:06,499
BRING UP IS THE INFLUENCE OF

1173
00:47:06,499 --> 00:47:09,669
REGULATORS AND HOW THAT MIGHT

1174
00:47:09,669 --> 00:47:12,438
PROVIDE FUNDING OR INCREASE THE

1175
00:47:12,438 --> 00:47:14,574
POTENTIAL FOR CAREGIVERS TO BE

1176
00:47:14,574 --> 00:47:16,475
AVAILABLE?

1177
00:47:16,475 --> 00:47:19,378
IS THAT TRUE OR LIKE REGULATORS

1178
00:47:19,378 --> 00:47:21,247
ARE YOU--IS THERE ANYWAY TO

1179
00:47:21,247 --> 00:47:22,048
INCREASE INSURANCE COVERAGE FOR

1180
00:47:22,048 --> 00:47:24,050
SOME OF THIS SO THAT THERE WOULD

1181
00:47:24,050 --> 00:47:25,651
BE A DEMAND FOR MORE CAREGIVERS

1182
00:47:25,651 --> 00:47:27,320
THAT COULD MAKE A LIVING DOING

1183
00:47:27,320 --> 00:47:31,490
THE WORK YOU NEED FOR THESE

1184
00:47:31,490 --> 00:47:33,426
PEOPLE?

1185
00:47:33,426 --> 00:47:35,494
>> AGAIN, THIS IS--SO,
WE'RE IN

1186
00:47:35,494 --> 00:47:37,763
YOUR--JUST STARTING YEAR 4 OF

1187
00:47:37,763 --> 00:47:42,368
THIS BIG GRAND VISION.

1188
00:47:42,368 --> 00:47:44,570
BUT I'M TAKING NOTES BECAUSE

1189
00:47:44,570 --> 00:47:45,871
THESE ARE EXACTLY THE THINGS WE

1190
00:47:45,871 --> 00:47:47,640
NEED TO DO AND YOU KNOW

1191
00:47:47,640 --> 00:47:48,841
MENTIONED, FIGURING OUT THE

1192
00:47:48,841 --> 00:47:51,978
FUNDING SO THAT'S A GREAT POINT

1193
00:47:51,978 --> 00:47:54,513
AND I AM REMEMBERING THAT MAYBE

1194
00:47:54,513 --> 00:47:56,182
FUNDING FOR CAREGIVERS MAY BE AN

1195
00:47:56,182 --> 00:47:56,616
IMPORTANT PIECE.

1196
00:47:56,616 --> 00:47:59,151
>> AND I FEEL LIKE, FROM
MY

1197
00:47:59,151 --> 00:48:00,419
EXPERIENCE AT LEAST, GETTING

1198
00:48:00,419 --> 00:48:01,921
THEM INVOLVED EARLY SO THAT THEY

1199
00:48:01,921 --> 00:48:04,890
FEEL LIKE THEY'RE PART OF THE

1200
00:48:04,890 --> 00:48:07,293
PROCESS AND NOT JUST THOUGHT OF

1201
00:48:07,293 --> 00:48:08,794
LATER WHEN THEY'RE NEEDED

1202
00:48:08,794 --> 00:48:10,630
SOMETIMES IS HELPFUL, YOU KNOW,

1203
00:48:10,630 --> 00:48:12,265
STILL A TOUGH ROAD BUT I THINK

1204
00:48:12,265 --> 00:48:19,338
THIS IS REALLY FANTASTIC.

1205
00:48:19,338 --> 00:48:20,172
>> FRANCISCO?

1206
00:48:20,172 --> 00:48:20,539
>> THANK YOU.

1207
00:48:20,539 --> 00:48:21,774
>> YES, GOOD MORNING, THIS
IS

1208
00:48:21,774 --> 00:48:23,643
CERTAINLY A VERY BROAD VIEW OF

1209
00:48:23,643 --> 00:48:24,810
ALL THE CHALLENGES AND I JUST

1210
00:48:24,810 --> 00:48:27,580
WANT TO FOLLOW UP A LITTLE BIT

1211
00:48:27,580 --> 00:48:30,049
ON THE QUESTION ABOUT YOU KNOW

1212
00:48:30,049 --> 00:48:33,152
PEOPLE OF A YOUNGER AGES OR

1213
00:48:33,152 --> 00:48:36,889
EVEN, EVEN ADULTS OFTEN TIMES

1214
00:48:36,889 --> 00:48:40,926
RETRAINING, MAYBE A DIFFERENT

1215
00:48:40,926 --> 00:48:44,530
PROFESSION IS WHERE THE

1216
00:48:44,530 --> 00:48:46,365
INDIVIDUAL WANTS TO GO AND TBI

1217
00:48:46,365 --> 00:48:51,437
HAS AN EFFECT ON LEARNING.

1218
00:48:51,437 --> 00:48:55,641
SO HOW DO YOU SEE THE

1219
00:48:55,641 --> 00:48:59,478
EDUCATIONAL ENVIRONMENT, SORT OF

1220
00:48:59,478 --> 00:49:01,213
BEING ACTIVATED TO EMBRACE AND

1221
00:49:01,213 --> 00:49:04,517
HELP PEOPLE WITH THESE

1222
00:49:04,517 --> 00:49:04,950
CONDITIONS.

1223
00:49:04,950 --> 00:49:09,922
IT'S A BIG QUESTION BUT THE

1224
00:49:09,922 --> 00:49:11,057
EDUCATION OF THESE INDIVIDUAL

1225
00:49:11,057 --> 00:49:13,326
SYSTEM WHAT WILL HELP THEM MOST

1226
00:49:13,326 --> 00:49:19,031
AND HELP THEM A LOT IN LIFE'S.

1227
00:49:19,031 --> 00:49:20,533
NTHAT'S REALLY ANOTHER EXAMPLE

1228
00:49:20,533 --> 00:49:22,935
WHERE WE NEED TO IDENTIFY THE

1229
00:49:22,935 --> 00:49:24,637
COMMUNITY PARTNER ANDS HOW WE

1230
00:49:24,637 --> 00:49:26,505
CAN WORK TOGETHER TO IMPROVE

1231
00:49:26,505 --> 00:49:27,973
THINGS.

1232
00:49:27,973 --> 00:49:30,409
SO, THIS WILL BE, YOU KNOW IT'S

1233
00:49:30,409 --> 00:49:31,477
VISIONARY RIGHT NOW, NOW TRYING

1234
00:49:31,477 --> 00:49:35,147
TO PUT SOME PIECES TOGETHER, AND

1235
00:49:35,147 --> 00:49:37,950
THE PIECES WILL CONTINUE TO

1236
00:49:37,950 --> 00:49:39,251
BE--TO EVOLVE AS WE'RE ABLE TO

1237
00:49:39,251 --> 00:49:42,421
DO SO AND YOU POINTED OUT

1238
00:49:42,421 --> 00:49:43,389
ANOTHER EXCELLENT AREA WHERE WE

1239
00:49:43,389 --> 00:49:50,096
WILL NEED TO PARTNER.

1240
00:49:50,096 --> 00:49:50,930
>> THANK YOU.

1241
00:49:50,930 --> 00:49:55,201
THIS IS EXCELLENT WORK AND AS A

1242
00:49:55,201 --> 00:49:57,636
PROVIDER IN A NEUROOUTPATIENT

1243
00:49:57,636 --> 00:49:58,671
CLINIC, I SEE HOW MANY PEOPLE

1244
00:49:58,671 --> 00:50:00,172
FALL THRU THE CRACKS AND HOW

1245
00:50:00,172 --> 00:50:01,273
THIS COULD HELP PEOPLE AND THEIR

1246
00:50:01,273 --> 00:50:03,109
FAMILIES IN THE ISES.

1247
00:50:03,109 --> 00:50:04,944
I'M CURIOUS HAVE YOU LAID THIS

1248
00:50:04,944 --> 00:50:06,078
MODEL OUT IN A PAPER YET.

1249
00:50:06,078 --> 00:50:08,147
I THINK IT WOULD BE HELPFUL TO

1250
00:50:08,147 --> 00:50:09,782
SEE IF YOU HADN'T, I WOULD

1251
00:50:09,782 --> 00:50:10,716
ENCOURAGE IT BECAUSE I THINK

1252
00:50:10,716 --> 00:50:12,885
IT'S A NEW WAY OF THINKING

1253
00:50:12,885 --> 00:50:14,587
THAT'S REALLY VISIONARY AND I

1254
00:50:14,587 --> 00:50:16,355
THINK THAT OUR FIELD IN OTHER

1255
00:50:16,355 --> 00:50:18,924
AREAS COULD BENEFIT FROM SEEING

1256
00:50:18,924 --> 00:50:23,095
IT, SO FLORA, SO I DID A QUICK

1257
00:50:23,095 --> 00:50:24,964
PUB MED SEARCH AND IT'S EARLY

1258
00:50:24,964 --> 00:50:25,998
BUT I EVAPORATE SEEN IT.

1259
00:50:25,998 --> 00:50:27,833
>> SO WE HAVE NOT.

1260
00:50:27,833 --> 00:50:28,901
WE'VE BEEN PRESENTING IT

1261
00:50:28,901 --> 00:50:30,336
EVERYWHERE AND TRYING TO GET

1262
00:50:30,336 --> 00:50:32,738
INPUT AND BUY-IN AND ALL THAT.

1263
00:50:32,738 --> 00:50:37,176
WE DID THE PAPER IN 2013 THAT WE

1264
00:50:37,176 --> 00:50:38,811
WILL UPDATE SOON AND MAYBE IT

1265
00:50:38,811 --> 00:50:40,980
BELONGS IN THERE BUT IT REALLY

1266
00:50:40,980 --> 00:50:42,181
MAY BE ITS OWN.

1267
00:50:42,181 --> 00:50:43,082
SO THANK YOU.

1268
00:50:43,082 --> 00:50:44,583
YES WE WILL.

1269
00:50:44,583 --> 00:50:47,186
>> JUST FOLLOWING UP ON
DAWN'S

1270
00:50:47,186 --> 00:50:47,753
COMMENT.

1271
00:50:47,753 --> 00:50:52,158
AS YOU WERE PRESENTING THIS, I

1272
00:50:52,158 --> 00:50:56,429
THINK ITS APPLICATION IS BROAD

1273
00:50:56,429 --> 00:50:58,697
AND ARE THERE OPPORTUNITIES FOR

1274
00:50:58,697 --> 00:51:01,367
US TO BRING TOGETHER OTHER

1275
00:51:01,367 --> 00:51:01,934
DISCIPLINES?

1276
00:51:01,934 --> 00:51:07,373
I'M THINKING SPINAL CORD,

1277
00:51:07,373 --> 00:51:11,110
STROKE, THESE--MENTAL HEALTH,

1278
00:51:11,110 --> 00:51:11,710
YES.

1279
00:51:11,710 --> 00:51:14,413
DEMENTIA, MULTIPLE SCLEROSIS,

1280
00:51:14,413 --> 00:51:17,183
THESE ARE CRITICAL PRINCIPLES

1281
00:51:17,183 --> 00:51:20,486
THAT ARE WIDELY APPLICABLE.

1282
00:51:20,486 --> 00:51:22,888
AND YOU KNOW PERHAPS AS WE

1283
00:51:22,888 --> 00:51:25,524
BRAINSTORM WHAT WE CAN DO, WE

1284
00:51:25,524 --> 00:51:31,464
CAN FIND WAYS TO BREAK DOWN

1285
00:51:31,464 --> 00:51:32,898
SILOS AND USE THE FOUNDATION

1286
00:51:32,898 --> 00:51:34,700
THAT YOU'RE BUILDING MORE

1287
00:51:34,700 --> 00:51:37,069
BROADLY. 

1288
00:51:37,069 --> 00:51:40,239
>> I'M DPLAD YOU MENTIONED
THAT,

1289
00:51:40,239 --> 00:51:41,640
OUR HEALTH IN OUR COMMUNITY ARE

1290
00:51:41,640 --> 00:51:44,176
SO HARD TO NOVEMBERIGATE AND IT

1291
00:51:44,176 --> 00:51:45,411
REALLY SHOULDN'T BE CONNECTICUT

1292
00:51:45,411 --> 00:51:46,779
DITION, FIGURING IT OUT AND THEN

1293
00:51:46,779 --> 00:51:48,948
FIGURING IT OUT, AND THEN

1294
00:51:48,948 --> 00:51:50,583
ANOTHER CONDITION AND FIGURING

1295
00:51:50,583 --> 00:51:53,819
IT OUT AND CREATING NEW MANAGE

1296
00:51:53,819 --> 00:51:56,021
WILL ACCIDENT ARE IT SHOULD BE

1297
00:51:56,021 --> 00:51:57,456
ABOUT NAVIGATING AND LIVING WITH

1298
00:51:57,456 --> 00:51:59,258
DISABILITY, WE HAD CONVERSATIONS

1299
00:51:59,258 --> 00:52:01,927
OF JUST ACROSS A SPINAL CORD

1300
00:52:01,927 --> 00:52:03,429
INJURY AND BURN MODEL SYSTEMS

1301
00:52:03,429 --> 00:52:06,098
BECAUSE BURN IS ALSO A CHRONIC

1302
00:52:06,098 --> 00:52:07,299
INJURY, BUT REALLY, WE JUST NEED

1303
00:52:07,299 --> 00:52:12,438
TO BE MOVING THE MEDICAL SYSTEM

1304
00:52:12,438 --> 00:52:15,741
AND THE COMMUNITY TOGETHER.

1305
00:52:15,741 --> 00:52:18,344
>> GREAT, I'M SO GLAD YOU

1306
00:52:18,344 --> 00:52:19,378
MENTIONED ABOUT OTHER DISCIPLINE

1307
00:52:19,378 --> 00:52:22,248
ANDS I SAW FLORA THAT YOU'RE

1308
00:52:22,248 --> 00:52:24,416
INGAUGING WITH

1309
00:52:24,416 --> 00:52:25,117
DR. [INDISCERNIBLE], THE PMR DOC

1310
00:52:25,117 --> 00:52:30,222
AND HE'S THE CO-LEADOT CHRONIC

1311
00:52:30,222 --> 00:52:30,823
[INDISCERNIBLE] NEUROTRAUMA

1312
00:52:30,823 --> 00:52:32,391
CENTER AND WITH THE VA AND

1313
00:52:32,391 --> 00:52:34,793
D.O.D. BUT WITH THE MULTIPLE

1314
00:52:34,793 --> 00:52:37,162
PROFESSIONS AND THE SORT OF

1315
00:52:37,162 --> 00:52:38,430
MULTIPLE CONDITIONS, SO I KNOW

1316
00:52:38,430 --> 00:52:41,667
YOU'RE GOING TO TALK WITH

1317
00:52:41,667 --> 00:52:42,468
DR. [INDISCERNIBLE], THE

1318
00:52:42,468 --> 00:52:48,574
POLYTRAUMA CENTERS IN VA, BRING

1319
00:52:48,574 --> 00:52:50,776
TOGETHER THE INTERDISCIPLINARY

1320
00:52:50,776 --> 00:52:52,144
GROUPS TO WORK WITH THE VETERANS

1321
00:52:52,144 --> 00:52:54,446
AND IN FACT, PRIOR TO THE

1322
00:52:54,446 --> 00:52:56,348
CURRENT CONFLICTS THEY WERE TBI

1323
00:52:56,348 --> 00:53:01,020
CENTERS AND THEY HAD TO RAPIDLY

1324
00:53:01,020 --> 00:53:02,121
RAMP UP AND BECOME TRAUMA

1325
00:53:02,121 --> 00:53:03,188
CENTERS BA UNITED STATES SERVICE

1326
00:53:03,188 --> 00:53:05,424
MEMBERS WERE COMING BACK WITH

1327
00:53:05,424 --> 00:53:10,429
MORE THAN 1 KIND OF YOUR AND SO

1328
00:53:10,429 --> 00:53:12,064
YOU COULDN'T JUST DO THAT NARROW

1329
00:53:12,064 --> 00:53:12,831
SLICE.

1330
00:53:12,831 --> 00:53:15,734
SO THEY RAPIDLY MOVED TO

1331
00:53:15,734 --> 00:53:17,970
POLYTRAUMA, AND NOW THEY'RE

1332
00:53:17,970 --> 00:53:18,671
POLYTRAUMA CENTERS, SO THAT'S

1333
00:53:18,671 --> 00:53:21,707
GREAT THAT YOU WILL TALK TO DAVE

1334
00:53:21,707 --> 00:53:22,474
[INDISCERNIBLE] ABOUT THAT.

1335
00:53:22,474 --> 00:53:27,780
IT'S A TEAM, RIGHT, IT'S A TEAM.

1336
00:53:27,780 --> 00:53:29,048
>> YEAH, FLORA, ALSO
YOU'VE BEEN

1337
00:53:29,048 --> 00:53:32,017
A LEADER WITH THE--AS PEOPLE

1338
00:53:32,017 --> 00:53:33,786
WERE SAYING WITH THE NIGHEDLER

1339
00:53:33,786 --> 00:53:35,087
MODEL SYSTEMS AND I WAS

1340
00:53:35,087 --> 00:53:37,022
WONDERING IF YOU COULD REFLECT A

1341
00:53:37,022 --> 00:53:39,992
LITTLE BIT ABOUT THE POWER AND

1342
00:53:39,992 --> 00:53:41,360
WHAT NIGHEDLER, THEIR VIEW POINT

1343
00:53:41,360 --> 00:53:42,895
AND THE WAY THEY SUPPORT

1344
00:53:42,895 --> 00:53:46,865
RESEARCH, HOW THAT HELPS YOU IN

1345
00:53:46,865 --> 00:53:48,667
YOUR TBI RESEARCH AND THE NIH,

1346
00:53:48,667 --> 00:53:49,702
THE CULTURES ARE SIMILAR AND

1347
00:53:49,702 --> 00:53:50,769
DIFFERENT ISSUES SO COULD YOU

1348
00:53:50,769 --> 00:53:52,204
HIGHLIGHT A LITTLE BIT ABOUT, I

1349
00:53:52,204 --> 00:53:53,606
KNOW YOU HAD NIH CONTECHNOLOGY

1350
00:53:53,606 --> 00:53:54,440
ORGANIZATIONS AS WELL, AND ABOUT

1351
00:53:54,440 --> 00:53:59,044
HOW WE CAN USE THEM THROUGH OUR

1352
00:53:59,044 --> 00:54:03,248
BEST ABILITIES?

1353
00:54:03,248 --> 00:54:04,883
>> YEAH, AND I--TO FOCUS
THE

1354
00:54:04,883 --> 00:54:09,154
TALK 1 OF THE SLIDES, I DIDN'T

1355
00:54:09,154 --> 00:54:12,891
LIST IS SO THIS EFFORT, HAS COME

1356
00:54:12,891 --> 00:54:17,162
ALONG OVER THE YEARS, A LOT

1357
00:54:17,162 --> 00:54:18,330
OF--LARGELY INFORMED BY MODEL

1358
00:54:18,330 --> 00:54:19,698
SYSTEMS DATA SO THAT NATIONAL

1359
00:54:19,698 --> 00:54:22,801
DATABASE OF BEING ABLE TO FOLLOW

1360
00:54:22,801 --> 00:54:28,374
PEOPLE'S LIFE LONG COURSE WAS

1361
00:54:28,374 --> 00:54:30,743
VERY IMPORTANT.

1362
00:54:30,743 --> 00:54:32,711
THIS PARTICULAR GRANT RELATIVELY

1363
00:54:32,711 --> 00:54:33,779
SMALL AMOUNT OF MONEY BUT WHAT

1364
00:54:33,779 --> 00:54:43,155
WE DID IS WE PUT TOGETHER, 7--WE

1365
00:54:43,155 --> 00:54:45,658
17 SITES SO MY GRANTS ADMIN

1366
00:54:45,658 --> 00:54:46,558
TRAITOR HAS 17 DIFFERENT

1367
00:54:46,558 --> 00:54:48,961
CONTRACTS THAT WE HAS TO MANAGE

1368
00:54:48,961 --> 00:54:50,929
FOR A RELATIVELY SMALL AMOUNT OF

1369
00:54:50,929 --> 00:54:53,799
MONEY BUT IT'S ALLOWED US TO

1370
00:54:53,799 --> 00:54:55,768
COME TOGETHER, IT'S ALL THE

1371
00:54:55,768 --> 00:54:57,169
MODEL SYSTEMS SITES PLUS THE

1372
00:54:57,169 --> 00:54:58,337
TAMPA VA AND WE'VE COME TOGETHER

1373
00:54:58,337 --> 00:55:01,774
WITH ALL OF THESE BRAINS TO BE

1374
00:55:01,774 --> 00:55:03,642
ABLE TO USE ALL THAT EXPERTISE

1375
00:55:03,642 --> 00:55:07,880
EMPLOY AS YOU KNOW RALPH, NIH

1376
00:55:07,880 --> 00:55:09,481
HAS ALSO COLLABORATED WITH THE

1377
00:55:09,481 --> 00:55:13,986
MODEL SYSTEMS IN REGARDS TO

1378
00:55:13,986 --> 00:55:16,388
LEARNING ABOUT THE TYPES OF CARE

1379
00:55:16,388 --> 00:55:19,892
WE ADMINISTER IN PATIENT THAT

1380
00:55:19,892 --> 00:55:22,828
SET SOMEONE UP FOR SUBASSESSES,

1381
00:55:22,828 --> 00:55:26,231
TRYING TO FIGURE OUT WHETHER THE

1382
00:55:26,231 --> 00:55:28,333
DIFFERENT ELEMENTS OF CARE

1383
00:55:28,333 --> 00:55:32,738
CERTAINLY NIH AND NIDLER WORKING

1384
00:55:32,738 --> 00:55:37,042
HAND IN HAND TO TRY TO USE AND

1385
00:55:37,042 --> 00:55:40,212
GET OUR DATA AND MOVE THE FIELD

1386
00:55:40,212 --> 00:55:40,479
FORWARD.

1387
00:55:40,479 --> 00:55:41,947
WE ARE AND SHOULD BE WORKING

1388
00:55:41,947 --> 00:55:46,385
HAND IN HAND TO DO THAT.

1389
00:55:46,385 --> 00:55:47,986
I THINK IDENTIFYING THESE THINGS

1390
00:55:47,986 --> 00:55:51,256
IT SHOULDN'T BE JUST 1

1391
00:55:51,256 --> 00:55:53,826
DIAGNOSIS, I THINK WITH NIDLER

1392
00:55:53,826 --> 00:55:55,360
OUR FUNDING IS OFTEN TIMES THE

1393
00:55:55,360 --> 00:55:57,129
BRAIN INJURY MODEL SYSTEMS OR

1394
00:55:57,129 --> 00:55:58,297
SPINAL CORD MODEL SYSTEMS, I

1395
00:55:58,297 --> 00:55:59,832
THINK OF COURSE YOU GUYS KNOW

1396
00:55:59,832 --> 00:56:07,906
BETTER THAN I DO AS FAR AS

1397
00:56:07,906 --> 00:56:12,244
OPPORTUNITIES FOR COLLABORATION

1398
00:56:12,244 --> 00:56:12,611
EMPLOY.

1399
00:56:12,611 --> 00:56:14,113
>> THANK YOU, AGAIN.

1400
00:56:14,113 --> 00:56:15,080
IF ANYONE ELSE AROUND THE TABLE

1401
00:56:15,080 --> 00:56:16,915
IS EXPERIENCING THE SAME THING I

1402
00:56:16,915 --> 00:56:19,985
AM, MY MIND IS TILL GOING WITH

1403
00:56:19,985 --> 00:56:23,388
POSSIBILITIES AND WHAT WHAT WE

1404
00:56:23,388 --> 00:56:24,056
CAN DO.

1405
00:56:24,056 --> 00:56:26,592
BUT LET'S MOVE ON TO THE NEXT

1406
00:56:26,592 --> 00:56:32,364
SESSION AND RALPH, YOU WERE

1407
00:56:32,364 --> 00:56:34,433
GOING TO INTRODUCE?

1408
00:56:34,433 --> 00:56:36,802
>> OKAY, SO AS PART OF THE

1409
00:56:36,802 --> 00:56:39,104
DEMOCRACY OF THE BOARD AT OUR

1410
00:56:39,104 --> 00:56:40,372
PREIOUS DISCUSSIONS, THE BOARD

1411
00:56:40,372 --> 00:56:43,242
SAID THEY WANT TO BE MORE ABOUT

1412
00:56:43,242 --> 00:56:44,643
MUSK LO SKELETAL AND INJURY

1413
00:56:44,643 --> 00:56:48,480
ISSUES THAT WE HAVE A TENDENCY

1414
00:56:48,480 --> 00:56:51,250
TO FOCUS SOMEWHAT MORE ON

1415
00:56:51,250 --> 00:56:55,320
NEUROREHAB, STROKES, SPINAL CORD

1416
00:56:55,320 --> 00:56:56,388
INJURY, TBI, CEREBRAL PALSY AND

1417
00:56:56,388 --> 00:57:01,827
WE WANTED TO SPREAD THAT LOVE TO

1418
00:57:01,827 --> 00:57:03,896
MUSK LO-SKELETAL ISSUES AND TO

1419
00:57:03,896 --> 00:57:04,930
START THAT DISCUSSION WE

1420
00:57:04,930 --> 00:57:06,565
ENVIETED 3 PEOPLE WHO WILL GIVE

1421
00:57:06,565 --> 00:57:08,734
US A BIT OF BACKGROUND, START OF

1422
00:57:08,734 --> 00:57:09,835
DISCUSSION ON THE ISSUES THAT

1423
00:57:09,835 --> 00:57:12,437
COME UP IN TERPS OF INJURY

1424
00:57:12,437 --> 00:57:15,374
RESEARCH AND THE WAY WE LAID IT

1425
00:57:15,374 --> 00:57:19,311
OUT WE HAVE TEEF GOLMAN WHO IS A

1426
00:57:19,311 --> 00:57:21,780
BIOENGINEER AND SENIOR SCIENTIST

1427
00:57:21,780 --> 00:57:24,483
AT THE DOA, I'M SORRY D.O.D.

1428
00:57:24,483 --> 00:57:29,121
DEPARTMENT OF DEFENSE AND THE

1429
00:57:29,121 --> 00:57:31,123
VA, I'M SORRY, GOLDMAN, HE'S

1430
00:57:31,123 --> 00:57:34,159
TAKEN THE TIME TO COME HERE AND

1431
00:57:34,159 --> 00:57:35,561
I--OKAY, SO STEVE AND I HAVE

1432
00:57:35,561 --> 00:57:38,063
BEEN E-MAILING BACK AND FORTH.

1433
00:57:38,063 --> 00:57:42,067
AND HE'S AT THE D.O.D.-VA

1434
00:57:42,067 --> 00:57:44,102
EXTREMITY TRAUM AND AMPUTATION

1435
00:57:44,102 --> 00:57:46,672
CENTER OF EXCELLENCE AND HE WILL

1436
00:57:46,672 --> 00:57:48,207
START THE DISCUSSION WITH

1437
00:57:48,207 --> 00:57:49,141
BACKGROUNDOT MILITARY CULT NUR

1438
00:57:49,141 --> 00:57:52,311
VA AND SOME OF THE RESEARCH THEY

1439
00:57:52,311 --> 00:57:55,147
FUND ON MUSK LO SKELETAL MUSCLE

1440
00:57:55,147 --> 00:58:02,087
INJURIES AND THEN WE WILL HAVE

1441
00:58:02,087 --> 00:58:04,590
RIANN P A LMIERI-SMITH WHO IS A

1442
00:58:04,590 --> 00:58:05,557
ATHLETIC TRAINING AT THE

1443
00:58:05,557 --> 00:58:06,158
UNIVERSITY OF MICHIGAN AND

1444
00:58:06,158 --> 00:58:08,794
TRECTOR OF O OTHER O PEDIC REHAB

1445
00:58:08,794 --> 00:58:11,396
AND BY O MECHANICS.

1446
00:58:11,396 --> 00:58:13,298
SHE WILL TALK TO US SPECIFICALLY

1447
00:58:13,298 --> 00:58:14,900
ABOUT SPORTS INJURIES AND HOW WE

1448
00:58:14,900 --> 00:58:18,203
TRY TO SUPPORT THEM TO THE

1449
00:58:18,203 --> 00:58:19,271
DEMOGRAPHICS AND SOME OF THE

1450
00:58:19,271 --> 00:58:23,008
RESEARCH ISSUES AND THEN WE WILL

1451
00:58:23,008 --> 00:58:26,378
HAVE LINDA VAN DILLEN, LINDA IS

1452
00:58:26,378 --> 00:58:29,548
A PROFESSOR OF PHYSICAL THERAPY

1453
00:58:29,548 --> 00:58:31,183
AT WASHINGTON UNIVERSITY IN

1454
00:58:31,183 --> 00:58:33,886
ST. LOUIS IN THE INTERACTION OF

1455
00:58:33,886 --> 00:58:35,754
BIOMECHANICAL AND NEUROLOGICAL

1456
00:58:35,754 --> 00:58:38,257
FACTORS IN MECHANISMS UNDERLYING

1457
00:58:38,257 --> 00:58:39,291
MUSK LO SKELETAL PAIN AND SHE

1458
00:58:39,291 --> 00:58:41,059
WILL TALK TO US ABOUT THE BACK

1459
00:58:41,059 --> 00:58:42,461
INJURY AND THE BROADER FIELD OF

1460
00:58:42,461 --> 00:58:44,196
PAIN TREATMENT AND THIS IS ONLY

1461
00:58:44,196 --> 00:58:45,364
TO START A DISCUSSION AND GIVE

1462
00:58:45,364 --> 00:58:48,033
US A TASTE OF SOME OF THE ISSUES

1463
00:58:48,033 --> 00:58:49,301
OF DEMOGRAPHICS AND SOME OF THE

1464
00:58:49,301 --> 00:58:51,603
ISSUES IN TERMS OF INJURY TO

1465
00:58:51,603 --> 00:58:56,008
SHIFT THE DISCUSSION A LITTLE

1466
00:58:56,008 --> 00:58:57,776
BIT AND BROADEN IT A BIT AND WE

1467
00:58:57,776 --> 00:58:59,278
LOOK FORWARD TO WHAT COMES OUT

1468
00:58:59,278 --> 00:59:03,582
OF THAT SO STEPHEN GOLDMAN,

1469
00:59:03,582 --> 00:59:03,849
[LAUGHTER]

1470
00:59:03,849 --> 00:59:14,393
, SORRY, WHY DON'T YOU START US

1471
00:59:22,634 --> 00:59:22,768
GOING.

1472
00:59:22,768 --> 00:59:23,869
>>  OKAY, THANK YOU FOR
HAVING

1473
00:59:23,869 --> 00:59:26,939
ME TODAY AND WE WILL TALK ABOUT

1474
00:59:26,939 --> 00:59:30,809
SOME ISSUES RELATED TO COMBAT

1475
00:59:30,809 --> 00:59:31,410
TRAUMA EXTREMITY RESEARCH.

1476
00:59:31,410 --> 00:59:31,877
THERE WE GO.

1477
00:59:31,877 --> 00:59:36,014
SO THIS IS MY PERSPECTIVE, THE

1478
00:59:36,014 --> 00:59:38,750
D. O. LIKES US TO DISCLAIM THAT

1479
00:59:38,750 --> 00:59:40,052
THIS IS NOT OFFICIAL STATEMENTS

1480
00:59:40,052 --> 00:59:41,687
BUT THAT OF MYSELF AS A

1481
00:59:41,687 --> 00:59:43,188
RESEARCHER EMPLOYED BY THE

1482
00:59:43,188 --> 00:59:43,388
D.O.D.

1483
00:59:43,388 --> 00:59:45,090
SO FIRST I ALWAYS LAKE TO START

1484
00:59:45,090 --> 00:59:47,559
OFF BY ACKNOWLEDGING ALL MY

1485
00:59:47,559 --> 00:59:48,493
COLLABORATOR THAT HELPED WITH A

1486
00:59:48,493 --> 00:59:50,362
NUMBER OF DIFFERENT PROJECTS

1487
00:59:50,362 --> 00:59:52,431
SOME OF WHICH YOU WILL SEE HERE

1488
00:59:52,431 --> 00:59:52,664
TODAY.

1489
00:59:52,664 --> 00:59:55,434
MY TEAM IS LOCATEDDA THE UNIFORM

1490
00:59:55,434 --> 00:59:57,069
SERVICES UNIVERSITY WHICH IS

1491
00:59:57,069 --> 00:59:58,270
JUST ACROSS THE STREET FROM THE

1492
00:59:58,270 --> 01:00:00,238
NIH AND SOME OF OUR SURGICAL

1493
01:00:00,238 --> 01:00:02,240
PARTNERS ARE ACTIVE SURGEONS AT

1494
01:00:02,240 --> 01:00:07,746
WALTER REED IN BETHESDA.

1495
01:00:07,746 --> 01:00:10,315
SO WITHIN THE D.O.D. THE

1496
01:00:10,315 --> 01:00:11,149
STRATEGIC DRIVERS OF RESEARCH

1497
01:00:11,149 --> 01:00:14,386
ARE REALLY FROM A TOP DOWN

1498
01:00:14,386 --> 01:00:16,088
APPROACH VERSUS PERHAPS WHAT YOU

1499
01:00:16,088 --> 01:00:18,190
ALL ARE MORE FAMILIAR WITH WHICH

1500
01:00:18,190 --> 01:00:19,958
IS MORE OF AN INVESTIGATOR

1501
01:00:19,958 --> 01:00:20,392
INITIATED APPROACH.

1502
01:00:20,392 --> 01:00:22,294
SO WHAT HAPPENS IN THE D.O.D. IS

1503
01:00:22,294 --> 01:00:26,465
THEY PRODUCE THESE STRATEGIC

1504
01:00:26,465 --> 01:00:28,867
PRIORITY DOCUMENTS AND IT LAYS

1505
01:00:28,867 --> 01:00:31,970
OUT WHAT THE FOLKS UP AT THE

1506
01:00:31,970 --> 01:00:33,472
HIGHER LEVELS THINK ARE GOING TO

1507
01:00:33,472 --> 01:00:37,242
BE THE NEEDS OF THE MILITARY

1508
01:00:37,242 --> 01:00:40,078
INTO THE COMING DECADES AND AS A

1509
01:00:40,078 --> 01:00:42,180
RESULT, THE FOCUS ON MANY OF THE

1510
01:00:42,180 --> 01:00:44,049
RESEARCH ENDEAVORS IS ON

1511
01:00:44,049 --> 01:00:47,019
OPERATIONAL READY WHICH IS TO

1512
01:00:47,019 --> 01:00:48,787
ENHANCE THE HEATHAL OF THE

1513
01:00:48,787 --> 01:00:51,089
FIGHTING FORCE AND RETURNED

1514
01:00:51,089 --> 01:00:52,858
SERVICE MEMBERS TO DUTY AS

1515
01:00:52,858 --> 01:00:53,525
QUICKLY AS POSSIBLE.

1516
01:00:53,525 --> 01:00:55,494
WE DO THIS BY IDENTIFYING

1517
01:00:55,494 --> 01:00:56,862
CLINICAL GAP AREA ANDS THAT IS A

1518
01:00:56,862 --> 01:01:00,365
PROCESS THAT IS DONE BETWEEN THE

1519
01:01:00,365 --> 01:01:02,200
PORTFOLIO MANAGERS AND THE

1520
01:01:02,200 --> 01:01:05,137
CAREGIVERS THEMSELVES AT THE

1521
01:01:05,137 --> 01:01:05,604
TREATMENT FACILITIES.

1522
01:01:05,604 --> 01:01:08,407
AND I WOULD SAY THERE IS AN

1523
01:01:08,407 --> 01:01:09,241
INTENSE FOCUS ON

1524
01:01:09,241 --> 01:01:11,510
TRANSLATABILITY, SO THE IDEA

1525
01:01:11,510 --> 01:01:13,512
HERE IS SEE A NEED, FILL A NEED

1526
01:01:13,512 --> 01:01:14,780
AND THE RESEARCH IS THE MEANS TO

1527
01:01:14,780 --> 01:01:17,849
FILL THAT NEED WHETHER IT BE

1528
01:01:17,849 --> 01:01:22,621
KNOWLEDGE OR MATERIAL PRODUCTS.

1529
01:01:22,621 --> 01:01:28,527
SO IN MY WORLD I'M FOCUSED

1530
01:01:28,527 --> 01:01:30,028
PRIMARILYOT EXTREMITIES, MUSKUE

1531
01:01:30,028 --> 01:01:31,163
LO SKELETAL TRAUMA.

1532
01:01:31,163 --> 01:01:33,065
THIS SUMS UP TEMPORARY CONFLIGZ

1533
01:01:33,065 --> 01:01:35,467
AND WHAT WE'VE SEEN, SO AS CASE

1534
01:01:35,467 --> 01:01:36,935
FATALITY RATE HAS DROPPED OVER

1535
01:01:36,935 --> 01:01:38,737
THE MOST RECENT CONFLICTS, YOU

1536
01:01:38,737 --> 01:01:41,306
KNOW THAT'S A RESULT OF IMPROVED

1537
01:01:41,306 --> 01:01:45,277
BODY ARMOR, ARMORED VEHICLES,

1538
01:01:45,277 --> 01:01:46,344
BASICALLY JUST TECHNOLOGICAL

1539
01:01:46,344 --> 01:01:47,179
IMPROVEMENTS ACROSS THE BOARD AS

1540
01:01:47,179 --> 01:01:49,247
WE SEE THOSE FACAS TAILITY

1541
01:01:49,247 --> 01:01:51,550
DROSOPHILA IN THE GREAT THING

1542
01:01:51,550 --> 01:01:53,985
WE'VE SEEN A GREAT INCREASE IN

1543
01:01:53,985 --> 01:01:55,854
THE SEVERITY OF INJURIES

1544
01:01:55,854 --> 01:01:57,456
SOLDIERS ARE COMING HOME WITH

1545
01:01:57,456 --> 01:02:00,459
AND PREDOMINANT LYE THOSE ARE

1546
01:02:00,459 --> 01:02:01,626
AFFECTING THE EXTREMITIES, IE

1547
01:02:01,626 --> 01:02:03,495
THE AREAS NOT COVERED BY BODY

1548
01:02:03,495 --> 01:02:03,995
ARMOR.

1549
01:02:03,995 --> 01:02:06,064
SO MY GROUP, I'M PART OF THE

1550
01:02:06,064 --> 01:02:07,732
EXTREMITY TRAUMA AND AMPUTATION

1551
01:02:07,732 --> 01:02:10,068
CENTER FOR EXCELLENCE AND WOE

1552
01:02:10,068 --> 01:02:11,536
DIVIDE OUR RESEARCH TO TRI TO

1553
01:02:11,536 --> 01:02:14,406
COVER THE FULL SPECTRUM OF CARE

1554
01:02:14,406 --> 01:02:16,241
FOR PATIENTS WITH AMPUTATION,

1555
01:02:16,241 --> 01:02:18,977
LIMB CONSTRUCTION AND OTHER

1556
01:02:18,977 --> 01:02:19,811
EXTREMITY TRAUMAS.

1557
01:02:19,811 --> 01:02:21,780
SO WE KIND OF BREAK THIS UP INTO

1558
01:02:21,780 --> 01:02:25,650
4 MAIN FOCUS AREAS WHICH IS

1559
01:02:25,650 --> 01:02:26,685
ADVANCE REHABILITATION

1560
01:02:26,685 --> 01:02:27,886
SCIENTISTS MEDICAL AND CERVICAL

1561
01:02:27,886 --> 01:02:30,922
INTERVENTIONS WHICH IS THE AREA

1562
01:02:30,922 --> 01:02:33,725
I'M IN, ADVANCED PROSTHETIC ANDS

1563
01:02:33,725 --> 01:02:35,093
EPITEEMIO LOGIC RESEARCH WHICH I

1564
01:02:35,093 --> 01:02:36,361
HAVE ALSO DOUBLE INDEED AS YOU

1565
01:02:36,361 --> 01:02:39,931
WILL SEE IN A FEW SLIDES.

1566
01:02:39,931 --> 01:02:44,002
SO THIS IS A FAIRLY SIMPLE

1567
01:02:44,002 --> 01:02:46,271
PICTOGRAPH OF THE WAY THAT I

1568
01:02:46,271 --> 01:02:47,472
INTERVIEW EXTREMITY YOURS AND

1569
01:02:47,472 --> 01:02:47,706
TRAUMA.

1570
01:02:47,706 --> 01:02:50,342
SO WITHIN THE SCOPE OF SEVERE

1571
01:02:50,342 --> 01:02:52,777
EXTREMITY TRAUMA YOU HAVE

1572
01:02:52,777 --> 01:02:54,079
AMPUTATIONS IN THE BIG BLUE

1573
01:02:54,079 --> 01:02:55,580
CIRCLE AND WE WILL TALK ABOUT

1574
01:02:55,580 --> 01:02:57,115
THOSE FIRST AND IN THE 2 RED

1575
01:02:57,115 --> 01:03:01,987
CIRCLES HAVE YOU THE FIELD CALLS

1576
01:03:01,987 --> 01:03:04,089
LIMB SALVAGE AND IT'S MORE

1577
01:03:04,089 --> 01:03:05,790
AMBIGUOUS OF A TERM AND A LOT

1578
01:03:05,790 --> 01:03:09,027
HARDER TO STUDY IN MY OPINION

1579
01:03:09,027 --> 01:03:10,061
THAN AMPUTATIONS SIMPLY BECAUSE

1580
01:03:10,061 --> 01:03:12,397
IT'S A BIT MORE AMBIGUOUS.

1581
01:03:12,397 --> 01:03:13,865
SO FOCUSING FIRST ON

1582
01:03:13,865 --> 01:03:16,101
AMPUTATIONS, AS YOU CAN SEE

1583
01:03:16,101 --> 01:03:17,802
HERE, THIS IS A STUDY PRODUCED

1584
01:03:17,802 --> 01:03:19,304
BY 1 OF MY COLLEAGUES, IT WAS A

1585
01:03:19,304 --> 01:03:21,206
FOLLOW UP STUDY THAT WAS PUB

1586
01:03:21,206 --> 01:03:23,441
LESH INDEED 2018 AND IT JUST

1587
01:03:23,441 --> 01:03:26,511
LAID OUT, THE NUMBER OF COMBAT

1588
01:03:26,511 --> 01:03:27,712
RELATED AMPUTATIONS THAT WERE

1589
01:03:27,712 --> 01:03:28,446
OBSERVED DURING MOST RECENT

1590
01:03:28,446 --> 01:03:30,515
CONFLICKS AND YOU CAN SEE KIND

1591
01:03:30,515 --> 01:03:34,452
OF SEE A PHASE WHERE THE AMPUE

1592
01:03:34,452 --> 01:03:39,191
TAIGS KIND OF FOLLOW INCREASE IN

1593
01:03:39,191 --> 01:03:40,492
ACTIVITY OVERSEAS BETWEEN 2003

1594
01:03:40,492 --> 01:03:41,793
AND 2013 EFFECTIVELY, A DECADE

1595
01:03:41,793 --> 01:03:44,996
OF CONFLICT AND IT FALLS OFF AS

1596
01:03:44,996 --> 01:03:48,433
WE BROUGHT OUR ACTIVITIES BACK

1597
01:03:48,433 --> 01:03:48,633
DOWN.

1598
01:03:48,633 --> 01:03:49,734
THE FACT THAT THIS WAS A FOLLOW

1599
01:03:49,734 --> 01:03:52,938
UP STUDY TO A PRIOR STUDY THAT

1600
01:03:52,938 --> 01:03:58,510
WAS PERFORMED IN 2010, KIND OF

1601
01:03:58,510 --> 01:04:00,278
ILLUSTRATES THE FACT THAT

1602
01:04:00,278 --> 01:04:01,780
THASMUE TEE POPULATION AND

1603
01:04:01,780 --> 01:04:02,847
RIGHTFULLY SO, IT'S BEEN VERY

1604
01:04:02,847 --> 01:04:05,784
WELL SERVED BY THE MILITARY

1605
01:04:05,784 --> 01:04:07,319
SETTLE SYSTEM AND IT'S BEEN VERY

1606
01:04:07,319 --> 01:04:08,019
WELL STUDIED.

1607
01:04:08,019 --> 01:04:10,522
SO FROM ALL THAT EFFORT WHAT WE

1608
01:04:10,522 --> 01:04:12,023
FOUND IS THAT WE'VE COME A LONG

1609
01:04:12,023 --> 01:04:16,261
WAY, SO HERE I SHOW SOME

1610
01:04:16,261 --> 01:04:18,096
SURGEONS FROM THE CIVIL WAR

1611
01:04:18,096 --> 01:04:22,834
TIMES AND UP TO THE COVER OF

1612
01:04:22,834 --> 01:04:23,668
SCIENCE TRANSLATIONAL MEDICINE

1613
01:04:23,668 --> 01:04:25,737
FROM A RECENT ISSUE THAT LOOKS

1614
01:04:25,737 --> 01:04:27,672
AT LIMB RESTORATION ADVANCE

1615
01:04:27,672 --> 01:04:30,375
TECHNIQUES TO COMBAT LIMB LOSS.

1616
01:04:30,375 --> 01:04:33,979
SO, 1 OF MY COLLEAGUES RETIRED

1617
01:04:33,979 --> 01:04:35,780
COLONEL POTTER, WE SPOKE WITH

1618
01:04:35,780 --> 01:04:37,916
HIM ABOUT WHAT IS IT THAT PEOPLE

1619
01:04:37,916 --> 01:04:40,185
SHOULD KNOW ABOUT AMPUTATION AND

1620
01:04:40,185 --> 01:04:42,754
HIS ADVICE IS DO A GOOD 1

1621
01:04:42,754 --> 01:04:43,054
EFFECTIVELY.

1622
01:04:43,054 --> 01:04:44,856
AND SO, WHEN HE THINKS ABOUT

1623
01:04:44,856 --> 01:04:46,157
DOING GOOD AMPUTATION, THESE

1624
01:04:46,157 --> 01:04:48,893
SOME ARE SOME OF THE FACTORS WE

1625
01:04:48,893 --> 01:04:51,229
LISTED OUT AS WAYS TO DO A GOOD

1626
01:04:51,229 --> 01:04:52,397
AMPUTATION, TO BE BE VERY

1627
01:04:52,397 --> 01:04:53,898
THOUGHTFUL ABOUT THE PROCESS,

1628
01:04:53,898 --> 01:04:55,634
THINK ABOUT THE LEVEL AT WHICH

1629
01:04:55,634 --> 01:04:57,636
THE AMPUTATION WILL BE

1630
01:04:57,636 --> 01:04:58,770
PERFORMED, TRY TO PRESERVE AS

1631
01:04:58,770 --> 01:05:00,405
MUCH LEPGHT AS POSSIBLE, GIVE

1632
01:05:00,405 --> 01:05:01,139
YOURSELF OPGS AND TREATMENT

1633
01:05:01,139 --> 01:05:03,341
BECAUSE YOU NEVER KNOW WHAT

1634
01:05:03,341 --> 01:05:07,479
MIGHT HAPPEN DOWN THE ROAD,

1635
01:05:07,479 --> 01:05:09,748
DELAY CLOSURE AS LONG AS

1636
01:05:09,748 --> 01:05:10,015
POSSIBLE.

1637
01:05:10,015 --> 01:05:12,284
STABILIZE FRACTURES, MAKE SURE

1638
01:05:12,284 --> 01:05:13,718
YOU HAVE SOFT TISSUE COVERS,

1639
01:05:13,718 --> 01:05:15,253
THESE ALL RESULT IN BETTER

1640
01:05:15,253 --> 01:05:16,554
CLINICAL OUTCOMES FOR THE

1641
01:05:16,554 --> 01:05:16,788
PEASHTS.

1642
01:05:16,788 --> 01:05:18,356
AND SO SOME OF THE AREAS THAT

1643
01:05:18,356 --> 01:05:20,191
THE D.O.D. HAS BEEN REALLY

1644
01:05:20,191 --> 01:05:22,694
INTERESTED IN, AND YOU KNOW MY

1645
01:05:22,694 --> 01:05:24,562
SURGICAL COLLEAGUES ARE REALLY

1646
01:05:24,562 --> 01:05:26,097
FOCUSED ON AND THE BUOY IS

1647
01:05:26,097 --> 01:05:30,068
TRYING TO INVEST IN ARE FIRST

1648
01:05:30,068 --> 01:05:31,236
AND FOREMOST ARE OFTIO

1649
01:05:31,236 --> 01:05:33,505
INTEGRATION, IT'S A MASSIVE

1650
01:05:33,505 --> 01:05:35,240
PROGRAM, THAT COLONEL POTTER

1651
01:05:35,240 --> 01:05:37,008
THAT I ALLUDED TO PREVIOUSLY

1652
01:05:37,008 --> 01:05:38,877
STARTED IN THESE, HE RUNS THAT

1653
01:05:38,877 --> 01:05:41,713
PROGRAM OUT OF WALTER REED, BUT

1654
01:05:41,713 --> 01:05:44,482
THE IDEA HERE IS TO TRY TO

1655
01:05:44,482 --> 01:05:45,850
CIRCUMVENT SOME OF THE

1656
01:05:45,850 --> 01:05:48,553
TRADITIONAL ISSUES ASSOCIATED

1657
01:05:48,553 --> 01:05:51,756
WITH PROSTHETIC WARE, AND BY

1658
01:05:51,756 --> 01:05:52,557
DIRECTLY ATTACHING THE

1659
01:05:52,557 --> 01:05:54,192
PROSTHETIC TO THE SKELETON CAN

1660
01:05:54,192 --> 01:05:55,293
THERE'S A NUMBER OF BENEFITS

1661
01:05:55,293 --> 01:05:57,562
THAT COME ALONG WITH THAT

1662
01:05:57,562 --> 01:06:02,500
SURGERY, FROM YOU KNOW AND JUST

1663
01:06:02,500 --> 01:06:04,969
INCREASE MOBILITY AND NOT HAVING

1664
01:06:04,969 --> 01:06:07,939
TO DEAL WITH DAUNTING OF A

1665
01:06:07,939 --> 01:06:09,474
PROSTHETIC, PATIENTS ARE UP AND

1666
01:06:09,474 --> 01:06:10,508
MOBILE MORE OFTEN.

1667
01:06:10,508 --> 01:06:13,611
A COUPLE OF COMPLIMENTARY

1668
01:06:13,611 --> 01:06:15,847
APPROACHES HERE ARE TARGETED

1669
01:06:15,847 --> 01:06:17,582
MUSCLE REINNERVATION ASK

1670
01:06:17,582 --> 01:06:18,383
REGENERATIVE PERIPHERAL NERVE

1671
01:06:18,383 --> 01:06:21,252
INTERFACE AND THESE ARE 2

1672
01:06:21,252 --> 01:06:23,188
APPROACHES THAT KIND OF GOT

1673
01:06:23,188 --> 01:06:26,925
THEIR START IN TERMS OF TRYING

1674
01:06:26,925 --> 01:06:32,464
TO COMMUNICATE WITH MYOELECTRIC

1675
01:06:32,464 --> 01:06:33,732
PROSTHESIS, BUT THEY ACTUALLY

1676
01:06:33,732 --> 01:06:34,966
FOUND ANOTHER APPLICATION AND

1677
01:06:34,966 --> 01:06:36,768
THE TREATMENT OF NEUROMA, SO

1678
01:06:36,768 --> 01:06:38,336
WHAT THAT I HAVE BEGUN TO FIND

1679
01:06:38,336 --> 01:06:41,072
IS THAT IF YOU GIVE THESE NERVES

1680
01:06:41,072 --> 01:06:42,841
SOMETHING TO DO, SOME MUSCLE TO

1681
01:06:42,841 --> 01:06:44,376
INNERIVATE, THEN THEY CAN KIND

1682
01:06:44,376 --> 01:06:46,144
OF TREAT PAIN USING THESE

1683
01:06:46,144 --> 01:06:48,346
APPROACHES, SO THE D.O.D. IS

1684
01:06:48,346 --> 01:06:50,215
LOOKING FURTHER INTO THIS AND

1685
01:06:50,215 --> 01:06:52,951
TRYING TO, YOU KNOW FIND BETTER

1686
01:06:52,951 --> 01:06:55,053
APPLICATIONS FOR THESE TYPES OF

1687
01:06:55,053 --> 01:06:58,890
APPROACHES AND THEN FINALLY, THE

1688
01:06:58,890 --> 01:07:00,058
COMPOSITE ALOE GRAFT WHICH IS

1689
01:07:00,058 --> 01:07:04,829
WHAT IT SOUNDS LIKE IT'S TAKING

1690
01:07:04,829 --> 01:07:06,765
CADAVER LIMBS AND THEN

1691
01:07:06,765 --> 01:07:07,632
TRANSPLANTING THOSE INTO THE

1692
01:07:07,632 --> 01:07:09,868
LOST LIMB OF THE PATIENT AND

1693
01:07:09,868 --> 01:07:11,536
RESTORE CERTAIN FUNCTION THROUGH

1694
01:07:11,536 --> 01:07:12,570
THOSE PROCEDURES.

1695
01:07:12,570 --> 01:07:14,706
OKAY, SO GOING BACK TO THE RED

1696
01:07:14,706 --> 01:07:17,642
CIRCLES NOW, WHICH I FIND

1697
01:07:17,642 --> 01:07:20,678
INTERESTING, AND CHALLENGING TO

1698
01:07:20,678 --> 01:07:21,045
DEFINE.

1699
01:07:21,045 --> 01:07:24,149
SO LIMB SALVAGE, WHAT IS LIMB

1700
01:07:24,149 --> 01:07:26,418
SALVAGE, CLINICALLY IT'S BONING

1701
01:07:26,418 --> 01:07:30,555
AND SOFT TISSUE LOSS WITH INTACT

1702
01:07:30,555 --> 01:07:32,657
SENSE BILITY.

1703
01:07:32,657 --> 01:07:34,392
THE LITERATURE SUGGESTED NO

1704
01:07:34,392 --> 01:07:36,027
DIFFERENCE BETWEEN EMILY SELVAGE

1705
01:07:36,027 --> 01:07:37,195
AND AMPUTATION PATIENTS HOWEVER

1706
01:07:37,195 --> 01:07:39,531
AS I ALLUDED TO MULTIPLE TIMES

1707
01:07:39,531 --> 01:07:41,099
NOW, EPIDEM QUO LOGICAL ANALYSIS

1708
01:07:41,099 --> 01:07:44,102
OF THIS POPULATION AND QUITE

1709
01:07:44,102 --> 01:07:45,570
FRANKLY JUST IDENTIFYING WHO

1710
01:07:45,570 --> 01:07:48,440
THESE PATES ARE IS CHALLENGED BY

1711
01:07:48,440 --> 01:07:49,841
AMBIG OW USE DEFINITION BECAUSE

1712
01:07:49,841 --> 01:07:51,509
IT VARIES FROM CLINICAL PROVIDER

1713
01:07:51,509 --> 01:07:53,945
TO CLINICAL PROVIDER AND IF YOU

1714
01:07:53,945 --> 01:07:55,113
ARE TRYING TO ATTACK THIS

1715
01:07:55,113 --> 01:07:57,816
PROBLEM ON A LARMING SCALE, YOU

1716
01:07:57,816 --> 01:08:01,019
KNOW IT CAN BE VERY TIME

1717
01:08:01,019 --> 01:08:02,954
SENSITIVE AND REQUIRES INTENSIVE

1718
01:08:02,954 --> 01:08:06,825
CHART REVIEW OR IT CAN RESULT IN

1719
01:08:06,825 --> 01:08:08,026
BIASED RESULTS IF YOU ONLY LOOK

1720
01:08:08,026 --> 01:08:09,461
AT A SUBSET OF THAT POPULATION.

1721
01:08:09,461 --> 01:08:14,999
SO TO TACKLE THAT PROBLEM, IN

1722
01:08:14,999 --> 01:08:17,068
COLLEAGUES AND I DEVELOP A DATA

1723
01:08:17,068 --> 01:08:18,536
DRIVEN APPROACH TO IDENTIFY

1724
01:08:18,536 --> 01:08:20,371
THESE COHORTS, AND THERE'S A

1725
01:08:20,371 --> 01:08:21,806
COUPLE PAPERS THAT HAVE BEEN

1726
01:08:21,806 --> 01:08:22,640
RECENTLY PUBLISHED BUT IN SHORT

1727
01:08:22,640 --> 01:08:25,610
WHAT WE DID IS WE TOOK A

1728
01:08:25,610 --> 01:08:28,213
SURROGATE POPULATION SO WE SAID

1729
01:08:28,213 --> 01:08:29,848
HOW--WHERE ARE SOME LIMB SALVAGE

1730
01:08:29,848 --> 01:08:32,350
PATIENTS THAT WE CAN ADENTIFY

1731
01:08:32,350 --> 01:08:33,318
AND WE'RE CONFIDENT OF.

1732
01:08:33,318 --> 01:08:34,853
AND THE REALITY IS THAT ANYONE

1733
01:08:34,853 --> 01:08:37,288
WHO HAS RECEIVED A SECONDARY

1734
01:08:37,288 --> 01:08:41,826
AMPUTATION FOLLOWING A TRAUMA IS

1735
01:08:41,826 --> 01:08:43,561
BY A DEFACTOR LIMB SALVAGE

1736
01:08:43,561 --> 01:08:46,764
PATIENT SO WE WENT IN THERE AND

1737
01:08:46,764 --> 01:08:50,468
IDENTIFIED ICD9 DIAGNOSE AND

1738
01:08:50,468 --> 01:08:51,870
PROCEDURE CODES THAT WERE

1739
01:08:51,870 --> 01:08:52,737
DISPARATELY ASSOCIATE WIDE THIS

1740
01:08:52,737 --> 01:08:54,339
POPULATION AND THEN WE APPLIED

1741
01:08:54,339 --> 01:08:56,808
THEM TO A BROADER EXTREMITY AND

1742
01:08:56,808 --> 01:08:59,511
TRAUMA POPULATION TO PULL OUT

1743
01:08:59,511 --> 01:09:00,778
THOSE PATIENTS THAT MAYBE YOU'RE

1744
01:09:00,778 --> 01:09:02,280
SLIPPING THROUGH THE CRACKS AND

1745
01:09:02,280 --> 01:09:08,520
ARE NOT EASILY IDENTIFIABLE FROM

1746
01:09:08,520 --> 01:09:09,220
AN EPIDEMIOLOGICAL STANDPOINT.

1747
01:09:09,220 --> 01:09:10,421
SO I'M NOT GOING TO GET BOGGED

1748
01:09:10,421 --> 01:09:12,090
DOWN TO THE LEADS OF THE

1749
01:09:12,090 --> 01:09:13,491
DEMOGRAPHICS OF THE POPULATIONS

1750
01:09:13,491 --> 01:09:14,659
BUT EFFECTIVELY I WOULD RATHER

1751
01:09:14,659 --> 01:09:17,996
SHOW YOU NEW RESULTS THERE THAT

1752
01:09:17,996 --> 01:09:19,597
ARE UNPUBLISHED AT THIS POINT

1753
01:09:19,597 --> 01:09:22,467
LOOKING AT THAT LIMB SALVAGE

1754
01:09:22,467 --> 01:09:24,002
POPULATION AND COMPARING TO A

1755
01:09:24,002 --> 01:09:25,103
COUPLE DIFFERENT POPULATIONS

1756
01:09:25,103 --> 01:09:27,171
WITHIN MHS WHICH IS OUR PRIMARY

1757
01:09:27,171 --> 01:09:29,941
ACHUTATION POPULATION AND THE

1758
01:09:29,941 --> 01:09:31,643
NONTHREATENNED LIMB TRAUMA, SO

1759
01:09:31,643 --> 01:09:32,577
STILL SEVERE EXTREMITY LIMB

1760
01:09:32,577 --> 01:09:35,213
TRAUMA BUT THE LIMB WAS NEVER

1761
01:09:35,213 --> 01:09:37,181
REALLY THREATENED, IT DIDN'T FIT

1762
01:09:37,181 --> 01:09:41,853
THE CLASSICAL DEFINITION OF LIMB

1763
01:09:41,853 --> 01:09:42,453
SALVAGE.

1764
01:09:42,453 --> 01:09:44,389
AND SO, FIRST FINDING WE LOOK AT

1765
01:09:44,389 --> 01:09:45,223
INJURY SEVERITY AND WE FOUND

1766
01:09:45,223 --> 01:09:46,958
WHAT WE EXPECTED TO FIND AND

1767
01:09:46,958 --> 01:09:48,826
THAT IS THAT LIMB SALVAGE IS NOT

1768
01:09:48,826 --> 01:09:51,362
MUCH DIFFERENT IN TERMS OF

1769
01:09:51,362 --> 01:09:52,764
INJURY SEVERITY FROM

1770
01:09:52,764 --> 01:09:54,699
NONTHREATENNED LIMB TRAUMA AND

1771
01:09:54,699 --> 01:09:56,968
THUS THE AMBIGUOUS NATURE OF

1772
01:09:56,968 --> 01:10:00,638
LIMB SALVAGE KIND OF SHOWED ITS

1773
01:10:00,638 --> 01:10:00,872
HERE.

1774
01:10:00,872 --> 01:10:05,410
OBVIOUSLY, WE ALSO SAW THAT THE

1775
01:10:05,410 --> 01:10:08,446
PRIMARY AMPUTEES WERE MORE

1776
01:10:08,446 --> 01:10:10,081
SEVERELY INJURED THAT THE LIMB

1777
01:10:10,081 --> 01:10:11,716
SALVAGE AND IT FITS MORE

1778
01:10:11,716 --> 01:10:13,818
HISTORICAL TO THAT WHEN IT COMES

1779
01:10:13,818 --> 01:10:14,619
TO LIMB SALVAGE.

1780
01:10:14,619 --> 01:10:16,154
MOVING ON TO SECONDARY HEALTH

1781
01:10:16,154 --> 01:10:17,889
EFFECTS, SO WE LOOKED AT THESE

1782
01:10:17,889 --> 01:10:19,324
POPULATIONS AND WE FOUND 3 AREAS

1783
01:10:19,324 --> 01:10:22,694
THAT KIND OF STUCK OUT TO US IN

1784
01:10:22,694 --> 01:10:26,230
THE LIMB SALVAGE POPULATION

1785
01:10:26,230 --> 01:10:28,466
RELATIVE TO PRIMARY AMPUTEES AND

1786
01:10:28,466 --> 01:10:32,236
NON, SO THE FIRST IS PAIN, OUR

1787
01:10:32,236 --> 01:10:34,939
PRIMARY AMPUTEES EXPERIENCED A

1788
01:10:34,939 --> 01:10:37,976
LOT MORE JUST NONSPECIFIC PAIN,

1789
01:10:37,976 --> 01:10:41,379
SO JUST I HURT EFFECTIVELY, BUT

1790
01:10:41,379 --> 01:10:44,782
IF YOU HONE IN ON LIKE A

1791
01:10:44,782 --> 01:10:46,317
SPECIFIC AREA, LIKE JOINT PAIN,

1792
01:10:46,317 --> 01:10:48,586
WE'VE ACTUALLY FOUND THAT THE

1793
01:10:48,586 --> 01:10:49,687
LIMB SALVAGE POPULATION

1794
01:10:49,687 --> 01:10:53,057
EXPERIENCES MORE YOINT PAIN THAN

1795
01:10:53,057 --> 01:10:57,261
OUR PRIMARY AMPUTEES WHICH WAS A

1796
01:10:57,261 --> 01:10:58,429
BIT UNEXPECTED FROM OUR

1797
01:10:58,429 --> 01:10:58,763
STANDPOINT.

1798
01:10:58,763 --> 01:11:02,667
THE OTHER AREA THAT WE NOTICED

1799
01:11:02,667 --> 01:11:07,138
WAS OSTEOARTHRITIS AND LATE

1800
01:11:07,138 --> 01:11:09,340
EFFECTS OF MUSKUE LO SKELETAL

1801
01:11:09,340 --> 01:11:09,607
INJURIES.

1802
01:11:09,607 --> 01:11:11,676
SO THIS WAS HIGHER THAN OUR

1803
01:11:11,676 --> 01:11:12,510
AMPUTEE POPULATIONS AND ALSO

1804
01:11:12,510 --> 01:11:17,749
RELATIVE TO THE SIMILARLY

1805
01:11:17,749 --> 01:11:18,549
INJURED NONTHREATENNED LIMB

1806
01:11:18,549 --> 01:11:19,550
TRAUMA GROUP.

1807
01:11:19,550 --> 01:11:21,853
SO THERE'S SOMETHING GOING ON

1808
01:11:21,853 --> 01:11:24,255
HERE IN TERMS OF THE NATURE OF

1809
01:11:24,255 --> 01:11:27,925
THESE YOURS THAT IS RESULTING IN

1810
01:11:27,925 --> 01:11:28,993
MORE OSTEOARTHRITIS AND WE FIND

1811
01:11:28,993 --> 01:11:31,262
ALSO IF YOU GIVING--YOU FURCATE

1812
01:11:31,262 --> 01:11:32,296
OUR LIMB SALVAGE POPULATION

1813
01:11:32,296 --> 01:11:35,066
BASED ON WHETHER OR NOT THEY

1814
01:11:35,066 --> 01:11:37,301
ULTIMATELY GO ON TO A SECONDARY

1815
01:11:37,301 --> 01:11:40,638
AMPUTATION, IT'S EVEN HIGHENER

1816
01:11:40,638 --> 01:11:43,041
THOSE THAT ULTIMATELY ELECT TO

1817
01:11:43,041 --> 01:11:44,876
HAVE A SECONDARY AMPUTATION.

1818
01:11:44,876 --> 01:11:46,644
THE LATE EFFECT MUSK LO SKELETAL

1819
01:11:46,644 --> 01:11:47,945
INJURIES THAT MAKES SENSE, TOO,

1820
01:11:47,945 --> 01:11:50,815
THAT THOSE ARE HIGH IN THE LIMB

1821
01:11:50,815 --> 01:11:52,550
SALVAGE COHORT SET, THAT TRIES

1822
01:11:52,550 --> 01:11:54,218
TO CAPTURE MUSCLE ATROPHY

1823
01:11:54,218 --> 01:11:55,286
FIBROSIS, THOSE TYPES OF THINGS

1824
01:11:55,286 --> 01:12:00,425
THAT ARE TYPICALLY ASSOCIATE

1825
01:12:00,425 --> 01:12:02,026
WIDE A RETAINED LIMB THAT

1826
01:12:02,026 --> 01:12:04,095
UNDERGOES A SEVERE INJURY LIKE

1827
01:12:04,095 --> 01:12:04,429
THIS.

1828
01:12:04,429 --> 01:12:06,097
AND THEN FINALLY MENTAL HEALTH,

1829
01:12:06,097 --> 01:12:07,732
THE PREVALENCE OF MELGT AT

1830
01:12:07,732 --> 01:12:10,234
HEALTH DISORDERS IS HIGH IN ALL

1831
01:12:10,234 --> 01:12:12,103
OF OUR POPULATIONS, AND WE ALSO

1832
01:12:12,103 --> 01:12:14,405
FOUND THAT YOU KNOW THE

1833
01:12:14,405 --> 01:12:15,807
PRIMARIASMUE TEES WHO TYPICALLY

1834
01:12:15,807 --> 01:12:19,043
HAVE A COMMUNITY OF RESOURCES

1835
01:12:19,043 --> 01:12:23,347
AND ACCESS TO MENTAL HEALTH,

1836
01:12:23,347 --> 01:12:25,416
TREATMENT, IT KIND OF MIRRORS

1837
01:12:25,416 --> 01:12:27,652
THAT OF OUR LIMB SALVATION THAT

1838
01:12:27,652 --> 01:12:29,087
ULTIMATELY ENDS UP ELECTING OR

1839
01:12:29,087 --> 01:12:36,260
YOU KNOW BEING TREATED WITH

1840
01:12:36,260 --> 01:12:36,928
SECONDARY MEDICATION EMPLOY SO

1841
01:12:36,928 --> 01:12:42,567
NOW WE WANT TO LOOK AT CLINIC

1842
01:12:42,567 --> 01:12:43,334
UTILIZATIONS.

1843
01:12:43,334 --> 01:12:46,237
SO WHAT ARE THERE IN-PATIENT

1844
01:12:46,237 --> 01:12:46,804
STATES LIKE EFFECTIVELY?

1845
01:12:46,804 --> 01:12:50,608
SO WHAT WE SEE HERE IS THAT OUR

1846
01:12:50,608 --> 01:12:52,677
PRIMARY AMPUTEES HAVE THE

1847
01:12:52,677 --> 01:12:54,879
HIGHEST LEVEL OF IN-PATIENT BED

1848
01:12:54,879 --> 01:12:57,148
AT AS RELATIVE TO LIMB SALVAGE

1849
01:12:57,148 --> 01:12:58,683
BUT IF YOU BIFURCATE LIMB

1850
01:12:58,683 --> 01:13:01,018
SALVAGE OUT, THOSE THAT GO ON TO

1851
01:13:01,018 --> 01:13:03,888
SECONDARY AMPUTATION GO UP AND

1852
01:13:03,888 --> 01:13:04,856
MATCH THE PRIMARY, SO THEY'RE IN

1853
01:13:04,856 --> 01:13:06,390
THE HOSPITAL FOR A LONG TIME,

1854
01:13:06,390 --> 01:13:10,561
UNDERGOING A NUMBER OF

1855
01:13:10,561 --> 01:13:12,296
PROCEDURES, AND IT'S

1856
01:13:12,296 --> 01:13:13,097
JUST--THERE'S AN OPPORTUNITY

1857
01:13:13,097 --> 01:13:14,966
THERE FOR BETTER CARE AND WE

1858
01:13:14,966 --> 01:13:16,367
NEED TO FURTHER RESEARCH THIS

1859
01:13:16,367 --> 01:13:18,236
POPULATION TO SEE IF WE CAN

1860
01:13:18,236 --> 01:13:19,270
IMPROVE THEIR OUTCOMES

1861
01:13:19,270 --> 01:13:21,806
EFFECTIVELY IS WHAT WE'RE TRYING

1862
01:13:21,806 --> 01:13:23,608
TO SHOW HERE.

1863
01:13:23,608 --> 01:13:26,210
NEXT UP, WE'RE LOOKING AT

1864
01:13:26,210 --> 01:13:27,211
OUTPATIENT CLINIC ENGAGE AM, SO

1865
01:13:27,211 --> 01:13:32,283
THIS IS THE NUMBER OF TIMES

1866
01:13:32,283 --> 01:13:33,751
THAT--THE FREQUENCY OF WHICH

1867
01:13:33,751 --> 01:13:36,254
PATIENTS FROM OUR VARIOUS GROUPS

1868
01:13:36,254 --> 01:13:37,889
ENGAGE WITH A CLINIC AT LEAST

1869
01:13:37,889 --> 01:13:38,122
ONCE.

1870
01:13:38,122 --> 01:13:40,224
SO DID YOU WALK IN THE DOORS AT

1871
01:13:40,224 --> 01:13:40,491
ALL?

1872
01:13:40,491 --> 01:13:44,695
SO WHAT WE SEE HERE IS THAT OUR

1873
01:13:44,695 --> 01:13:48,299
PTN, ORTHOPEDIC CLINICS ARE HIGH

1874
01:13:48,299 --> 01:13:51,402
ACROSS THE BOARD BUT THERE'S

1875
01:13:51,402 --> 01:13:52,203
DISPROPORTIONATE ENGAGEMENT

1876
01:13:52,203 --> 01:13:55,039
ACROSS THE COHORTS AND IF YOU

1877
01:13:55,039 --> 01:13:58,042
LOOK AT ENGAGE WANT RATES OF THE

1878
01:13:58,042 --> 01:14:02,113
CLINICS, EVERYTHING EXCEPT FOR

1879
01:14:02,113 --> 01:14:03,481
ORTHOPEDIC PSYCHIATRY, MENTAL

1880
01:14:03,481 --> 01:14:05,483
HEALTH AND PSYCHIATRY IS HIGHER

1881
01:14:05,483 --> 01:14:09,754
THAN FOR OUR LIMB PATIENTS THAN

1882
01:14:09,754 --> 01:14:11,155
OUR FOR OUR LIMB SALVAGE

1883
01:14:11,155 --> 01:14:11,422
PATIENTS.

1884
01:14:11,422 --> 01:14:13,124
SO YOU LOOK AT WHAT I MENTIONED.

1885
01:14:13,124 --> 01:14:15,293
WHAT DID THAT LEAVE?

1886
01:14:15,293 --> 01:14:16,460
THAT'S OCCUPATIONAL THERAPY,

1887
01:14:16,460 --> 01:14:17,295
PHYSICAL MEDICINE, THAT'S

1888
01:14:17,295 --> 01:14:20,865
NEUROLOGY, THESE PEOPLE ARE NOT

1889
01:14:20,865 --> 01:14:25,069
BEING SEEN AT THE SAME RATE OR

1890
01:14:25,069 --> 01:14:27,605
AT THE SAME FREQUENCY AS THEIR

1891
01:14:27,605 --> 01:14:29,140
PEERS IN THE PRIMARY AMPUTEE.

1892
01:14:29,140 --> 01:14:30,541
WE DON'T KNOW WHY THAT IS.

1893
01:14:30,541 --> 01:14:34,312
WE DON'T KNOW IF IT'S THE

1894
01:14:34,312 --> 01:14:35,479
PIER-COMMUNITY ASPECT THAT TENDS

1895
01:14:35,479 --> 01:14:37,782
TO DEVELOP AROUND THE AMPUTEE

1896
01:14:37,782 --> 01:14:41,085
POPULATION RELATIVE TO LIMB

1897
01:14:41,085 --> 01:14:42,353
SALVAGE POPULATION BUT IT'S

1898
01:14:42,353 --> 01:14:46,891
THERE  IT DESERVES FURTHER

1899
01:14:46,891 --> 01:14:47,525
ATTENTION EFFECTIVELY.

1900
01:14:47,525 --> 01:14:49,527
SO THAT WAS ENGAGEMENT.

1901
01:14:49,527 --> 01:14:51,596
THIS IS UTILIZE SO NOT ONLY DID

1902
01:14:51,596 --> 01:14:53,197
THEY WALK IN THE DOOR BUT HOW

1903
01:14:53,197 --> 01:14:54,532
MANY TIMES DID THEY COME BACK TO

1904
01:14:54,532 --> 01:14:57,034
THE CLINIC EMPLOY SO HOW HIGHEST

1905
01:14:57,034 --> 01:14:59,403
VOLUME ACROSS THE COHORTS WAS

1906
01:14:59,403 --> 01:15:02,506
SEEN IN THE PT AND OT CLINICS

1907
01:15:02,506 --> 01:15:04,775
AND FOR THOSE THAT GO ON TO A

1908
01:15:04,775 --> 01:15:08,646
SECONDARY AMPUTATION FROM OUR

1909
01:15:08,646 --> 01:15:10,548
LIMB SALVAGE GROUP, WE SEE THEY

1910
01:15:10,548 --> 01:15:12,083
VISIT ALL THE CLIPPICS MORE THAN

1911
01:15:12,083 --> 01:15:14,652
THEIR PEERS THAT DO NOT

1912
01:15:14,652 --> 01:15:15,486
ULTIMATELY RECEIVE AN

1913
01:15:15,486 --> 01:15:16,454
AMPUTATION, WE DON'T KNOW IF

1914
01:15:16,454 --> 01:15:20,391
THAT'S CAUSE AND EFFECT ISSUE

1915
01:15:20,391 --> 01:15:22,360
BUT THAT XIFS AND 1 WE'RE WE'RE

1916
01:15:22,360 --> 01:15:24,095
LOOKING INTO THIS FURTHER TO

1917
01:15:24,095 --> 01:15:25,930
VIEW THAT IS LIKE ONCE THEY

1918
01:15:25,930 --> 01:15:27,131
RECEIVE THEIR AMPUTATION, ALL OF

1919
01:15:27,131 --> 01:15:28,799
A SUDDEN DO THEY START BEING

1920
01:15:28,799 --> 01:15:30,301
SCENE IN THESE CLINICS MORE

1921
01:15:30,301 --> 01:15:31,903
OFTEN BECAUSE THEY RECEIVE THEIR

1922
01:15:31,903 --> 01:15:33,938
AMPUTATION SORE IS IT RELATED

1923
01:15:33,938 --> 01:15:36,107
MORE TO THE SEVERITY OF THEIR

1924
01:15:36,107 --> 01:15:36,340
INJURY?

1925
01:15:36,340 --> 01:15:37,074
AND THAT'S JUST SOMETHING WE

1926
01:15:37,074 --> 01:15:38,943
HAVE TO DIG FURRINGER INTO AND

1927
01:15:38,943 --> 01:15:46,484
WE HAVEN'T GOTTEN THAT FAR INTO

1928
01:15:46,484 --> 01:15:46,951
THE DATA YET.

1929
01:15:46,951 --> 01:15:48,686
SO WE WILL LOOK AT 1 PARTICULAR

1930
01:15:48,686 --> 01:15:50,521
INJURY PATTERN THAT I'M

1931
01:15:50,521 --> 01:15:51,689
INTERESTED IN, WITHIN THAT

1932
01:15:51,689 --> 01:15:54,659
SUBSET OF LIMB SALVAGE IS THAT

1933
01:15:54,659 --> 01:15:57,628
IS VOLUMEETIC MUSCLE LOSS,

1934
01:15:57,628 --> 01:15:59,030
VOLUMETRIC MUSCLE LOSS WAS

1935
01:15:59,030 --> 01:16:00,631
FORMALLY DEFEIGNED, IT'S BEEN

1936
01:16:00,631 --> 01:16:02,133
AROUND FOREVER AS LONG AS THERE

1937
01:16:02,133 --> 01:16:04,535
HAS BEEN COMBAT EFFECTIVELY, BUT

1938
01:16:04,535 --> 01:16:06,704
IT WAS KIND OF FORMALLY

1939
01:16:06,704 --> 01:16:08,472
DEFEIGNED IN 2011 SO WE'VE BEEN

1940
01:16:08,472 --> 01:16:10,074
STUDYING THIS FOR JUST OVER 10

1941
01:16:10,074 --> 01:16:12,310
YEARS NOW BUT IT'S THE TRAUMATIC

1942
01:16:12,310 --> 01:16:13,644
OR SURGICAL LOSS OF SKELETAL

1943
01:16:13,644 --> 01:16:18,182
MUSCLE THAT RESULS IN A CHRONIC

1944
01:16:18,182 --> 01:16:18,616
FUNCTIONAL DEFICIT.

1945
01:16:18,616 --> 01:16:20,851
IT IS LIMITED IN TERMS OF

1946
01:16:20,851 --> 01:16:21,552
CLINICAL TREATMENT OPTIONS SO

1947
01:16:21,552 --> 01:16:23,554
THERE IS NO SURNLICAL STANDARD

1948
01:16:23,554 --> 01:16:26,590
OF CARE FOR VOLUNTEERS UMKCET

1949
01:16:26,590 --> 01:16:27,525
RICK MUSCLE LOSS.

1950
01:16:27,525 --> 01:16:28,759
REHABILITATION IS COMMONLY THE

1951
01:16:28,759 --> 01:16:30,728
ONLY TREATMENT THAT GIVEN BUT

1952
01:16:30,728 --> 01:16:34,532
IT'S OFTEN CHALLENGED BY THE

1953
01:16:34,532 --> 01:16:41,172
FACT THAT IT'S, THE PATHOBIOLOGY

1954
01:16:41,172 --> 01:16:43,140
OF VML IS DIFFICULT, SO THE

1955
01:16:43,140 --> 01:16:45,776
AMOUNT OF HEALTHY TISSUE THERE

1956
01:16:45,776 --> 01:16:46,744
TO BE USED IS GONE.

1957
01:16:46,744 --> 01:16:49,180
SO WE USE THIS AS AN OPPORTUNITY

1958
01:16:49,180 --> 01:16:50,247
FOR BIOENGINEERING SOLUTIONS TO

1959
01:16:50,247 --> 01:16:51,782
TRY TO REGENERATE SOME OF THIS

1960
01:16:51,782 --> 01:16:52,883
MUSCLE AND HOPEFULLY IMPROVE THE

1961
01:16:52,883 --> 01:16:58,789
OUTCOMES OF THESE PATIENTS.

1962
01:16:58,789 --> 01:17:01,759
SO THIS IS AN EFFORT THAT 1 OF

1963
01:17:01,759 --> 01:17:03,027
THE POST DOCS FROM OUR GROUP LED

1964
01:17:03,027 --> 01:17:05,563
AND WE WANTED TO TAKE A ELECTRIC

1965
01:17:05,563 --> 01:17:07,231
AT THE LITERATURE AROUND VML.

1966
01:17:07,231 --> 01:17:09,767
SO IT'S BEEN OVER 10 YEARS WE'VE

1967
01:17:09,767 --> 01:17:11,302
BEEN DOING THIS, WHAT KIND OF

1968
01:17:11,302 --> 01:17:12,136
PROGRESS HAVE WE MADE?

1969
01:17:12,136 --> 01:17:14,238
SO IF WE LOOK AT THE FIELD AS A

1970
01:17:14,238 --> 01:17:15,973
WHOLE WE SEE EXPOTENTIAL GROWTH

1971
01:17:15,973 --> 01:17:17,508
IF PUBLICATIONS SO THERE'S BEEN

1972
01:17:17,508 --> 01:17:18,576
INCREASED INTEREST IN THIS FIELD

1973
01:17:18,576 --> 01:17:22,646
AND IN THIS PROBLEM, IN GENERAL,

1974
01:17:22,646 --> 01:17:25,716
THE PUBLICATIONS IN THE FIELD OF

1975
01:17:25,716 --> 01:17:27,351
VML ARE CITED AT A HIGHER RATE

1976
01:17:27,351 --> 01:17:29,754
THAN THOSE OF OTHER

1977
01:17:29,754 --> 01:17:30,688
BIOENGINEERING FIELDS THAT THIS

1978
01:17:30,688 --> 01:17:34,225
DATA WAS PULLED FROM THE

1979
01:17:34,225 --> 01:17:36,861
[INDISCERNIBLE] TOOL PROVIDED BY

1980
01:17:36,861 --> 01:17:37,328
NIH.

1981
01:17:37,328 --> 01:17:38,496
PREDOMINANTLY THE STUDIES ARE

1982
01:17:38,496 --> 01:17:39,964
DONE IN ANIMAL MODELS, THEY'RE

1983
01:17:39,964 --> 01:17:41,899
IN VIVO IN NATURE SIMPLY BECAUSE

1984
01:17:41,899 --> 01:17:44,268
IT'S HARD TO RECAPITULATE THE

1985
01:17:44,268 --> 01:17:46,404
PATHOBIOLOGY OF THESE YOURS IN

1986
01:17:46,404 --> 01:17:48,639
YOU KNOW CELL OR TISSUE BASED

1987
01:17:48,639 --> 01:17:49,640
MODELS.

1988
01:17:49,640 --> 01:17:51,909
AND THEN OBVIOUSLY HUMAN

1989
01:17:51,909 --> 01:17:55,646
CLINICAL TRIALS ARE EXPENSIVE

1990
01:17:55,646 --> 01:17:56,981
ANDY DON'T KNOW A LOT ABOUT THE

1991
01:17:56,981 --> 01:17:58,883
YOUR SO WE'RE NOT GOING TO JUMP

1992
01:17:58,883 --> 01:17:59,417
STRAIGHT INTO HUMANS.

1993
01:17:59,417 --> 01:18:01,886
O THERE WERE SOME CLINICAL

1994
01:18:01,886 --> 01:18:03,154
TRIALS BUT PREDOMINANTLY THESE

1995
01:18:03,154 --> 01:18:04,688
HAVE BEEN FOCUSED ON ANIMAL

1996
01:18:04,688 --> 01:18:06,424
MODELS, BOTH SMALL AND LARNG

1997
01:18:06,424 --> 01:18:08,859
ANIMAL MODELS AND THEN OVER TIME

1998
01:18:08,859 --> 01:18:11,028
WE'VE ALSO SEEN THIS GROWTH IN

1999
01:18:11,028 --> 01:18:17,368
PATENT APPLICATIONS AND PATENTS

2000
01:18:17,368 --> 01:18:17,768
ISSUED.

2001
01:18:17,768 --> 01:18:18,903
AGAIN LOOKING BROADLY AT THE

2002
01:18:18,903 --> 01:18:21,906
FIELD, THIS IS A COLLABORATOR OF

2003
01:18:21,906 --> 01:18:23,240
MINE STARTED RISING UP AT THE

2004
01:18:23,240 --> 01:18:24,275
UNIVERSITY OF MINNESOTA.

2005
01:18:24,275 --> 01:18:26,677
THEY DID A META-ANALYSIS OF THE

2006
01:18:26,677 --> 01:18:28,145
LITERATURE THAT HAS BEEN PUB

2007
01:18:28,145 --> 01:18:30,347
LESHED IN VML, LOOKING AT THE

2008
01:18:30,347 --> 01:18:31,649
EFFICACY OF TREATMENT, SO WHAT

2009
01:18:31,649 --> 01:18:32,516
ARE WE DOING?

2010
01:18:32,516 --> 01:18:35,119
I ALOUDED TO THE FACT THAT

2011
01:18:35,119 --> 01:18:37,221
THERE'S NO SURGICAL STANDARD OF

2012
01:18:37,221 --> 01:18:41,325
CARE FOR VML.

2013
01:18:41,325 --> 01:18:42,660
SO YOU KNOW, SARAH WANTED TO

2014
01:18:42,660 --> 01:18:44,395
LOOK THROUGH THE LITERATURE AND

2015
01:18:44,395 --> 01:18:45,796
SEE WHAT WORKS, WHAT DOESN'T

2016
01:18:45,796 --> 01:18:47,665
WORK AND WHY, AND THERE ARE SOME

2017
01:18:47,665 --> 01:18:49,166
KIND OF THINGS HERE SO THE KEY

2018
01:18:49,166 --> 01:18:50,468
FINDINGS FROM THAT STUDY WERE

2019
01:18:50,468 --> 01:18:52,570
THAT TREATMENT DOES RESULT IN

2020
01:18:52,570 --> 01:18:54,538
SIGNIFICANT I IMPROVEMENT AND

2021
01:18:54,538 --> 01:18:55,473
FUNCTIONAL CAPACITY OF MUSCLE

2022
01:18:55,473 --> 01:18:58,542
MAY SEEM LIKE KIND OF A--YOU

2023
01:18:58,542 --> 01:19:00,311
KNOW AN OBVIOUS ANSWER BUT WHEN

2024
01:19:00,311 --> 01:19:03,280
THERE'S NO STANDARD OF CARE,

2025
01:19:03,280 --> 01:19:04,582
KNOWING THAT TREATING DOES HELP

2026
01:19:04,582 --> 01:19:06,650
AS CORRELATED POSE TO JUST

2027
01:19:06,650 --> 01:19:09,854
LETTING THESE INJURIES FIEB

2028
01:19:09,854 --> 01:19:11,088
RESOURCES, THAT'S A SIGNIFICANT

2029
01:19:11,088 --> 01:19:12,590
FINDING AND THEN SHE ALSO FOUND

2030
01:19:12,590 --> 01:19:14,658
THAT THE MOST EFFICACIOUS OF THE

2031
01:19:14,658 --> 01:19:16,193
TREATMENTS THAT SRO BEEN TRIED

2032
01:19:16,193 --> 01:19:19,463
AND SOME COMBINATION OF AN

2033
01:19:19,463 --> 01:19:21,298
ACELLULAR BIOMATERIAL COMBINED

2034
01:19:21,298 --> 01:19:23,234
WITH PROGENITOR CELLS STEM

2035
01:19:23,234 --> 01:19:30,207
CELLS, MY  MYOBLASTS, THE DOWN E

2036
01:19:30,207 --> 01:19:32,710
IS THAT THE TREATMENT IS STILL

2037
01:19:32,710 --> 01:19:34,145
SMALL, SO ROUGHLY 16%

2038
01:19:34,145 --> 01:19:35,079
IMPROVEMENT WHICH MEANS WE HAVE

2039
01:19:35,079 --> 01:19:39,016
A WAYS TO GO EFFECTIVELY.

2040
01:19:39,016 --> 01:19:41,018
SO BASED ON THAT SMALL EFFECT,

2041
01:19:41,018 --> 01:19:42,086
YOU KNOW THE FIELD HAS STARTED

2042
01:19:42,086 --> 01:19:43,921
TO THINK ABOUT WAYS TO ENHANCE

2043
01:19:43,921 --> 01:19:46,824
THAT EFFECT AND LOOK AT

2044
01:19:46,824 --> 01:19:48,893
PERCENTAGES, AND SO, 1 OF THE

2045
01:19:48,893 --> 01:19:51,529
WAYS WE'VE DONE THAT WE'VE

2046
01:19:51,529 --> 01:19:54,198
SPRENG OFF THAT IS THE CONCEPT

2047
01:19:54,198 --> 01:19:55,032
OF REHABILITATION WHICH IS WHAT

2048
01:19:55,032 --> 01:19:56,734
YOU MAY BE FURTHERMORE WITH, SO

2049
01:19:56,734 --> 01:19:58,302
VML WAS 1 OF THE FIELDS THAT

2050
01:19:58,302 --> 01:20:01,338
KIND OF HOPPED ON THE REGION OF

2051
01:20:01,338 --> 01:20:03,607
REHAB TRAINED FAIRLY EARLY IN

2052
01:20:03,607 --> 01:20:07,378
THE PROCESS, BUT THE IDEA HERE

2053
01:20:07,378 --> 01:20:08,445
IS THAT REHABILITATIVE

2054
01:20:08,445 --> 01:20:10,414
INTERVENTIONS CAN HAVE DIRECT

2055
01:20:10,414 --> 01:20:11,649
BENEFITS FOR THERAPY EMPLOY SO

2056
01:20:11,649 --> 01:20:15,186
WE KNOW THAT LOADING CAN IMPACT

2057
01:20:15,186 --> 01:20:19,924
STEM CELL FATES IN THE MUSCLE,

2058
01:20:19,924 --> 01:20:22,326
AS WELL AS OTHER MUSK LO

2059
01:20:22,326 --> 01:20:23,060
SKELETAL TISSUES, HOWEVER THE

2060
01:20:23,060 --> 01:20:25,362
PROGRESS IN THIS FIELD HAS BEEN

2061
01:20:25,362 --> 01:20:27,097
HAMPERED BY THE REGENERATIVE

2062
01:20:27,097 --> 01:20:28,065
THERAPIES HAVE NOT BEEN

2063
01:20:28,065 --> 01:20:31,969
EFFECTIVE ENOUGH AND SO, LOOKING

2064
01:20:31,969 --> 01:20:33,470
FOR SYNERGYS BEFORE YOU HAVE A

2065
01:20:33,470 --> 01:20:37,341
THERAPY THAT IS EFFECTIVE ON ITS

2066
01:20:37,341 --> 01:20:39,109
OWN, CAN BE KIND OF CHALLENGING.

2067
01:20:39,109 --> 01:20:40,911
ONE THINK THIS I WILL SAY THAT

2068
01:20:40,911 --> 01:20:43,447
WE FOUND THUS FAR IN THE FIELD

2069
01:20:43,447 --> 01:20:47,218
IS THAT TIME TO INITIATION OF A

2070
01:20:47,218 --> 01:20:49,420
REHAB THERAPY FOR THE VML WILL

2071
01:20:49,420 --> 01:20:52,356
BE A KEY VARIABLE TO SUCCESS

2072
01:20:52,356 --> 01:20:54,925
EMPLOY AT LEAST THAT'S MY

2073
01:20:54,925 --> 01:20:56,927
INITIAL INCLINATION, AND YOU

2074
01:20:56,927 --> 01:20:57,895
KNOW EARLY REPORTS FROM STUDIES

2075
01:20:57,895 --> 01:20:59,530
OUT OF MY GROUP AND OTHERS

2076
01:20:59,530 --> 01:21:01,065
SUGGEST THAT EARLY INITIATION OF

2077
01:21:01,065 --> 01:21:07,471
REHAB WILL BE DELETERIOUS TO

2078
01:21:07,471 --> 01:21:08,372
REGENERATIVE OUTCOMES.

2079
01:21:08,372 --> 01:21:11,008
OKAY, SO NOW, I'M GOING TO SHIFT

2080
01:21:11,008 --> 01:21:13,177
THE FOCUS TOWARDS KIND OF THE

2081
01:21:13,177 --> 01:21:14,812
FUTURE REQUIREMENTS THAT THE

2082
01:21:14,812 --> 01:21:19,950
D.O.D. IS  KIND OF SENDING DOWN

2083
01:21:19,950 --> 01:21:22,253
OUR WAY AS WE MOVE FORWARD AND

2084
01:21:22,253 --> 01:21:24,188
THATTA AS WE LOOK FORWARD TO THE

2085
01:21:24,188 --> 01:21:25,823
NEXT CONFLICT.

2086
01:21:25,823 --> 01:21:27,691
SO PROJECTIONS FOR THE NEXT

2087
01:21:27,691 --> 01:21:34,131
CONFLICT, THE BATTLEFIELD WILL

2088
01:21:34,131 --> 01:21:35,499
BE MULTINATURAL, LAND, SEE,

2089
01:21:35,499 --> 01:21:37,268
SPACE, ALL OF THE ABOVE AND THE

2090
01:21:37,268 --> 01:21:38,535
PROJECTIONS ARE ALSO THAT WE'RE

2091
01:21:38,535 --> 01:21:40,604
NONAPOPTOTIC LONGER GOING TO

2092
01:21:40,604 --> 01:21:44,275
HAVE SUPERIORITY IN TERMS OF AIR

2093
01:21:44,275 --> 01:21:46,443
OR ARMS RELATIVE TO THE

2094
01:21:46,443 --> 01:21:48,412
ADVERSARY SO WE'RE TALKING ABOUT

2095
01:21:48,412 --> 01:21:50,581
NEAR PEER ADVERSE SARYS, THEY'RE

2096
01:21:50,581 --> 01:21:52,216
VERY SOPHISTICATE INDEED THEIR

2097
01:21:52,216 --> 01:21:53,417
TECHNOLOGIES AND SO WHAT DOES

2098
01:21:53,417 --> 01:21:54,785
THAT FUTURE CONFLICT GOING TO

2099
01:21:54,785 --> 01:21:59,123
ELECTRIC LIKE AND HOW CAN WE BE

2100
01:21:59,123 --> 01:22:01,091
PREPARED FOR IT?

2101
01:22:01,091 --> 01:22:04,228
SO PERSPECTIVE, SO THE WHYED

2102
01:22:04,228 --> 01:22:08,999
FROM THAT IS THAT YOU KNOW OUR

2103
01:22:08,999 --> 01:22:13,070
INJURED SERVICE MEMBERS WILL BE

2104
01:22:13,070 --> 01:22:15,005
EFFECTIVELY LEFT TO FEND THR

2105
01:22:15,005 --> 01:22:16,006
THEMSELVES IN THE BATTLEFIELD

2106
01:22:16,006 --> 01:22:17,007
THAN THEY WERE IN THE PAST.

2107
01:22:17,007 --> 01:22:21,412
SO IF I GO BACK ACTUALLY DURING

2108
01:22:21,412 --> 01:22:26,183
THE CONFLICTS IN AFGHANISTAN AND

2109
01:22:26,183 --> 01:22:28,452
IRAQ, THERE WAS A POLICY KNOWN

2110
01:22:28,452 --> 01:22:30,587
AS THE GOLDEN HOUR WHICH WAS

2111
01:22:30,587 --> 01:22:32,456
WITHIN AN HOUR OF INJURY, AN

2112
01:22:32,456 --> 01:22:35,225
INJURED SERVICE MEMBER WOULD BE

2113
01:22:35,225 --> 01:22:37,928
EVACUATED TO A HIGHER LEVEL CARE

2114
01:22:37,928 --> 01:22:40,097
FACILITY AND THEY WOULD BE SEEN

2115
01:22:40,097 --> 01:22:43,000
BY A SURGEON WITHIN 60 MINUTES

2116
01:22:43,000 --> 01:22:44,535
OF INJURY, MOVING FORWARD, THEY

2117
01:22:44,535 --> 01:22:46,503
DO NOT PROJECT THAT WILL BE THE

2118
01:22:46,503 --> 01:22:49,707
CASE AND SPECIAL PROJECTIONS

2119
01:22:49,707 --> 01:22:51,675
SUGGEST THEY MAY NOT BE ABLE TO

2120
01:22:51,675 --> 01:22:53,177
MED VAC AN INJURED SERVICE

2121
01:22:53,177 --> 01:22:55,245
MEMBER FOR ANYWHERE UP TO 2

2122
01:22:55,245 --> 01:22:56,714
WEEKS, SO THAT'S A LONG TIME TO

2123
01:22:56,714 --> 01:22:58,282
BE SUFFERING WITH AN INJURY IS

2124
01:22:58,282 --> 01:23:03,020
NOT HAVE HIGH LEVEL MEDICAL

2125
01:23:03,020 --> 01:23:03,253
CARE.

2126
01:23:03,253 --> 01:23:06,323
SO AS WE STARTED TO THINK ABOUT

2127
01:23:06,323 --> 01:23:07,958
THIS WE KIND OF PUT THIS

2128
01:23:07,958 --> 01:23:10,027
PERSPECTIVE PIECE ON HOW TO YOU

2129
01:23:10,027 --> 01:23:14,331
KNOW MANAGE THESE TYPES OF YOURS

2130
01:23:14,331 --> 01:23:18,502
FROM A BIOLOGICAL STANDPOINT.

2131
01:23:18,502 --> 01:23:20,371
SO, WHAT--WHAT ARE GOING TO BE

2132
01:23:20,371 --> 01:23:22,606
THE DESIGN CRITERIA THAT ARE

2133
01:23:22,606 --> 01:23:23,741
NECESSARY FOR BIOLOGICALLY

2134
01:23:23,741 --> 01:23:27,811
FOCUSED TECHNOLOGY TO TRY TO

2135
01:23:27,811 --> 01:23:31,415
STABILIZE THAT INJURY, AND/OR

2136
01:23:31,415 --> 01:23:33,584
BEGIN TREATING THAT INJURY ON

2137
01:23:33,584 --> 01:23:36,220
THE BATTLEFIELD BY A COMBAT

2138
01:23:36,220 --> 01:23:39,156
MEDIC THAT CAN YOU KNOW PREVENT

2139
01:23:39,156 --> 01:23:39,823
DELETEEROUS OUTCOMES EFFECTIVELY

2140
01:23:39,823 --> 01:23:43,127
SO THAT WHEN THEY DO REACH A

2141
01:23:43,127 --> 01:23:46,530
HIGHER LEVEL OF CARE, THEY'RE IN

2142
01:23:46,530 --> 01:23:47,731
THE BEST POSITION POSSIBLE TO

2143
01:23:47,731 --> 01:23:51,135
HAVE A POSITIVE OUTCOME OF

2144
01:23:51,135 --> 01:23:53,170
SURGERY OR WHAT HAVE YOU EMPLOY

2145
01:23:53,170 --> 01:23:56,473
SO WE PUT TOGETHER THIS

2146
01:23:56,473 --> 01:23:58,308
PERSPECTIVE PAPER WHICH WAS

2147
01:23:58,308 --> 01:24:00,244
PUBLISHED 2 YEARS AGO AT THIS

2148
01:24:00,244 --> 01:24:03,580
POINT ON KIND OF WHAT DO WE

2149
01:24:03,580 --> 01:24:03,781
NEED.

2150
01:24:03,781 --> 01:24:06,383
THE MATERIALS WILL NEED TO BE

2151
01:24:06,383 --> 01:24:09,119
SELF-ADMINISTERRABLE, SIMPLE TO

2152
01:24:09,119 --> 01:24:11,088
USE, LIGHT WEIGHT, SHELF STABLE,

2153
01:24:11,088 --> 01:24:14,491
MINIMAL OR 0 ELECTRICAL

2154
01:24:14,491 --> 01:24:16,226
REQUIREMENTS, AND IDEALLY THEY

2155
01:24:16,226 --> 01:24:19,630
WOULD HAVE SOME BENEFIT TO

2156
01:24:19,630 --> 01:24:22,499
RESTORING FUNCTION OR OTHERWISE

2157
01:24:22,499 --> 01:24:31,642
SLOWING THE DETERIORATION OF

2158
01:24:31,642 --> 01:24:33,544
THAT LIMB.

2159
01:24:33,544 --> 01:24:35,813
SO JUST TO HIGHLIGHT A PIRP FROM

2160
01:24:35,813 --> 01:24:37,781
OUR GROUP, THIS IS HIGHLIGHTING

2161
01:24:37,781 --> 01:24:38,849
TRYING TO COMPLISH THOSE GOALS.

2162
01:24:38,849 --> 01:24:41,985
SO WHAT WE DID HERE IS TRY TO

2163
01:24:41,985 --> 01:24:43,620
DEVELOP AN INSITU FORMING MUSCLE

2164
01:24:43,620 --> 01:24:45,155
VOID FILLERS SO THE IDEA HERE IS

2165
01:24:45,155 --> 01:24:46,423
THAT YOU INRECYCLING THIS

2166
01:24:46,423 --> 01:24:49,460
MATERIAL INTO THE WOUND, AND IT

2167
01:24:49,460 --> 01:24:50,627
WILL STABILIZE THAT SPACE, IT

2168
01:24:50,627 --> 01:24:53,430
WILL SIT THERE FOR UP TO 4

2169
01:24:53,430 --> 01:24:56,133
WEEKS, IT'LL PREVENT FIBROTIC

2170
01:24:56,133 --> 01:24:57,968
INFILTRATION, IT HAS A MINIMAL

2171
01:24:57,968 --> 01:25:01,538
HOST RESPONSE SO WE'RE TRYING TO

2172
01:25:01,538 --> 01:25:02,673
MINIMIZE DELETERIOUS OUTCOMES

2173
01:25:02,673 --> 01:25:04,741
HERE, THIS WAS JUST OUR FIRST

2174
01:25:04,741 --> 01:25:07,611
FORAY INTO THIS FUTURE EFFORTS

2175
01:25:07,611 --> 01:25:10,714
ARE CURRENTLY ONGOING TO ADD

2176
01:25:10,714 --> 01:25:12,316
BIOACTIVE PAY LOADS THAT MIGHT

2177
01:25:12,316 --> 01:25:15,586
BE ABLE TO RELEASE ANTIFIBROTICS

2178
01:25:15,586 --> 01:25:16,320
OR ANTIBIOTICS, OTHER THINGS

2179
01:25:16,320 --> 01:25:19,056
THAT WOULD TRY TO STABILIZE THAT

2180
01:25:19,056 --> 01:25:19,690
WOUND ENVIRONMENT.

2181
01:25:19,690 --> 01:25:21,725
AND THEN WE'RE ALSO MOVING IT UP

2182
01:25:21,725 --> 01:25:22,793
TO LARGER ANIMAL STUDIES AS

2183
01:25:22,793 --> 01:25:23,026
WELL.

2184
01:25:23,026 --> 01:25:25,896
WE WILL BE TRAVELING UP TO

2185
01:25:25,896 --> 01:25:26,830
INDIANA UNIVERSITY TO WORK WITH

2186
01:25:26,830 --> 01:25:28,765
SOME OF OUR COLLEAGUES FROM THE

2187
01:25:28,765 --> 01:25:30,701
SCHOOL OF MEDICINE THERE TO PUT

2188
01:25:30,701 --> 01:25:35,072
THESE INTO A PIG MODEL IN

2189
01:25:35,072 --> 01:25:40,010
JANUARY EMPLOY SO WITH THAT WANT

2190
01:25:40,010 --> 01:25:41,745
TO LEAVE WUFINAL IMPRESSIONS AND

2191
01:25:41,745 --> 01:25:42,813
PINS PAL INSIGHTS HERE.

2192
01:25:42,813 --> 01:25:46,250
SO AFTER THE LAST 2 DECADES THE

2193
01:25:46,250 --> 01:25:48,452
D.O.D. AND OUR SILLIVIAN

2194
01:25:48,452 --> 01:25:53,290
PARTNERS HAVE MADE TREAMENDOUS

2195
01:25:53,290 --> 01:25:55,058
ADVANCEMENTS IN THE TERMS OF

2196
01:25:55,058 --> 01:25:56,326
CARE, METHODS AND TECHNOLOGIES

2197
01:25:56,326 --> 01:25:57,661
WHICH HAS DELIVERED AN

2198
01:25:57,661 --> 01:25:58,362
UNPRECEDENTED LEVEL OF FUNCTION

2199
01:25:58,362 --> 01:26:01,532
AND QUALITY OF LIFE FOR OUR

2200
01:26:01,532 --> 01:26:02,966
SERVICE MEMBERS IN TERMS OF

2201
01:26:02,966 --> 01:26:04,368
AREAS FOR CONTINUED IMPROVEMENT

2202
01:26:04,368 --> 01:26:06,904
AND ENGAGEMENT FROM OUR CIVILIAN

2203
01:26:06,904 --> 01:26:12,576
PARTNERS, IS WE NEED A CONTINUE

2204
01:26:12,576 --> 01:26:14,077
GENERATING HIGHER LEVELS OF

2205
01:26:14,077 --> 01:26:15,946
CONCEPTS, SO FAIRLY NEW

2206
01:26:15,946 --> 01:26:16,246
CONACCEPTS.

2207
01:26:16,246 --> 01:26:17,614
WE NEED TO FIND FUNDING FOR

2208
01:26:17,614 --> 01:26:20,417
CLINICAL TRIAL ANDS THAT SORT OF

2209
01:26:20,417 --> 01:26:22,819
THING TO FURTHER THAT FIELD.

2210
01:26:22,819 --> 01:26:25,789
WE NEED TO PUSH HARDER INTO

2211
01:26:25,789 --> 01:26:26,657
TECHNOLOGIES FOR PROLONGED CARE

2212
01:26:26,657 --> 01:26:30,294
TO PREPARE US FOR THAT FUTURE

2213
01:26:30,294 --> 01:26:31,361
BATTLEFIELD AND ALL THESE AREAS

2214
01:26:31,361 --> 01:26:38,368
ARE GOING TO BENEFIT FROM

2215
01:26:38,368 --> 01:26:40,137
INTERDISCIPLINARY MULTISECTOR

2216
01:26:40,137 --> 01:26:40,938
COLLABORATIONS, ACADEMIA,

2217
01:26:40,938 --> 01:26:43,507
INDUSTRY AND FEDERAL.

2218
01:26:43,507 --> 01:26:44,808
AND THEN FINALLY, FROM MY

2219
01:26:44,808 --> 01:26:50,213
PERSPECTIVE AS A FAIRLY NEW

2220
01:26:50,213 --> 01:26:53,483
FACULTY MEMBER, TRAINING

2221
01:26:53,483 --> 01:26:54,418
OPPORTUNITIES AND FOSTERING THE

2222
01:26:54,418 --> 01:26:55,819
NEXT GENERATION OF SCIENTISTS TO

2223
01:26:55,819 --> 01:26:58,121
WORK ACROSS THESE VARIOUS FIELDS

2224
01:26:58,121 --> 01:27:01,058
TO ENGAGE REHAB COLLEAGUES LIKE

2225
01:27:01,058 --> 01:27:03,060
YOU ALL WITH ENGINEERS AND BASIC

2226
01:27:03,060 --> 01:27:04,261
CELL BIOLOGISTS, I THINK THAT'S

2227
01:27:04,261 --> 01:27:07,164
WHERE WE'RE REALLY GOING TO SEE

2228
01:27:07,164 --> 01:27:07,731
INNOVATION MOVING FORWARD.

2229
01:27:07,731 --> 01:27:10,834
AND I THINK THAT WE NEED TO BE

2230
01:27:10,834 --> 01:27:12,235
FACILITATING WAYS FOR A CELL

2231
01:27:12,235 --> 01:27:14,304
BIOLOGIST FROM MY LAB TO GO

2232
01:27:14,304 --> 01:27:16,773
SPEND SOME TIME IN A PHYSICAL

2233
01:27:16,773 --> 01:27:18,675
MEDICINE LAB SOMEWHERE AND TO

2234
01:27:18,675 --> 01:27:19,109
LEARN ABOUT REHAB.

2235
01:27:19,109 --> 01:27:21,845
SO WITH THAT I WILL THANK YOU

2236
01:27:21,845 --> 01:27:32,089
FOR YOUR TIME AND OPEN UP THE

2237
01:27:32,089 --> 01:27:35,292
FLOOR FOR QUESTIONS.

2238
01:27:35,292 --> 01:27:36,226
>> THANK YOU SO MUCH.

2239
01:27:36,226 --> 01:27:39,296
WE'RE OPEN TO QUESTIONS.

2240
01:27:39,296 --> 01:27:39,529
BOB IN.

2241
01:27:39,529 --> 01:27:40,664
>> THANK YOU VERY MUCH.

2242
01:27:40,664 --> 01:27:41,465
THAT WAS FASCINATING.

2243
01:27:41,465 --> 01:27:44,501
WHEN YOU SHOWED THE SEQUEL I FOR

2244
01:27:44,501 --> 01:27:46,837
VARIOUS MEASURES SUCH AS PAIN

2245
01:27:46,837 --> 01:27:48,672
WHEN YOU COMPARED PRIMARY

2246
01:27:48,672 --> 01:27:53,977
AMPUTATION TO LIMB SALVAGE, WAS

2247
01:27:53,977 --> 01:27:55,145
THAT FOR LOWER EXTREMITY ALONE

2248
01:27:55,145 --> 01:27:56,880
OR DO YOU SEE DIFFERENCES

2249
01:27:56,880 --> 01:28:00,417
BETWEEN UPPER AND LOWER FOR

2250
01:28:00,417 --> 01:28:02,085
THOSE COMPARISONS?

2251
01:28:02,085 --> 01:28:03,453
>> YEAH, SO I SHOULD HAVE

2252
01:28:03,453 --> 01:28:04,521
CLARIFIED THAT, ALL WORK TO DATE

2253
01:28:04,521 --> 01:28:07,724
HAS BEEN DONE ON THE LOWER

2254
01:28:07,724 --> 01:28:08,692
EXTREMITIES, AND THE REASON FOR

2255
01:28:08,692 --> 01:28:11,128
THAT IS BECAUSE WE USE THIS DATA

2256
01:28:11,128 --> 01:28:11,561
DRIVEN APPROACH.

2257
01:28:11,561 --> 01:28:15,232
WE HAVE A LOT MORE LOWER

2258
01:28:15,232 --> 01:28:17,067
EXTREMITY TRAUMA PATIENTS AND SO

2259
01:28:17,067 --> 01:28:19,002
THE NUMBERS ARE JUST TOO SMALL

2260
01:28:19,002 --> 01:28:20,871
TO ROLELY PULL OUT THOSE CODES

2261
01:28:20,871 --> 01:28:22,639
IN THE SAME WAY FOR THE UPPER

2262
01:28:22,639 --> 01:28:25,275
EXTREMITY SO IT WAS VERY MUCH

2263
01:28:25,275 --> 01:28:30,981
FOCUSED LOWER EXTREMITY ONLY.

2264
01:28:30,981 --> 01:28:32,249
>> FRANCISCO, THEN LEWIS?

2265
01:28:32,249 --> 01:28:35,052
>> YES, GOOD MORNING,
THANK YOU

2266
01:28:35,052 --> 01:28:38,755
FOR GREAT INSIGHT INTO THIS

2267
01:28:38,755 --> 01:28:39,890
DR. GOLDMAN.

2268
01:28:39,890 --> 01:28:41,725
SO ABOUT BIOMETRIC BONE LOSS I

2269
01:28:41,725 --> 01:28:43,360
WAS VERY IMPRESSED WITH YOUR

2270
01:28:43,360 --> 01:28:45,962
ABILITY TO START MOVING IN THAT

2271
01:28:45,962 --> 01:28:48,799
PARTICULAR DIRECTION, SO MY

2272
01:28:48,799 --> 01:28:51,034
QUESTION IS REALLY ABOUT THE

2273
01:28:51,034 --> 01:28:52,569
FUNCTION OF THAT MUSCLE TISSUE

2274
01:28:52,569 --> 01:28:55,072
THAT IS BEING REGENERATED.

2275
01:28:55,072 --> 01:28:58,275
FOR EXAMPLE, ARE YOU CONSIDERING

2276
01:28:58,275 --> 01:29:00,077
MOTOR END PLATES, WOULD IT BE

2277
01:29:00,077 --> 01:29:02,312
FUNCTIONAL MUSCLE BECAUSE I HAVE

2278
01:29:02,312 --> 01:29:02,913
SOME IDEAS, SUGGESTIONS, ET

2279
01:29:02,913 --> 01:29:07,084
CETERA ABOUT HOW TO MAKE THAT

2280
01:29:07,084 --> 01:29:09,152
FUNCTIONING MUSCLE TISSUE THAT'S

2281
01:29:09,152 --> 01:29:13,123
ORGANIZED AND INNERIVATED AND SO

2282
01:29:13,123 --> 01:29:14,357
ON.

2283
01:29:14,357 --> 01:29:16,293
>> YEAH, SO MOTOR

2284
01:29:16,293 --> 01:29:17,594
[INDISCERNIBLE] AND

2285
01:29:17,594 --> 01:29:18,528
NEUROMUSCULAR JUNCTIONS THAT'S

2286
01:29:18,528 --> 01:29:22,399
DEFINITELY AN AREA THAT'S BEING

2287
01:29:22,399 --> 01:29:23,533
LOOKED AT MORE--UNDER MORE

2288
01:29:23,533 --> 01:29:24,034
SCRUTINY NOW.

2289
01:29:24,034 --> 01:29:25,969
YOU KNOW EARLY ON IN THE FIELD

2290
01:29:25,969 --> 01:29:27,270
PEOPLE WERE JUST TRYING TO GET

2291
01:29:27,270 --> 01:29:30,474
ABOUT SORT OF OUTCOME AND THE

2292
01:29:30,474 --> 01:29:34,544
ANSWER TO YOUR QUESTION IS I

2293
01:29:34,544 --> 01:29:37,814
BELIEVE, MOST OF THE REGENERATED

2294
01:29:37,814 --> 01:29:39,716
MUSCLE IS FUNCTIONAL.

2295
01:29:39,716 --> 01:29:44,321
THE PROBLEM HOWEVER IS THE

2296
01:29:44,321 --> 01:29:48,291
QUANTITY THAT IS ACTUALLY

2297
01:29:48,291 --> 01:29:50,393
REGENERATED AND THE EFFICIENCY

2298
01:29:50,393 --> 01:29:50,861
OF REINNERVATION.

2299
01:29:50,861 --> 01:29:54,965
I THINK THERE'S SOMETHING LOST

2300
01:29:54,965 --> 01:29:57,300
THERE IN TERMS OF RECRUITMENT,

2301
01:29:57,300 --> 01:29:59,703
MUSCLE FIBER RECRUITMENT AND YOU

2302
01:29:59,703 --> 01:30:02,339
KNOW OPTIMIZING THOSE

2303
01:30:02,339 --> 01:30:03,940
NEUROMUSCULAR JUNCTIONS IN THE

2304
01:30:03,940 --> 01:30:04,775
REGENERATIVE TISSUE.

2305
01:30:04,775 --> 01:30:07,077
THE OTHER PROBLEM, THERE IS, YOU

2306
01:30:07,077 --> 01:30:09,646
KNOW THERE'S STILL SOME FIBROTIC

2307
01:30:09,646 --> 01:30:10,447
DEPOSITION, WITH ALL THE

2308
01:30:10,447 --> 01:30:12,215
TREATMENTS THAT HAVE BEEN TRIED

2309
01:30:12,215 --> 01:30:15,685
EFFECTIVELY, SO THERE'S TILL

2310
01:30:15,685 --> 01:30:20,157
ISSUES WITH, YOU KNOW LOSS OF

2311
01:30:20,157 --> 01:30:20,857
ARCHITECTURE, SUBOPTIMAL

2312
01:30:20,857 --> 01:30:22,592
ALIGNMENT OF MUSCLE FIBERS THAT

2313
01:30:22,592 --> 01:30:25,495
WERE REGENERATED SO IT'S A

2314
01:30:25,495 --> 01:30:28,832
MULTIFACTORIAL PROBLEM.

2315
01:30:28,832 --> 01:30:29,699
THERE'S SOME MITOCHONDRIAL

2316
01:30:29,699 --> 01:30:31,234
DYSFUNCTION AS WELL, SO THERE'S

2317
01:30:31,234 --> 01:30:33,170
NUMEROUS TARGETS TO GO AFTER.

2318
01:30:33,170 --> 01:30:36,139
BUT APPROXIMATE YOU DO HAVE

2319
01:30:36,139 --> 01:30:37,440
IDEAS ON MOTOR INPLATES FEEL

2320
01:30:37,440 --> 01:30:39,042
FREE TO REACH OUT AFTERWARDS,

2321
01:30:39,042 --> 01:30:41,411
WOULD BE HAPPY TO TALK IN MORE

2322
01:30:41,411 --> 01:30:42,546
DEPTH. 

2323
01:30:42,546 --> 01:30:46,183
>> THANK YOU.

2324
01:30:46,183 --> 01:30:46,483
>> LEWIS?

2325
01:30:46,483 --> 01:30:48,285
>> GOOD MORNING.

2326
01:30:48,285 --> 01:30:49,920
THANKS FOR A REALLY

2327
01:30:49,920 --> 01:30:50,754
[INDISCERNIBLE], I REALLY

2328
01:30:50,754 --> 01:30:52,122
ENJOYED THAT QUITE A BIT.

2329
01:30:52,122 --> 01:30:55,358
AS SOMEBODY WHO DOES A LOT OF

2330
01:30:55,358 --> 01:30:56,993
UPPER LIMB AMPUTATION, RESEARCH,

2331
01:30:56,993 --> 01:30:58,295
MORE PRACTICES A NEURAL REHAB

2332
01:30:58,295 --> 01:31:00,163
POINT OF VIEW, I AM ALWAYS

2333
01:31:00,163 --> 01:31:01,331
REALLY CURIOUS ABOUT HOW SOME OF

2334
01:31:01,331 --> 01:31:02,833
THE THINGS YOU TALKED ABOUT

2335
01:31:02,833 --> 01:31:04,668
REALLY CAN BE INTEGRATED MORE

2336
01:31:04,668 --> 01:31:06,570
INTO OUR KNOWLEDGE OF NEURAL

2337
01:31:06,570 --> 01:31:08,505
RECOVERY AFTER AMPUTATION, RIGHT

2338
01:31:08,505 --> 01:31:10,006
AND PROSTHESIS USAGE AND I'VE

2339
01:31:10,006 --> 01:31:14,077
ALWAYS BEEN CURIOUS ABOUT WAYS

2340
01:31:14,077 --> 01:31:15,912
IN WHICH WE CAN KIND OF DO WHAT

2341
01:31:15,912 --> 01:31:18,782
YOU WERE SORT OF TALKING ABOUT

2342
01:31:18,782 --> 01:31:20,450
IN THERE, OF BETTER CONNECTING

2343
01:31:20,450 --> 01:31:22,886
SOME OF THE WORK THAT YOU KNOW I

2344
01:31:22,886 --> 01:31:24,654
DO MORE SPECIFICALLY IN

2345
01:31:24,654 --> 01:31:25,689
NEUROREHAB AND HUMAN POPULATIONS

2346
01:31:25,689 --> 01:31:30,360
AND ALL THAT STUFF, WITH SOME OF

2347
01:31:30,360 --> 01:31:31,761
THESE REALLY EXCITING NEW

2348
01:31:31,761 --> 01:31:33,930
FRONTIERS, I THINK KIND OF

2349
01:31:33,930 --> 01:31:38,201
COMING FROM A CELL PHYSIOLOGY

2350
01:31:38,201 --> 01:31:41,872
AND YOU KNOW MOTOR, YOU KNOW

2351
01:31:41,872 --> 01:31:42,606
REGENERATIVE MUSCLE POINT OF

2352
01:31:42,606 --> 01:31:44,140
VIEW, I THINK ABOUT WAYS IN

2353
01:31:44,140 --> 01:31:45,208
WHICH THAT CAN ACTUALLY HAPPEN,

2354
01:31:45,208 --> 01:31:47,177
WAYS IN WHICH WE CAN BROADEN

2355
01:31:47,177 --> 01:31:50,247
CONVERSATIONS, WAYS IN WHICH

2356
01:31:50,247 --> 01:31:53,450
LIKE YOU SAID, THE MILITARY AND

2357
01:31:53,450 --> 01:31:56,753
VA SYSTEMS CAN WORK BETTER WITH

2358
01:31:56,753 --> 01:31:58,922
PEOPLE LIKE ME, GEORGIA TECH,

2359
01:31:58,922 --> 01:32:01,057
THAT'S NOT IN THAT SYSTEM, I WAS

2360
01:32:01,057 --> 01:32:02,692
JUST REALLY INSPIRED BY THE ALL

2361
01:32:02,692 --> 01:32:04,527
THINGS YOU WERE TALKING ABOUT, I

2362
01:32:04,527 --> 01:32:06,196
THINK THERE'S A HUGE OPPORTUNITY

2363
01:32:06,196 --> 01:32:07,898
FOR STRONGER COLLABORATIONS, SO

2364
01:32:07,898 --> 01:32:09,966
THAT WE'RE KIND OF WORKING

2365
01:32:09,966 --> 01:32:13,169
ALTOGETHER, AND WORKING IN

2366
01:32:13,169 --> 01:32:13,536
PARALLEL.

2367
01:32:13,536 --> 01:32:15,105
>> YEAH, I AGREE.

2368
01:32:15,105 --> 01:32:17,741
I FEEL LIKE A LOT OF PEOPLE

2369
01:32:17,741 --> 01:32:19,109
CHEER LEAD COLLABORATION BUT

2370
01:32:19,109 --> 01:32:20,176
WHEN IT'S TIME TO HAVE THE

2371
01:32:20,176 --> 01:32:23,847
RUBBER HIT THE ROAD, THERE'S

2372
01:32:23,847 --> 01:32:24,581
ALWAYS CHALLENGES.

2373
01:32:24,581 --> 01:32:27,183
AND SO, I DON'T KNOW WHAT THE

2374
01:32:27,183 --> 01:32:29,019
ANSWER THERE IS, YOU KNOW I

2375
01:32:29,019 --> 01:32:30,320
WOULD CHALLENGE, YOU KNOW THE

2376
01:32:30,320 --> 01:32:32,989
FOLKS WITHIN THE D.O.D., THE

2377
01:32:32,989 --> 01:32:36,192
FOLKS AT NIH, THOSE THAT LEAD

2378
01:32:36,192 --> 01:32:37,661
OUR PROFESSIONAL SOCIETIES TO

2379
01:32:37,661 --> 01:32:41,631
TRY TO YOU KNOW PROVIDE THE

2380
01:32:41,631 --> 01:32:43,833
PLATFORMS FOR FOLKS TO MEET,

2381
01:32:43,833 --> 01:32:44,501
INVITE SPECIFIC SPEAKERS WITH

2382
01:32:44,501 --> 01:32:47,737
THE IPT GREATER TENSION OF

2383
01:32:47,737 --> 01:32:49,706
HAVING THESE INTERDISCIPLINARY

2384
01:32:49,706 --> 01:32:50,907
PANELS AT EVENTS, THAT'S REALLY

2385
01:32:50,907 --> 01:32:52,275
THE ONLY WAY IT'S GOING TO

2386
01:32:52,275 --> 01:32:53,576
HAPPEN, THAT IS JUST COLD

2387
01:32:53,576 --> 01:32:54,778
CALLING SOME FOLKS AND REACHING

2388
01:32:54,778 --> 01:32:58,048
OUT AND YOU KNOW ASKING.

2389
01:32:58,048 --> 01:33:06,289
I DO THAT MORE THAN I SHOULD,

2390
01:33:06,289 --> 01:33:06,556
PROBABLY.

2391
01:33:06,556 --> 01:33:08,959
>> YEAH, I APPRECIATE THE
SHOUT

2392
01:33:08,959 --> 01:33:09,926
OUT TO REGENERATIVE

2393
01:33:09,926 --> 01:33:12,529
REHABILATION, AND IN 1 OF OUR

2394
01:33:12,529 --> 01:33:14,331
NETWORKS WE HEARD RICK SEEINGLE

2395
01:33:14,331 --> 01:33:16,366
HIGHLIGHT THAT'S 1 OF OUR, SO

2396
01:33:16,366 --> 01:33:17,734
I'M DPLAD THAT CONNECTION'S

2397
01:33:17,734 --> 01:33:17,968
THERE.

2398
01:33:17,968 --> 01:33:21,404
I WANT TO PUSH MORE ON WHAT

2399
01:33:21,404 --> 01:33:22,806
LEWIS WAS SAYING, I WAS THINKING

2400
01:33:22,806 --> 01:33:24,708
THE SAME THING, WHO ACTUALLY IS

2401
01:33:24,708 --> 01:33:26,543
DOING THE SURMRY, THE AMPUTATION

2402
01:33:26,543 --> 01:33:27,744
AND ARE THEY THINKING AHEAD TO

2403
01:33:27,744 --> 01:33:29,746
THE FACT THAT PEOPLE LEAK LEWIS

2404
01:33:29,746 --> 01:33:31,581
WILL BE TRYING TO PUT WHOLE

2405
01:33:31,581 --> 01:33:34,050
NERVE SIGNALS THERE AND YOU

2406
01:33:34,050 --> 01:33:36,252
MENTIONED ABOUT PAIN AND TO WHAT

2407
01:33:36,252 --> 01:33:38,822
EXTENT CAN PLANNING OUT THAT

2408
01:33:38,822 --> 01:33:40,590
SURGERY PREVENT NEUROMAS AND

2409
01:33:40,590 --> 01:33:42,058
PREVENT--DOES IT MAKE SENSE TO

2410
01:33:42,058 --> 01:33:46,629
PREVENT THE PAIN BY PLANNING THE

2411
01:33:46,629 --> 01:33:47,197
SURMRY MORE CAREFULLY.

2412
01:33:47,197 --> 01:33:48,231
>>  YEAH, SO I WOULD SAY
THAT IS

2413
01:33:48,231 --> 01:33:52,068
SOMETHING THAT I HAVE SEEN A FEW

2414
01:33:52,068 --> 01:33:52,702
VERY THOUGHTFUL SURGEONS START

2415
01:33:52,702 --> 01:33:56,172
TO DO MORE AND MORE OVER MY

2416
01:33:56,172 --> 01:33:57,540
TENURE AT WALTER REED WHICH HAS

2417
01:33:57,540 --> 01:33:59,709
BEEN 6 YEARS NOW, BUT YEAH,

2418
01:33:59,709 --> 01:34:02,178
FOLKS LIKE COLNET POTTER WHO I

2419
01:34:02,178 --> 01:34:11,488
A--COLNET --COLONEL POTTER, HE'S

2420
01:34:11,488 --> 01:34:13,256
AN ORTHOPEDIC SURGEON BUT WHEN I

2421
01:34:13,256 --> 01:34:15,125
ALLUDED TO HIS IDEAS OF HOW TO

2422
01:34:15,125 --> 01:34:17,594
DO A GOOD AMPUTATION, IT'S ALL

2423
01:34:17,594 --> 01:34:18,261
ABOUT BEING THOUGHTFUL.

2424
01:34:18,261 --> 01:34:21,331
THINKING ABOUT NOT JUST AN

2425
01:34:21,331 --> 01:34:22,866
AMPUTATION BUT ABOUT LIMB

2426
01:34:22,866 --> 01:34:24,401
OPTIMIZATION, SO LOOKING FORWARD

2427
01:34:24,401 --> 01:34:29,806
TO THE OUTCOMES, PREPARING THAT

2428
01:34:29,806 --> 01:34:32,909
LIMB TO RECEIVE A PROSTHESIS

2429
01:34:32,909 --> 01:34:35,011
WHETHER IT'S AN OFTIO GENERATED

2430
01:34:35,011 --> 01:34:38,214
PROSTHESIS OR A TRADITIONAL

2431
01:34:38,214 --> 01:34:39,416
PROSTHESIS, AND HOW TO DO THAT

2432
01:34:39,416 --> 01:34:40,850
IN A THOUGHTFUL WAY TO MAXIMIZE

2433
01:34:40,850 --> 01:34:43,586
THE OUTCOME FOR THE PATIENT.

2434
01:34:43,586 --> 01:34:46,356
AND SO, THINGS LIKE PRESERVING

2435
01:34:46,356 --> 01:34:47,657
SOFTTISSUE, PRESERVING AS MUCH

2436
01:34:47,657 --> 01:34:49,025
LENGTH AS POSSIBLE, THOUGHTFUL

2437
01:34:49,025 --> 01:34:52,796
NERVE MANAGE AM, SOME OF THE TMR

2438
01:34:52,796 --> 01:34:55,899
AND RPI, TYPE OF APPROACHES,

2439
01:34:55,899 --> 01:34:57,267
THOSE ARE ALL GETTING AT EXACTLY

2440
01:34:57,267 --> 01:34:59,702
WHAT YOU'RE TALKING ABOUT WHICH

2441
01:34:59,702 --> 01:35:00,737
IS PREVENTING NEUROMA AND TRYING

2442
01:35:00,737 --> 01:35:03,373
TO TREAT THOSE THINGS TO YOU

2443
01:35:03,373 --> 01:35:05,008
KNOW IMPROVE THE OVERALL QUALITY

2444
01:35:05,008 --> 01:35:15,118
OF LIFE OF THE PATIENT.

2445
01:35:15,118 --> 01:35:16,119
>> [INDISCERNIBLE]

2446
01:35:16,119 --> 01:35:17,120
>> SORRY.

2447
01:35:17,120 --> 01:35:17,353
YEAH.

2448
01:35:17,353 --> 01:35:20,423
NLAST QUESTION.

2449
01:35:20,423 --> 01:35:22,992
>> THANK YOU, SO WITH THE
GOLDEN

2450
01:35:22,992 --> 01:35:24,194
HOUR BEING EXTENDED TO 2 WEEKS

2451
01:35:24,194 --> 01:35:27,464
WE NEED TO CARRY A LITTLE MORE

2452
01:35:27,464 --> 01:35:28,765
EQUIPMENT AND RESOURCE AND THEN

2453
01:35:28,765 --> 01:35:31,134
THIS TERMS OF TECHNOLOGY

2454
01:35:31,134 --> 01:35:33,470
FACILITATION OF WHAT'S IN THE

2455
01:35:33,470 --> 01:35:37,040
PIPELINE, WITH THE SMART GARMINS

2456
01:35:37,040 --> 01:35:39,976
OR BIOPNEUMATIC SYSTEMS, YOU

2457
01:35:39,976 --> 01:35:42,812
KNOW HOW DO YOU COPE WITH THAT

2458
01:35:42,812 --> 01:35:42,979
IN.

2459
01:35:42,979 --> 01:35:44,013
>> WE'RE STILL PRETTY
YOUNG IN

2460
01:35:44,013 --> 01:35:45,448
THAT FIELD AND SO THE ANSWER IS

2461
01:35:45,448 --> 01:35:46,916
NO, YOU'RE FOCUS ON THE GOING TO

2462
01:35:46,916 --> 01:35:50,120
BE ABLE TO CARRY MORE AND MORE

2463
01:35:50,120 --> 01:35:51,221
EQUIPMENT JUST PHYSICAL

2464
01:35:51,221 --> 01:35:53,756
LIMITATIONS OF THE SERVICE

2465
01:35:53,756 --> 01:35:53,990
MEMBER.

2466
01:35:53,990 --> 01:35:56,159
SO THAT'S KIND OF WHY WE PUT

2467
01:35:56,159 --> 01:35:57,994
FORTH THOSE DESIGN CRITERIA,

2468
01:35:57,994 --> 01:36:00,063
LIKE THINGS NEED TO BE

2469
01:36:00,063 --> 01:36:01,464
REPURPOSABLE OR VERY LIGHT

2470
01:36:01,464 --> 01:36:02,765
WEIGHT AND RUGGED AND SO LIKE IF

2471
01:36:02,765 --> 01:36:04,267
YOU PUT SOMETHING IN A PACK,

2472
01:36:04,267 --> 01:36:05,802
SOMETHING ELSE IS GOING TO HAVE

2473
01:36:05,802 --> 01:36:08,505
TO COME OUT. 

2474
01:36:08,505 --> 01:36:10,940
AND SO THAT'S A MAJOR TRADE-OFF

2475
01:36:10,940 --> 01:36:13,176
AND THERE'S BEEN A OF EFFORTS

2476
01:36:13,176 --> 01:36:15,145
ONGOING, SOME OF THE STUFF I

2477
01:36:15,145 --> 01:36:16,779
DIDN'T EVEN TOUCH ON FROM 1 OF

2478
01:36:16,779 --> 01:36:19,782
MY COLLEAGUES AT THE CFI IN SAN

2479
01:36:19,782 --> 01:36:21,651
ANTONIO, THEY'RE WORKING ON

2480
01:36:21,651 --> 01:36:23,052
NOVEL EXOSKELETON SOLUTIONS TO

2481
01:36:23,052 --> 01:36:25,822
RYE THAT CAN BE APPLIED IN THE

2482
01:36:25,822 --> 01:36:27,123
FIELD TO TRY TO GET THAT SERVICE

2483
01:36:27,123 --> 01:36:28,858
MEMBER UP AND RUNNING TO EITHER

2484
01:36:28,858 --> 01:36:30,627
GET OUT OF HARM'S WAY OR YOU

2485
01:36:30,627 --> 01:36:35,031
KNOW ALLOW THEM TO FIGHT BACK.

2486
01:36:35,031 --> 01:36:36,666
SO WE HAVE THOUGHTS AS WELL ON

2487
01:36:36,666 --> 01:36:38,701
HOW TO INTEGRATE THAT WITH

2488
01:36:38,701 --> 01:36:39,836
BIOLOGICAL HEALING AND PREPPING

2489
01:36:39,836 --> 01:36:42,839
THE WOUND TO HAVE A BETTER

2490
01:36:42,839 --> 01:36:45,441
SURGICAL AND ULTIMATELY

2491
01:36:45,441 --> 01:36:45,875
FUNCTIONAL OUTCOME.

2492
01:36:45,875 --> 01:36:48,778
BUT, IT'S GOING TO BE A

2493
01:36:48,778 --> 01:36:49,946
CHALLENGE AND THAT'S GOING TO BE

2494
01:36:49,946 --> 01:36:52,815
A HOT AREA FOR TWEPMENT FOR

2495
01:36:52,815 --> 01:36:55,351
YEARS TO COME IN MY MIND.

2496
01:36:55,351 --> 01:36:59,689
>> THANK YOU DR. GOLDMAN,
MUCH

2497
01:36:59,689 --> 01:36:59,989
APPRECIATED.

2498
01:36:59,989 --> 01:37:02,258
I THINK WE WILL MOVE ON TO THE

2499
01:37:02,258 --> 01:37:05,361
NEXT SPEAKER.

2500
01:37:05,361 --> 01:37:07,997
DR. P A LMIER-SMITH AND ARE WE

2501
01:37:07,997 --> 01:37:11,935
SET UP ONLINE IN? 

2502
01:37:11,935 --> 01:37:13,069
>> I THINK SO.

2503
01:37:13,069 --> 01:37:22,345
GOOD MORNING, CAN EVERYONE HEAR

2504
01:37:22,345 --> 01:37:22,812
ME?

2505
01:37:22,812 --> 01:37:23,146
>> YES.

2506
01:37:23,146 --> 01:37:26,082
>> LET'S SEE IF WE CAN
SHARE THE

2507
01:37:26,082 --> 01:37:27,250
SCREEN AND EVERYTHING GOES

2508
01:37:27,250 --> 01:37:27,850
SMOOTHLY HERE.

2509
01:37:27,850 --> 01:37:29,586
LET ME START PRESENTATION MODE

2510
01:37:29,586 --> 01:37:30,553
AND SEE WHERE WE GO.

2511
01:37:30,553 --> 01:37:31,854
YOU WILL SEE NOTE SLIDES WHICH

2512
01:37:31,854 --> 01:37:33,723
WE DON'T WANT YOU TO SEE, RIGHT?

2513
01:37:33,723 --> 01:37:44,267
SEE IF I SWITCH THIS ON MY KREEN

2514
01:37:45,068 --> 01:37:45,802
HERE?

2515
01:37:45,802 --> 01:37:48,338
ARE YOU SEEING NOTE SLIDES OR

2516
01:37:48,338 --> 01:37:49,005
REGULAR?

2517
01:37:49,005 --> 01:37:50,840
>> REGULAR.

2518
01:37:50,840 --> 01:37:51,741
>> GREAT.

2519
01:37:51,741 --> 01:37:53,042
GOOD MORNING, THANKS FOR HAVING

2520
01:37:53,042 --> 01:37:56,012
ME HERE, I'M A PROFESSOR IN THE

2521
01:37:56,012 --> 01:37:58,581
SCHOOL OF KINESIOLOGY AND

2522
01:37:58,581 --> 01:37:59,415
DEPARTMENT OF ORTHOPEDIC SURGERY

2523
01:37:59,415 --> 01:38:00,383
AT THE UNIVERSITY OF MICHIGAN

2524
01:38:00,383 --> 01:38:02,085
AND I WAS GIVEN THE TASK OF

2525
01:38:02,085 --> 01:38:03,620
TALKING TO YOU ABOUT SPORTS

2526
01:38:03,620 --> 01:38:05,288
YOURS WHICH IS QUITE COMPLICATED

2527
01:38:05,288 --> 01:38:07,123
TO DO IF 20 MINUTES TIME SO KNOW

2528
01:38:07,123 --> 01:38:09,025
IT'S GOING TO BE BROAD AND I AM

2529
01:38:09,025 --> 01:38:10,260
HAPPY TO TAKE DETAILED QUESTIONS

2530
01:38:10,260 --> 01:38:15,498
YOU HAVE AS WE MOVE FORWARD.

2531
01:38:15,498 --> 01:38:17,000
SO I THOUGHT WE WOULD START OFF

2532
01:38:17,000 --> 01:38:17,967
BY TALKING ABOUT SPORT AND WHERE

2533
01:38:17,967 --> 01:38:19,402
WE SHOULD BE DOING IT AND THEN

2534
01:38:19,402 --> 01:38:21,704
SOME OF THE CONSEQUENCES THAT

2535
01:38:21,704 --> 01:38:23,973
HAPPEN WITH IT AND SO, IF YOU

2536
01:38:23,973 --> 01:38:26,409
JUST LOOK AT KIDS THERE'S OVER

2537
01:38:26,409 --> 01:38:27,443
46 MILLION CHILDREN THAT

2538
01:38:27,443 --> 01:38:28,478
PARTICIPATE IN SPORTS ANNUALLY

2539
01:38:28,478 --> 01:38:30,179
AND WE WANT TO THEM TO

2540
01:38:30,179 --> 01:38:31,147
PARTICIPATE IN SPORTS BA UNITED

2541
01:38:31,147 --> 01:38:33,416
STATES IT PROVIDES A LIFETIME OF

2542
01:38:33,416 --> 01:38:33,783
BENEFIT.

2543
01:38:33,783 --> 01:38:35,985
AND IF YOU LACK AT THE GRAPHIC,

2544
01:38:35,985 --> 01:38:37,520
IF YOU PARTICIPATE IN SPORT, YOU

2545
01:38:37,520 --> 01:38:38,855
WILL LESS LIKELY TO BE OBESE,

2546
01:38:38,855 --> 01:38:40,390
YOU WILL DO BETTER IN WILL 62,

2547
01:38:40,390 --> 01:38:43,393
YOU ARE LESS LIKELY TO ENGAGE IN

2548
01:38:43,393 --> 01:38:45,595
RISKY BEHAVIOR, AS AN ADULT THE

2549
01:38:45,595 --> 01:38:46,429
CHILDREN THAT PARTICIPATE INDEED

2550
01:38:46,429 --> 01:38:47,730
ARK DULTS ARE MORE SUCCESS OF AT

2551
01:38:47,730 --> 01:38:49,599
WORK AND THEY ARE REDUCE RISK OF

2552
01:38:49,599 --> 01:38:52,035
DISEASE SO WE WANT TO ENCOURAGE

2553
01:38:52,035 --> 01:38:52,969
SPORT PARTICIPATION AND IT'S NOT

2554
01:38:52,969 --> 01:38:55,004
JUST KIDS THAT ARE PARTICIPATING

2555
01:38:55,004 --> 01:38:56,372
IN SPORTS, ABOUT 20% OF THE

2556
01:38:56,372 --> 01:38:58,074
WHOLE U.S. POPULATION IS

2557
01:38:58,074 --> 01:38:58,875
PARTICIPATE NOTHING SPORES AND

2558
01:38:58,875 --> 01:39:00,243
THERE'S BEN FIELD FUNCTIONSES TO

2559
01:39:00,243 --> 01:39:01,344
HEALTH, ET CETERA, TO DOING

2560
01:39:01,344 --> 01:39:01,544
THAT.

2561
01:39:01,544 --> 01:39:03,313
SO WE WANT TO ENCOURAGE THAT,

2562
01:39:03,313 --> 01:39:06,983
BUT  1 CONSEQUENCES OF THE BAD

2563
01:39:06,983 --> 01:39:10,653
THINGS ABOUT SPORT PARTICIPATION

2564
01:39:10,653 --> 01:39:12,255
IS SPORTS OBVIOUSLY CAN LEAD TO

2565
01:39:12,255 --> 01:39:13,756
YOUR AND WE JUST LOOK AT KIDS

2566
01:39:13,756 --> 01:39:15,625
THAT ARE 18 AND UNDER, THERE'S

2567
01:39:15,625 --> 01:39:17,960
ABOUT 8 AND HALF BILLION SPORTS

2568
01:39:17,960 --> 01:39:21,931
YOURS THAT ARE OCCURRING EACH

2569
01:39:21,931 --> 01:39:22,865
YEAR.

2570
01:39:22,865 --> 01:39:23,766
ABOUT EVERY 25-SECONDS A CHILD

2571
01:39:23,766 --> 01:39:24,734
IS SEEN IN THE EMERGENCY

2572
01:39:24,734 --> 01:39:26,235
DEPARTMENT BECAUSE OF A SPORT

2573
01:39:26,235 --> 01:39:26,469
INJURY.

2574
01:39:26,469 --> 01:39:29,806
COMMON DIAGNOSIS THAT WE SEE ARE

2575
01:39:29,806 --> 01:39:33,376
SPRAIN ANDS TRAINS, CONDUGZS,

2576
01:39:33,376 --> 01:39:34,544
FRACTURES, ABRASIONS AND

2577
01:39:34,544 --> 01:39:36,045
CONTUSIONS, AND THEN YOUR RATE

2578
01:39:36,045 --> 01:39:39,015
WILL VARY BY SPORT AND BY TYPE

2579
01:39:39,015 --> 01:39:39,649
OF COMPETITION OR PRACTICE

2580
01:39:39,649 --> 01:39:40,950
RESEARCH THAIS YOU'RE IN AND IF

2581
01:39:40,950 --> 01:39:44,020
YOU TAKE A LOOK AT THE GRAPHIC

2582
01:39:44,020 --> 01:39:45,421
THERE THIS IS IN COLLEGIATE

2583
01:39:45,421 --> 01:39:47,857
SPORTS AND SO IT WOULD VARY IF

2584
01:39:47,857 --> 01:39:50,059
WE'RE LOOKING AT HIGH SCHOOL OR

2585
01:39:50,059 --> 01:39:51,694
RECREATIONAL SPORT BUT HAD IS

2586
01:39:51,694 --> 01:39:53,763
LOOKING AT PRACTICE YOUR RATES

2587
01:39:53,763 --> 01:39:56,432
VERSUS GAME YOUR RATES ACROSS A

2588
01:39:56,432 --> 01:39:58,735
VARIETY OF SPORTS AND IT'S

2589
01:39:58,735 --> 01:39:59,802
PRETTY UBIQUITOUS THAT WE

2590
01:39:59,802 --> 01:40:01,104
SUSTAIN MORE INJURIES DURING

2591
01:40:01,104 --> 01:40:02,105
GAMES THAN AT PRACTICE, THE

2592
01:40:02,105 --> 01:40:03,406
PRACTICE IS THE BROWN, THE BLUE

2593
01:40:03,406 --> 01:40:04,674
IS THE GAME, CAN YOU SEE THERE'S

2594
01:40:04,674 --> 01:40:07,343
MORE INJURIES THAT OCCUR DURING

2595
01:40:07,343 --> 01:40:08,945
PRACTICE AND THEN SOME OF THE

2596
01:40:08,945 --> 01:40:10,012
SPORTS WITH HIGHER INJURY RATES

2597
01:40:10,012 --> 01:40:12,882
WILL BE AMERICAN FOOTBALL,

2598
01:40:12,882 --> 01:40:14,217
SOCCER, BASKETBALL, AND HOCKEY

2599
01:40:14,217 --> 01:40:16,552
AS WELL AS GYMNASTICS.

2600
01:40:16,552 --> 01:40:21,824
BUT IN ALL SPORTS, FOLKS ARE

2601
01:40:21,824 --> 01:40:22,325
SUSTAINING INJURY.

2602
01:40:22,325 --> 01:40:23,960
I WOULD SAY THE FINANCIAL BURDEN

2603
01:40:23,960 --> 01:40:25,695
FROM SPORT INJURY IS NOT WELL

2604
01:40:25,695 --> 01:40:26,462
UNDERSTOOD.

2605
01:40:26,462 --> 01:40:27,764
MOST OF THE RESEARCH IS DONE

2606
01:40:27,764 --> 01:40:30,299
LOOKING AT THE COST FOR

2607
01:40:30,299 --> 01:40:31,701
IN-PATIENT HOSPITALIZATION OR

2608
01:40:31,701 --> 01:40:32,268
EMERGENCY DEPARTMENT VISITS.

2609
01:40:32,268 --> 01:40:36,339
WHEN WE LOCK AT OVERALL

2610
01:40:36,339 --> 01:40:37,273
COMBINING ALL OF SPORTS

2611
01:40:37,273 --> 01:40:40,410
INJURIES, YOU SEE THE STATISTICS

2612
01:40:40,410 --> 01:40:42,111
HERE, ABOUT $133 MILLION

2613
01:40:42,111 --> 01:40:45,114
ANNUALLY ARE SPENT ON SPORTS

2614
01:40:45,114 --> 01:40:45,615
INJURIES IN-PATIENT

2615
01:40:45,615 --> 01:40:46,783
HOSPITALIZATIONS AND THAT'S JUST

2616
01:40:46,783 --> 01:40:47,617
IN IEWGHT SPORTS ALONE.

2617
01:40:47,617 --> 01:40:49,619
IN A TODAY THAT WAS PRETTY COMP

2618
01:40:49,619 --> 01:40:52,422
REHENNIVE JUST DONE IN FLORIDA

2619
01:40:52,422 --> 01:40:56,292
WHERE THEY LOOK AT IN-PATIENT

2620
01:40:56,292 --> 01:40:57,560
HOSPITALIZEITION AND EMERGENCY

2621
01:40:57,560 --> 01:40:59,495
DEDEPARTMENT VISITS THEY SHOWED

2622
01:40:59,495 --> 01:41:00,930
THAT $22.3 MILLION IS SPENT ON

2623
01:41:00,930 --> 01:41:02,465
SPORT YOURS JUST IN THEIR STATE

2624
01:41:02,465 --> 01:41:03,533
AND YOU COULD APPLY THAT ACROSS

2625
01:41:03,533 --> 01:41:04,600
AND IT'S NOT CONSIDERING ALL OF

2626
01:41:04,600 --> 01:41:06,235
THE CARE THAT IS ROUGH ATOM

2627
01:41:06,235 --> 01:41:07,637
VIEDED BY ATHLETIC TRAINERS THAT

2628
01:41:07,637 --> 01:41:10,406
ARE AT COOLS OR VISITS TO URIENT

2629
01:41:10,406 --> 01:41:12,141
CARE OR DOCTOR'S OFFICE VISITS

2630
01:41:12,141 --> 01:41:14,110
SO THESE COSTS ARE WAY

2631
01:41:14,110 --> 01:41:15,411
UNDERESTIMATED AND THEN HIGH

2632
01:41:15,411 --> 01:41:17,146
SCHOOL AGED ATHLETES AND MALES

2633
01:41:17,146 --> 01:41:18,881
ARE 2 GROUPS THAT GENERALLY HAVE

2634
01:41:18,881 --> 01:41:20,216
A HIGHER COST OF SPORTS YOURED

2635
01:41:20,216 --> 01:41:22,618
AND IF WE WANT TO PROVIDE JUST

2636
01:41:22,618 --> 01:41:24,454
FOR A VERY SPISK SPRAIN, THE

2637
01:41:24,454 --> 01:41:26,122
SOCIETAL COST IS ESTIMATED TO BE

2638
01:41:26,122 --> 01:41:28,024
ABOUT $10,000.

2639
01:41:28,024 --> 01:41:28,858
SO CURRENT ESTIMATE SUGGESTS

2640
01:41:28,858 --> 01:41:30,493
THAT THE COST IS SUBSTANTIAL BUT

2641
01:41:30,493 --> 01:41:31,928
WE NEED MORE WORK IN THIS AREA

2642
01:41:31,928 --> 01:41:33,663
TO BETTER UNDERSTAND WHAT THE

2643
01:41:33,663 --> 01:41:34,464
FIEP ACIAL BURDEN IS.

2644
01:41:34,464 --> 01:41:36,466
AND LIKE I SAID BUYER I GOT

2645
01:41:36,466 --> 01:41:38,234
STARTED THERE'S A TON OF SPORTS

2646
01:41:38,234 --> 01:41:39,469
INJURIES IING TALK ABOUT AND I

2647
01:41:39,469 --> 01:41:41,204
STRUGGLED FOR A BIT OF TIME WITH

2648
01:41:41,204 --> 01:41:43,473
WHICH 1S TO PRESENT TO YOU

2649
01:41:43,473 --> 01:41:43,706
TODAY.

2650
01:41:43,706 --> 01:41:46,108
BUT I PUT THE SLIDE UP THERE TO

2651
01:41:46,108 --> 01:41:47,710
SHOW YOU THERE'S INJURIES

2652
01:41:47,710 --> 01:41:50,112
OCCURRING TO THE HEAD, NECK,

2653
01:41:50,112 --> 01:41:51,280
TRUNK, TO THE UPPER AND LOWER

2654
01:41:51,280 --> 01:41:53,049
BODY ISSUE THE VAST MAJORITY OF

2655
01:41:53,049 --> 01:41:54,450
SPORT INJURIES, HALF OF SPORT

2656
01:41:54,450 --> 01:41:56,118
INJURIES OCCUR TO THE LOWER

2657
01:41:56,118 --> 01:41:57,753
BODY, ROUGHLY 50% IF YOU LOOK AT

2658
01:41:57,753 --> 01:41:58,688
THAT GRAPHIC HERE, THAT'S WHAT

2659
01:41:58,688 --> 01:41:59,989
YOU WILL SEE.

2660
01:41:59,989 --> 01:42:04,193
AND THEN ABOUT 30% TO THE HEAD,

2661
01:42:04,193 --> 01:42:06,195
NECK AND TRINK AND THEN THE LAST

2662
01:42:06,195 --> 01:42:08,130
20% ARE UPPER EXTREMITY SO I

2663
01:42:08,130 --> 01:42:09,365
LISTED OUT SOME OF THOSE YOURS

2664
01:42:09,365 --> 01:42:11,801
MIGHT BE AND AGAIN THIS IS NOT

2665
01:42:11,801 --> 01:42:12,502
AN ALL-INCLUSIVE LIST.

2666
01:42:12,502 --> 01:42:14,370
AND THEN I BOLDED 3 YOURS THEY

2667
01:42:14,370 --> 01:42:16,706
WILL SPEND TIME TALKING TO YOU

2668
01:42:16,706 --> 01:42:22,245
ABOUT TODAY IN A VERY

2669
01:42:22,245 --> 01:42:23,212
ACCELERATED WAY.

2670
01:42:23,212 --> 01:42:24,747
BECAUSE THEY'RE INJURIES THAT

2671
01:42:24,747 --> 01:42:27,049
HAVE LOCK TERM CONSEQUENCES AND

2672
01:42:27,049 --> 01:42:28,951
THEY CAN DO DONE TO IMPROVE

2673
01:42:28,951 --> 01:42:29,485
CARE.

2674
01:42:29,485 --> 01:42:32,922
SO LET'S TALK ABOUT THE SAMPLING

2675
01:42:32,922 --> 01:42:38,861
OF SPORTS INJURIES THAT I CHOSE

2676
01:42:38,861 --> 01:42:39,061
TODAY.

2677
01:42:39,061 --> 01:42:41,330
THE FIRST 1 IS ANKLE SPRAINS SO

2678
01:42:41,330 --> 01:42:43,533
IF WE LOOK AT BASIC FACTS, ABOUT

2679
01:42:43,533 --> 01:42:45,601
2 OF THESE OCCUR EACH YEAR AND

2680
01:42:45,601 --> 01:42:47,003
THIS IS A BIG UNDERESTIMATE

2681
01:42:47,003 --> 01:42:48,538
BECAUSE THIS NUMBER IS JUST

2682
01:42:48,538 --> 01:42:55,711
BASED ON ER VISITING AND MOST

2683
01:42:55,711 --> 01:42:57,680
WILL BE NOT GET TO THE ER, THEY

2684
01:42:57,680 --> 01:43:01,817
WILL BE SEEN BY A PHYSICAL

2685
01:43:01,817 --> 01:43:02,685
TRAINER OR CAREGIVER.

2686
01:43:02,685 --> 01:43:08,257
SO THIS IS A MASSIVE INACCURATE

2687
01:43:08,257 --> 01:43:08,524
REPORTING.

2688
01:43:08,524 --> 01:43:09,959
FEMALES ALSO HAVE A HIGH

2689
01:43:09,959 --> 01:43:11,427
EN--STRATEGIES DENSE OF INJURY

2690
01:43:11,427 --> 01:43:17,099
RATE, SO THEY SUSTAIN ABOUT 14

2691
01:43:17,099 --> 01:43:20,870
FRAMES PER EXPOSURES VERSUS MEN

2692
01:43:20,870 --> 01:43:23,506
WHO GET 7 SPRAINS FOR THOUSAND

2693
01:43:23,506 --> 01:43:25,007
EXPOSURES, KIDS AT 12 ARE MOST

2694
01:43:25,007 --> 01:43:26,709
AT LIFIC FOLLOWED BY ADOLESCENT

2695
01:43:26,709 --> 01:43:28,511
ANDS THEN ADULT ANDS THEN

2696
01:43:28,511 --> 01:43:30,479
ATHLETES THAT ARE PARTICIPATING

2697
01:43:30,479 --> 01:43:33,950
IN COURT SPORTS ARE AT MORE RISK

2698
01:43:33,950 --> 01:43:35,718
THAN FOLKS PARTICIPATING IN

2699
01:43:35,718 --> 01:43:36,752
OTHER SURFACES.

2700
01:43:36,752 --> 01:43:41,290
PROBABLY WHAT'S MOST ALARMING

2701
01:43:41,290 --> 01:43:43,492
ABOUT THIS IS THAT THE ANKLE

2702
01:43:43,492 --> 01:43:44,994
SPRAINS HAVE THE HIGHEST

2703
01:43:44,994 --> 01:43:46,395
OCCURRENCE OF ALL MUSK LO

2704
01:43:46,395 --> 01:43:47,263
SKELETAL INJURIES.

2705
01:43:47,263 --> 01:43:48,531
THERE'S A 2 FOLD INCREASE IN

2706
01:43:48,531 --> 01:43:50,366
RISK IN THE YOUR FOLLOWING YOUR

2707
01:43:50,366 --> 01:43:51,701
AND OCCURRENCE AND GENERALLY

2708
01:43:51,701 --> 01:43:52,635
SPEAKING PROBABLY ALL OF YOU ON

2709
01:43:52,635 --> 01:43:54,704
THIS CALL, YOU THINK OF AN ANKLE

2710
01:43:54,704 --> 01:43:58,274
SPRAIN YOU THINK OF IT AS A

2711
01:43:58,274 --> 01:43:58,908
RELATIVELY INSIGNIFICANT INJURY,

2712
01:43:58,908 --> 01:43:59,342
BUT ISN'T.

2713
01:43:59,342 --> 01:44:01,544
IT HAS A LONG-TERM COST AND

2714
01:44:01,544 --> 01:44:03,045
DISABLES SHOASHTED WITH IT.

2715
01:44:03,045 --> 01:44:04,380
I WANT TO MENTION THERE'S A

2716
01:44:04,380 --> 01:44:06,549
BUNCH OF DIFFERENT TYPES OF

2717
01:44:06,549 --> 01:44:09,018
ANKLE SPRAINS, I SHOW 3 TYPES,

2718
01:44:09,018 --> 01:44:10,953
INVERSION ANKLE SPRAINS AND HIGH

2719
01:44:10,953 --> 01:44:11,988
ANKLE SPRAINS, THE MOST COMMON

2720
01:44:11,988 --> 01:44:13,189
TYPE THAT WE'RE DEALING WITH AND

2721
01:44:13,189 --> 01:44:15,725
THE 1S THAT CAUSE A LOT OF

2722
01:44:15,725 --> 01:44:17,460
LONG-TERM COMPLICATIONS WERE

2723
01:44:17,460 --> 01:44:20,763
THESE INVERSION ANKLE SPRAINS

2724
01:44:20,763 --> 01:44:22,264
OVER LATERAL ANKLE SPRAINS AND

2725
01:44:22,264 --> 01:44:24,000
THESE TURN WHEN THEY'RE FORCED

2726
01:44:24,000 --> 01:44:25,568
INWARD AND CAUSES THE LIGAPTS OR

2727
01:44:25,568 --> 01:44:27,169
THE LIGAMENTS ON THE OUTSIDE OF

2728
01:44:27,169 --> 01:44:29,372
THE ANKLE TO TEAR AND THESE

2729
01:44:29,372 --> 01:44:30,406
LATERAL ANKLE SPRAINS HAVE A

2730
01:44:30,406 --> 01:44:33,376
HIGH EN--STRATEGIES DENSE OF

2731
01:44:33,376 --> 01:44:34,543
LONG-TERM INSTABILITY, ABOUT

2732
01:44:34,543 --> 01:44:36,979
80-NIEBT% OF FOLKS WILL GO ON

2733
01:44:36,979 --> 01:44:47,523
AND OCCUR IN STABILITY WITH THIS

2734
01:44:51,861 --> 01:44:52,495
INJURY.

2735
01:44:52,495 --> 01:44:53,429
SO CHRONIC ANKLE INTAIBILITY AND

2736
01:44:53,429 --> 01:44:55,398
THE POGHT ALGORITHMS OF RESIDUAL

2737
01:44:55,398 --> 01:44:57,700
SYMPTOMS AFTER AN INITIAL

2738
01:44:57,700 --> 01:44:57,933
SPRAIN.

2739
01:44:57,933 --> 01:45:01,203
SO THIS IS THOUGHT TO OCCUR FROM

2740
01:45:01,203 --> 01:45:03,639
2 MAIN REASONS, THIS MECHANICAL

2741
01:45:03,639 --> 01:45:07,610
INSTABILITY THAT MAY PERSIST,

2742
01:45:07,610 --> 01:45:08,844
AND/OR DISFUNKAL INSTABILITY

2743
01:45:08,844 --> 01:45:10,846
THAT PATIENTS DESCRIBE EMPLOY SO

2744
01:45:10,846 --> 01:45:11,681
THE MECHANICAL INSTABILITY IS

2745
01:45:11,681 --> 01:45:14,216
THE RESULT OF INCREASED LAXITY

2746
01:45:14,216 --> 01:45:21,257
OR LOOSENESS IN THE JOINT AND

2747
01:45:21,257 --> 01:45:24,260
THEN ARGT ROW KINEMATIC

2748
01:45:24,260 --> 01:45:26,162
FUNCTIONAL AFTER THE SPRAIN AS

2749
01:45:26,162 --> 01:45:30,666
WELL AS THE PATIENT MAY PERCEIVE

2750
01:45:30,666 --> 01:45:31,867
COMPLETE STABILITY RESTORE BUT

2751
01:45:31,867 --> 01:45:37,206
THEY'RE EXPERIENCING  EXPERIENCF

2752
01:45:37,206 --> 01:45:39,008
GIVING WAY AND THEY CALL THAT

2753
01:45:39,008 --> 01:45:39,608
FUNCTIONAL INSTABILITY PIECE.

2754
01:45:39,608 --> 01:45:41,243
IF YOU TAKE A LACK AT THE

2755
01:45:41,243 --> 01:45:41,844
LITERATURE AREYALATED TO THAT

2756
01:45:41,844 --> 01:45:47,349
AND WHAT ARE THE RISK FACTORS

2757
01:45:47,349 --> 01:45:49,618
THAT PERPETUATE WHETHER SOMEBODY

2758
01:45:49,618 --> 01:45:52,488
GOES ON TO THIS VERSUS SOMEBODY

2759
01:45:52,488 --> 01:45:54,557
THAT DID NOT, IF YOU LACK AT THE

2760
01:45:54,557 --> 01:45:56,892
ITEMS ON THIS GRAPHIC THAT ARE

2761
01:45:56,892 --> 01:45:58,728
HAVE BIGGER TEXT, THESE ARE THE

2762
01:45:58,728 --> 01:46:00,129
FACTORS THAT HAVE BEEN

2763
01:46:00,129 --> 01:46:01,797
REPETITIVELY OVER AND OVER

2764
01:46:01,797 --> 01:46:02,631
AGAIN, META-ANALYSIS SHOWN TO

2765
01:46:02,631 --> 01:46:04,033
REALLY PLAY A ROLE IN WHETHER

2766
01:46:04,033 --> 01:46:07,236
SOMEBODY GOES ON TO TWEP CHRONIC

2767
01:46:07,236 --> 01:46:09,705
ANKLE INSTABILITY.

2768
01:46:09,705 --> 01:46:11,407
SO THE PERO NEAL MUSCLES WHICH

2769
01:46:11,407 --> 01:46:12,541
ARE THE EVETERINARY COMMUNITIER

2770
01:46:12,541 --> 01:46:14,610
MUSCLES OF THE FOOD THAT WILL E

2771
01:46:14,610 --> 01:46:15,978
SPHOND THIS INVERSION MOTION WE

2772
01:46:15,978 --> 01:46:18,514
SEE WITH THE LATERAL ANKLE

2773
01:46:18,514 --> 01:46:20,349
SPRAIN, IF THE PERO NEAL MUSCLES

2774
01:46:20,349 --> 01:46:22,118
ARE WEEK OR DON'T REACT AS

2775
01:46:22,118 --> 01:46:30,059
QUICKLY TO AN INVERSION TYPE

2776
01:46:30,059 --> 01:46:30,292
MOTION.

2777
01:46:30,292 --> 01:46:34,897
THESE FOLKS WILL GO ON AND HAVE

2778
01:46:34,897 --> 01:46:36,165
INSTABILITY, ALSO THEY HAVE

2779
01:46:36,165 --> 01:46:38,567
FOLKS WHO HAVE TO JUMP FORWARD

2780
01:46:38,567 --> 01:46:40,569
OR PERFORMING VARIOUS REACH TYPE

2781
01:46:40,569 --> 01:46:41,737
ACTIVITIES, WHILE BALANCING ON

2782
01:46:41,737 --> 01:46:43,372
THE LEG, FECES THAT HAVE BALANCE

2783
01:46:43,372 --> 01:46:44,707
DEFINITES IN THESE WAYS ARE MORE

2784
01:46:44,707 --> 01:46:47,376
LIKELY TO GO ON AND SUFFER

2785
01:46:47,376 --> 01:46:48,077
CHRONIC INSTABILITY.

2786
01:46:48,077 --> 01:46:50,713
AND THE SMALLER 1S DOWN AT THE

2787
01:46:50,713 --> 01:46:53,883
BOTTOM, THERE'S BEEN IN STUDIES

2788
01:46:53,883 --> 01:46:56,552
THAT HAVE SHOWN THAT PROPRIMATES

2789
01:46:56,552 --> 01:46:58,521
O ACCEPTION OR STANDING ON LEGS

2790
01:46:58,521 --> 01:47:01,157
WITH EYES CLOSED CAN BE A FACTOR

2791
01:47:01,157 --> 01:47:02,057
FOR CHRONIC ANKLE INSTABILITY

2792
01:47:02,057 --> 01:47:05,427
BUT THERE'S NOT AS MUCH EVIDENCE

2793
01:47:05,427 --> 01:47:05,861
TO SUPPORT THOSE.

2794
01:47:05,861 --> 01:47:07,596
I USE THIS SLIDE BECAUSE BASIC

2795
01:47:07,596 --> 01:47:09,665
LYE ONCE YOU SUSTAIN AN ANKLE

2796
01:47:09,665 --> 01:47:11,200
SPRAIN THERE'S A HIGH LIKELIHOOD

2797
01:47:11,200 --> 01:47:12,701
OF THIS SMOA BALL EFFECT THAT

2798
01:47:12,701 --> 01:47:15,104
OCCURS EMPLOY SO THERE'S ACUTE

2799
01:47:15,104 --> 01:47:17,406
ANKLE SPRAIN, MOST OF WHICH WILL

2800
01:47:17,406 --> 01:47:22,678
GO ON TO LEAD TO THIS RECURRENT

2801
01:47:22,678 --> 01:47:23,445
INSTABILITY OR CHRONIC

2802
01:47:23,445 --> 01:47:24,213
INSTABILITY OF THE JOINT AND

2803
01:47:24,213 --> 01:47:26,148
THEN A GOOD NOB OF PEOPLE WHO

2804
01:47:26,148 --> 01:47:28,784
HAVE A SINGLE ANKLE SPRAIN OR

2805
01:47:28,784 --> 01:47:34,023
RECURRENT INSTABILITY WILL GO ON

2806
01:47:34,023 --> 01:47:34,790
AND DEVELOP POST-TRAUMATIC

2807
01:47:34,790 --> 01:47:35,457
OSTEOARTHRITIS.

2808
01:47:35,457 --> 01:47:37,993
SO THIS CONTRIBUTES TO TWEBT% OF

2809
01:47:37,993 --> 01:47:39,395
ALL OSTEOARTHRITIS CASES THAT

2810
01:47:39,395 --> 01:47:43,199
INVOLVE THE ANKLE AND 80% OF THE

2811
01:47:43,199 --> 01:47:45,968
OSTEOARTHRITIS CASES THAT

2812
01:47:45,968 --> 01:47:50,739
INVOLVE THE ANKLE. 

2813
01:47:50,739 --> 01:47:53,175
PATIENTS WITH END STAGE, THEY

2814
01:47:53,175 --> 01:47:55,744
HAVE A FASTER LOSS OF FUNCTION

2815
01:47:55,744 --> 01:47:56,679
AND PROGRESSION TO

2816
01:47:56,679 --> 01:47:57,146
OSTEOARTHRITIS.

2817
01:47:57,146 --> 01:47:59,682
THE PHYSICAL BURDEN THAT'S

2818
01:47:59,682 --> 01:48:00,749
ASSOCIATE WIDE POST-TRAUMATIC OA

2819
01:48:00,749 --> 01:48:02,284
IN THIS POPULATION HAS BEEN

2820
01:48:02,284 --> 01:48:03,752
COMPARABLE TO THAT REPORTED BY

2821
01:48:03,752 --> 01:48:05,487
PATES WITH KIDNEY DISEASE,

2822
01:48:05,487 --> 01:48:06,522
CONGESTIVE HEART FAIL AND YOU

2823
01:48:06,522 --> 01:48:09,391
ARE CERVICAL PAIN AND RADICKUE

2824
01:48:09,391 --> 01:48:09,625
LOPATHY.

2825
01:48:09,625 --> 01:48:12,895
SO IT'S A BIG PROBLEM THAT NEEDS

2826
01:48:12,895 --> 01:48:13,462
SOME WORK.

2827
01:48:13,462 --> 01:48:14,797
AND SO 1 OF THE THINGS I WAS

2828
01:48:14,797 --> 01:48:16,565
ASKED TO DO WAS TALK ABOUT

2829
01:48:16,565 --> 01:48:18,634
RESEARCH DOMAINS THAT MIGHT BE

2830
01:48:18,634 --> 01:48:20,603
ASSOCIATE WIDE ANKLE SPRAINS OR

2831
01:48:20,603 --> 01:48:21,570
ANKLE INSTABILITY RESEARCH AND I

2832
01:48:21,570 --> 01:48:23,138
WOULD SAY SPORTS MEDICINE IN

2833
01:48:23,138 --> 01:48:24,340
GENERAL WE LACK CLINICAL TRIALS

2834
01:48:24,340 --> 01:48:25,341
TO SHOW WHICH TREATMENTS ARE

2835
01:48:25,341 --> 01:48:26,876
MORE CENTER FOR EXCELLENCE ON

2836
01:48:26,876 --> 01:48:29,078
AGINGIVE, AND SO THAT'S A BIG

2837
01:48:29,078 --> 01:48:30,112
MESSAGE THAT I'M HOPING TO

2838
01:48:30,112 --> 01:48:31,280
ACCEPTED TODAY IS THAT WE JUST

2839
01:48:31,280 --> 01:48:36,051
DON'T HAVE THE DATA TO SAY, HEY,

2840
01:48:36,051 --> 01:48:38,020
DOING REHABILATION AND WHAT TYPE

2841
01:48:38,020 --> 01:48:38,988
OF REHABILITATION AND WHAT

2842
01:48:38,988 --> 01:48:41,023
INTERVENTIONS SHOULD BE PART OF

2843
01:48:41,023 --> 01:48:42,658
THE REHABILITATION ARE EFFECTIVE

2844
01:48:42,658 --> 01:48:43,692
EMPLOY THAT DATA DOESN'T EXIST

2845
01:48:43,692 --> 01:48:46,896
AND WE DON'T HAVE A--WE DON'T

2846
01:48:46,896 --> 01:48:48,063
HAVE LARGE PROSPECTIVE STUDIES

2847
01:48:48,063 --> 01:48:51,166
THAT LOOK AT WHAT FACTORS

2848
01:48:51,166 --> 01:48:52,568
CONTRIBUTE TO LINGERING

2849
01:48:52,568 --> 01:48:54,069
INSTABILITY AFTER ANKLE SPRAINS

2850
01:48:54,069 --> 01:48:56,939
AND WHAT FACTORS LEAD TO

2851
01:48:56,939 --> 01:48:58,073
OSTEOARTHRITIS OR ANKLE SPRAINS

2852
01:48:58,073 --> 01:49:00,175
SO THERE'S A WHOLE LOT OF THINGS

2853
01:49:00,175 --> 01:49:01,710
THAT FOLKS COULD BE DOING TO

2854
01:49:01,710 --> 01:49:06,115
IMPROVE OR FILL RESEARCH GAPS IN

2855
01:49:06,115 --> 01:49:08,117
THIS AREA.

2856
01:49:08,117 --> 01:49:09,818
THE SECOND INJURY THAT I'M GOING

2857
01:49:09,818 --> 01:49:13,222
TO TALK ABOUT IS ANTERIOR

2858
01:49:13,222 --> 01:49:14,356
CRUCIATE LIGAMENT, THIS IS THE 1

2859
01:49:14,356 --> 01:49:17,993
WE SPEND ALL OF MIEM TIME BASIC

2860
01:49:17,993 --> 01:49:19,662
LYE STUDYING, ANTERIOR CRUCIATE

2861
01:49:19,662 --> 01:49:21,830
LIGAMENT STUDIES ARE THE MOST

2862
01:49:21,830 --> 01:49:24,199
COMMONLY INJURED KNEE █LIGAMENT,

2863
01:49:24,199 --> 01:49:25,601
IT'S THIS LEGAMENT, YOU SEE HERE

2864
01:49:25,601 --> 01:49:28,170
IN THE FRONT OF THE KNEE IF I

2865
01:49:28,170 --> 01:49:30,172
CAN GET MY MOUSE TO SHOW, AND IT

2866
01:49:30,172 --> 01:49:33,008
CONNEBS THE FEMUR TO THE TIBIA,

2867
01:49:33,008 --> 01:49:34,410
PRIMARYIA BE TO PROY VENT THE

2868
01:49:34,410 --> 01:49:35,911
TIBIA FROM SLIDING FORWARD ON

2869
01:49:35,911 --> 01:49:39,181
THE FEMUR AND IT PREVEBTS ROTARY

2870
01:49:39,181 --> 01:49:40,582
INSTABILITY AT THE KNEE.

2871
01:49:40,582 --> 01:49:43,452
300,000 OF THESE INJURIES OCCUR

2872
01:49:43,452 --> 01:49:43,819
ANNUALLY.

2873
01:49:43,819 --> 01:49:45,187
FEMALES SUFFER THESE INJURIES AT

2874
01:49:45,187 --> 01:49:46,655
A GREATER RATE THAN MALES BUT IF

2875
01:49:46,655 --> 01:49:48,624
WE WERE TO LOOK AT THE OVERALL

2876
01:49:48,624 --> 01:49:49,491
NUMBER OF ACL INJURIES THAT

2877
01:49:49,491 --> 01:49:50,659
OCCUR IN THE UNITED STATES,

2878
01:49:50,659 --> 01:49:53,062
THERE'S A GREATER NUMBER OF MALE

2879
01:49:53,062 --> 01:49:55,965
INJURIES BUT THE RATES ARE

2880
01:49:55,965 --> 01:49:56,832
HIGHER IN FEMALES.

2881
01:49:56,832 --> 01:49:58,634
THIS INJURY HAS GOTTEN A LOT OF

2882
01:49:58,634 --> 01:50:00,469
ATTENTION AS FAR AS HOW MUCH

2883
01:50:00,469 --> 01:50:01,770
MONEY IS SPENT ON IT, THERE'S

2884
01:50:01,770 --> 01:50:03,872
BEEN A LOT OF GOOD QUALITY

2885
01:50:03,872 --> 01:50:04,606
STUDIES RELATED TO THAT WHY UOF

2886
01:50:04,606 --> 01:50:09,645
THE ON THIS INITIAL INJURY ALL

2887
01:50:09,645 --> 01:50:12,181
THE WAY THROUGH POST-TRAUMATIC

2888
01:50:12,181 --> 01:50:13,248
OUTCOMES, 8 BILLION THERE IS

2889
01:50:13,248 --> 01:50:14,683
GETS SPENT ON THIS INJURY

2890
01:50:14,683 --> 01:50:14,950
ANNUALLY.

2891
01:50:14,950 --> 01:50:16,518
ONE THING I WANT TO POINT OUT IS

2892
01:50:16,518 --> 01:50:18,721
THAT IT'S A AN YOUR THAT OCCURS

2893
01:50:18,721 --> 01:50:20,889
OFTEN IN YOUNG ADOLESCENT ADULTS

2894
01:50:20,889 --> 01:50:24,026
WITH A PEAK AGE OF A TEAR

2895
01:50:24,026 --> 01:50:25,060
OCCURRING AT 14.

2896
01:50:25,060 --> 01:50:26,762
AND ABOUT 50% OF THE PEOPLE THAT

2897
01:50:26,762 --> 01:50:28,063
TEAR AN ACL, WHETHER THEY HAVE

2898
01:50:28,063 --> 01:50:31,166
SURGELY OR THEY DO NOT TO FIX

2899
01:50:31,166 --> 01:50:34,937
THAT INJURY ARE GOING TO GO ON

2900
01:50:34,937 --> 01:50:35,904
AND DEVELOP OSTEOARTHRITIS

2901
01:50:35,904 --> 01:50:39,608
WITHIN 10 YEARS OR SOME EVIDENT

2902
01:50:39,608 --> 01:50:41,310
OF IT WITHIN 10 YEARS AND I WANT

2903
01:50:41,310 --> 01:50:44,380
TO YOU PUT THOSE LAST 2 PIECES

2904
01:50:44,380 --> 01:50:46,315
TOGETHER, THEY TEAR AN ACL AT 14

2905
01:50:46,315 --> 01:50:48,117
AND BY 24 THEY CAN HAVE

2906
01:50:48,117 --> 01:50:49,618
ARTHRITIS IN THEIR KNEE WHICH

2907
01:50:49,618 --> 01:50:50,352
WOULD AFFECT THEIR PHYSICAL

2908
01:50:50,352 --> 01:50:51,487
FUNCTION FOR A LANGUAGE TIME TO

2909
01:50:51,487 --> 01:50:53,455
COME EMPLOY SO 1 THINK THIS I

2910
01:50:53,455 --> 01:50:55,124
FOCUSUS A LOT OF MY RESEARCH ON

2911
01:50:55,124 --> 01:50:56,191
IS MANY PATIENTS THAT ARE

2912
01:50:56,191 --> 01:50:57,926
GETTING RETURNED TO SPORT OR

2913
01:50:57,926 --> 01:50:59,194
RETURN TO ACTIVITY, WHATEVERRA

2914
01:50:59,194 --> 01:51:01,497
THEY'RE GOING TO DO AFTERWARDS

2915
01:51:01,497 --> 01:51:02,097
HAVE INADEQUATE RECOVERY.

2916
01:51:02,097 --> 01:51:05,968
THESE PATES ARE DOING AT LEAST 9

2917
01:51:05,968 --> 01:51:06,535
MONTHS OF REHABILITATION,

2918
01:51:06,535 --> 01:51:08,404
THEY'RE IN THE CLINIC ALL THE

2919
01:51:08,404 --> 01:51:10,239
TIME, THEY HAVE THIS BIG

2920
01:51:10,239 --> 01:51:12,541
SURGERY, AND THE FACT OF THE

2921
01:51:12,541 --> 01:51:13,776
MATTER IS, HOW WE'RE TREATING

2922
01:51:13,776 --> 01:51:15,144
THEM IS CENTER FOR EXCELLENCE ON

2923
01:51:15,144 --> 01:51:16,478
AGINGIVE AT RESTORING MECHANICAL

2924
01:51:16,478 --> 01:51:19,848
STABILITY OF THE JOINT BUT IT'S

2925
01:51:19,848 --> 01:51:22,351
NOT--IT'S NOT EFFECTIVE AT

2926
01:51:22,351 --> 01:51:23,285
IMPROVING LONG-TERM KNEE JOINT

2927
01:51:23,285 --> 01:51:25,020
HEALTH OR SUSTAINING LONG-TERM

2928
01:51:25,020 --> 01:51:26,221
KNEE JOINT HEALTH EMPLOY THEY

2929
01:51:26,221 --> 01:51:27,423
HAVE INADMIN RECORDS AND QUAIT

2930
01:51:27,423 --> 01:51:27,689
RECOVERY.

2931
01:51:27,689 --> 01:51:29,158
SO WHAT ARE SOME OF THE

2932
01:51:29,158 --> 01:51:31,593
CONSEQUENCES OR WHAT ARE WE SEE

2933
01:51:31,593 --> 01:51:34,863
ON  ACL PATIENTS THAT ARE IN THE

2934
01:51:34,863 --> 01:51:36,932
CLINIC THAT ARE LINGERING ISSUES

2935
01:51:36,932 --> 01:51:38,667
ARE, 1 OF THE BIG 1S WE SEE IS

2936
01:51:38,667 --> 01:51:40,402
THAT 4 OUT OF 5 PATIENTS WHEN

2937
01:51:40,402 --> 01:51:41,703
THEY'RE CLEAR TO RETURN TO SPORT

2938
01:51:41,703 --> 01:51:43,105
AND FOR YEARS AFTER THEIR RETURN

2939
01:51:43,105 --> 01:51:46,241
TO SPORT OR ACTIVITY WILL HAVE

2940
01:51:46,241 --> 01:51:48,377
QUADRICEPS WEAKNESS, SO IT'S A

2941
01:51:48,377 --> 01:51:50,112
LARGE PERCENT OF THESE FOLKS,

2942
01:51:50,112 --> 01:51:51,947
THIS TOP SLIDE SHOW ATROPHY IN

2943
01:51:51,947 --> 01:51:53,048
THIS PERSON EARLY AFTER SURGERY

2944
01:51:53,048 --> 01:51:56,018
BUT I TEST A LOT OF PATIENTS

2945
01:51:56,018 --> 01:51:58,487
COME INTO MY LAB AND I SEE THEM,

2946
01:51:58,487 --> 01:51:59,421
THERE'S CLINICAL RECOMMENDATIONS

2947
01:51:59,421 --> 01:52:00,489
ABOUT WHAT THEY'RE SUPPOSED TO

2948
01:52:00,489 --> 01:52:02,758
BE ACHIEVING AND IT'S SUPPOSED

2949
01:52:02,758 --> 01:52:04,426
TO BE 90% STRENGTH OF THE CONTRA

2950
01:52:04,426 --> 01:52:05,694
LATERAL SIDE AND THERE'S EVIDENT

2951
01:52:05,694 --> 01:52:07,463
TO SUPPORT IF YOU CAN ACHIEVE

2952
01:52:07,463 --> 01:52:09,098
THAT, YOU'RE LESS LIKELY TO TEAR

2953
01:52:09,098 --> 01:52:10,532
YOUR GRAFT, OKAY, I WILL SAY,

2954
01:52:10,532 --> 01:52:12,167
40% OF THE PATIENTS THAT COME

2955
01:52:12,167 --> 01:52:13,202
THROUGH MY LAB ACTUALLY ACHIEVE

2956
01:52:13,202 --> 01:52:14,837
THAT AT THE TIME THEY RETURN TO

2957
01:52:14,837 --> 01:52:16,605
ACTIVITY YET THEY GO BACK TO THE

2958
01:52:16,605 --> 01:52:17,506
SPORT ANYWAYS WHICH IS PROBABLY

2959
01:52:17,506 --> 01:52:20,008
A REASON WE ARE A HIGH RATE OF

2960
01:52:20,008 --> 01:52:22,144
RECURRENCE OF THIS YOUR.

2961
01:52:22,144 --> 01:52:23,645
OTHER FACTORS THAT WE SEE THAT

2962
01:52:23,645 --> 01:52:27,516
ARE COMMON AFTER ACL YOUR ASK

2963
01:52:27,516 --> 01:52:28,217
RECONSTRUCTION OF THAT

2964
01:52:28,217 --> 01:52:31,620
LIGAMILLIO, IS THAT WE SEE

2965
01:52:31,620 --> 01:52:32,354
BIOMECHANICAL CHANGES AT THE

2966
01:52:32,354 --> 01:52:33,755
JOINT EMPLOY SO THE WAY PEOPLE

2967
01:52:33,755 --> 01:52:35,724
ARE WALKING OR COMPLOATING THEIR

2968
01:52:35,724 --> 01:52:36,592
ACTIVITY, THEY'RE MOVING THEIR

2969
01:52:36,592 --> 01:52:38,060
JOINT IN DIFFERENT WAYS AND

2970
01:52:38,060 --> 01:52:39,128
DIFFERENT LOADS ARE HAPPENING

2971
01:52:39,128 --> 01:52:40,262
ABOUT THE JOINT.

2972
01:52:40,262 --> 01:52:41,630
SO WE SEE THAT 1 OF THE

2973
01:52:41,630 --> 01:52:43,065
CHARACTERISTIC PAT OTHER THANS

2974
01:52:43,065 --> 01:52:46,268
IS THAT FOLKS TEND TO UNDERLOAD

2975
01:52:46,268 --> 01:52:47,669
THEIR ACL LIMB, SO THE LEG THAT

2976
01:52:47,669 --> 01:52:49,538
WAS AFFECTED WITH THE ACL TEAR,

2977
01:52:49,538 --> 01:52:51,740
THEY HAVE LESS VERTICAL GROUND

2978
01:52:51,740 --> 01:52:53,542
REACTION FORCES WHICH MEANS LESS

2979
01:52:53,542 --> 01:52:55,511
LOADS GOING UP FROM THE GROUND,

2980
01:52:55,511 --> 01:52:56,578
SMALLER CONTACT FORCES OCCURRING

2981
01:52:56,578 --> 01:52:58,347
AT THE NEED, SMALLER JOINT

2982
01:52:58,347 --> 01:53:00,015
MOMENTS OCCURRING AT THE KNEE,

2983
01:53:00,015 --> 01:53:01,150
SOPHISTICATEDY THEY TEND TO

2984
01:53:01,150 --> 01:53:02,885
AVOID THAT LIMB BUT THIS

2985
01:53:02,885 --> 01:53:05,120
AVOIDANCE OF THAT LIMB HAS BEEN

2986
01:53:05,120 --> 01:53:07,189
LINKED TO BIOMARKERS OF AFTIO

2987
01:53:07,189 --> 01:53:09,925
ARTHRITIS AS HAS THE QUADRICEPS

2988
01:53:09,925 --> 01:53:11,160
WEAKNESS BEEN LINKED TO

2989
01:53:11,160 --> 01:53:12,261
ARTHRITIS AND REINJURY.

2990
01:53:12,261 --> 01:53:13,795
THESE FOLK VS LESS FUNCTIONAL

2991
01:53:13,795 --> 01:53:14,897
PERFORMANCE AND YOU CAN DEFINE

2992
01:53:14,897 --> 01:53:16,765
THAT IN A VARIETY OF WAYS, THEY

2993
01:53:16,765 --> 01:53:18,600
DON'T HOP AS FAST OR AS LONG,

2994
01:53:18,600 --> 01:53:22,771
THEY CAN'T RUN AS FAST, THEY ARE

2995
01:53:22,771 --> 01:53:23,939
NOT PERFORMING AS WELL AS

2996
01:53:23,939 --> 01:53:24,273
BEFORE.

2997
01:53:24,273 --> 01:53:26,608
THERE IS ABOUT A 20% INDENSE OF

2998
01:53:26,608 --> 01:53:28,210
A RETEAR OF THE GRAFT IN THESE

2999
01:53:28,210 --> 01:53:30,646
PATES SO 1 IN 5 ATHLETES WILL

3000
01:53:30,646 --> 01:53:32,381
RETEAR THEIR GRAFT AFTER THEY'VE

3001
01:53:32,381 --> 01:53:35,584
GONE THRU THIS MASSIVE SURGERY

3002
01:53:35,584 --> 01:53:37,686
AND HAVE SPENT 9 MONTHS

3003
01:53:37,686 --> 01:53:38,287
REHABILITATING THEIR LIMB AND

3004
01:53:38,287 --> 01:53:41,123
THEY WILL GO ON AND RETEAR, AND

3005
01:53:41,123 --> 01:53:43,158
14% TEAR THE OTHER ACL ON THE

3006
01:53:43,158 --> 01:53:46,161
OTHER SIDE OF THE LEG.

3007
01:53:46,161 --> 01:53:48,764
THESE FOLKS HAVE LESS, THEY'RE

3008
01:53:48,764 --> 01:53:50,832
MEETING OUR U.S. REQUIREMENTS

3009
01:53:50,832 --> 01:53:53,001
FOR PHYSICAL ACTIVITY OR

3010
01:53:53,001 --> 01:53:53,869
RECOMMENDATIONS FOR A PHYSICAL

3011
01:53:53,869 --> 01:53:56,104
ACTIVITY, THEY'RE DOING IT 2.36

3012
01:53:56,104 --> 01:53:57,873
TIMES LESS THAN WHAT IS

3013
01:53:57,873 --> 01:54:00,275
RECOMMENDED EVEN WHEN THEY

3014
01:54:00,275 --> 01:54:01,076
SUCCESSFULLY REPORTED BY THE

3015
01:54:01,076 --> 01:54:03,645
PATIENT GO BACK TO SPORT.

3016
01:54:03,645 --> 01:54:06,481
AND ABOUT--AGAIN, LIKE I SAID

3017
01:54:06,481 --> 01:54:08,016
SAID PEOPLE 50% OF THE PEOPLE

3018
01:54:08,016 --> 01:54:13,388
ARE GOING TO TO DEVELOP

3019
01:54:13,388 --> 01:54:14,256
POST-TRAUMATIC OSTEOARTHRITIS.

3020
01:54:14,256 --> 01:54:15,591
SO I BORROWED THIS SLIDE FROM A

3021
01:54:15,591 --> 01:54:16,992
RESEARCHER OUT IN EUROPE AND HE

3022
01:54:16,992 --> 01:54:17,726
DEVELOPED THIS A WHILE BACK CAN

3023
01:54:17,726 --> 01:54:19,261
APPROXIMATE HE WAS LOOKING AT

3024
01:54:19,261 --> 01:54:21,964
ALL THE FACTORS THAT COULD LEAD

3025
01:54:21,964 --> 01:54:23,265
TO AFTIO ARTHRITIS AND THERE'S

3026
01:54:23,265 --> 01:54:24,499
NOT EVIDENT TO SUPPORT ALL OF

3027
01:54:24,499 --> 01:54:25,434
THESE, THESE ARE THINGS THAT

3028
01:54:25,434 --> 01:54:27,502
COULD AFFECT IT, THERE IS SOME

3029
01:54:27,502 --> 01:54:28,770
EVIDENCE THAT COULD SHOW THE

3030
01:54:28,770 --> 01:54:31,173
AGE, SEX AND TIME OF INJURY DO

3031
01:54:31,173 --> 01:54:34,509
AFFECT OA RISK BUT I CIRCLED 1S

3032
01:54:34,509 --> 01:54:37,145
THAT ARE MODIFIABLE IS DEEMED TO

3033
01:54:37,145 --> 01:54:38,080
HAVE STRONG REHABILITATION AND

3034
01:54:38,080 --> 01:54:39,147
INTERVENTION TO SUPPORT THEM.

3035
01:54:39,147 --> 01:54:42,217
SO FOLKS WITH HIGHER BMI ARE

3036
01:54:42,217 --> 01:54:43,151
MORE LIKELY--THERE'S EVIDENCE

3037
01:54:43,151 --> 01:54:47,256
THAT SUPPORTS THAT, THEY HAVE

3038
01:54:47,256 --> 01:54:48,624
EARLIER CARTILAGE DEGENERATION.

3039
01:54:48,624 --> 01:54:49,591
THIS DECREASED JOINT LOADING

3040
01:54:49,591 --> 01:54:51,660
THAT I TALKED ABOUT OR THIS

3041
01:54:51,660 --> 01:54:54,363
UNDERLOADING HAS BEEN LINKED TO

3042
01:54:54,363 --> 01:54:54,963
BIOMARKERS OF OSTEOARTHRITIS,

3043
01:54:54,963 --> 01:54:56,632
IT'S PROBABLY THE 1 THAT IS MOST

3044
01:54:56,632 --> 01:54:58,300
SIGNIFICANT OR HAS THE MOST

3045
01:54:58,300 --> 01:54:59,368
RESEARCH ASSOCIATE WIDE IT RIGHT

3046
01:54:59,368 --> 01:55:01,503
NOW IS THAT AS EARLY AS 4 MONTHS

3047
01:55:01,503 --> 01:55:06,141
AFTER SURGERY FYOU HAVE A WEAKER

3048
01:55:06,141 --> 01:55:07,109
QUADRICEP OR AN EQUAL

3049
01:55:07,109 --> 01:55:09,311
COUNTERPART TO YOU, YOU ARE MORE

3050
01:55:09,311 --> 01:55:11,046
LIKELY TO DEVELOP RADIO GRAPHIC

3051
01:55:11,046 --> 01:55:12,114
EVIDENCE OF AFTIO ARTHRITIS

3052
01:55:12,114 --> 01:55:13,415
WITHIN A FEW YEARS.

3053
01:55:13,415 --> 01:55:15,717
SO FOCUSING ON SOME OF THESE

3054
01:55:15,717 --> 01:55:21,056
RICK FACTORS ARE GOING TO BE

3055
01:55:21,056 --> 01:55:22,658
CRITICAL TO RHETORRING LONG-TERM

3056
01:55:22,658 --> 01:55:25,227
JOINT HELP FOR THESE FOLKINGS

3057
01:55:25,227 --> 01:55:26,128
AFTER ACL RECONSTRUCTION.

3058
01:55:26,128 --> 01:55:27,329
SO AGAIN, THESE RESEARCH DOMAINS

3059
01:55:27,329 --> 01:55:28,597
ARE THINGS WE NEED TO WORK ON,

3060
01:55:28,597 --> 01:55:30,132
THEREYA A TON OF THEM.

3061
01:55:30,132 --> 01:55:32,434
ACLs ARE PROBABLY THE MOST

3062
01:55:32,434 --> 01:55:33,602
RESEARCHED SPORTS INJURY THAT WE

3063
01:55:33,602 --> 01:55:35,037
HAVE, BUT THAT BEING SAID,

3064
01:55:35,037 --> 01:55:36,138
THERE'S STILL SO MANY GAPS THAT

3065
01:55:36,138 --> 01:55:38,507
NEED TO BE FILLED, A LOT OF

3066
01:55:38,507 --> 01:55:40,609
THESE RESEARCHER OR CASE CONTROL

3067
01:55:40,609 --> 01:55:42,344
STUDIES OR COHORT STUDIES,

3068
01:55:42,344 --> 01:55:44,646
THEY'RE NOT PROTECTIVE STUDIES,

3069
01:55:44,646 --> 01:55:45,547
THEY'RE NOT RANDOMIZED CLINICAL

3070
01:55:45,547 --> 01:55:48,884
TRIALS WHICH WE DESPERATELY NEED

3071
01:55:48,884 --> 01:55:51,019
IN SPORT INJURY RESEARCH AND ACL

3072
01:55:51,019 --> 01:55:51,353
RESEARCH.

3073
01:55:51,353 --> 01:55:55,857
FOCUSING ON JUST ON

3074
01:55:55,857 --> 01:55:57,726
REHABILITATION WE HAVE STANDARD

3075
01:55:57,726 --> 01:55:59,361
OF CARE ACL REHABILATION, IT DID

3076
01:55:59,361 --> 01:56:03,532
A GREAT JOB OF RESTORING

3077
01:56:03,532 --> 01:56:04,733
MECHANICAL STABILITY ALONG WITH

3078
01:56:04,733 --> 01:56:05,801
RESTORING RANGE OF MOTION AND

3079
01:56:05,801 --> 01:56:07,436
GETTING PEOPLE TO RETURN TO

3080
01:56:07,436 --> 01:56:07,803
ACTIVITY.

3081
01:56:07,803 --> 01:56:08,970
POST PEOPLE ARE RETURNING TO

3082
01:56:08,970 --> 01:56:10,138
SOME LEVEL OF ACTIVITY BUT

3083
01:56:10,138 --> 01:56:11,740
WHETHER THEY'RE DOING IT SAFELY

3084
01:56:11,740 --> 01:56:13,408
OR NOT IS DEBATABLE SO AGAIN WE

3085
01:56:13,408 --> 01:56:17,879
HAVE A LOT OF LINGERING

3086
01:56:17,879 --> 01:56:18,347
 LINGERING DEFICITS

3087
01:56:18,347 --> 01:56:19,715
WHEN THESE PEOPLE GO BACK

3088
01:56:19,715 --> 01:56:22,351
SPHORTS AND WE NEED TO TEST

3089
01:56:22,351 --> 01:56:23,151
SYSTEMATICALLY ENTERVENTIONS

3090
01:56:23,151 --> 01:56:26,788
THAT HAVE THE POTENTIAL AND HAVE

3091
01:56:26,788 --> 01:56:29,758
EVIDENCE BEHIND THEM TO RESTORE

3092
01:56:29,758 --> 01:56:31,593
MUSCLE FUNCTION AND

3093
01:56:31,593 --> 01:56:32,394
BIOMECHANICAL ABNORMALITY ANDS

3094
01:56:32,394 --> 01:56:33,829
THAT STUFF IS GREAT AND THERE'S

3095
01:56:33,829 --> 01:56:34,996
A VARIETY OF OTHER THINGS AND 1

3096
01:56:34,996 --> 01:56:36,431
OF THE BIGGEST THINGS THAT'S AT

3097
01:56:36,431 --> 01:56:38,200
ISSUE FOR ME IS BRIDGING THE GAP

3098
01:56:38,200 --> 01:56:39,201
BETWEEN RESEARCH AND CLINICAL

3099
01:56:39,201 --> 01:56:40,936
PRACTICE, I WISH I HAD A MAGIC

3100
01:56:40,936 --> 01:56:41,970
WAND I COULD WAVE AND MAKE THE

3101
01:56:41,970 --> 01:56:43,839
FOLKS IN THE CLINIC USE THE

3102
01:56:43,839 --> 01:56:45,340
THINGS WE KNOW IN RESEARCH,

3103
01:56:45,340 --> 01:56:47,209
STRENGTH IS 1 OF THOSE THINGS, I

3104
01:56:47,209 --> 01:56:50,479
CAN'T EVEN GET FOLKS TO MEASURE

3105
01:56:50,479 --> 01:56:51,813
STRENGTH IN THE CLINIC BEFORE

3106
01:56:51,813 --> 01:56:53,315
THEY RETURN SOMETHING TO THE

3107
01:56:53,315 --> 01:56:54,383
SPORT, IT'S HARDER TO DO BECAUSE

3108
01:56:54,383 --> 01:56:56,184
THEY HAVE TO PUT THEM ON THE BIG

3109
01:56:56,184 --> 01:56:57,552
DEVICE, SO HAVING DEVICES

3110
01:56:57,552 --> 01:56:59,187
AVAILABLE TO MAKE THINGS EASIER

3111
01:56:59,187 --> 01:57:01,857
FOR CLINICIANS TO USE AND BE

3112
01:57:01,857 --> 01:57:03,592
ABLE TO IMPLEMENT RESEARCH IN A

3113
01:57:03,592 --> 01:57:09,431
CLINICAL PRACTICE WOULD BE VERY

3114
01:57:09,431 --> 01:57:09,731
BENEFICIAL.

3115
01:57:09,731 --> 01:57:12,200
THE LAST INJURY I WANT TO SPEBD

3116
01:57:12,200 --> 01:57:13,835
A COUPLE MINUTES ON IS SHOULDER

3117
01:57:13,835 --> 01:57:14,669
IPT GREATER STABILITY, I WANT TO

3118
01:57:14,669 --> 01:57:17,305
GIVE US SOMETHING FROM THE UPPER

3119
01:57:17,305 --> 01:57:17,539
BODY.

3120
01:57:17,539 --> 01:57:19,141
SHOULDER INSTABILITY IS AN

3121
01:57:19,141 --> 01:57:20,409
INJURY WITH BASICALLY REFERRING

3122
01:57:20,409 --> 01:57:22,377
TO THE LOSS OF THE ABILITY TO

3123
01:57:22,377 --> 01:57:24,413
MAINTAIN NORMAL JOINT ALIGNMENT.

3124
01:57:24,413 --> 01:57:26,648
AND SO IF YOU TAKE A LOOK AT

3125
01:57:26,648 --> 01:57:29,351
THIS GRAPHIC HERE, WE HAVE A

3126
01:57:29,351 --> 01:57:33,588
LOOK AT THE DPLEN O HIEWMERAL

3127
01:57:33,588 --> 01:57:36,858
JOINT, THE SCALPULA, AND WHEN WE

3128
01:57:36,858 --> 01:57:38,226
SEE DISLOCATIONS OR WE SEE

3129
01:57:38,226 --> 01:57:39,995
INSTABILITY WHERE THE HIEWMEROUS

3130
01:57:39,995 --> 01:57:43,432
MOVES AROUND THE SURF FASOF THE

3131
01:57:43,432 --> 01:57:46,735
THE GLENOID FOSA, IT CAN BE AN

3132
01:57:46,735 --> 01:57:48,170
INSTABILITY, IT COULD HAVE

3133
01:57:48,170 --> 01:57:49,671
TRAUMATIC CAUSES, IT WE CAN HAVE

3134
01:57:49,671 --> 01:57:52,307
THIS INSTABILITY THAT LEADS TO

3135
01:57:52,307 --> 01:57:53,041
PAIN, NUMBNESS, TINGLING THAT

3136
01:57:53,041 --> 01:57:55,110
HAPPEN AT THE YOIP AFTER THIS

3137
01:57:55,110 --> 01:57:58,013
AND CAN HAVE TRAUMATIC AND

3138
01:57:58,013 --> 01:57:59,381
A-AWMATTIC CAUSES, THE MOST

3139
01:57:59,381 --> 01:58:06,321
COMMON CAUSE OF SHOULDER 

3140
01:58:06,321 --> 01:58:07,456
INSTABILITY IS TRAUMATIC JOINT

3141
01:58:07,456 --> 01:58:09,257
TRAUMA FROM THE SHOULDER.

3142
01:58:09,257 --> 01:58:14,062
SO FOLKS THAT HAVE DIFFERENT

3143
01:58:14,062 --> 01:58:15,197
CONGENITAL BONY SHAPE,

3144
01:58:15,197 --> 01:58:17,599
CONGENITAL SHAPE OF THEIR BONE

3145
01:58:17,599 --> 01:58:19,768
SO THEIR FLENNOID PROCESS IS

3146
01:58:19,768 --> 01:58:21,102
FLATTER THAN OTHERS, FOR

3147
01:58:21,102 --> 01:58:22,838
EXAMPLE, OR LAXITY OF THE

3148
01:58:22,838 --> 01:58:24,306
LIGAMENTS FROM REPETITIVE

3149
01:58:24,306 --> 01:58:25,607
THROWING OR OVERHEAD MOTION

3150
01:58:25,607 --> 01:58:27,342
WHICH WOULD BE ARK TRAUMATIC CAN

3151
01:58:27,342 --> 01:58:32,948
ALSO LEAD TO INSTABILITY.

3152
01:58:32,948 --> 01:58:34,549
GIVEN THE TRAUMATIC OR

3153
01:58:34,549 --> 01:58:36,518
DISLOCATION IS THE MOST COMMON

3154
01:58:36,518 --> 01:58:39,020
CAUSE OF INSTABILITY, JUST 1

3155
01:58:39,020 --> 01:58:40,522
DISLOCATION DOES NOT MEAN

3156
01:58:40,522 --> 01:58:41,456
SOMEONE HAS SHOULDER

3157
01:58:41,456 --> 01:58:43,291
INSTABILITY, INTAIBILITY NEEDS

3158
01:58:43,291 --> 01:58:46,094
TO BE RECURRENT SYMPTOMATIC

3159
01:58:46,094 --> 01:58:47,429
DISLOCATIONS OR SUBLEXATION OF

3160
01:58:47,429 --> 01:58:48,063
THAT JOINT.

3161
01:58:48,063 --> 01:58:50,966
BUT 50% OF THE TEEM THAT SOMEONE

3162
01:58:50,966 --> 01:58:52,701
SUSTAINS AN ACUTE DISLOCATION,

3163
01:58:52,701 --> 01:58:55,337
IT'S GOING TO BECOME RECURRENT.

3164
01:58:55,337 --> 01:58:57,305
SO HALF THESE PEOPLE WILL GO TO

3165
01:58:57,305 --> 01:58:59,574
TO DEVELOP THIS RECURRENT

3166
01:58:59,574 --> 01:59:00,208
INSTABILITY AFTER A TRAUMATIC

3167
01:59:00,208 --> 01:59:01,543
EVENT AND USUALLY THE TIME FOR

3168
01:59:01,543 --> 01:59:03,111
THIS TO OCCUR IS LESS THAN 1

3169
01:59:03,111 --> 01:59:03,478
YEAR.

3170
01:59:03,478 --> 01:59:07,449
SO IT'S HAPPENING PRETTY

3171
01:59:07,449 --> 01:59:08,016
QUICKLY.

3172
01:59:08,016 --> 01:59:09,451
SO WHAT'S THINGS ABOUT SHOULDER

3173
01:59:09,451 --> 01:59:11,086
INSTABILITY WE SHOULD KNOW, IT'S

3174
01:59:11,086 --> 01:59:12,287
MORE COMMON IN ATHLETES PEOPLE

3175
01:59:12,287 --> 01:59:14,356
USING THEIR SHOULDER IN CONTACT

3176
01:59:14,356 --> 01:59:15,624
SPORTS, THE MOST COMMON TYPE OF

3177
01:59:15,624 --> 01:59:18,260
INSTABILITY THAT WE SEE IS

3178
01:59:18,260 --> 01:59:20,061
ANTERIOR WHERE THIS HUMORAL HEAD

3179
01:59:20,061 --> 01:59:23,832
MOVES FORWARD, ON THE GLENOID

3180
01:59:23,832 --> 01:59:27,269
FOSSA, CONTACT FORS SO FOOTBALL,

3181
01:59:27,269 --> 01:59:29,304
LACROSSE, RUGBY WHERE THERE'S

3182
01:59:29,304 --> 01:59:30,705
THINGS WITH CONTACT FOR ATHLETES

3183
01:59:30,705 --> 01:59:33,275
WELL AS WELL AS OVERHEAD SPORTS

3184
01:59:33,275 --> 01:59:35,110
WHERE SEE SEE THIS LAXITY

3185
01:59:35,110 --> 01:59:36,411
DEVELOP OVERTIME AS FOLKS USING

3186
01:59:36,411 --> 01:59:37,412
THEIR ARM.

3187
01:59:37,412 --> 01:59:39,881
THERE'S AN INCREASE RISK OF

3188
01:59:39,881 --> 01:59:41,516
POST-TRAUMATIC OFTIO ARGT RIGHTS

3189
01:59:41,516 --> 01:59:43,818
IN THIS POPULATION, 62% OF PATES

3190
01:59:43,818 --> 01:59:45,420
DEPENDING ON WHICH STUDY YOU

3191
01:59:45,420 --> 01:59:49,157
LOOK AT, MAY DEVELOP

3192
01:59:49,157 --> 01:59:49,758
POST-TRAUMATIC OSTEOARTHRITIS

3193
01:59:49,758 --> 01:59:51,126
AND THERE WAS 1 STUDY THAT

3194
01:59:51,126 --> 01:59:52,961
FOLLOWED PATIENTS AFTER AN ACUTE

3195
01:59:52,961 --> 01:59:55,730
DISLOCATION FOR 25 YEARS.

3196
01:59:55,730 --> 01:59:57,732
AND THEY FOUND THAT THE

3197
01:59:57,732 --> 02:00:01,436
STANDARDIZED MORTALITY RATE IN

3198
02:00:01,436 --> 02:00:02,370
PATIENTS WITH SHOULDER

3199
02:00:02,370 --> 02:00:03,672
DISLOCATION WAS TWICE AS HIGH AS

3200
02:00:03,672 --> 02:00:05,206
WOULD BE EXPECTED IN THE GENERAL

3201
02:00:05,206 --> 02:00:05,840
POPULATION.

3202
02:00:05,840 --> 02:00:08,109
SO THERE MAY BE AN INCREED

3203
02:00:08,109 --> 02:00:11,112
MORTALITY RATE WITH THIS

3204
02:00:11,112 --> 02:00:12,113
INCREASE AS WELL.

3205
02:00:12,113 --> 02:00:14,015
SO WHAT ARE SOME RISK FACTORS

3206
02:00:14,015 --> 02:00:14,950
FOR SHOULDER INSTABILITY, MOST

3207
02:00:14,950 --> 02:00:16,751
OF THESE, MOST OF THE 1S WE KNOW

3208
02:00:16,751 --> 02:00:20,855
OF, AT THIS POINT IN TIME, ARE

3209
02:00:20,855 --> 02:00:22,991
NONMODIFIABLE, SO MORPHOLOGY,

3210
02:00:22,991 --> 02:00:25,226
LIKE THE GLENOID FOSSA, LONGER

3211
02:00:25,226 --> 02:00:26,828
AND TALLER RATHER THAN SHORTER

3212
02:00:26,828 --> 02:00:27,596
AND WIDER.

3213
02:00:27,596 --> 02:00:29,130
THE HIEWMEROUS DOESN'T SIT AS

3214
02:00:29,130 --> 02:00:31,232
CLOA CLOSE TO THE COTTERACOID

3215
02:00:31,232 --> 02:00:33,501
PROCESS, THERE'S DATA THAT SHOWS

3216
02:00:33,501 --> 02:00:35,604
THAT CHILDREN WITH CLOSED

3217
02:00:35,604 --> 02:00:37,539
[INDISCERNIBLE] PLATES ARE MORE

3218
02:00:37,539 --> 02:00:39,407
LIKELY TO HAVE RECURRENT

3219
02:00:39,407 --> 02:00:40,809
INTAIBILITY THAN FOLKS WITH OPEN

3220
02:00:40,809 --> 02:00:42,243
PLATES SO SOME OF THESE THINGS

3221
02:00:42,243 --> 02:00:43,178
THERE'S NOTHING, WE CAN'T DO

3222
02:00:43,178 --> 02:00:45,380
ANYTHING ABOUT THOSE THINGS,

3223
02:00:45,380 --> 02:00:48,149
THERE'S NOTHING THERE, SEX,

3224
02:00:48,149 --> 02:00:50,385
MALES ARE MORE LIKELY, AGE,

3225
02:00:50,385 --> 02:00:53,288
PEOPLE UNDER 20 ARE MORE LIKELY

3226
02:00:53,288 --> 02:00:54,656
TO EXPERIENCE RECURRENT

3227
02:00:54,656 --> 02:00:54,956
INSTABILITY.

3228
02:00:54,956 --> 02:00:56,358
TYPE OFACKIVITY THAT YOU'RE

3229
02:00:56,358 --> 02:00:57,926
PARTICIPATING IN, CONTACT OR

3230
02:00:57,926 --> 02:00:58,493
OVERHEAD ACTIVITY.

3231
02:00:58,493 --> 02:01:01,229
YOU'RE ABOUT 3 TIMES MORE LIKELY

3232
02:01:01,229 --> 02:01:01,896
THAN OTHER SPORTS.

3233
02:01:01,896 --> 02:01:04,299
SO CAN YOU CHANGE YOUR ACTIVITY,

3234
02:01:04,299 --> 02:01:06,301
BUT WE'RE TRYING TO NOT MAKE

3235
02:01:06,301 --> 02:01:07,002
PEOPLE CHANGE ACTIVITY.

3236
02:01:07,002 --> 02:01:13,408
THE 1 FACTOR THAT'S BEEN STUDIED

3237
02:01:13,408 --> 02:01:15,043
THAT MAY PLAY A ROLE, BUT

3238
02:01:15,043 --> 02:01:18,279
THERE'S NOT A LOT OF RESEARCH,

3239
02:01:18,279 --> 02:01:20,015
IS ROTATOR CUFF WEAKNESS, NOT A

3240
02:01:20,015 --> 02:01:21,416
FACTOR FOR FIRST TIME

3241
02:01:21,416 --> 02:01:22,384
DISLOCATIONS BUT SOME EVIDENCE

3242
02:01:22,384 --> 02:01:24,552
THAT SHOWS THAT WEAKNESS OF THE

3243
02:01:24,552 --> 02:01:27,322
ROTATOR CUFF MAY BE ASSOCIATE

3244
02:01:27,322 --> 02:01:28,023
WIDE RECURRENT ANTERIOR

3245
02:01:28,023 --> 02:01:28,323
INSTABILITY.

3246
02:01:28,323 --> 02:01:30,191
SO THAT WOULD BE SOMETHING THAT

3247
02:01:30,191 --> 02:01:34,763
WE COULD DEFINITELY TARGET WITH

3248
02:01:34,763 --> 02:01:36,865
REHABILITATION INTERVENTIONS TO

3249
02:01:36,865 --> 02:01:42,103
PREVENT RECURRENT INSTABILITY.

3250
02:01:42,103 --> 02:01:44,773
AGAIN WE'VE DONE, THERE'S A

3251
02:01:44,773 --> 02:01:47,008
WHOLE--THERE'S A SLEW OF

3252
02:01:47,008 --> 02:01:48,910
ACTUALLY SHOULDER STABILIZATION

3253
02:01:48,910 --> 02:01:52,247
PROCEDURES, SO LATTER JET,

3254
02:01:52,247 --> 02:01:52,947
[INDISCERNIBLE] ARGTROSCOPY,

3255
02:01:52,947 --> 02:01:54,149
OPEN [INDISCERNIBLE] AND OTHERS,

3256
02:01:54,149 --> 02:01:56,217
SO KNOWING WHICH 1 OF THOSE ARE

3257
02:01:56,217 --> 02:01:58,153
BEST AND DOES REHAB NEED TO BE

3258
02:01:58,153 --> 02:01:59,287
INDIVIDUALIZED TO THE TYPE OF

3259
02:01:59,287 --> 02:02:01,089
SURGERY OR TO THE PATIENT AND

3260
02:02:01,089 --> 02:02:02,323
THEIR SYMPTOMS OF RECURRENT

3261
02:02:02,323 --> 02:02:03,458
INSTABILITY, THAT NEEDS TO BE

3262
02:02:03,458 --> 02:02:06,261
LOOKED AT, WHAT ARE THE

3263
02:02:06,261 --> 02:02:09,431
MODIFIABLE FACTORS WE COULD

3264
02:02:09,431 --> 02:02:14,536
TARGET WITH REHABILITATION TO

3265
02:02:14,536 --> 02:02:16,905
HOPEFULLY PREVENT REINSTABILITY,

3266
02:02:16,905 --> 02:02:17,405
PREVENT POST-TRAUMATIC

3267
02:02:17,405 --> 02:02:18,840
OSTEOARTHRITIS.

3268
02:02:18,840 --> 02:02:20,475
WHAT ABOUT RETURN TO ACTIVITY,

3269
02:02:20,475 --> 02:02:23,111
THAT WILL LEAD TO BETTER JOINT

3270
02:02:23,111 --> 02:02:24,379
OUTCOMES, WE DON'T KNOW THAT

3271
02:02:24,379 --> 02:02:26,614
EITHER AND ALL THIS NEEDS TO BE

3272
02:02:26,614 --> 02:02:26,981
STUDIED.

3273
02:02:26,981 --> 02:02:29,751
THERE'S A LOT OF GAPS

3274
02:02:29,751 --> 02:02:30,919
 GAPS THAT NEED

3275
02:02:30,919 --> 02:02:31,486
TO BE FILLED.

3276
02:02:31,486 --> 02:02:33,688
I WANT END WITH 2 SLIDES I WAS

3277
02:02:33,688 --> 02:02:36,858
ASKED MAYBE YOU ALL WOULD BE

3278
02:02:36,858 --> 02:02:39,494
INTERESTED IN SURGICAL VERSUS

3279
02:02:39,494 --> 02:02:40,061
NONSURGAL TREATMENT OPGS.

3280
02:02:40,061 --> 02:02:42,163
IT'S TOO MUCH FOR ME TO GO

3281
02:02:42,163 --> 02:02:43,765
THROUGH THE SURGICAL IF VERSUS

3282
02:02:43,765 --> 02:02:46,434
REHAB FOR ALL THE INJURIES BUT I

3283
02:02:46,434 --> 02:02:48,236
THOUGHT IT WOULD BE INTERESTING

3284
02:02:48,236 --> 02:02:53,208
TO SEE THAT SURMRY DOES NOT HELP

3285
02:02:53,208 --> 02:02:54,242
PREVENT AGAINST AFTIOARTRITIS.

3286
02:02:54,242 --> 02:02:55,677
IF YOU TAKE A ELECTRIC AT

3287
02:02:55,677 --> 02:02:56,544
META-ANALYSIS OF CLINICAL

3288
02:02:56,544 --> 02:02:57,812
TRIALS, THERE'S NOT A LOT OF

3289
02:02:57,812 --> 02:02:59,714
EVIDENT THAT SUPPORTS THAT ACL

3290
02:02:59,714 --> 02:03:02,250
SURGERY REDUCES THE RISK OF OA.

3291
02:03:02,250 --> 02:03:05,487
IN FACT IF YOU LOOK AT A LOT OF

3292
02:03:05,487 --> 02:03:09,524
THE STUDIES THAT RCTs ARE

3293
02:03:09,524 --> 02:03:10,925
NOT--THE INCIDENCE RATE IS ABOUT

3294
02:03:10,925 --> 02:03:12,193
THE SAME.

3295
02:03:12,193 --> 02:03:13,461
SHOULDER INSTABILITY, THE STUDY,

3296
02:03:13,461 --> 02:03:15,697
1 STUDY THAT LOOKINGAD THIS THAT

3297
02:03:15,697 --> 02:03:19,334
SHOWED THAT 33% OF PATIENTS THAT

3298
02:03:19,334 --> 02:03:20,201
UNDERWENT SURGERY, DISPLAYED

3299
02:03:20,201 --> 02:03:23,271
RADIO GRAPHIC SIGNS OF OA WHILE

3300
02:03:23,271 --> 02:03:24,839
24% OF NONOPERATIVE FOLKS

3301
02:03:24,839 --> 02:03:26,007
DISPLAYED SIGNS OF OA,

3302
02:03:26,007 --> 02:03:27,308
SUGGESTING THAT SURGERY IS NOT

3303
02:03:27,308 --> 02:03:28,243
PROTECTIVE IN THE LEAST.

3304
02:03:28,243 --> 02:03:30,345
AND AS FAR AS CHRONIC ANKLE

3305
02:03:30,345 --> 02:03:31,412
INSTABILITY, THERE'S NO STUDY

3306
02:03:31,412 --> 02:03:34,015
FOR ME TO POINT TO, USUALLY

3307
02:03:34,015 --> 02:03:36,451
CHRONIC ANKLE INTAIBILITY IS

3308
02:03:36,451 --> 02:03:37,919
TREATED CONSERVATIVELY FIRST.

3309
02:03:37,919 --> 02:03:40,188
AND IT'S USUALLY TREATEDON

3310
02:03:40,188 --> 02:03:41,322
SERVAATIVELY BEFORE 6 MONTHS

3311
02:03:41,322 --> 02:03:42,390
BEFORE THEY MAKE A DECISION TO

3312
02:03:42,390 --> 02:03:44,058
GO IN AND TREAT THAT FOR SURGERY

3313
02:03:44,058 --> 02:03:48,062
BUT THIS' NO STUDY THAT COMPARES

3314
02:03:48,062 --> 02:03:48,730
SURMRY VERSUS REHAB.

3315
02:03:48,730 --> 02:03:51,366
AND THEN LAST BUT NOT LEAST IS

3316
02:03:51,366 --> 02:03:55,770
THERE'S VERY LITTLE EVIDENCE

3317
02:03:55,770 --> 02:03:57,005
BASED REHABILITATION SCIENCE IN

3318
02:03:57,005 --> 02:03:57,372
SPORTS MEDICINE.

3319
02:03:57,372 --> 02:04:00,975
WE TEND TO THROW THE KITCHEN

3320
02:04:00,975 --> 02:04:03,845
SINK AT THING ANDS HOPE IT WORK

3321
02:04:03,845 --> 02:04:04,445
ANDS IT'S NOT.

3322
02:04:04,445 --> 02:04:08,183
SO WE NEED TO REALLY USE RCTs

3323
02:04:08,183 --> 02:04:09,384
FOR EVIDENCE BASED

3324
02:04:09,384 --> 02:04:10,752
REHABILITATION PROGRAMS,

3325
02:04:10,752 --> 02:04:12,754
ELECTRIC AT INDIVIDUALIZED

3326
02:04:12,754 --> 02:04:13,588
REHABILITATION STRATEGIES, THE

3327
02:04:13,588 --> 02:04:16,524
DOSAGES OF ISHT VENTIONS BEING

3328
02:04:16,524 --> 02:04:17,826
USED ARE BASICALLY BEST GUESSES

3329
02:04:17,826 --> 02:04:19,360
AND NOT REALLY WELL STUDIED.

3330
02:04:19,360 --> 02:04:23,698
ASK WE NEED TO HAVE

3331
02:04:23,698 --> 02:04:24,966
EVIDENT-BASED CRITERIA TO RETURN

3332
02:04:24,966 --> 02:04:26,501
PEOPLE TO SPORT ACTIVITY AMONGST

3333
02:04:26,501 --> 02:04:26,835
OTHER THINGS.

3334
02:04:26,835 --> 02:04:28,369
SO THANK YOU FOR YOUR TAME AND

3335
02:04:28,369 --> 02:04:29,571
ATTENTION I'M HAPPY TO FIELD ANY

3336
02:04:29,571 --> 02:04:40,014
QUESTIONS YOU MIGHT HAVE.

3337
02:04:49,958 --> 02:04:51,693
>> ARE WE OPEN TO
DISCUSSIONS

3338
02:04:51,693 --> 02:04:57,165
AND QUESTIONS, YES IN LINDA? 

3339
02:04:57,165 --> 02:04:59,033
YOU'RE MUTED.

3340
02:04:59,033 --> 02:04:59,467
>> THANK YOU.

3341
02:04:59,467 --> 02:05:04,105
THAT WAS A GREAT TALK IN 20

3342
02:05:04,105 --> 02:05:04,339
MINUTES.

3343
02:05:04,339 --> 02:05:06,774
SO I FOLLOW YOU SO I FEEL YOUR

3344
02:05:06,774 --> 02:05:07,275
PAIN.

3345
02:05:07,275 --> 02:05:08,743
I'M REALLY INTERESTED, I READ A

3346
02:05:08,743 --> 02:05:11,012
LOT ABOUT THE ACL, IN THE ACL

3347
02:05:11,012 --> 02:05:14,082
LITERATURE, CAN YOU TALK ABOUT

3348
02:05:14,082 --> 02:05:15,583
1, WHETHER THE AMOUNT OF REHAB

3349
02:05:15,583 --> 02:05:18,887
HAS ANYTHING TO DO WITH REINJURY

3350
02:05:18,887 --> 02:05:22,657
IN AND THEN THE OTHER IS LIKE

3351
02:05:22,657 --> 02:05:23,925
PSYCHOLOGICAL FACTORS, SO THOSE

3352
02:05:23,925 --> 02:05:25,560
ARE BIG IN BACK PAIN BUT I'M

3353
02:05:25,560 --> 02:05:27,328
WONDERING WHERE THAT IS IN THAT

3354
02:05:27,328 --> 02:05:29,797
LITERATURE WITH REGARD TO ACL

3355
02:05:29,797 --> 02:05:29,998
YOURS?

3356
02:05:29,998 --> 02:05:32,200
>> SO THE AMOUNT OF REHAB,

3357
02:05:32,200 --> 02:05:34,636
THERE'S NO DATA FOR ME TO GO OFF

3358
02:05:34,636 --> 02:05:34,869
OF.

3359
02:05:34,869 --> 02:05:37,005
LITERALLY FOR A VERY LONG PERIOD

3360
02:05:37,005 --> 02:05:38,640
OF TIME, PEOPLE JUST WERE

3361
02:05:38,640 --> 02:05:39,707
RETURPING PEOPLE TO SPORTS BASED

3362
02:05:39,707 --> 02:05:41,910
ON TIME, BUT IT WASN'T TIME

3363
02:05:41,910 --> 02:05:43,912
BASED ON WHETHER THE GRAFT WAS

3364
02:05:43,912 --> 02:05:45,313
HEALED OR ANYTHING, IT WAS LIKE

3365
02:05:45,313 --> 02:05:46,981
6 MONTHS WE FEEL LIKE THAT'S A

3366
02:05:46,981 --> 02:05:48,182
GOOD SPOT, THEY CAN RUN THEN,

3367
02:05:48,182 --> 02:05:50,952
THEY CAN DO THINGS AND THEN THEY

3368
02:05:50,952 --> 02:05:53,388
PROGRESSED IT TO 9 MONTHS, AND

3369
02:05:53,388 --> 02:05:56,424
NOW AT 9 MONTHS WE FEEL PEOPLE

3370
02:05:56,424 --> 02:05:59,560
ARE READY TO BACK TO SPORT ORE

3371
02:05:59,560 --> 02:06:01,229
ACTIVITY BUT IF YOU LOOK AT

3372
02:06:01,229 --> 02:06:02,430
THESE PATIENT ANDS THEY COME IN

3373
02:06:02,430 --> 02:06:05,500
THE LAB AND TEST THE CRITERIA

3374
02:06:05,500 --> 02:06:07,001
THAT WERE SUGGEST SHOULD BE USED

3375
02:06:07,001 --> 02:06:08,536
TO RETURN SOMEBODY TO ACTIVITY,

3376
02:06:08,536 --> 02:06:09,637
THEY ARE NOT MEETING THEM.

3377
02:06:09,637 --> 02:06:12,707
SO WE NEED LONGER REHABILATION

3378
02:06:12,707 --> 02:06:15,009
IN MY OPINION OR MORE OF IT IN

3379
02:06:15,009 --> 02:06:16,311
THE 6 OR 9 MONTH PERIOD, BUT

3380
02:06:16,311 --> 02:06:17,345
IT'S VERY HARD WHEN YOU'RE

3381
02:06:17,345 --> 02:06:18,446
DEALING WITH A YOUNG ATHLETES

3382
02:06:18,446 --> 02:06:20,748
THAT ARE TRYING TO COMPETE FOR

3383
02:06:20,748 --> 02:06:23,718
TO GET INTO COLLEGES AND GET

3384
02:06:23,718 --> 02:06:24,786
SCHOLARSHIPS, YOU KNOW PARENTS

3385
02:06:24,786 --> 02:06:25,987
THAT REALLY WANT THESE KIDS TO

3386
02:06:25,987 --> 02:06:27,722
GO BACK IT SPORTS SO THEREYA A

3387
02:06:27,722 --> 02:06:29,691
PUSH TO GET PEOPLE BACK EARLIER

3388
02:06:29,691 --> 02:06:32,193
AND THERE'S EVIDENT TO SUPPORT

3389
02:06:32,193 --> 02:06:34,762
THAT THE GRAFTS NOT EACH HEALED

3390
02:06:34,762 --> 02:06:35,596
UNTIL ABOUT WOYEARS.

3391
02:06:35,596 --> 02:06:36,965
SO THE GRAFT TISSUE THAT THEY'RE

3392
02:06:36,965 --> 02:06:38,933
USING FOR THE SURGEERAL

3393
02:06:38,933 --> 02:06:41,102
RECONSTRUCTION, IT DOESN'T EVEN

3394
02:06:41,102 --> 02:06:43,104
MATURE UNTIL ABOUT 2 YEARS TO

3395
02:06:43,104 --> 02:06:45,006
THE EQUIVALENT OF THAT TO A

3396
02:06:45,006 --> 02:06:45,306
NATIVE ACL.

3397
02:06:45,306 --> 02:06:47,241
SO I WOULD SAY I DON'T HAVE A

3398
02:06:47,241 --> 02:06:49,544
GOOD ANSWER TBR THE AMOUNT OF

3399
02:06:49,544 --> 02:06:51,612
REHAB BUT I WILL SAY IS WHAT

3400
02:06:51,612 --> 02:06:52,547
WE'RE DOING IS INSUFFICIENT

3401
02:06:52,547 --> 02:06:53,514
BASED ON ALL EVIDENCE THAT WE

3402
02:06:53,514 --> 02:06:55,950
HAVE AND THEN AS FAR AS LIKE

3403
02:06:55,950 --> 02:06:57,785
DINNIESIA PHOBIA IS WHAT YOU'RE

3404
02:06:57,785 --> 02:06:59,921
ASKING ME ABOUT OR PSYCHOLOGICAL

3405
02:06:59,921 --> 02:07:02,023
FACTORS RELATED TO THAT?

3406
02:07:02,023 --> 02:07:03,725
>> YES NAND WHETHER
TAKEN--THEY

3407
02:07:03,725 --> 02:07:04,792
RELATES TO REYOUR IN.

3408
02:07:04,792 --> 02:07:06,894
>> YEAH, I DON'T KNOW

3409
02:07:06,894 --> 02:07:08,162
THAT--THERE'S NOT GOOD EVIDENT

3410
02:07:08,162 --> 02:07:09,797
THAT IT RELATES TO GOOD INJURY

3411
02:07:09,797 --> 02:07:11,199
BUT THERE'S GOOD EVIDENT THAT AT

3412
02:07:11,199 --> 02:07:12,500
THE TIME PATIENTS RETURN BACK TO

3413
02:07:12,500 --> 02:07:16,738
SPORT OR ACTIVITY THERE'S A GOOD

3414
02:07:16,738 --> 02:07:18,106
AMOUNT OF KINNIESIA PHOBIA OR

3415
02:07:18,106 --> 02:07:20,942
CAN YOU SEE HOW THEY LOAD THE

3416
02:07:20,942 --> 02:07:23,478
JOINT OR HOP OR DO SOME SPORTS

3417
02:07:23,478 --> 02:07:25,446
ACTIVITY, THEY ARE NERVOUS TO DO

3418
02:07:25,446 --> 02:07:26,948
SO AND THERE'S EVIDENCE TO

3419
02:07:26,948 --> 02:07:29,050
SUPPORT LIKE THE TAMPA SCALE AND

3420
02:07:29,050 --> 02:07:29,984
OTHER VALIDATED METRICS THAT

3421
02:07:29,984 --> 02:07:31,953
THAT EXISTS AT THE TIME THEY

3422
02:07:31,953 --> 02:07:37,058
RETURN TO ACTIVITY AND BEYOND.

3423
02:07:37,058 --> 02:07:38,059
NTHANK YOU.

3424
02:07:38,059 --> 02:07:38,659
>> YOU'RE WELCOME.

3425
02:07:38,659 --> 02:07:40,395
>> I HAD SOME OF THE SAME

3426
02:07:40,395 --> 02:07:40,661
QUESTIONS.

3427
02:07:40,661 --> 02:07:46,234
YOU KNOW I WAS--I'M GLAD YOU

3428
02:07:46,234 --> 02:07:47,468
ACKNOWLEDGED THE INCREDIBLE

3429
02:07:47,468 --> 02:07:49,103
PRESSURE THESE KIDS ARE UNDER TO

3430
02:07:49,103 --> 02:07:50,438
RETURN TO SPORTS AND THAT

3431
02:07:50,438 --> 02:07:51,839
CREATES PORT OF A PROBLEM WITH

3432
02:07:51,839 --> 02:07:52,907
THE FAMILIES AND SO ON.

3433
02:07:52,907 --> 02:07:55,309
AND I THINK WHAT LINDA WAS--I

3434
02:07:55,309 --> 02:07:56,844
WANT TO MAKE SURE I UNDERSTOOD,

3435
02:07:56,844 --> 02:07:59,914
I WAS CURIOUS ABOUT HOW MUCH

3436
02:07:59,914 --> 02:08:02,784
WHEN PEOPLE ARE RECOVERING, NOT

3437
02:08:02,784 --> 02:08:06,454
JUST ATHLETES BUT OLD FOLKS LIKE

3438
02:08:06,454 --> 02:08:08,489
ME, THAT PEOPLE HOW MUCH OF IT

3439
02:08:08,489 --> 02:08:11,325
IS IN THEIR HEAD THAT BECAUSE

3440
02:08:11,325 --> 02:08:12,393
THEY'RE OVERPROTECTIVE, ABNORMAL

3441
02:08:12,393 --> 02:08:13,127
BEHAVIORS ARE CAUSING MORE

3442
02:08:13,127 --> 02:08:15,963
PROBLEM, I THINK THAT'S WHAT

3443
02:08:15,963 --> 02:08:20,968
LINDA WAS ASKING AND CAN YOU

3444
02:08:20,968 --> 02:08:22,403
HAVE PEOPLE GET PAST THAT?

3445
02:08:22,403 --> 02:08:23,838
>> YEAH, I THINK THAT'S
PART OF

3446
02:08:23,838 --> 02:08:25,006
THIS UNDERLOADING I WAS TALKING

3447
02:08:25,006 --> 02:08:27,608
TO YOU ABOUT WITH THE

3448
02:08:27,608 --> 02:08:28,576
BIOMECHANICAL CONSEQUENCES.

3449
02:08:28,576 --> 02:08:31,512
PEOPLE TRY TO AVOID BEARING

3450
02:08:31,512 --> 02:08:32,914
WEIGHT ON THAT KNEE OR LOADING

3451
02:08:32,914 --> 02:08:36,784
THAT KNEE AND BY DOING THAT,

3452
02:08:36,784 --> 02:08:38,753
EVIDENT SUGGESTS THAT THEY'RE

3453
02:08:38,753 --> 02:08:39,687
CAUSING MORE LONG-TERM JOINT

3454
02:08:39,687 --> 02:08:41,556
HEALTH PROBLEMS FOR THEMSELVES.

3455
02:08:41,556 --> 02:08:44,125
IT'S AN INCREASED FOR RISK FOR

3456
02:08:44,125 --> 02:08:45,059
OSTEOARTHRITIS SO I DO THINK

3457
02:08:45,059 --> 02:08:49,197
THAT IF WE COULD IMPROVE SOME OF

3458
02:08:49,197 --> 02:08:51,132
OUR ABILITY TO--OR THE PASHT'S

3459
02:08:51,132 --> 02:08:53,167
ABILITY TO FEEL MORE CONFIDENT

3460
02:08:53,167 --> 02:08:55,837
IN THEIR KNEE AND MORE

3461
02:08:55,837 --> 02:08:56,537
FUNCTIONAL REHABILITATION YOU

3462
02:08:56,537 --> 02:08:58,372
WILL MAKE THEM FEEL THAT THEIR

3463
02:08:58,372 --> 02:08:59,874
KNEE IS MORE STABLE AND THAT

3464
02:08:59,874 --> 02:09:01,242
THEY CAN PERFORM TO THE SAME

3465
02:09:01,242 --> 02:09:02,210
LEVEL THEY COULD BEFORE THEN I

3466
02:09:02,210 --> 02:09:03,377
THINK THAT WOULD HELP BUT I

3467
02:09:03,377 --> 02:09:04,979
THINK THAT HALF THE PROBLEM IS

3468
02:09:04,979 --> 02:09:07,281
THAT WHEN THEY ARE GOING BACK TO

3469
02:09:07,281 --> 02:09:09,350
ACTIVITY, THEY CAN'T HAVE

3470
02:09:09,350 --> 02:09:10,184
CONFIDENCE BECAUSE THEIR KNEE IS

3471
02:09:10,184 --> 02:09:12,253
NOT THE SAME AS IT WAS BEFORE

3472
02:09:12,253 --> 02:09:14,722
EMPLOY THEY HAVE ALL THIS

3473
02:09:14,722 --> 02:09:17,125
WEAKNESS, AND IT'S NOT--BECAUSE

3474
02:09:17,125 --> 02:09:20,595
THEY'RE WEAK, THEY DON'T HAVE

3475
02:09:20,595 --> 02:09:21,395
GOOD DYNAMIC STABILIZERS

3476
02:09:21,395 --> 02:09:22,263
SURROWPPEDDING THE KNEE SO THEY

3477
02:09:22,263 --> 02:09:24,432
ARE LESS STABLE AND I THEY FEEL

3478
02:09:24,432 --> 02:09:27,768
IT SO IF WE COULD IMPROVE OUR

3479
02:09:27,768 --> 02:09:28,603
REHABILITATION TO MAKE THEM MORE

3480
02:09:28,603 --> 02:09:30,938
STABLE WE MAY BE ABLE TO BUILD

3481
02:09:30,938 --> 02:09:32,673
MORE CONFIDENCE BUT THAT'S NOT

3482
02:09:32,673 --> 02:09:34,175
TO SAY THAT PSYCHOLOGICAL

3483
02:09:34,175 --> 02:09:35,343
INTERVENTIONS WOULD BE OF VALUE

3484
02:09:35,343 --> 02:09:36,677
BECAUSE I DO FEEL THEY WOULD BE

3485
02:09:36,677 --> 02:09:37,979
OF VALUE EMPLOY I DON'T KNOW IF

3486
02:09:37,979 --> 02:09:38,880
THAT ANSWERS YOUR QUESTION, YOU

3487
02:09:38,880 --> 02:09:40,248
ABOUT I DON'T KNOW THERE'S A

3488
02:09:40,248 --> 02:09:43,050
WHOLE LOT OF DAT ON GO OFF, TOO.

3489
02:09:43,050 --> 02:09:44,218
>> THAT'S FINE, I WILL
JUST SIGN

3490
02:09:44,218 --> 02:09:46,254
UP FOR YOUR CLINIC.

3491
02:09:46,254 --> 02:09:46,587
THANKS.

3492
02:09:46,587 --> 02:09:46,854
[LAUGHTER]

3493
02:09:46,854 --> 02:09:47,989
>> WE HAVE 4 QUESTIONS AND
THEN

3494
02:09:47,989 --> 02:09:56,397
WE WILL FINISH UP WITH THOSE 4,

3495
02:09:56,397 --> 02:09:57,598
LINDA JOSEPH?

3496
02:09:57,598 --> 02:09:58,566
>> HI, TBRAIT TALK, MY
QUESTION

3497
02:09:58,566 --> 02:10:04,272
IS SORT OF FOLLOWING UP ON

3498
02:10:04,272 --> 02:10:05,806
RALPH'S QUESTION AND IT HAS TO

3499
02:10:05,806 --> 02:10:09,677
DO WITH THAT, THE SAID THE

3500
02:10:09,677 --> 02:10:10,978
CHANGE TO BIOMECHANIC ANDS THEIR

3501
02:10:10,978 --> 02:10:11,646
LOADING.

3502
02:10:11,646 --> 02:10:14,282
SO MY QUESTION IS DO YOU KNOW OF

3503
02:10:14,282 --> 02:10:16,017
ANY RESEARCH THAT FOLLOWS THESE

3504
02:10:16,017 --> 02:10:21,389
GUYS AS THEY AGE TO SEE HOW IT

3505
02:10:21,389 --> 02:10:23,658
NOT ONLY EFFECTS THE INJURED

3506
02:10:23,658 --> 02:10:25,092
KNEE BUT UNYOURED KNEE IN

3507
02:10:25,092 --> 02:10:32,433
EMERGING ITS OF OA, ANY SORT OF

3508
02:10:32,433 --> 02:10:33,334
JOINT ISSUES?

3509
02:10:33,334 --> 02:10:35,770
>> I AM AWARE OF NO DATA
THAT

3510
02:10:35,770 --> 02:10:36,871
HAS THAT TO FOLLOW THEM ALL THE

3511
02:10:36,871 --> 02:10:38,839
WAY OUT AND WHETHER THE

3512
02:10:38,839 --> 02:10:40,675
UNDERLOADING WOULD INFLUENCE THE

3513
02:10:40,675 --> 02:10:43,077
DEVELOPMENT OF BILATERAL OA FROM

3514
02:10:43,077 --> 02:10:44,612
AN IDIO PATHIC OA STANDPOINT WE

3515
02:10:44,612 --> 02:10:46,581
KNOW THERE'S A GOOD INCIDENCE OF

3516
02:10:46,581 --> 02:10:48,583
BILATERAL OA BUT I DON'T KNOW

3517
02:10:48,583 --> 02:10:51,018
WHAT THE INCIDENCE RATE IS OF

3518
02:10:51,018 --> 02:10:52,286
BILATERAL OA AND RELATED YOUR

3519
02:10:52,286 --> 02:10:56,090
AND WHETHER IT'S RELATED TO THE

3520
02:10:56,090 --> 02:10:56,824
BIOMECHANICAL CHANGES AFTER THE

3521
02:10:56,824 --> 02:10:57,058
INJURY.

3522
02:10:57,058 --> 02:11:00,661
I DO KNOW THAT THE WEAKNESS, THE

3523
02:11:00,661 --> 02:11:01,362
BIOMECHANICAL ADAPTATIONS, THERE

3524
02:11:01,362 --> 02:11:03,531
ARE STUDIES THAT HAVE SHOWN LIKE

3525
02:11:03,531 --> 02:11:05,466
2, 3, 4 YEARS AFTERWARDS THAT

3526
02:11:05,466 --> 02:11:12,206
THESE THINGS STILL LINGER.

3527
02:11:12,206 --> 02:11:13,541
>> DAWN?

3528
02:11:13,541 --> 02:11:14,008
>> VERY INTERESTING

3529
02:11:14,008 --> 02:11:15,676
PRESENTATION, QUICK FOLLOW UP ON

3530
02:11:15,676 --> 02:11:18,045
THE PSYCHOLOGICAL ASSPECS AS A

3531
02:11:18,045 --> 02:11:19,247
PSYCHOLOGIST I'M SITTING HERE

3532
02:11:19,247 --> 02:11:21,449
WONDERING AND MOM OF AN ATHLETE

3533
02:11:21,449 --> 02:11:23,751
WHO WAS INJURED, I'M WONDER

3534
02:11:23,751 --> 02:11:26,254
FIGURE ANYONE'S DOING RESEARCH

3535
02:11:26,254 --> 02:11:28,256
ON PSYCHOLOGICAL OUTCOMES AFTER

3536
02:11:28,256 --> 02:11:29,790
SPORTS YOURS, LOOKING AT RATES,

3537
02:11:29,790 --> 02:11:31,759
NOT JUST FACTORS THAT INFLUENCE

3538
02:11:31,759 --> 02:11:34,762
HOW THEY MOVE, BUT ADAPTATION,

3539
02:11:34,762 --> 02:11:35,830
AJUST ACCIDENT, DEPRESSION, ET

3540
02:11:35,830 --> 02:11:36,163
CETERA.

3541
02:11:36,163 --> 02:11:37,798
NYES, WELL ARE PEOPLE DOING THAT

3542
02:11:37,798 --> 02:11:39,400
TYPE OF RESEARCH BUT I WOULD SAY

3543
02:11:39,400 --> 02:11:41,302
THAT IT'S A SMALLER PROPORTION

3544
02:11:41,302 --> 02:11:42,737
OF THE RESEARCH THAT'S BEING

3545
02:11:42,737 --> 02:11:45,339
DONE AND IT'S AN UNDERSTUDIED

3546
02:11:45,339 --> 02:11:47,775
AREA THAT SHOULD CONTINUE TO GET

3547
02:11:47,775 --> 02:11:49,710
FOCUSED AND I THINK IN LIKE BACK

3548
02:11:49,710 --> 02:11:51,379
PAIN THAT THAT GETS STUDIED

3549
02:11:51,379 --> 02:11:53,648
QUITE A BIT.

3550
02:11:53,648 --> 02:11:55,750
ACL IT'S PICKED UP A BIT AND

3551
02:11:55,750 --> 02:11:57,218
CONCUSSION, THEY'VE BEEN

3552
02:11:57,218 --> 02:11:59,453
STUDYING THAT A LOT BUT I'M

3553
02:11:59,453 --> 02:12:01,889
NOT--NOT ACROSS ALL SPORTS YOURS

3554
02:12:01,889 --> 02:12:02,356
IF THAT HAPPENED.

3555
02:12:02,356 --> 02:12:06,560
BUT I WOULD SAY THE BIGGER 1S

3556
02:12:06,560 --> 02:12:07,762
ACL, CONCUSSION, BACK PAIN BUT I

3557
02:12:07,762 --> 02:12:09,297
HAVEN'T SEEN IT IN SHOULDER

3558
02:12:09,297 --> 02:12:11,132
BUTIME NOT REALLY INVEST INDEED

3559
02:12:11,132 --> 02:12:12,300
THAT LITERATURE BUT I'M NOT

3560
02:12:12,300 --> 02:12:22,777
AWARE OF MUCH OF IT THERE..

3561
02:12:22,777 --> 02:12:23,077
>> SHERRY?

3562
02:12:23,077 --> 02:12:25,079
>> THANKS AGAIN FOR YOUR
AWESOME

3563
02:12:25,079 --> 02:12:25,446
TALK.

3564
02:12:25,446 --> 02:12:28,182
I WANTED TO ASK MAYBE LEAK A

3565
02:12:28,182 --> 02:12:29,350
LITTLE ZOOM OUT, 30,000-FOOT

3566
02:12:29,350 --> 02:12:30,751
VIEW, YOUR INPUT ON THE FUTURE

3567
02:12:30,751 --> 02:12:33,754
OF FUNDING IN THIS SPACE?

3568
02:12:33,754 --> 02:12:36,257
CLINICALLY, THIS IS WHERE MY

3569
02:12:36,257 --> 02:12:37,625
PRACTICE IS BASED ALSO MORE SO

3570
02:12:37,625 --> 02:12:40,061
ON THE MUSK LO SKELETAL SIDE AND

3571
02:12:40,061 --> 02:12:41,662
I KNOW THERE'S CONSISTENT

3572
02:12:41,662 --> 02:12:46,701
CHALLENGES WITH REGARD TO THE

3573
02:12:46,701 --> 02:12:47,768
LANDSCAPE OF FEDERAL FUNDING

3574
02:12:47,768 --> 02:12:49,870
OPPORTUNITIES FOR THIS TYPE OF

3575
02:12:49,870 --> 02:12:50,604
WORK, THERE'S SUPPLEMENTATION,

3576
02:12:50,604 --> 02:12:52,640
OF COURSE BY SOME OF THE SPORTS

3577
02:12:52,640 --> 02:12:53,941
MEDICINE FOCUSED MEDICAL

3578
02:12:53,941 --> 02:12:54,909
SOCIETIES THAT'S HELPFUL, BUT

3579
02:12:54,909 --> 02:12:56,711
CERTAINLY DIDN'T GET US TO THE

3580
02:12:56,711 --> 02:12:59,947
SAME LEVEL AS IT WOULD IF THERE

3581
02:12:59,947 --> 02:13:01,248
WERE LARGER GRANT PROGRAMS

3582
02:13:01,248 --> 02:13:02,983
THROUGH, YOU KNOW NIH FOR

3583
02:13:02,983 --> 02:13:04,719
EXAMPLE, SO WOULD LOVE YOUR

3584
02:13:04,719 --> 02:13:06,887
THOUGHTS ON KIND OF THE FUTURE

3585
02:13:06,887 --> 02:13:08,322
OF THAT SPACE, WHAT WOULD BE

3586
02:13:08,322 --> 02:13:10,091
HELPFUL, HOW WE ADVANCE THIS TO

3587
02:13:10,091 --> 02:13:11,092
THE NEXT LEVEL.

3588
02:13:11,092 --> 02:13:15,062
NWE NEED MORE FUNDING.

3589
02:13:15,062 --> 02:13:15,629
[LAUGHTER]

3590
02:13:15,629 --> 02:13:16,564
WE'RE ALREADY SAYING, YOU'RE

3591
02:13:16,564 --> 02:13:18,666
ALREADY SAYING THE THINGS THAT I

3592
02:13:18,666 --> 02:13:19,033
KNOW.

3593
02:13:19,033 --> 02:13:19,867
THERE ARE OPPORTUNITIES FOR

3594
02:13:19,867 --> 02:13:23,938
FUNDING IN THIS SPACE, I THINK

3595
02:13:23,938 --> 02:13:26,674
WE--AS A SPORTS MEDICINE

3596
02:13:26,674 --> 02:13:28,843
PROFESSION AS A WHOLE THAT

3597
02:13:28,843 --> 02:13:30,478
ENCOMPASSES A LOT OF DIFFERENT

3598
02:13:30,478 --> 02:13:33,013
PROFESSIONS WE NEED TO MAKE A

3599
02:13:33,013 --> 02:13:34,081
BETTER CASE FOR WHY FUNDING

3600
02:13:34,081 --> 02:13:35,483
NEEDS TO BE THERE.

3601
02:13:35,483 --> 02:13:38,018
PEOPLE NEED TO SEE THE COST OF

3602
02:13:38,018 --> 02:13:38,886
THESE INJURIES, LONG-TERM

3603
02:13:38,886 --> 02:13:39,620
CONSEQUENCES OF THESE INJURIES

3604
02:13:39,620 --> 02:13:42,056
AND THEN WHEN WE PROPOSE

3605
02:13:42,056 --> 02:13:43,190
REHABILITATION STRATEGIC PLAN

3606
02:13:43,190 --> 02:13:45,559
KNOWLEDGEYS, WE NEED TO PROPOSE

3607
02:13:45,559 --> 02:13:47,328
THINGS THAT ARE MECHANISTIC,

3608
02:13:47,328 --> 02:13:48,596
THERE'S SOME SORT OF MECHANISM

3609
02:13:48,596 --> 02:13:51,298
BEHIND THEM AND WE'RE JUST NO

3610
02:13:51,298 --> 02:13:52,800
THROT THROWING THE KITCHEN SINK

3611
02:13:52,800 --> 02:13:54,068
AT IT, HEY THIS, IS WORK OVER

3612
02:13:54,068 --> 02:13:55,836
HERE IN STROKE SO LET'S SEE IF

3613
02:13:55,836 --> 02:13:57,371
WE CAN MOVE IT OVER HERE AND USE

3614
02:13:57,371 --> 02:13:59,240
IT OR IT'S WORKED ON AN ANKLE

3615
02:13:59,240 --> 02:14:00,608
INJURY SO LET'S TRY IT IN A

3616
02:14:00,608 --> 02:14:01,175
SHOULDER YOUR.

3617
02:14:01,175 --> 02:14:07,248
THERE'S JUST NOT A LOT OF FOLKS

3618
02:14:07,248 --> 02:14:09,550
THAT ARE PROVIDING NECK

3619
02:14:09,550 --> 02:14:10,684
MECHANISTIC BASED INTERVENTIONS

3620
02:14:10,684 --> 02:14:12,520
AND THERE NEED TO BE A LAND CAPE

3621
02:14:12,520 --> 02:14:14,054
FOR THAT SO WE NEED TO

3622
02:14:14,054 --> 02:14:14,989
UNDERSTAND WHAT'S CAUSING THESE

3623
02:14:14,989 --> 02:14:17,291
AFTER YOUR AND THEN DEVELOP

3624
02:14:17,291 --> 02:14:18,926
REHABILITATION AND APPROACHES

3625
02:14:18,926 --> 02:14:19,894
THAT TARGET THOSE RISK FACTORS

3626
02:14:19,894 --> 02:14:21,429
THAT ARE KNOWN TO BE ASSOCIATED

3627
02:14:21,429 --> 02:14:22,963
OTHERWISE WE DON'T MAKE

3628
02:14:22,963 --> 02:14:25,733
PROGRESS. 

3629
02:14:25,733 --> 02:14:26,333
>> THANK YOU.

3630
02:14:26,333 --> 02:14:32,206
NAND WRAPPING UP THE QUESTIONS

3631
02:14:32,206 --> 02:14:35,810
FRANCISCO IN.

3632
02:14:35,810 --> 02:14:37,111
>> THANK YOU.

3633
02:14:37,111 --> 02:14:38,412
JUST QUICKLY, I ALSO HAVE WORK

3634
02:14:38,412 --> 02:14:40,147
IN THIS FIELD, SOMETHING YOU

3635
02:14:40,147 --> 02:14:41,782
INTIMATED BUT I WANT TO SEE IF

3636
02:14:41,782 --> 02:14:43,884
YOU HAVE SORT OF AN OPINION ON

3637
02:14:43,884 --> 02:14:45,986
THIS ABOUT HOW WE'RE EVOLVING

3638
02:14:45,986 --> 02:14:47,655
FROM SEEING ACL OR ANKLE

3639
02:14:47,655 --> 02:14:49,824
INSTABILITY YOURS OR SHOULDER

3640
02:14:49,824 --> 02:14:50,891
INSTABILITY INJURIES HOW TO MOVE

3641
02:14:50,891 --> 02:14:55,162
AWAY FROM A STRUCTURAL

3642
02:14:55,162 --> 02:14:56,564
SIRNLGICAL TISSUE PROBLEM TO 1

3643
02:14:56,564 --> 02:15:01,969
MORE OF A SENSORY MOTOR CONTROL

3644
02:15:01,969 --> 02:15:06,674
AND ADAPTATION BECAUSE THERE'S

3645
02:15:06,674 --> 02:15:10,811
EVIDENCE OF COTTERRIC O

3646
02:15:10,811 --> 02:15:12,046
EXCITABILITY, DECREASES, ET

3647
02:15:12,046 --> 02:15:14,548
CETERA, JUST YOUR THOUGHTS ON

3648
02:15:14,548 --> 02:15:14,748
THAT?

3649
02:15:14,748 --> 02:15:15,716
>> YEAH, I THINK IT'S A

3650
02:15:15,716 --> 02:15:17,051
DIRECTION WE NEED TO MOVE IT.

3651
02:15:17,051 --> 02:15:18,319
WE'RE DOING SOME WORK IN THAT

3652
02:15:18,319 --> 02:15:20,187
SPACE RIGHT NOW, WHERE WE'RE

3653
02:15:20,187 --> 02:15:22,490
LOOKING AT DECREASED COTTERRIC O

3654
02:15:22,490 --> 02:15:23,424
EXCITABILITY IN THESE ACL

3655
02:15:23,424 --> 02:15:28,729
PATIENTS AND WE'RE LOOKING AT

3656
02:15:28,729 --> 02:15:30,431
OPERATE CONDITIONING USING

3657
02:15:30,431 --> 02:15:31,499
ELECTRICAL STIMULATION AND WE

3658
02:15:31,499 --> 02:15:33,167
WARDS BASED METHODS TO SEE IF WE

3659
02:15:33,167 --> 02:15:34,268
CAN IMPROVE THE EXCITABILITY

3660
02:15:34,268 --> 02:15:36,003
BECAUSE 1 OF THE ISSUES WITH

3661
02:15:36,003 --> 02:15:37,805
LET'S SAY THE WEAKNESS WITH ACL

3662
02:15:37,805 --> 02:15:39,406
RECONSTRUCTION IS NOT ALL ALL

3663
02:15:39,406 --> 02:15:42,543
MUSCLE SO WHEN SOMEONE TEARS

3664
02:15:42,543 --> 02:15:46,614
THEIR ACL, IT DOESN'T DAMAGE THE

3665
02:15:46,614 --> 02:15:48,449
QUADRICEPS MUSCLES BUT IT DOES

3666
02:15:48,449 --> 02:15:49,650
SHUT DOWN THERE IS RINKING THAT

3667
02:15:49,650 --> 02:15:51,318
UPON HAS AND ACCEPTEDS MESSAGES

3668
02:15:51,318 --> 02:15:51,852
FROM THE BRAIN.

3669
02:15:51,852 --> 02:15:53,721
AND SO IF THE BRAIN TELLING THE

3670
02:15:53,721 --> 02:15:55,122
MUSCLE NOT TO CONTRACT, WE CAN

3671
02:15:55,122 --> 02:15:56,657
TRY TO CONTRACT THE MUSCLE ALL

3672
02:15:56,657 --> 02:15:58,292
WE WANT BUT THAT NEURAL

3673
02:15:58,292 --> 02:15:59,360
INHIBITION IS NEVER GETTING

3674
02:15:59,360 --> 02:16:02,663
OVERCOME SO WE NEED TO TARGET

3675
02:16:02,663 --> 02:16:05,833
THESE OTHER YIRS SENSORY MOTOR

3676
02:16:05,833 --> 02:16:07,001
NEUROLOGICAL THAT ARE

3677
02:16:07,001 --> 02:16:08,502
CONTRIBUTING TO DEFICITS WITH

3678
02:16:08,502 --> 02:16:09,570
INJURY OR WE'RE NOT TARGETING

3679
02:16:09,570 --> 02:16:10,738
MECH INFORMS AND WE'RE NOT GOING

3680
02:16:10,738 --> 02:16:13,641
TO GET THIS FULL COMPLETE

3681
02:16:13,641 --> 02:16:15,376
REHABILITATION THAT NEEZ PATES

3682
02:16:15,376 --> 02:16:16,176
NEED AND DESERVE.

3683
02:16:16,176 --> 02:16:19,513
>> THANK YOU.

3684
02:16:19,513 --> 02:16:21,849
>> YOU'RE WELCOME.

3685
02:16:21,849 --> 02:16:23,017
>> WHOOPS DOUBLE CLICKING
DIDN'T

3686
02:16:23,017 --> 02:16:24,785
WORK FOR THE MIC.

3687
02:16:24,785 --> 02:16:25,686
THANK YOU AGAIN.

3688
02:16:25,686 --> 02:16:28,122
LET'S GO ON AND HALF A

3689
02:16:28,122 --> 02:16:29,823
PRESENTATION BY DR. LINDA

3690
02:16:29,823 --> 02:16:35,362
VILLAIN DILLEN ON BACK INJURY.

3691
02:16:35,362 --> 02:16:35,863
>> ALL RIGHT.

3692
02:16:35,863 --> 02:16:46,273
WE WILL SEE IF I DO THIS

3693
02:16:47,808 --> 02:16:48,008
CORRECTLY.

3694
02:16:48,008 --> 02:16:48,375
>> LOOKS GOOD.

3695
02:16:48,375 --> 02:16:48,676
>> GREAT.

3696
02:16:48,676 --> 02:16:50,744
CAN YOU SEE MY NOTE WHICH IS IS

3697
02:16:50,744 --> 02:16:51,078
HELPFUL.

3698
02:16:51,078 --> 02:16:52,479
OKAY, SO THANKS FOR THE

3699
02:16:52,479 --> 02:16:53,447
INVITATION TO SPEAK TODAY TO THE

3700
02:16:53,447 --> 02:16:55,282
BOARD AND I ALWAYS LIKE BEING

3701
02:16:55,282 --> 02:16:58,252
THE LAST SPEAKER ON THE LAST

3702
02:16:58,252 --> 02:16:58,485
DAY.

3703
02:16:58,485 --> 02:17:01,655
IT'S A GREAT PLACE TO BE.

3704
02:17:01,655 --> 02:17:02,823
I DO APPRECIATE THE OPPORTUNITY

3705
02:17:02,823 --> 02:17:05,526
TO PAWK ABOUT THIS TOPIC, I

3706
02:17:05,526 --> 02:17:06,360
REALLY DEVELOPED AN INTEREST IN

3707
02:17:06,360 --> 02:17:09,463
BACK PAIN AS A CLINICIAN, I

3708
02:17:09,463 --> 02:17:10,998
WORKED WITH NEUROSCIENCE OR

3709
02:17:10,998 --> 02:17:11,632
NEUROMEDICINE AND NEUROSURGERY

3710
02:17:11,632 --> 02:17:14,335
AND I SAW A LOT OF PATIENTS WHO

3711
02:17:14,335 --> 02:17:16,070
GOT SURGERY TO RELIEVE THEIR

3712
02:17:16,070 --> 02:17:18,639
BACK PAIN AND THE AMOUNT OF

3713
02:17:18,639 --> 02:17:19,873
SURGERY THAT'S OCCURRING PER

3714
02:17:19,873 --> 02:17:21,108
BACK PAIN HAS CHANGED OVER THE

3715
02:17:21,108 --> 02:17:22,276
YEARS BECAUSE OF THE EVIDENCE

3716
02:17:22,276 --> 02:17:23,577
THAT'S BEEN GENERATED WHICH I

3717
02:17:23,577 --> 02:17:25,546
THINK IS REALLY ENCOURAGING.

3718
02:17:25,546 --> 02:17:28,182
SO, FIRST, I'M GOING TO TALK TO

3719
02:17:28,182 --> 02:17:31,719
YOU AND GIVE YOUA I BIG OVERVIEW

3720
02:17:31,719 --> 02:17:33,053
OF LOW BACK PAIN SO HAVE YOU AN

3721
02:17:33,053 --> 02:17:34,688
PREERK OF WHAT IT IS AND HOW

3722
02:17:34,688 --> 02:17:35,856
THESE CONDITIONS ARE QUITE

3723
02:17:35,856 --> 02:17:37,224
DIFFERENT FROM WHAT YOU HEARD

3724
02:17:37,224 --> 02:17:38,325
ABOUT THIS MORNING SO FAR.

3725
02:17:38,325 --> 02:17:39,526
I WILL TALK ABOUT THE POTENTIAL

3726
02:17:39,526 --> 02:17:43,163
CAUSES AND THE BURDEN AND THEN I

3727
02:17:43,163 --> 02:17:44,231
WILL GIVE YOU, DISCUSS WITH YOU

3728
02:17:44,231 --> 02:17:45,566
THE IMPORTANCE OF UNDERSTANDING

3729
02:17:45,566 --> 02:17:48,002
THE COURSE OF BACK PAIN TO STUDY

3730
02:17:48,002 --> 02:17:48,736
THESE CONDITIONS.

3731
02:17:48,736 --> 02:17:50,604
AND THEN I WILL PRESENT THE MOST

3732
02:17:50,604 --> 02:17:52,206
CURRENT RESEARCH INTO THE

3733
02:17:52,206 --> 02:17:53,974
POTENTIAL CONTRIBUTORS TO BACK

3734
02:17:53,974 --> 02:17:56,010
PAIN AND DISABILITY, THAT'S

3735
02:17:56,010 --> 02:17:59,613
ASSOCIATE WIDE IT AT I EMPHASIZE

3736
02:17:59,613 --> 02:18:00,581
DISABILITY HERE BECAUSE IT'S

3737
02:18:00,581 --> 02:18:02,750
BEEN DOCUM THAD THE INABILITY TO

3738
02:18:02,750 --> 02:18:04,018
PERFORM FUNCTIONAL ACTIVITY

3739
02:18:04,018 --> 02:18:05,419
SYSTEM THE PRIMARY REASON PEOPLE

3740
02:18:05,419 --> 02:18:06,687
WITH BACK PAIN ACTUALLY SEEK

3741
02:18:06,687 --> 02:18:08,422
INITIAL AS WELL AS SUBSIDIARY

3742
02:18:08,422 --> 02:18:10,057
QUEBT CARE RATHER THAN JUST THE

3743
02:18:10,057 --> 02:18:10,257
PEAP.

3744
02:18:10,257 --> 02:18:12,059
I WILL TALK ABOUT THE

3745
02:18:12,059 --> 02:18:13,127
BIOPSYCHOSOCIAL MODEL AS IT

3746
02:18:13,127 --> 02:18:15,195
APLAYS TO BACK PAIN AND THEN,

3747
02:18:15,195 --> 02:18:17,898
REVIEW THE MOST CONSISTENT

3748
02:18:17,898 --> 02:18:19,066
FINDINGS IN THIS AREA AND 1 OF

3749
02:18:19,066 --> 02:18:20,601
THE BIG TAKE HOMES THAT I'M

3750
02:18:20,601 --> 02:18:22,002
GOING TO TELL YOU NOW IS THAT

3751
02:18:22,002 --> 02:18:27,307
BACK PAIN IS A COMPLEX CONDITION

3752
02:18:27,307 --> 02:18:28,709
AND THERE'S LARGE INDIVIDUAL

3753
02:18:28,709 --> 02:18:30,010
VARIABILITY AND PRESENTATION AND

3754
02:18:30,010 --> 02:18:31,745
COURSE CAN THAT'S REALLY SLOWED

3755
02:18:31,745 --> 02:18:33,280
THE RESEARCH DOWN IN SOME WAYS

3756
02:18:33,280 --> 02:18:34,314
BY NOT UNDERSTANDING AND

3757
02:18:34,314 --> 02:18:35,182
REALIZING THAT AND ADDRESSING IT

3758
02:18:35,182 --> 02:18:36,884
EMPLOY AND THEN I WILL DESCRIBE

3759
02:18:36,884 --> 02:18:37,918
SOME OF THE RESEARCH APPROACHES

3760
02:18:37,918 --> 02:18:39,920
THAT ARE BEING TAKEN TO ADDRESS

3761
02:18:39,920 --> 02:18:43,657
THIS ISSUE OF VARIABILITY AND

3762
02:18:43,657 --> 02:18:44,024
PRESENTATION.

3763
02:18:44,024 --> 02:18:45,526
SO 1 THING TO KNOW IS BACK PAIN

3764
02:18:45,526 --> 02:18:46,894
IS AN EXTREMELY COMMON SYMPTOM,

3765
02:18:46,894 --> 02:18:48,662
IT'S NOT A DEC, IT IS DEFEIGNED

3766
02:18:48,662 --> 02:18:53,233
BY LOCATION OF PAIN, SO IT'S

3767
02:18:53,233 --> 02:18:55,636
PAIN BETWEEN THE LOWER RIB

3768
02:18:55,636 --> 02:18:57,671
MARGIN AND THE GLUTEAL FOLD.

3769
02:18:57,671 --> 02:18:59,540
YOU CAN HAVE PAIN IN 1 OR BOTH

3770
02:18:59,540 --> 02:19:01,308
LEG ANDS YOU CAN HAVE

3771
02:19:01,308 --> 02:19:03,010
NEUROLOGICAL SYMPTOMS ARE NOT.

3772
02:19:03,010 --> 02:19:05,779
THE DIAGNOSIS FALL INTOS 2 MAJOR

3773
02:19:05,779 --> 02:19:07,147
CATEGORIES, SPECIFIC LOW BACK

3774
02:19:07,147 --> 02:19:09,116
PAIN AND NONSPECIFIC LO BACK

3775
02:19:09,116 --> 02:19:11,785
PAIN AND THE MA YOURITY OF

3776
02:19:11,785 --> 02:19:14,088
PEOPLE, ESTIMATES UP TO 90%

3777
02:19:14,088 --> 02:19:16,757
CASES ARE GIVEN THE DIAGNOSIS OF

3778
02:19:16,757 --> 02:19:17,891
NONSPECIFIC BACK PAIN AND IS

3779
02:19:17,891 --> 02:19:20,194
BECAUSE MOST PEOPLE WHO PREVENT

3780
02:19:20,194 --> 02:19:22,529
IN THE CLINIC, THE PAIN

3781
02:19:22,529 --> 02:19:24,064
GENERATOR CAN'T BE IDENTIFIED.

3782
02:19:24,064 --> 02:19:26,734
SO IN TERMS OF CAUSES OF BACK

3783
02:19:26,734 --> 02:19:28,235
PAIN, CLINICAL TESTS ARE NOT

3784
02:19:28,235 --> 02:19:29,503
ABLE TO ACCURATELY IEE, AUDIENCE

3785
02:19:29,503 --> 02:19:31,238
TENTIFY THE TISSUE SOURCE OF

3786
02:19:31,238 --> 02:19:31,805
MOST BACK PAIN.

3787
02:19:31,805 --> 02:19:32,940
AND SO IN PARTICULAR, THERE'S

3788
02:19:32,940 --> 02:19:34,875
QUITE A BIT OF DEBATE OVER THE

3789
02:19:34,875 --> 02:19:36,844
IMPORTANCE OF USING IMAGING THEN

3790
02:19:36,844 --> 02:19:40,013
FOR DIAGNOSIS, PARTICULARLY IN

3791
02:19:40,013 --> 02:19:42,583
THE CLATIONZ, SO MANY IMAGING

3792
02:19:42,583 --> 02:19:44,384
FINDINGS IESHES DENTIFIED IN

3793
02:19:44,384 --> 02:19:46,086
PEOPLE WITH BACK PAIN ARE NOT

3794
02:19:46,086 --> 02:19:48,288
COMOP IN THOSE WITH NO BACK PAIN

3795
02:19:48,288 --> 02:19:51,892
AND THERE'S NO STRONG EVIDENCE

3796
02:19:51,892 --> 02:19:53,660
WITH THE FUTURE TO PREDIC LOW

3797
02:19:53,660 --> 02:19:57,131
BACK PAIN AND GIVEN THIS, THE

3798
02:19:57,131 --> 02:19:57,931
GUIDELINES CURRENTLY

3799
02:19:57,931 --> 02:19:58,899
CONSISTENTLY RECOMMEND AGAINST

3800
02:19:58,899 --> 02:20:00,434
ROUTINE USE OF IMAGING AT LEAST

3801
02:20:00,434 --> 02:20:02,302
INITIALLY EMPLOY SO IN TERMS OF

3802
02:20:02,302 --> 02:20:03,804
CAUSES, OR IN TERPS OF HOW FAR

3803
02:20:03,804 --> 02:20:05,672
COMMON BACK PAIN IS, IT'S NOT

3804
02:20:05,672 --> 02:20:06,607
COMMON IN THE FIRST DECADE OF

3805
02:20:06,607 --> 02:20:10,043
LIFE BUT THEN THE PREVALENCE

3806
02:20:10,043 --> 02:20:12,479
INCREASES PRETTY STEEP LE DURING

3807
02:20:12,479 --> 02:20:14,948
THE TEENAGE YEARS SO 40-NIEPT%

3808
02:20:14,948 --> 02:20:16,517
OF THE 18 YEAR-OLDS REPORT

3809
02:20:16,517 --> 02:20:19,887
HAVING BACK PAIN, IN ADUTS THE

3810
02:20:19,887 --> 02:20:21,021
PREVALENCE IS 37% AND MOST

3811
02:20:21,021 --> 02:20:21,889
PEOPLE WILL EXPERIENCE BACK PAIN

3812
02:20:21,889 --> 02:20:23,991
AT LEAST ONCE IN A LIFETIME SO

3813
02:20:23,991 --> 02:20:24,691
IEWM SURE THAT'S TRUCKS--THEN OF

3814
02:20:24,691 --> 02:20:27,427
ALL OF YOU IN THE AUDIENCE, SO

3815
02:20:27,427 --> 02:20:28,128
RECURRENCES ARE COMMON, AS YOU

3816
02:20:28,128 --> 02:20:30,798
CAN SEE IN THE GROF THE, IT

3817
02:20:30,798 --> 02:20:31,865
PEAKS IN MIDLIFE ISSUES IT'S

3818
02:20:31,865 --> 02:20:33,634
MORE COMMON IN WOMEN THAN IN MEN

3819
02:20:33,634 --> 02:20:36,503
AND THE PREVALENCE OF BACK PAIN

3820
02:20:36,503 --> 02:20:38,172
THAT'S ACCOMPANIED BY ACTIVITY

3821
02:20:38,172 --> 02:20:39,773
LIMITATIONS SO REHAB KIND OF

3822
02:20:39,773 --> 02:20:47,080
FOCUS INCREASES AS PEOPLE AGE.

3823
02:20:47,080 --> 02:20:50,551
IN TERMS OF IMPACT, IT HAS

3824
02:20:50,551 --> 02:20:51,919
HIGHER CONDITIONS GLOBAL, IT IS

3825
02:20:51,919 --> 02:20:53,821
THE LEADING CAUSE OF YEARS LIVED

3826
02:20:53,821 --> 02:20:56,323
WITH DISABILITY AND IT IS NUMBER

3827
02:20:56,323 --> 02:20:59,226
6 IN DISEASE BURDEN GLOBAL.

3828
02:20:59,226 --> 02:21:01,662
TWENTY-EIGHT CASES ARE IN THE

3829
02:21:01,662 --> 02:21:03,497
SEVERE LIMITATIONS CATEGORIES

3830
02:21:03,497 --> 02:21:06,466
AND THE REMAINDER ARE IN THE

3831
02:21:06,466 --> 02:21:09,069
MODERATE TO LOW LIMITATIONS

3832
02:21:09,069 --> 02:21:09,636
CATEGORIES, SO THE OVERALL

3833
02:21:09,636 --> 02:21:10,270
CENTER FOR EXCELLENCE ON AGING

3834
02:21:10,270 --> 02:21:12,372
IS HAY HIGH BURDEN ON SOCIETY.

3835
02:21:12,372 --> 02:21:14,374
SO GIVEN BACK PAIN REALLY IS THE

3836
02:21:14,374 --> 02:21:15,509
LEADING CAUSE OF DISABILITY

3837
02:21:15,509 --> 02:21:16,710
WORLD WIDE, IT'S CLEARLY A

3838
02:21:16,710 --> 02:21:18,812
CONDITION WITH A NEED FOR

3839
02:21:18,812 --> 02:21:21,148
EFFECTIVE AND EFFICIENT APPROACH

3840
02:21:21,148 --> 02:21:23,050
TO TREATMENT.

3841
02:21:23,050 --> 02:21:23,851
IMPORTANTLY, MOST CLINICAL

3842
02:21:23,851 --> 02:21:26,887
PRACTICE GUIDE LINES CURRENTLY

3843
02:21:26,887 --> 02:21:27,487
RECOMMEND NONPHARMAICOLOGICAL

3844
02:21:27,487 --> 02:21:28,388
TREATMENT AS PART OF THE FIRST

3845
02:21:28,388 --> 02:21:30,591
LINE OF CARE FOR NONSPECIFIC LOW

3846
02:21:30,591 --> 02:21:32,025
BACK PAIN AND IN PARTICULAR, THE

3847
02:21:32,025 --> 02:21:33,627
EVIDENCE SUPPORTS THE USE OF

3848
02:21:33,627 --> 02:21:35,295
EDUCATION IN THE EARLY ACUTE

3849
02:21:35,295 --> 02:21:37,598
PHASE AND THEN ADDING EXERCISE

3850
02:21:37,598 --> 02:21:42,202
BEYOND THE ACUTE PHASE.

3851
02:21:42,202 --> 02:21:43,904
HOWEVER BECAUSE ABOUT 90% OF THE

3852
02:21:43,904 --> 02:21:45,806
CASES ARE GIVEN THE DIAGNOSIS OF

3853
02:21:45,806 --> 02:21:47,407
NONSPECIFIC BACK PAIN, THE FOCUS

3854
02:21:47,407 --> 02:21:48,942
OF MANAGEMENT FOR THE MA YOURITY

3855
02:21:48,942 --> 02:21:52,779
OF CASES IS NOT ON A SPECIFIC

3856
02:21:52,779 --> 02:21:53,680
PATHOANATOMY OR PATHOPHYSIOLOGY

3857
02:21:53,680 --> 02:21:55,949
BUT RATHER IT'SON ALLEVIATING

3858
02:21:55,949 --> 02:21:58,185
THE PERSON'S PAIN AND

3859
02:21:58,185 --> 02:21:59,853
COUNTERACTING THE ASSOCIATED

3860
02:21:59,853 --> 02:22:00,787
DISABILITY AND IN PARTICULAR

3861
02:22:00,787 --> 02:22:02,756
TRYING TO AVOID OR MEN MYSELF

3862
02:22:02,756 --> 02:22:05,292
THE DEVELOPMENT OF THAT

3863
02:22:05,292 --> 02:22:07,027
DISABILITY OR LESSEN IT IF IT'S

3864
02:22:07,027 --> 02:22:09,129
ALREADY PRESENT.

3865
02:22:09,129 --> 02:22:10,330
SO REALLY IT'S IMPORTANT TO BE

3866
02:22:10,330 --> 02:22:12,399
ABLE TO HAVE THE BEST APPROACH

3867
02:22:12,399 --> 02:22:13,767
TO RESEARCH AND TREATMENT BY

3868
02:22:13,767 --> 02:22:15,068
UNDERSTANDING THE COURSE OF BACK

3869
02:22:15,068 --> 02:22:15,369
PAIN.

3870
02:22:15,369 --> 02:22:19,406
AND WHAT YOU SEE UP HERE IN THE

3871
02:22:19,406 --> 02:22:22,709
UPPER RIGHT HAND CORNER IS A

3872
02:22:22,709 --> 02:22:24,578
GRAPH OF WHAT WE THOUGHT WAS THE

3873
02:22:24,578 --> 02:22:25,545
COURSE OF NONSPECIFIC BACK PAIN

3874
02:22:25,545 --> 02:22:26,813
YEARS AGO AND IT WAS CONSIDERED

3875
02:22:26,813 --> 02:22:28,248
TO BE A CONDITION CHARACTERIZED

3876
02:22:28,248 --> 02:22:30,751
AS A SERIES OF THESE AKIEWLT

3877
02:22:30,751 --> 02:22:31,685
UNRELATED EVENTS THAT WERE

3878
02:22:31,685 --> 02:22:32,986
REALLY SHORT LIVED AND THEY

3879
02:22:32,986 --> 02:22:34,721
RECOVERED ON THEIR OWN OR YOU

3880
02:22:34,721 --> 02:22:36,323
ENDED UP WITH THIS VERY CHRONIC

3881
02:22:36,323 --> 02:22:39,660
PROBLEM THAT JUST CONTINUED ON

3882
02:22:39,660 --> 02:22:41,395
INDEFINITELY, BUT THE CURRENT

3883
02:22:41,395 --> 02:22:44,031
EVIDENT NOW SUPPORTS A RECOVERY

3884
02:22:44,031 --> 02:22:46,266
PATERB OF ACUTE BACK PAIN THAT'S

3885
02:22:46,266 --> 02:22:48,302
REALLY HIGHLY VARIABLE.

3886
02:22:48,302 --> 02:22:50,137
SO STUDIES ANALYZING INDIVIDUAL

3887
02:22:50,137 --> 02:22:53,540
PATIENT'S BACK PAIN AND

3888
02:22:53,540 --> 02:22:54,841
DISABILITY TRAJECTORIES HAVE

3889
02:22:54,841 --> 02:22:56,076
CONSISTENTLY IDENTIFIED THERE

3890
02:22:56,076 --> 02:22:57,177
ARE 5 DISTINCT PATTERNS THAT

3891
02:22:57,177 --> 02:22:58,879
DIFFER FROM THE POPULATION

3892
02:22:58,879 --> 02:22:59,746
AVERAGED COURSE THAT YOU SEE UP

3893
02:22:59,746 --> 02:23:01,949
HERE IN THE UPPER RIGHT HAND

3894
02:23:01,949 --> 02:23:02,416
CORNER.

3895
02:23:02,416 --> 02:23:04,151
SO, WHILE BACK PAIN GOES AWAY,

3896
02:23:04,151 --> 02:23:05,819
QUICKLY FOR SOME PEOPLE, SO THE

3897
02:23:05,819 --> 02:23:09,456
DATA HERE IN GREEN, UNDER MINOR

3898
02:23:09,456 --> 02:23:10,624
RECOVERY, OTHER PEOPLE

3899
02:23:10,624 --> 02:23:13,226
EXPERIENCE AN ONGOING COURSE OF

3900
02:23:13,226 --> 02:23:15,095
FLUCTUATING PORE CYSTENT BACK

3901
02:23:15,095 --> 02:23:16,997
PAIN OF VARYING DEGREES OF

3902
02:23:16,997 --> 02:23:19,066
SEVERITY AND THE ESTIMATES FOR

3903
02:23:19,066 --> 02:23:21,568
THESE ENCOMPLETE CASES IS AS

3904
02:23:21,568 --> 02:23:22,836
HIGH AS 80% OF THE BACK PAIN

3905
02:23:22,836 --> 02:23:25,272
CASES AND EVEN IN THOSE WHO

3906
02:23:25,272 --> 02:23:26,406
RECOVER, A RECURRENCE WITHIN A

3907
02:23:26,406 --> 02:23:28,709
YEAR IS COMMON WITH ESTIMATES

3908
02:23:28,709 --> 02:23:32,946
BETWEEN 37 AND 73%. 

3909
02:23:32,946 --> 02:23:34,214
AND THEY VARIED DEPENDING ON

3910
02:23:34,214 --> 02:23:37,551
WHAT THE DEFINITION IS FOR

3911
02:23:37,551 --> 02:23:37,851
RECURRENCE.

3912
02:23:37,851 --> 02:23:38,986
SO, REALLY THE QUEE QUESTION

3913
02:23:38,986 --> 02:23:41,822
THEN BASED ON WHAT I TOLD YOU IS

3914
02:23:41,822 --> 02:23:43,190
WHAT ARE THESE VARIABLES THAT

3915
02:23:43,190 --> 02:23:44,124
CONTRIBUTE TO DIFFERENT COURSES

3916
02:23:44,124 --> 02:23:46,226
AND KNOWLEDGE OF THESE VARIABLES

3917
02:23:46,226 --> 02:23:48,295
OR FACTORS WOULD ALLOW DECISIONS

3918
02:23:48,295 --> 02:23:49,596
THAT ARE EFFECTIVE ABOUT WHO TO

3919
02:23:49,596 --> 02:23:52,366
TREAT, WHEN TO TREAT THEM, HOW

3920
02:23:52,366 --> 02:23:53,467
TO TREAT THEM, WHAT TO TREAT AND

3921
02:23:53,467 --> 02:23:54,401
HOW MUCH TO TREAT.

3922
02:23:54,401 --> 02:23:56,737
SO AS PART OF THIS PROCESS

3923
02:23:56,737 --> 02:23:57,904
THERE'S BEEN AN EMPHASIS ON

3924
02:23:57,904 --> 02:23:59,206
TRYING TO DEFINE WHO WILL

3925
02:23:59,206 --> 02:24:01,375
RECOVER, SO THIS DATA OVER HERE

3926
02:24:01,375 --> 02:24:03,710
ON THE LEFT VERSUS WHO WILL HAVE

3927
02:24:03,710 --> 02:24:04,878
INCOMPLETE RECOVERY EMPLOY THESE

3928
02:24:04,878 --> 02:24:07,381
ARE PEOPLE OFTEN REFERRED TO AS

3929
02:24:07,381 --> 02:24:08,548
HAVING CHRONIC OR PERSISTENT LOW

3930
02:24:08,548 --> 02:24:11,651
BACK PAIN AND WHO IS GOG HAVE A

3931
02:24:11,651 --> 02:24:14,488
RECURRENCE BECAUSE THIS KIND OF

3932
02:24:14,488 --> 02:24:16,323
INFORMATION IF IT'S KNOWN AT THE

3933
02:24:16,323 --> 02:24:18,058
BEGINNING OF AN EPISODE OR

3934
02:24:18,058 --> 02:24:19,893
HAVING BACK PAIN CONDITION COULD

3935
02:24:19,893 --> 02:24:24,064
HELP MAKE DECISIONWHERE TO SPEND

3936
02:24:24,064 --> 02:24:24,631
RESOURCES.

3937
02:24:24,631 --> 02:24:25,932
SO THE CURRENT FRAMEWORK FOR

3938
02:24:25,932 --> 02:24:27,901
RESEARCH AND TREATMENT IS

3939
02:24:27,901 --> 02:24:29,002
BIOPSYCHOSOCIAL MODEL AND THIS

3940
02:24:29,002 --> 02:24:30,537
MODEL PROPOSES THAT MULTIPLE

3941
02:24:30,537 --> 02:24:31,571
FACTORS INTERACT TO CONTRIBUTE

3942
02:24:31,571 --> 02:24:32,806
TO THE CLINICAL PRESENTATION AND

3943
02:24:32,806 --> 02:24:35,976
COURSE OF THE CONDITION.

3944
02:24:35,976 --> 02:24:40,213
AND BACK PAIN SYMPTOMS DO,A RISE

3945
02:24:40,213 --> 02:24:42,282
FROM NOSICEPTIVE INPUT BUT IT'S

3946
02:24:42,282 --> 02:24:43,583
BEING BETTER ACCEPTED, THE

3947
02:24:43,583 --> 02:24:44,951
VECTING REPORTS AND RELATED

3948
02:24:44,951 --> 02:24:46,920
DISABILITY THAT PEOPLE RECEPT

3949
02:24:46,920 --> 02:24:52,826
WITH ARE NOT NEARLY THE RESULT

3950
02:24:52,826 --> 02:24:54,661
OF NOSI-ACCEPTION, AND SO YOU

3951
02:24:54,661 --> 02:24:56,663
SEE THE CONCEPT AND THESE ARE

3952
02:24:56,663 --> 02:24:58,732
THE MAJOR CATEGORIES THAT ARE

3953
02:24:58,732 --> 02:25:00,033
PROPOSED TO INFLUENCE THE

3954
02:25:00,033 --> 02:25:01,068
PERSON'S PRESENTATION AND

3955
02:25:01,068 --> 02:25:01,301
COURSE.

3956
02:25:01,301 --> 02:25:02,602
THE BIG CHALLENGE IN TERMS OF

3957
02:25:02,602 --> 02:25:03,670
RESEARCH BUT ALSO AT THE

3958
02:25:03,670 --> 02:25:05,572
CLINICAL LEVEL IS TO DETERMINE

3959
02:25:05,572 --> 02:25:08,708
AT THE INDIVIDUAL LEVEL, THE

3960
02:25:08,708 --> 02:25:10,243
RELATIVE IMPORTANCE OF THESE 3

3961
02:25:10,243 --> 02:25:11,445
DIFFERENT CATEGORIES OF FACTORS

3962
02:25:11,445 --> 02:25:12,279
BECAUSE THAT VARIES FROM 1

3963
02:25:12,279 --> 02:25:15,215
PERSON TO THE NEXT.

3964
02:25:15,215 --> 02:25:16,149
SO NOW I'M GOING TO HIGHLIGHT

3965
02:25:16,149 --> 02:25:18,785
SOME OF THE MOST CONSISTENT KEY

3966
02:25:18,785 --> 02:25:19,820
FINDINGS THAT HAD BEEN FOUND

3967
02:25:19,820 --> 02:25:21,288
WITHIN EACH OF THE CATEGORIES OF

3968
02:25:21,288 --> 02:25:23,123
THE MODEL THAT CONTRIBUTE TO OUR

3969
02:25:23,123 --> 02:25:24,057
CURRENT UNDERSTANDING OF BACK

3970
02:25:24,057 --> 02:25:27,394
PAIN, AND I WILL START WITH

3971
02:25:27,394 --> 02:25:28,061
BIOPHYSICAL FACTORS.

3972
02:25:28,061 --> 02:25:29,262
AND SO IF YOU LOOK AT PEOPLE

3973
02:25:29,262 --> 02:25:30,564
WITH BACK PAIN COMPARED TO

3974
02:25:30,564 --> 02:25:32,999
PEOPLE WITHOUT BACK PAIN, THERE

3975
02:25:32,999 --> 02:25:33,767
ARE MULTIPLE BIOPHYSICAL

3976
02:25:33,767 --> 02:25:35,235
IMPAIRMENTS THAT HAVE BEEN

3977
02:25:35,235 --> 02:25:36,103
IDENTIFY AS DIFFERENT BETWEEN

3978
02:25:36,103 --> 02:25:39,339
THE 2 AND I'M GOING TO FOCUS ON

3979
02:25:39,339 --> 02:25:40,874
SPECIFICALLY THE MOTOR SYSTEM,

3980
02:25:40,874 --> 02:25:42,275
TALKING ABOUT MOTOR CONTROL

3981
02:25:42,275 --> 02:25:43,844
IMPAIRMENTS AND MUSCLE STRUCTURE

3982
02:25:43,844 --> 02:25:45,078
ALTERATIONS AND THEN I WILL TALK

3983
02:25:45,078 --> 02:25:46,113
ABOUT THE SENSORY SYSTEM AND

3984
02:25:46,113 --> 02:25:47,881
WHAT DO WE KNOW ABOUT PAIN

3985
02:25:47,881 --> 02:25:48,949
PROCESSING IN THESE PEOPLE.

3986
02:25:48,949 --> 02:25:50,650
SO FIRST, I WILL TALK ABOUT

3987
02:25:50,650 --> 02:25:53,820
MOTOR CONTROL AND MUSCLE

3988
02:25:53,820 --> 02:25:54,888
STRUCTURE FINDINGS, AND MOTOR

3989
02:25:54,888 --> 02:25:55,889
CONTROL IN THIS CONTEXT IS

3990
02:25:55,889 --> 02:25:57,624
REFERRING TO THE WAYS

3991
02:25:57,624 --> 02:26:00,460
PEOPLE--WAYS IN WHICH THE

3992
02:26:00,460 --> 02:26:01,528
NERVOUS SYSTEM CONTROLS

3993
02:26:01,528 --> 02:26:02,729
POSTURING MOVEMENT TO PERFORM A

3994
02:26:02,729 --> 02:26:04,264
SPECIFIC MOTOR TASK AND THIS IS

3995
02:26:04,264 --> 02:26:05,765
MOST COMMONLY STUDIED IN HUMANS

3996
02:26:05,765 --> 02:26:08,602
AT THE LEVEL OF PATTERNS OF

3997
02:26:08,602 --> 02:26:10,003
TRUNK MUSCLE ACTIVITY AND TRUNK

3998
02:26:10,003 --> 02:26:11,671
MOVE AM ANDS POSTURES AND THE

3999
02:26:11,671 --> 02:26:12,706
COMPARISON IS BETWEEN PEOPLE

4000
02:26:12,706 --> 02:26:14,007
WITH AND WITHOUT BACK PAIN AND

4001
02:26:14,007 --> 02:26:16,977
HAD IS REALLY IMPORTANT BECAUSE

4002
02:26:16,977 --> 02:26:18,145
MUSCLE ACTIVATION, MOVEMENT AND

4003
02:26:18,145 --> 02:26:19,446
POSTURE CONTRIBUTE TO OPTIMIZING

4004
02:26:19,446 --> 02:26:20,614
A PERSON'S SPINAL CONTROL, AND

4005
02:26:20,614 --> 02:26:23,150
SO IF ANY OF THESE ARE IMPAIRS

4006
02:26:23,150 --> 02:26:24,351
YOUR CONTROL CAN BE DECREASED

4007
02:26:24,351 --> 02:26:28,021
AND YOU WILL HAVE A CHANGE IN

4008
02:26:28,021 --> 02:26:28,822
TISSUE LOADING.

4009
02:26:28,822 --> 02:26:30,657
AND THE RESULT IMMEDIATELY OR

4010
02:26:30,657 --> 02:26:33,026
OVERTIME IS THAT THE SPINAL

4011
02:26:33,026 --> 02:26:35,162
TISSUE HEALTH IS DIMINISHED AND

4012
02:26:35,162 --> 02:26:36,663
THIS IS PROPOSED THEM TO BE THE

4013
02:26:36,663 --> 02:26:39,766
REASON WHY PEOPLE DEVELOP BACK

4014
02:26:39,766 --> 02:26:40,433
PAIN AND DISABILITY.

4015
02:26:40,433 --> 02:26:42,302
SO THE STUDIES OF MOTOR CONTROL

4016
02:26:42,302 --> 02:26:44,938
ARE FOCUSED ON TASKS THAT AFFECT

4017
02:26:44,938 --> 02:26:46,273
SPINAL LOADING AND THEREFORE

4018
02:26:46,273 --> 02:26:47,240
COULD CONTRIBUTE TO INJURY.

4019
02:26:47,240 --> 02:26:49,309
AND SO WHAT YOU SEE HERE ON THE

4020
02:26:49,309 --> 02:26:52,045
LEFT ARE STUDIES OF MOTOR TASKS

4021
02:26:52,045 --> 02:26:54,214
THAT CHALLENGE TRUNK MUSCLES IN

4022
02:26:54,214 --> 02:26:55,415
DIFFERENT WAYS AND TRUNK MUSCLE

4023
02:26:55,415 --> 02:26:57,450
ACTIVITY IS MEASURED AND THEN

4024
02:26:57,450 --> 02:26:58,418
HERE YOU SEE, DIFFERENT STUDIES

4025
02:26:58,418 --> 02:27:01,922
THAT LOOK THEA ASPECTS OF TRUNK

4026
02:27:01,922 --> 02:27:02,822
POSTURING AND MOVEMENT.

4027
02:27:02,822 --> 02:27:05,125
SO PEOPLE WITH BACK PAIN EXHIBIT

4028
02:27:05,125 --> 02:27:06,760
A VARIETY OF IMPAIRMENTS OF

4029
02:27:06,760 --> 02:27:10,163
MOTOR CONTROL, AND THERE'S HIGH

4030
02:27:10,163 --> 02:27:10,897
INTERINDIVIDUAL VARIABILITY, SO

4031
02:27:10,897 --> 02:27:12,499
WHAT YOU SEE HERE ON THE LEFT

4032
02:27:12,499 --> 02:27:13,934
ARE 3 ACTIVITIES THAT HAVE BEEN

4033
02:27:13,934 --> 02:27:17,437
REPORTED ON QUITE A BIT AND THE

4034
02:27:17,437 --> 02:27:19,472
FIRST XASMINES TRUNK MUSCLE

4035
02:27:19,472 --> 02:27:20,774
ACTIVITY DURING STEADY STATE

4036
02:27:20,774 --> 02:27:22,609
POSTURE OF STANDING, THE SECOND

4037
02:27:22,609 --> 02:27:23,743
IS 1 WHERE STRUNK MOVEMENT IS

4038
02:27:23,743 --> 02:27:26,046
LOOKED AT WITH THE DYNAMIC TASK

4039
02:27:26,046 --> 02:27:27,247
OF ELECTRICKING FORWARD AND THE

4040
02:27:27,247 --> 02:27:30,817
THIRD IS LOOKING AT ALINEMENT OF

4041
02:27:30,817 --> 02:27:32,686
THE PELVIS AND TRUNK AND IN ALL

4042
02:27:32,686 --> 02:27:33,720
THESE EXPERIMENTS IS COMPARING

4043
02:27:33,720 --> 02:27:35,188
PEOPLE WITH BACK PAIN TO PEOPLE

4044
02:27:35,188 --> 02:27:35,722
WITHOUT BACK PAIN.

4045
02:27:35,722 --> 02:27:37,057
SO WHAT I'M SHOWING YOU ON THE

4046
02:27:37,057 --> 02:27:40,927
RIGHT ARE THE FINDINGS FOR EACH

4047
02:27:40,927 --> 02:27:42,429
OF THE ACTIVITIES THAT HAS BEEN

4048
02:27:42,429 --> 02:27:43,797
REPORTED IN THE LITERATURE AND

4049
02:27:43,797 --> 02:27:45,065
THE FIRST DETAIL TO NOTICE IS

4050
02:27:45,065 --> 02:27:46,700
THAT THERE'S A LOT OF

4051
02:27:46,700 --> 02:27:48,101
VARIABILITY IN FINDINGS FOR EACH

4052
02:27:48,101 --> 02:27:49,069
OF THE ACTIVITIES SO FOR

4053
02:27:49,069 --> 02:27:53,273
EXAMPLE, IF YOU LOOK AT MUSCLE

4054
02:27:53,273 --> 02:27:54,074
ACTIVITY DURING STANDING BETWEEN

4055
02:27:54,074 --> 02:27:56,076
PEOPLE WITH AND WITHOUT LOW BACK

4056
02:27:56,076 --> 02:27:59,045
PAIN, YOU WILL SEE THAT SOME

4057
02:27:59,045 --> 02:28:00,480
REPORTS INCREASED OTHERS SAY

4058
02:28:00,480 --> 02:28:01,748
INCREASED WITH BACK PAIN AND

4059
02:28:01,748 --> 02:28:03,350
OTHERS REPORT NO DIFFERENCES

4060
02:28:03,350 --> 02:28:05,318
BETWEEN PEOPLE WITH AND WITHOUT

4061
02:28:05,318 --> 02:28:05,785
LOW BACK PAIN.

4062
02:28:05,785 --> 02:28:07,754
SO IF YOU LOOK DOWN HERE AT

4063
02:28:07,754 --> 02:28:09,155
ALIGNMENT OF THE PELVIS AND

4064
02:28:09,155 --> 02:28:11,324
TRUNK AND YOU LOOK AT PEOPLE

4065
02:28:11,324 --> 02:28:13,526
WITH LOW BACK PEOPLE AS A WHOLE,

4066
02:28:13,526 --> 02:28:17,330
COMPARED TO THOSE BACK PAIN,

4067
02:28:17,330 --> 02:28:18,832
THERE'S NO DIFFERENCE BETWEEN

4068
02:28:18,832 --> 02:28:21,601
THESE 2 GROUPS WITH REGARD TO

4069
02:28:21,601 --> 02:28:21,968
ALIGNMENT.

4070
02:28:21,968 --> 02:28:26,273
BUT MOTIER --MORE REEBTLY IN THE

4071
02:28:26,273 --> 02:28:29,042
LAST 15 YEARS WHAT'S BEEN GOING

4072
02:28:29,042 --> 02:28:29,976
ON INCLUDING RESEARCHERS

4073
02:28:29,976 --> 02:28:31,378
INCLUDING OUR OWN GROUP HAVE

4074
02:28:31,378 --> 02:28:32,846
BEEN SUBTYPING THEM OR

4075
02:28:32,846 --> 02:28:33,947
PHENOTYPING THEM BASED ON

4076
02:28:33,947 --> 02:28:35,348
MOVEMENT OR PAIN BEHAVIOR, SO

4077
02:28:35,348 --> 02:28:37,784
WHEN YOU DO THAT YOU SEE

4078
02:28:37,784 --> 02:28:38,718
PRELICATIBLE DIFFERENCES BETWEEN

4079
02:28:38,718 --> 02:28:40,086
THE SUBGROUPS BUT ALSO BETWEEN

4080
02:28:40,086 --> 02:28:42,589
PEOPLE WHO HAVE BACK PAIN, SNCHT

4081
02:28:42,589 --> 02:28:44,190
SUBGROUPS TO THOSE WITHOUT LOW

4082
02:28:44,190 --> 02:28:45,025
BACK PAIN.

4083
02:28:45,025 --> 02:28:46,760
SO GETTING AT THIS IDEA OF

4084
02:28:46,760 --> 02:28:48,395
TRYING TO INTRODUCE THE

4085
02:28:48,395 --> 02:28:49,062
INDIVIDUAL VARIABILITY AMONG

4086
02:28:49,062 --> 02:28:51,931
PEOPLE WITH BACK PAIN.

4087
02:28:51,931 --> 02:28:54,234
SO IN TERMS OF FINDINGS THERE'S

4088
02:28:54,234 --> 02:28:56,536
A BROAD ARRAY OF ALTERATIONS OF

4089
02:28:56,536 --> 02:28:59,039
PEOPLE WITH BACK PAIN AND ONCE

4090
02:28:59,039 --> 02:29:00,206
AGAIN HIGH INDIVIDUAL

4091
02:29:00,206 --> 02:29:00,607
VARIABILITY.

4092
02:29:00,607 --> 02:29:01,508
THIS IS IMPORTANT BECAUSE THE

4093
02:29:01,508 --> 02:29:05,745
ABILITY OF A MUSCLE TO ENMOTOR

4094
02:29:05,745 --> 02:29:07,914
COMMANDS DETERMINED HOW GOOD

4095
02:29:07,914 --> 02:29:08,682
SOMEONE'S MOTOR CONTROL IS AND

4096
02:29:08,682 --> 02:29:10,650
IF YOU HAVE AN ALTERATION IN THE

4097
02:29:10,650 --> 02:29:12,986
MUSCLE, IT COULD NEG5 LE IMPACT

4098
02:29:12,986 --> 02:29:13,853
MOTOR CONTROL AND I ALREADY

4099
02:29:13,853 --> 02:29:15,221
TALKED ABOUT THE CONS QUESTIONSS

4100
02:29:15,221 --> 02:29:16,956
OF THAT.

4101
02:29:16,956 --> 02:29:19,059
SO STRUCTURAL CHEANCHS ARE BEEN

4102
02:29:19,059 --> 02:29:20,126
CONSISTENTLY IDENTIFY INDEED THE

4103
02:29:20,126 --> 02:29:21,561
SPINAL MUSCLE ANDS THE POSTERIOR

4104
02:29:21,561 --> 02:29:23,396
ASPECT OF THE SPINE AND IN

4105
02:29:23,396 --> 02:29:25,265
PARTICULAR IN THE MUSCLE WHICH

4106
02:29:25,265 --> 02:29:28,568
IS THE MEDIA MUSCLES, SO THESE

4107
02:29:28,568 --> 02:29:29,636
STRUCTURE ALTASD RAYINGINGS HAVE

4108
02:29:29,636 --> 02:29:31,404
BEEN LOOKED AT IN HUMANS AS WELL

4109
02:29:31,404 --> 02:29:33,139
AS IN ANIMAL STUDIES USING

4110
02:29:33,139 --> 02:29:36,109
DIFFERENT INJURY MODELS SO IN

4111
02:29:36,109 --> 02:29:38,411
HUMANS THE DATA IS CROSS

4112
02:29:38,411 --> 02:29:40,380
SECTIONAL AND POM PAIRS PEOPLE

4113
02:29:40,380 --> 02:29:42,949
WITH PAIN TO LOW BACK PAIN AND

4114
02:29:42,949 --> 02:29:44,317
OVERALL WHAT'S BEEN DOCUMENT

4115
02:29:44,317 --> 02:29:45,919
SIDE THAT THERE'S DECREASED

4116
02:29:45,919 --> 02:29:46,853
CROSS SECTION LEVEL IN THE AREA

4117
02:29:46,853 --> 02:29:49,055
OF PAIN IN THE ACUTE PHASE AND

4118
02:29:49,055 --> 02:29:51,324
IN THE CHRONIC YOU SEE A GREATER

4119
02:29:51,324 --> 02:29:54,227
ON PROPORTION OF FAT, INCREASED

4120
02:29:54,227 --> 02:29:55,562
FIBROGENESIS AND INCREASED

4121
02:29:55,562 --> 02:29:57,330
STIFFNESS IN THE ANIMAL MODEL

4122
02:29:57,330 --> 02:29:58,865
STUDIES YOU SEE MOSTLY A DISK

4123
02:29:58,865 --> 02:30:00,633
LESION MODEL THAT'S USED, THESE

4124
02:30:00,633 --> 02:30:02,369
KINDS OF STUDIES PROVIDE

4125
02:30:02,369 --> 02:30:03,203
LONGITUDINAL DAT SOY CAN

4126
02:30:03,203 --> 02:30:05,372
UNDERSTAND THE CHANGE IN MUSCLE

4127
02:30:05,372 --> 02:30:07,340
OVERTIME, AND ALSO PROBE THE

4128
02:30:07,340 --> 02:30:09,776
POTENTIAL MECHANISMS THAT

4129
02:30:09,776 --> 02:30:10,577
UNDERLIE THOSE ALTERATIONS.

4130
02:30:10,577 --> 02:30:12,879
AND SO OVERALL WHAT YOU SEE IN

4131
02:30:12,879 --> 02:30:14,848
THE ACUTE PHASE IS DECREASED

4132
02:30:14,848 --> 02:30:16,249
CROSS SECTIONAL AREA IN THE

4133
02:30:16,249 --> 02:30:19,352
EARLY CHRONIC PHASE, FATTY

4134
02:30:19,352 --> 02:30:21,588
INFILTRATION, FIBROSIS, LOSS OF

4135
02:30:21,588 --> 02:30:23,223
1 MUSCLE, POETIC FATIGUE

4136
02:30:23,223 --> 02:30:25,392
RESISTANT FIBERS AND THEN IN THE

4137
02:30:25,392 --> 02:30:27,927
LATE CHRONIC PHASE MORE MUSCLE

4138
02:30:27,927 --> 02:30:28,528
FIBROATROPHY.

4139
02:30:28,528 --> 02:30:29,696
SO THESE CHANGES ARE LIKELY TO

4140
02:30:29,696 --> 02:30:33,666
BE TIME DEPEND CHENT IS REALLY

4141
02:30:33,666 --> 02:30:34,968
IMPORTANT IMPLICATIONS TO

4142
02:30:34,968 --> 02:30:35,935
REHABILITATION, THE ANIMAL MODEL

4143
02:30:35,935 --> 02:30:37,170
DATA SUGGESTS THAT THE MECH

4144
02:30:37,170 --> 02:30:38,605
INFORMS THAT UNDERLIE STRUCTURE

4145
02:30:38,605 --> 02:30:39,506
CHANGES DIFFER OVER TIME AND SO

4146
02:30:39,506 --> 02:30:44,811
THIS FIGURE ON THE RIGHT IS AN

4147
02:30:44,811 --> 02:30:46,212
ILLUSTRATION OF THE DIFFERENCES

4148
02:30:46,212 --> 02:30:47,714
IN THE MECHIMISMS OVER TIME

4149
02:30:47,714 --> 02:30:49,115
AFTER AN ACUTE DISK LESION AND

4150
02:30:49,115 --> 02:30:51,918
YOU SEE INITIALLY THERE'S AN

4151
02:30:51,918 --> 02:30:52,852
ACUTE INHIBITOR RESILIENCE

4152
02:30:52,852 --> 02:30:54,154
GENERATION PROCESS GOING ON,

4153
02:30:54,154 --> 02:30:57,724
THEN THERE'S PRO INFLAMMATORY

4154
02:30:57,724 --> 02:30:59,459
CYTOKINE PROCESSES, FOLLOWED BY

4155
02:30:59,459 --> 02:31:01,561
THE LAST 9-12 MONTHS, TYPICAL

4156
02:31:01,561 --> 02:31:04,764
LOW DISUSE AND DECONDITIONING

4157
02:31:04,764 --> 02:31:05,031
PROCESSES.

4158
02:31:05,031 --> 02:31:06,633
SO THIS IS IMPORTANT TO REHAB

4159
02:31:06,633 --> 02:31:07,567
BECAUSE IT'S BEEN SUGGEST THAD

4160
02:31:07,567 --> 02:31:10,537
THE TYPE OF EXERCISE THAT YOU

4161
02:31:10,537 --> 02:31:13,139
USE SHOULD BE RELATED TO THESE

4162
02:31:13,139 --> 02:31:14,374
TIME RELATED MECHANISMS, SO FOR

4163
02:31:14,374 --> 02:31:17,343
EXAMPLE, THE IDEA IS TO USE

4164
02:31:17,343 --> 02:31:19,479
MOTOR CONTROL EXERCISE TO

4165
02:31:19,479 --> 02:31:21,781
OVERCOME INHIBITION, IN THE

4166
02:31:21,781 --> 02:31:22,415
EARLY INHIBITORY REGENERATION

4167
02:31:22,415 --> 02:31:25,251
PHASE AND THEN IN THE VERY LATE

4168
02:31:25,251 --> 02:31:28,621
PHASE, STRENGTH AND ENDURANCE

4169
02:31:28,621 --> 02:31:30,390
TRAINING TO WORK AGAINST THIS

4170
02:31:30,390 --> 02:31:33,092
DISUSE AND DECONDITIONING THAT

4171
02:31:33,092 --> 02:31:33,460
OCCURS.

4172
02:31:33,460 --> 02:31:35,094
SO THE MOST RELEVANT WORK WITH

4173
02:31:35,094 --> 02:31:36,629
REGARD TO THE SENSORY SYSTEM IS

4174
02:31:36,629 --> 02:31:38,031
THE RECOGNITION, AND PEOPLE WITH

4175
02:31:38,031 --> 02:31:39,332
BACK PAIN HAVE DIFFERENT

4176
02:31:39,332 --> 02:31:40,133
UNDERLYING MECHANISMS THAT

4177
02:31:40,133 --> 02:31:42,101
CONTRIBUTE TO THEIR

4178
02:31:42,101 --> 02:31:42,902
PRESENTATION, AND COURSE.

4179
02:31:42,902 --> 02:31:47,240
SO ONCE AGAIN VARIABILITY AMONG

4180
02:31:47,240 --> 02:31:47,540
INDIVIDUALS.

4181
02:31:47,540 --> 02:31:49,876
AND THERE'S 3 BIOLOGICAL PAIN

4182
02:31:49,876 --> 02:31:51,411
MECHANISMS TO BE IMPOSED WITH

4183
02:31:51,411 --> 02:31:53,947
PEOPLE WITH BACK PAIN, THE FIRST

4184
02:31:53,947 --> 02:31:56,049
IS THE NOCI-PAIN MECHANISM,

4185
02:31:56,049 --> 02:31:57,183
TRADITIONAL MODEL OF TISSUE

4186
02:31:57,183 --> 02:31:59,953
INJURY WHERE PAIN IS DUE TO

4187
02:31:59,953 --> 02:32:01,688
ACTIVATION OF NOSI RECEPTORS

4188
02:32:01,688 --> 02:32:04,457
THAT BE A RESULT OF

4189
02:32:04,457 --> 02:32:05,091
INFLAMMATION, MECHANICAL

4190
02:32:05,091 --> 02:32:06,759
INFLAMMATION OR DIRECT INJURY.

4191
02:32:06,759 --> 02:32:08,294
YOU ALSO HAVE A PLASTIC PAIN

4192
02:32:08,294 --> 02:32:09,729
MECH INFORM, THIS IS 1 IN WHICH

4193
02:32:09,729 --> 02:32:11,798
PAIN IS THE RESULT OF ALERATIONS

4194
02:32:11,798 --> 02:32:13,099
OF SEBTERAL PAIN PROCESSING,

4195
02:32:13,099 --> 02:32:15,568
WHERE YOU SEE INCREASED SEBTERAL

4196
02:32:15,568 --> 02:32:17,070
EXCITABILITY, OR DECREASED

4197
02:32:17,070 --> 02:32:18,204
CENTRAL INHIBITION OR BOTH.

4198
02:32:18,204 --> 02:32:19,606
AND THEN YOU CAN HAVE PEOPLE

4199
02:32:19,606 --> 02:32:22,308
WITH LOW BACK PAIN, WHO HAVE

4200
02:32:22,308 --> 02:32:23,309
NEUROPATHIC PAIN MECHANISM,

4201
02:32:23,309 --> 02:32:24,477
WHERE THERE'S A LESION OR

4202
02:32:24,477 --> 02:32:25,311
DISEASE WITHIN THE SOPHISTICATED

4203
02:32:25,311 --> 02:32:26,579
MAT O SENSORY SYSTEM, AND IMEAN

4204
02:32:26,579 --> 02:32:30,016
GOING BACK TO THIS IDEA, OF

4205
02:32:30,016 --> 02:32:30,617
INTERINDIVIDUAL VARIABILITY,

4206
02:32:30,617 --> 02:32:31,651
PEOPLE WITH LOW BACK PAIN CAN

4207
02:32:31,651 --> 02:32:36,222
HAVE 1 OR ANY COMBINATION OF

4208
02:32:36,222 --> 02:32:37,123
THESE PAIN MECHANISMS.

4209
02:32:37,123 --> 02:32:38,691
SO THERE IS WORK ONGOING TO

4210
02:32:38,691 --> 02:32:40,493
IMPROVE THE IDEPTICTION OF

4211
02:32:40,493 --> 02:32:41,194
MECHANISMS IN PEOPLE WITH BACK

4212
02:32:41,194 --> 02:32:42,862
PAIN AND THE IDEA IS CAN YOU

4213
02:32:42,862 --> 02:32:44,264
PHENOTYPE PEOPLE AND THE BIGGEST

4214
02:32:44,264 --> 02:32:46,666
CHALLENGE IN HUMAN SYSTEM THAT

4215
02:32:46,666 --> 02:32:48,735
THE IDENTIFICATION IS LIMITED TO

4216
02:32:48,735 --> 02:32:50,570
VERY INDIRECT METHODS SO WE CAN

4217
02:32:50,570 --> 02:32:51,304
USE PATIENT HISTORY,

4218
02:32:51,304 --> 02:32:53,706
QUESTIONNAIRES AND MORE RECENTLY

4219
02:32:53,706 --> 02:32:56,509
QUANTITATIVE SENSORY TESTING

4220
02:32:56,509 --> 02:32:59,479
WHICH IS CONSISTS OF THESE

4221
02:32:59,479 --> 02:33:00,747
STANDARDIZED PSYCHOTESTS WHERE

4222
02:33:00,747 --> 02:33:02,081
THEY'RE INTRODUCED TO TRY AND

4223
02:33:02,081 --> 02:33:06,085
IDENTIFY WHETHER OR NOT THE PAIN

4224
02:33:06,085 --> 02:33:06,619
PROCESSING IS ALTERED.

4225
02:33:06,619 --> 02:33:08,087
BUT THERE ARE LIMITATIONS

4226
02:33:08,087 --> 02:33:08,922
CURRENTLY TO THE TESTING, THERE

4227
02:33:08,922 --> 02:33:11,157
IS A LACK OF CONSENSUSOT TEST,

4228
02:33:11,157 --> 02:33:13,159
THE TEST METRICS ARE NOT FULLY

4229
02:33:13,159 --> 02:33:14,928
ESTABLISHED AND THERE'S A LACK

4230
02:33:14,928 --> 02:33:16,429
OF NORMATIVE VALUES, AND THESE

4231
02:33:16,429 --> 02:33:18,064
METHODS REALLY ARE NOT

4232
02:33:18,064 --> 02:33:18,898
CLENICALLY FEASIBLE TO USE AT

4233
02:33:18,898 --> 02:33:23,269
THIS POINT IN TIME.

4234
02:33:23,269 --> 02:33:24,771
SO PSYCHOLOGICAL FACTORS ARE

4235
02:33:24,771 --> 02:33:26,372
LOOKED AT BECAUSE PAIN IS

4236
02:33:26,372 --> 02:33:29,742
DEFINED AS BOTH A SENSORY AND AN

4237
02:33:29,742 --> 02:33:30,343
CERTAINLY--CERTAINLY MOTIONAL

4238
02:33:30,343 --> 02:33:30,643
EXPERIENCE.

4239
02:33:30,643 --> 02:33:32,345
AND SO THE PRIMARY INTEREST IN

4240
02:33:32,345 --> 02:33:33,346
PSYCHOLOGICAL FACTORS AND PEOPLE

4241
02:33:33,346 --> 02:33:35,782
WITH BACK PAIN IS THEIR ROLE IN

4242
02:33:35,782 --> 02:33:37,250
ACUTE TO CHRONIC TRANSITION,

4243
02:33:37,250 --> 02:33:38,518
THEIR IMPACT ON THE LONG-TERM

4244
02:33:38,518 --> 02:33:41,087
COURSE OF BACK PAIN, AND IT

4245
02:33:41,087 --> 02:33:42,522
THEIR IMPACT OF TREATMENT

4246
02:33:42,522 --> 02:33:44,624
CHRONIC LOW BACK PAIN AND THERE

4247
02:33:44,624 --> 02:33:45,692
ARE THE--2 CATEGORIES OF FACTORS

4248
02:33:45,692 --> 02:33:47,927
THAT HAVE BEEN LOOKED AT IN THE

4249
02:33:47,927 --> 02:33:49,862
LITERATURE AND THE FIRST IS

4250
02:33:49,862 --> 02:33:50,597
GENERAL PSYCHOLOGICAL FACTORS

4251
02:33:50,597 --> 02:33:51,798
AND THESE ARE FACTORS THAT ARE

4252
02:33:51,798 --> 02:33:53,533
NOT UNIQUE TO PEOPLE WITH BACK

4253
02:33:53,533 --> 02:33:56,269
PAIN, AND INCLUDE DEPRESSION,

4254
02:33:56,269 --> 02:33:58,071
TRAIT ANXIETY AND EMOTIONAL

4255
02:33:58,071 --> 02:33:59,539
DISTRESS, THE SECOND CATEGORIES

4256
02:33:59,539 --> 02:34:01,107
OF FACTORS ARE PAIN SPECIFIC

4257
02:34:01,107 --> 02:34:02,175
FACTORS, THESE ARE FACTORS THAT

4258
02:34:02,175 --> 02:34:05,144
ARE UNIQUE TO PEOPLE WITH PAIN,

4259
02:34:05,144 --> 02:34:07,447
AND THEY'RE SEPARATED INTO 2

4260
02:34:07,447 --> 02:34:08,548
CATEGORIES, NEGATIVE MOOD AND

4261
02:34:08,548 --> 02:34:09,749
FEAR FACTORS, THESE ARE PROPOSED

4262
02:34:09,749 --> 02:34:13,453
TO BE RISK FACTORS FOR THAT

4263
02:34:13,453 --> 02:34:14,721
INCOMPLETE RECOVERY, AND THEN

4264
02:34:14,721 --> 02:34:16,456
YOU HAVE POSITIVE AFFECT IN

4265
02:34:16,456 --> 02:34:19,025
COPING FACTORS AND THESE ARE

4266
02:34:19,025 --> 02:34:22,562
SUPPOSED TO BE PROTECTIVE

4267
02:34:22,562 --> 02:34:24,364
FACTORS FOR COMPLETE RECOVERY OR

4268
02:34:24,364 --> 02:34:24,964
LONG-TERM DISABLE.

4269
02:34:24,964 --> 02:34:28,234
SO IN TERMS OF GENERAL

4270
02:34:28,234 --> 02:34:29,035
PSYCHOLOGICAL FACTORS PREMORBID

4271
02:34:29,035 --> 02:34:30,303
PSYCHOLOGICAL DYSFUNCTION CAN BE

4272
02:34:30,303 --> 02:34:31,671
A RISK FACTOR FOR FUTURE LOW

4273
02:34:31,671 --> 02:34:32,305
BACK PAIN.

4274
02:34:32,305 --> 02:34:34,273
WE ALSO KNOW THAT THESE FACTORS

4275
02:34:34,273 --> 02:34:36,242
ARE ELEVATED IN PEOPLE WITH

4276
02:34:36,242 --> 02:34:37,510
CHRONIC BACK PAIN WHEN YOU

4277
02:34:37,510 --> 02:34:38,811
COMPARE THEM TO PEOPLE WITHOUT

4278
02:34:38,811 --> 02:34:40,313
BACK PAIN SUGGEST THRG ARE

4279
02:34:40,313 --> 02:34:43,282
CONSEQUENCE OF HAVING CHRONIC

4280
02:34:43,282 --> 02:34:44,317
LOW BACK PAIN.

4281
02:34:44,317 --> 02:34:46,285
AND THEY ALSO HAVE PROGNOSTIC

4282
02:34:46,285 --> 02:34:46,486
VALUE.

4283
02:34:46,486 --> 02:34:48,221
SOME OF THEM CAN PREDICT THE

4284
02:34:48,221 --> 02:34:50,490
LIKELIHOOD OF THE ACUTE TO

4285
02:34:50,490 --> 02:34:52,091
CHRONIC BACK PAIN TRANSITION AND

4286
02:34:52,091 --> 02:34:53,926
THEY'RE ASSOCIATED WITH THE

4287
02:34:53,926 --> 02:34:57,363
OUTCOMES OF BACK PAIN SUCH AS

4288
02:34:57,363 --> 02:34:59,232
PHYSICAL, WORK DISABLE, AMOUNT

4289
02:34:59,232 --> 02:35:01,834
OF HEALTHCARE COSTS AS WELL AS

4290
02:35:01,834 --> 02:35:02,201
MORTALITY.

4291
02:35:02,201 --> 02:35:04,170
SO PAIN SPECIFIC FACTORS SO

4292
02:35:04,170 --> 02:35:08,474
NEGATIVE MOOD AND FEAR HAVE BEEN

4293
02:35:08,474 --> 02:35:10,109
FOUND TO BE RISK FACTORS FOR THE

4294
02:35:10,109 --> 02:35:11,210
DEVELOPMENT OF LOW BACK PAIN SO

4295
02:35:11,210 --> 02:35:12,912
GOING ON TO THE LONG-TERM

4296
02:35:12,912 --> 02:35:13,713
COURSE.

4297
02:35:13,713 --> 02:35:14,881
THERE ARE ALSO PROGNOSTIC AND

4298
02:35:14,881 --> 02:35:16,182
THERE ARE ASSOCIATE WIDE

4299
02:35:16,182 --> 02:35:17,116
MULTIPLE OUTCOMES SUCH AS LEVEL

4300
02:35:17,116 --> 02:35:19,952
OF RETURN TO WORK, LEVEL OF PAIN

4301
02:35:19,952 --> 02:35:21,954
INTENSITY, INTOLERANCE AS WELL

4302
02:35:21,954 --> 02:35:24,624
AS RISK FOR OPIOID MISUSE.

4303
02:35:24,624 --> 02:35:28,094
IN TERMS OF POSITIVE EFFECTIVE

4304
02:35:28,094 --> 02:35:29,128
COPING, SELF-EFFICACY HAS BEEN

4305
02:35:29,128 --> 02:35:33,232
FOUND TO MEDIATE CHANGE IN MAIN,

4306
02:35:33,232 --> 02:35:34,467
PLEASNESS AND PHYSICAL

4307
02:35:34,467 --> 02:35:36,069
DISABILITY OVER A 1 YORE COURSE

4308
02:35:36,069 --> 02:35:38,705
AND ACTIVE PAIN COPING AS BEEN

4309
02:35:38,705 --> 02:35:40,773
ASSOCIATE WIDE PAIN RELATED

4310
02:35:40,773 --> 02:35:41,340
INTERFERENCE WITH LONG-TERM

4311
02:35:41,340 --> 02:35:43,276
FOLLOW UP EMPLOY SO THERE ARE

4312
02:35:43,276 --> 02:35:43,976
CHALLENGES IN STUDYING

4313
02:35:43,976 --> 02:35:46,212
PSYCHOLOGICAL FACTORS AND LOW

4314
02:35:46,212 --> 02:35:47,947
PACK PAIN AS I ALREADY HAVE

4315
02:35:47,947 --> 02:35:49,415
SHOWN YOU, THERE ARE A LARGE

4316
02:35:49,415 --> 02:35:51,751
NUMBER OF FACTORS, THERE ARE

4317
02:35:51,751 --> 02:35:53,152
IRPT CORRELATED VARYING DETBREES

4318
02:35:53,152 --> 02:35:54,020
AND THERE'S NO 1 FACTOR THAT'S

4319
02:35:54,020 --> 02:35:56,989
BEEN FOUND TO BE MORE IMPORTANT

4320
02:35:56,989 --> 02:35:57,657
THAN ANOTHER.

4321
02:35:57,657 --> 02:35:59,258
AND REEBT DATA SUGGIESTS THAT

4322
02:35:59,258 --> 02:36:00,693
ELEVATED SCORES ON A GREATER

4323
02:36:00,693 --> 02:36:03,129
NUMBER OF VARIABLES IS WHAT'S

4324
02:36:03,129 --> 02:36:05,064
PREDICTIVE OF THE DEVELOPMENT OF

4325
02:36:05,064 --> 02:36:06,365
PERSISTENT PAIN AND DISABILITY

4326
02:36:06,365 --> 02:36:10,369
AND GIVEN THIS RECOMMENDATION,

4327
02:36:10,369 --> 02:36:14,373
AND THE USE OF CUMULATIVE GLOBAL

4328
02:36:14,373 --> 02:36:15,308
RISK INDICES, RATHER THAN

4329
02:36:15,308 --> 02:36:17,043
FOCUSING ON THE INDIVIDUAL

4330
02:36:17,043 --> 02:36:18,344
PSYCHOLOGICAL FACTORS.

4331
02:36:18,344 --> 02:36:19,979
SO FEIGNALLY SOCIAL FACTORS

4332
02:36:19,979 --> 02:36:21,414
THESE ARE EXTERNAL FACTS OR

4333
02:36:21,414 --> 02:36:24,350
CIRCUMSTANCES THAT INFLUENCE A

4334
02:36:24,350 --> 02:36:26,619
PERSON'S BEHAVIORS AND ADITUTES

4335
02:36:26,619 --> 02:36:28,254
RELATED TO THEIR PACK PAIN.

4336
02:36:28,254 --> 02:36:29,589
AND A RECENT STUDY DOCUM THAD

4337
02:36:29,589 --> 02:36:31,591
COMPARED TO THE WO, THAT'S BEEN

4338
02:36:31,591 --> 02:36:33,326
DONE IN THE BIOPHYSICAL AND

4339
02:36:33,326 --> 02:36:34,727
PSYCHOLOGICAL SPACE, THERE'S FAR

4340
02:36:34,727 --> 02:36:36,496
FEWER STUDIES THAT HAVE

4341
02:36:36,496 --> 02:36:37,096
ADEQUATELY EXAMINED SOCIAL

4342
02:36:37,096 --> 02:36:41,267
FACTORS IN BACK PAIN EMPLOY

4343
02:36:41,267 --> 02:36:42,535
IMIVEN THIS THERE ARE A NUMBER

4344
02:36:42,535 --> 02:36:44,537
OF SOCIAL FACTORS THAT HAVE BEEN

4345
02:36:44,537 --> 02:36:46,038
HYPOTHESIZED TO BACK PAIN AND

4346
02:36:46,038 --> 02:36:46,739
IT'S RELATED DISABILITY AND HERE

4347
02:36:46,739 --> 02:36:48,541
CAN YOU SEE THAT THERE'S 4

4348
02:36:48,541 --> 02:36:51,410
CATEGORIES, THE FIRST IS SOCIAL

4349
02:36:51,410 --> 02:36:53,479
DISADVANTAGED, THE NEXT IS

4350
02:36:53,479 --> 02:36:55,248
SOCIAL FACTORS RELATED TO WORK

4351
02:36:55,248 --> 02:36:55,948
ENVIRONMENT, SOCIAL FACTORS

4352
02:36:55,948 --> 02:36:57,216
RELATED TO THE CLINICAL

4353
02:36:57,216 --> 02:36:58,484
EXPERIENCE WITH TREATMENT AND

4354
02:36:58,484 --> 02:36:59,719
ARK ASSESSESMENT, AND THEN

4355
02:36:59,719 --> 02:37:02,054
SOCIAL FACTORS RELATED TO THE

4356
02:37:02,054 --> 02:37:02,555
HOME ENVIRONMENT.

4357
02:37:02,555 --> 02:37:04,323
AND SO IN TERMS OF WHAT WE KNOW

4358
02:37:04,323 --> 02:37:05,825
ABOUT THESE SOCIAL FACTORS AND

4359
02:37:05,825 --> 02:37:07,560
BACK PAIN, THERE IS AN INCREASED

4360
02:37:07,560 --> 02:37:09,629
RISK OF LOW PACK PAIN INITIAL

4361
02:37:09,629 --> 02:37:11,063
DEVELOPMENT AS WELL AS RICK OF

4362
02:37:11,063 --> 02:37:12,465
RECURRENCE WHICH IS COMMON IN

4363
02:37:12,465 --> 02:37:15,201
BACK PAIN, AND THIS IS TRUE FOR

4364
02:37:15,201 --> 02:37:17,603
PEOPLE WITH REGARD TO WORK WHO

4365
02:37:17,603 --> 02:37:19,305
HAVE WORK EXPENSURES, OF

4366
02:37:19,305 --> 02:37:20,706
LIFTING, BENDING AND AWKWARD

4367
02:37:20,706 --> 02:37:22,275
POSTURES AS WELL AS HEAVY WORK

4368
02:37:22,275 --> 02:37:25,011
AND DEMANDING WORK AS WELL AS

4369
02:37:25,011 --> 02:37:27,847
PEOPLE WHO HAVE JOB

4370
02:37:27,847 --> 02:37:29,682
DISSATISFACTION AND LOW JOB

4371
02:37:29,682 --> 02:37:30,583
CONTROL.

4372
02:37:30,583 --> 02:37:31,617
THESE FACTORS HAVE HAVE ALSO

4373
02:37:31,617 --> 02:37:34,587
BEEN FOUND TO BE PROGNOSTIC SO

4374
02:37:34,587 --> 02:37:37,190
LOW INCOME, LOW SOCIAL SUPPORT,

4375
02:37:37,190 --> 02:37:39,425
AT WORK AND OUTSIDE OF WORK HAVE

4376
02:37:39,425 --> 02:37:40,493
BEEN ASSOCIATE WIDE PROGNOSIS

4377
02:37:40,493 --> 02:37:42,361
FOR INDOMAIN PLETE RECOVERY OR

4378
02:37:42,361 --> 02:37:44,297
PERSISTENT BACK PAIN AND

4379
02:37:44,297 --> 02:37:44,597
DISABILITY.

4380
02:37:44,597 --> 02:37:48,634
SO WHAT ARE THE CHALLENGES

4381
02:37:48,634 --> 02:37:51,037
MOVING REHABILATION RESEARCH FOR

4382
02:37:51,037 --> 02:37:53,005
WITH REGARD TO LOW BACK PAIN.

4383
02:37:53,005 --> 02:37:56,242
AS I TOLD YOU MOST CLINICAL

4384
02:37:56,242 --> 02:37:56,909
PRACTICE GUIDELINES SUPPORT

4385
02:37:56,909 --> 02:37:58,544
NONFARM ON CO LONGICAL TREATMENT

4386
02:37:58,544 --> 02:38:02,248
AS PART OF FIRST LINE CARE

4387
02:38:02,248 --> 02:38:03,983
PARTICULARLY AFTER THE ACUTE

4388
02:38:03,983 --> 02:38:04,183
PHASE.

4389
02:38:04,183 --> 02:38:06,219
IMPORTANTLY THOUGH, THERE IS AN

4390
02:38:06,219 --> 02:38:08,287
EMPHASIS IN THE ACUTE PHASE OF

4391
02:38:08,287 --> 02:38:09,555
RESUMING FUNCTION AND

4392
02:38:09,555 --> 02:38:10,389
PARTICIPATION AS QUICKLY AS

4393
02:38:10,389 --> 02:38:14,193
POSSIBLE, SO VERY MUCH REHAB

4394
02:38:14,193 --> 02:38:16,128
GOALS, REHAB GOALS.

4395
02:38:16,128 --> 02:38:17,763
UNFORTUNATELY TO DATE MOST REHAB

4396
02:38:17,763 --> 02:38:18,631
TREATMENTS FOR BACK PAIN,

4397
02:38:18,631 --> 02:38:20,032
PARTICULARLY THOSE THAT ARE

4398
02:38:20,032 --> 02:38:21,868
ACTIVITY AND EXERCISE BASED,

4399
02:38:21,868 --> 02:38:23,703
WHEN YOU COMPARE 1 TREATMENT TO

4400
02:38:23,703 --> 02:38:25,538
ANOTHER, HAVE RESULTED IN ONLY

4401
02:38:25,538 --> 02:38:26,839
VERY SMALL, TO MODERATE EFFECT

4402
02:38:26,839 --> 02:38:29,375
SIDES AT BEST AND THE EFFECTS OF

4403
02:38:29,375 --> 02:38:34,313
SHORT-TERM WHICH IS NOT GOOD FOR

4404
02:38:34,313 --> 02:38:36,649
A CONDITION THAT FOR MANY PEOPLE

4405
02:38:36,649 --> 02:38:38,184
HAS A LONG TIME COURSE.

4406
02:38:38,184 --> 02:38:40,019
AND THE EXPLANATION FOR THESE

4407
02:38:40,019 --> 02:38:41,187
RESULTS IS HIGH INDIVIDUAL

4408
02:38:41,187 --> 02:38:43,189
VARIABILITY THAT IS PROPOSED TO

4409
02:38:43,189 --> 02:38:44,223
BE ATTENUATING TREATMENT EFFECTS

4410
02:38:44,223 --> 02:38:54,767
BECAUSE THEY'RE NOT AS TARGETED

4411
02:38:56,535 --> 02:39:04,610
AS THEY AS THEY NEED TO BE.

4412
02:39:04,610 --> 02:39:06,812
THE PROPOSAL IS TO SUBGROUP OR

4413
02:39:06,812 --> 02:39:09,015
PHENOTYPE PEOPLE BASED ON THEIR

4414
02:39:09,015 --> 02:39:10,983
SUSCEPTIBILITY TO THEIR BACK

4415
02:39:10,983 --> 02:39:11,817
PAIN, BIOLOGY, PROGNOSIS OR

4416
02:39:11,817 --> 02:39:12,785
RESPONSE TO TREATMENT WITH THE

4417
02:39:12,785 --> 02:39:15,755
IDEA THAT THIS WILL ALLOW BETTER

4418
02:39:15,755 --> 02:39:17,456
TAILORING OF TREATMENT TO

4419
02:39:17,456 --> 02:39:19,191
INDIVIDUAL CHARACTERISTICS.

4420
02:39:19,191 --> 02:39:19,959
SO THERE ARE 2 RESEARCH

4421
02:39:19,959 --> 02:39:21,761
APPROACHES THAT ARE CURRENTLY

4422
02:39:21,761 --> 02:39:24,096
BEING EXAMINED AND TESTED IN LOW

4423
02:39:24,096 --> 02:39:26,465
BACK PAIN, FOLLOWING THIS MODEL,

4424
02:39:26,465 --> 02:39:28,367
THE FIRST IS TO PHENOTYPE OR

4425
02:39:28,367 --> 02:39:29,468
SUBGROUP PEOPLE BASED ON THOSE

4426
02:39:29,468 --> 02:39:30,937
FACTORS THAT I JUST TALKED

4427
02:39:30,937 --> 02:39:32,972
ABOUT, SUCH AS MOTOR CONTROL

4428
02:39:32,972 --> 02:39:34,340
FACTORS, POSTURE MOVEMENT AND

4429
02:39:34,340 --> 02:39:36,542
PAIN, OR PAIN MECHANISMS, AND

4430
02:39:36,542 --> 02:39:37,944
THERE ARE A NUMBER OF STUDIES

4431
02:39:37,944 --> 02:39:40,646
THAT HAVE BEEN CONDUCTED, EACH

4432
02:39:40,646 --> 02:39:42,481
ARE AT DIFFERENT STAGES OF

4433
02:39:42,481 --> 02:39:44,050
INQUIRY, USING THIS APPROACH AND

4434
02:39:44,050 --> 02:39:45,985
THESE HAVE HAD SOME PRETTY

4435
02:39:45,985 --> 02:39:47,820
PROMISING RESULTS, THE OTHER IS

4436
02:39:47,820 --> 02:39:49,555
THAT'S BEEN PROPOSE SIDE TO

4437
02:39:49,555 --> 02:39:51,757
DEVELOP AND TEST

4438
02:39:51,757 --> 02:39:52,758
MULTIDIMENSIONAL CLINICAL

4439
02:39:52,758 --> 02:39:53,326
REASONING ALGORITHMS WHERE

4440
02:39:53,326 --> 02:39:54,827
THEREYA A BROAD ARRAY OF FACTORS

4441
02:39:54,827 --> 02:39:57,697
THAT ARE ASSESSED AND WEIGHTED

4442
02:39:57,697 --> 02:39:58,698
TYPICALLY USING CLINICIAN

4443
02:39:58,698 --> 02:40:00,633
JUDGMENT AND THEN THAT

4444
02:40:00,633 --> 02:40:01,901
INFORMATION IS USED TO

4445
02:40:01,901 --> 02:40:03,636
INDIVIDUALIZE THE TREATMENT AND

4446
02:40:03,636 --> 02:40:06,605
THERE WAS RECENTLY A STUDY THAT

4447
02:40:06,605 --> 02:40:12,078
WAS PUBLISH FRIDAY AUSTRALIA

4448
02:40:12,078 --> 02:40:14,880
WHERE IT WAS A CLINICAL TRIAL,

4449
02:40:14,880 --> 02:40:16,415
WHERE THEY TESTED A ALGORITHM

4450
02:40:16,415 --> 02:40:17,950
AND ALSO REPORTED PROMISING

4451
02:40:17,950 --> 02:40:18,184
RESULTS.

4452
02:40:18,184 --> 02:40:19,719
SO WHAT I'VE TOLD YOU IS THAT

4453
02:40:19,719 --> 02:40:21,220
BACK PAIN IS A COMPLEX

4454
02:40:21,220 --> 02:40:22,955
CONDITION, MOST PEOPLE ARE GIVEN

4455
02:40:22,955 --> 02:40:23,856
THE DIAGNOSIS OF NONSPECIFIC

4456
02:40:23,856 --> 02:40:25,257
BACK PAIN AND THAT'S THE

4457
02:40:25,257 --> 02:40:28,327
MAIORITY OF CASES YOU SEE IN

4458
02:40:28,327 --> 02:40:29,028
REHABILITATION EMPLOY IT'S

4459
02:40:29,028 --> 02:40:30,529
UNDERSTOOD AS A VERY LONG

4460
02:40:30,529 --> 02:40:31,931
LASTING CONDITION WITH A

4461
02:40:31,931 --> 02:40:33,899
VARIABLE COURSE RATHER THAN THE

4462
02:40:33,899 --> 02:40:35,401
SHORT-TERM VERY UNRELATED

4463
02:40:35,401 --> 02:40:36,335
EVENTS.

4464
02:40:36,335 --> 02:40:37,236
THE CURRENT FRAMEWORK FOR

4465
02:40:37,236 --> 02:40:40,573
RESEARCH AS WELL AS TREATMENT IS

4466
02:40:40,573 --> 02:40:41,507
THE BIOPSYCHOSOCIAL MODEL, AND

4467
02:40:41,507 --> 02:40:45,544
RESEARCH AND LOW BACK PAIN IS

4468
02:40:45,544 --> 02:40:47,046
HOPEFULLY MOVING TOWARDS MORE

4469
02:40:47,046 --> 02:40:48,447
PRECISION MODEL TO BETTER

4470
02:40:48,447 --> 02:40:49,148
INDIVIDUALIZED TREATMENT AND

4471
02:40:49,148 --> 02:40:52,518
THIS IS JUST TO ACKNOWLEDGE OUR

4472
02:40:52,518 --> 02:40:55,154
FUNDING FROM NIH, PARTICULARLY

4473
02:40:55,154 --> 02:40:56,555
THE NCMRR THAT HAS SUPPORTED OUR

4474
02:40:56,555 --> 02:40:58,457
WORK AND OUR TRAINEES OVER THE

4475
02:40:58,457 --> 02:40:59,725
YEARS AND THANK YOU FOR YOUR

4476
02:40:59,725 --> 02:41:06,165
ATTENTION AND I'M HAPPY TO TAKE

4477
02:41:06,165 --> 02:41:09,101
ANY QUESTIONS. 

4478
02:41:09,101 --> 02:41:10,236
>> THANK YOU SO MUCH.

4479
02:41:10,236 --> 02:41:12,438
WE'RE OPEN FOR QUESTIONS.

4480
02:41:12,438 --> 02:41:12,905
YES, KATHLEEN?

4481
02:41:12,905 --> 02:41:15,241
>> FIRST OF ALL THANK YOU
FOR A

4482
02:41:15,241 --> 02:41:17,143
REAL, REALLY INTERESTING TALK

4483
02:41:17,143 --> 02:41:18,844
GOOD TO SEE YOU.

4484
02:41:18,844 --> 02:41:19,912
ALSO I'M CURIOUS, YOU DIDN'T

4485
02:41:19,912 --> 02:41:21,080
MENTION, I FEEL LIKE I HAVE TO

4486
02:41:21,080 --> 02:41:25,718
ELECTRIC AT YOU THIS WAY, I'M

4487
02:41:25,718 --> 02:41:28,988
CURIOUS YOU DIDN'T REALLY

4488
02:41:28,988 --> 02:41:30,656
MENTION THE USE OF WEARABLE

4489
02:41:30,656 --> 02:41:31,957
TOOLS OR DIGITAL TOOLS TO HELP

4490
02:41:31,957 --> 02:41:32,892
WITH THIS RESEARCH AND THAT

4491
02:41:32,892 --> 02:41:34,293
BEING DONE OR NOT REALLY

4492
02:41:34,293 --> 02:41:35,728
ADVANCED ENOUGH TO BE HELPFUL IN

4493
02:41:35,728 --> 02:41:37,596
THIS PARTICULAR CASE IN.

4494
02:41:37,596 --> 02:41:38,831
>> YEAH, GREAT QUESTION.

4495
02:41:38,831 --> 02:41:40,599
IT'S NOT BEEN EXPLORE AS MUCH AS

4496
02:41:40,599 --> 02:41:44,336
IT HAS IN THE NEUROLOGICAL

4497
02:41:44,336 --> 02:41:45,871
CONDITION WORLD, BUT IT IS BEING

4498
02:41:45,871 --> 02:41:49,575
EXPLORED AND THERE'S SOME WORK

4499
02:41:49,575 --> 02:41:52,645
BEING DONE AT STANFORD THERE'S

4500
02:41:52,645 --> 02:41:53,746
ACTUALLY A WEARABLE SENSOR

4501
02:41:53,746 --> 02:41:55,047
TECHNOLOGY GROUP THAT'S DOING

4502
02:41:55,047 --> 02:41:56,649
WORK, THEY'RE MOSTLY LOOKING AT

4503
02:41:56,649 --> 02:41:58,317
ACTIVITY LEVELS AND WE'RE

4504
02:41:58,317 --> 02:41:58,918
CURRENTLY COLLABORATING WITH

4505
02:41:58,918 --> 02:42:01,087
THEM BECAUSE WE'RE LOOKING AT

4506
02:42:01,087 --> 02:42:03,022
ACTIVITY LEVELS IN ACUTE LOW

4507
02:42:03,022 --> 02:42:04,190
BACK PAIN.

4508
02:42:04,190 --> 02:42:06,725
IF YOU LOOK--IT'S VERY HARD WITH

4509
02:42:06,725 --> 02:42:08,561
WEARABLES TO MEASURE THE KINDS

4510
02:42:08,561 --> 02:42:09,895
OF VARIABLES THAT I WAS TALKING

4511
02:42:09,895 --> 02:42:11,997
ABOUT, LIKE HOW DO YOU MOVE,

4512
02:42:11,997 --> 02:42:14,700
RIGHT, OR WHAT ARE THE POSTURES

4513
02:42:14,700 --> 02:42:15,234
YOU ASSUME?

4514
02:42:15,234 --> 02:42:16,735
SO THAT'S BEEN A LIMITATION.

4515
02:42:16,735 --> 02:42:17,970
PEOPLE ARE WORKING ON IT, PEOPLE

4516
02:42:17,970 --> 02:42:19,505
ARE TRYING TO PUSH IT FORWARD

4517
02:42:19,505 --> 02:42:22,374
FASTER THAN I THINK IT SHOULD BE

4518
02:42:22,374 --> 02:42:24,577
BEFORE YOU'RE CONFIDENT OF WHAT

4519
02:42:24,577 --> 02:42:25,144
YOU'RE GETTING.

4520
02:42:25,144 --> 02:42:26,312
BUT WELL IS SOME INTERESTING

4521
02:42:26,312 --> 02:42:30,249
WORK GOING ON IN SAN DIEGO

4522
02:42:30,249 --> 02:42:31,317
STATE, SARAH GAMBATO IS DOING

4523
02:42:31,317 --> 02:42:32,618
SOME OF THAT WORK, SHE WORKED

4524
02:42:32,618 --> 02:42:35,454
WITH US EMPLOY PAUL HODGES IN

4525
02:42:35,454 --> 02:42:36,489
AUSTRALIA, IS DOING SOME OF THAT

4526
02:42:36,489 --> 02:42:43,863
WORK AND AGAIN PEOPLE AT

4527
02:42:43,863 --> 02:42:44,130
STANFORD.

4528
02:42:44,130 --> 02:42:50,269
>> OTHER THOUGHTS,
QUESTIONS IN

4529
02:42:50,269 --> 02:42:50,536
MICHELLE?

4530
02:42:50,536 --> 02:42:50,903
>> HELLO.

4531
02:42:50,903 --> 02:42:52,037
>> THANK YOU FOR THE TALK.

4532
02:42:52,037 --> 02:42:53,939
IT WAS REALLY INTERESTING, I

4533
02:42:53,939 --> 02:42:55,908
WILL KEEP IN MIGHT BE AS AN

4534
02:42:55,908 --> 02:42:57,309
ENGINEER, I NOTICED THAT THERE'S

4535
02:42:57,309 --> 02:42:59,645
A LOT MORE NIH CALLS AND 1 OF

4536
02:42:59,645 --> 02:43:02,715
THEM WAS TALKING A LITTLE BIT

4537
02:43:02,715 --> 02:43:03,849
ABOUT TECHNOLOGY TO ACTUALLY

4538
02:43:03,849 --> 02:43:06,819
HELP WITH THE TREATMENT FOR BACK

4539
02:43:06,819 --> 02:43:08,888
PAIN AND I HAD A POST DOC

4540
02:43:08,888 --> 02:43:16,428
STUDENT THAT WAS TALKING ABOUT

4541
02:43:16,428 --> 02:43:17,563
DEVELOPING LIKE INTIMATE MASSAGE

4542
02:43:17,563 --> 02:43:20,666
KIND OF LIKE PLAYING WITH THE

4543
02:43:20,666 --> 02:43:21,500
MASSAGE PROCESSES FOR LOW BACK

4544
02:43:21,500 --> 02:43:23,702
PAIN AND I WAS JUST CURIOUS HAS

4545
02:43:23,702 --> 02:43:27,339
TO IN YOUR RESEARCH, AND LOOKING

4546
02:43:27,339 --> 02:43:29,275
AT THE WORK HAVE YOU COME ACROSS

4547
02:43:29,275 --> 02:43:31,810
ANY OF THOSE TYPES OF THOUGHTS

4548
02:43:31,810 --> 02:43:34,980
ABOUT USING TECHNOLOGY OR

4549
02:43:34,980 --> 02:43:37,383
DEVELOPING TECHNOLOGY TO TREAT

4550
02:43:37,383 --> 02:43:39,985
OR TO ADMINISTER, YOU KNOW MAYBE

4551
02:43:39,985 --> 02:43:42,755
MASSAGE TREATMENT OR ET CETERA?

4552
02:43:42,755 --> 02:43:44,523
>> YEAH, YEAH, THAT'S AN

4553
02:43:44,523 --> 02:43:46,258
INTERESTING QUESTION.

4554
02:43:46,258 --> 02:43:50,095
WE ARE NOT OURSELVES IN THIS

4555
02:43:50,095 --> 02:43:52,064
SPACE OF TECHNOLOGY PER SE FOR

4556
02:43:52,064 --> 02:43:52,565
TREATMENT.

4557
02:43:52,565 --> 02:43:55,301
A LOT OF WHAT'S BEEN SEEN IN THE

4558
02:43:55,301 --> 02:43:57,303
LITERATURE IN TERMS OF KIND OF

4559
02:43:57,303 --> 02:43:58,871
PASSIVE TREATMENTS WHICH MASSAGE

4560
02:43:58,871 --> 02:44:01,440
WOULD BE VERSUS ACTIVE, IS THAT

4561
02:44:01,440 --> 02:44:04,977
WE SHOULD BE MOVING TOWARDS

4562
02:44:04,977 --> 02:44:05,511
ACTIVE TREATMENTS.

4563
02:44:05,511 --> 02:44:08,948
YOU ALSO HAVE AN ADHERENCE

4564
02:44:08,948 --> 02:44:11,116
ISSUE, YOU GIVE SOMEBODY

4565
02:44:11,116 --> 02:44:12,351
TECHNOLOGY, YOU HAVE ISSUES OF

4566
02:44:12,351 --> 02:44:13,219
UNDERSTANDING HOW TO USE IT

4567
02:44:13,219 --> 02:44:14,520
ACCURATELY AND IF YOU CAN, ARE

4568
02:44:14,520 --> 02:44:16,956
THEY GOING TO DO ENOUGH TO GET A

4569
02:44:16,956 --> 02:44:17,690
THERAPEUTIC EFFECT OR LONG

4570
02:44:17,690 --> 02:44:18,757
LASTING EFFECT AND I THINK

4571
02:44:18,757 --> 02:44:20,726
THAT'S TRUE, WHETHER YOU TALK

4572
02:44:20,726 --> 02:44:23,462
ABOUT TECHNOLOGY OR ACTIVE KINDS

4573
02:44:23,462 --> 02:44:25,564
OF TREATMENT, SO THE THINGS THAT

4574
02:44:25,564 --> 02:44:30,002
WE DO, ARE REALLY FOCUSED ON

4575
02:44:30,002 --> 02:44:31,036
CHANGING MOVEMENT BEHAVIOR

4576
02:44:31,036 --> 02:44:32,304
DURING FUNCTION BECAUSE THEN

4577
02:44:32,304 --> 02:44:35,107
THEY CAN PRACTICE IT ACROSS

4578
02:44:35,107 --> 02:44:37,610
THEIR DAY AND IT FACILITATES

4579
02:44:37,610 --> 02:44:44,483
THEIR ADHERENCE BUT THAT'S MY

4580
02:44:44,483 --> 02:44:46,719
BIAS. 

4581
02:44:46,719 --> 02:44:47,486
>> OTHER QUESTIONS?

4582
02:44:47,486 --> 02:44:50,856
SARAH IN?

4583
02:44:50,856 --> 02:44:55,461
>> HI, THANK YOU FOR A
VERY

4584
02:44:55,461 --> 02:44:55,861
INTERESTING TALK.

4585
02:44:55,861 --> 02:44:57,396
ONE OF MY AREAS OF RESEARCH IS

4586
02:44:57,396 --> 02:45:00,032
LOOKING AT CARE GIVING IN STROKE

4587
02:45:00,032 --> 02:45:02,134
AND SO I WAS STRUCK BY THE SLIDE

4588
02:45:02,134 --> 02:45:04,203
YOU MENTIONED SOCIAL FACTORS IN

4589
02:45:04,203 --> 02:45:08,674
HOME, AND SO, NOT ONLY I THINK

4590
02:45:08,674 --> 02:45:12,811
THE ROLE OF CARE GIVING BUT ALSO

4591
02:45:12,811 --> 02:45:14,246
FAMILY CONFLICK AND HOW THAT MAY

4592
02:45:14,246 --> 02:45:15,781
IMPACT, CAN YOU SPEAK A BIT MORE

4593
02:45:15,781 --> 02:45:17,283
IT TO THAT WORK IN.

4594
02:45:17,283 --> 02:45:18,717
>> YEAH, I CAN TALK NOT

4595
02:45:18,717 --> 02:45:19,752
SPECIFICALLY ABOUT THAT PER SE,

4596
02:45:19,752 --> 02:45:29,495
BUT THIS IDEA OF TRAUMA AND

4597
02:45:29,495 --> 02:45:30,796
CONFLICT DEFINITELY HAS A

4598
02:45:30,796 --> 02:45:31,730
NEGATIVE IMPACT ON THE ABILITY

4599
02:45:31,730 --> 02:45:34,466
OF PEOPLE TO REALLY ENGAGE THIS

4600
02:45:34,466 --> 02:45:37,436
REHAB AND FOLLOW THROUGH IN

4601
02:45:37,436 --> 02:45:40,739
REHAB AND SO PEOPLE WHO HAVE

4602
02:45:40,739 --> 02:45:42,474
CONFLICT AT HOME AND/OR HAVE HAD

4603
02:45:42,474 --> 02:45:44,877
TRAUMA ARE ALSO MORE SUSCEPTIBLE

4604
02:45:44,877 --> 02:45:48,847
TO THE DEVELOPMENT OF LOW BACK

4605
02:45:48,847 --> 02:45:51,050
PAIN IN PARTICULAR CHILDHOOD

4606
02:45:51,050 --> 02:45:51,283
TRAUMA.

4607
02:45:51,283 --> 02:45:52,451
THE DATA'S BEEN COMING OUT IN

4608
02:45:52,451 --> 02:45:53,819
THE LAST 5 YEARS SUGGESTING

4609
02:45:53,819 --> 02:45:54,987
THAT, SO THINGS THAT I WOULD

4610
02:45:54,987 --> 02:45:55,754
NEVER HAVE THOUGHT ABOUT, YOU

4611
02:45:55,754 --> 02:45:59,258
KNOW WHEN I STARTED IN THIS

4612
02:45:59,258 --> 02:45:59,591
AREA.

4613
02:45:59,591 --> 02:46:00,993
DOES THAT ANSWER YOUR QUESTION

4614
02:46:00,993 --> 02:46:02,961
IN

4615
02:46:02,961 --> 02:46:03,395
>> YES, YES.

4616
02:46:03,395 --> 02:46:06,732
SO I THINK TO ME AND ALSO IT

4617
02:46:06,732 --> 02:46:08,133
UNDERSCORES AN OPPORTUNITY WHEN

4618
02:46:08,133 --> 02:46:10,069
YOU'RE DOING EVALUATION OF THE

4619
02:46:10,069 --> 02:46:10,936
PATIENT, DO AN

4620
02:46:10,936 --> 02:46:11,537
CERTAINLY--CERTAINLY VALUATION

4621
02:46:11,537 --> 02:46:13,439
OF FAMILY AS WELL.

4622
02:46:13,439 --> 02:46:14,740
AND THOSE FACTORS AND HOW ALL

4623
02:46:14,740 --> 02:46:17,409
THAT MAY IMPACT YOUR CARE.

4624
02:46:17,409 --> 02:46:19,945
>> YEAH, WE'VE DONE A LOT
OF

4625
02:46:19,945 --> 02:46:21,080
WORK IN ADHERENCE AND THIS IDEA

4626
02:46:21,080 --> 02:46:22,514
OF HAVING PEOPLE WHO ENCOURAGE

4627
02:46:22,514 --> 02:46:24,683
YOU TO DO WHAT YOU'RE SUPPOSED

4628
02:46:24,683 --> 02:46:27,553
TO DO IS SUPER IMPORTANT.

4629
02:46:27,553 --> 02:46:29,455
>> ONE LAST QUESTION FOR

4630
02:46:29,455 --> 02:46:31,090
MICHELLE?

4631
02:46:31,090 --> 02:46:32,057
>> YEAH, YOU MENTIONED
ABOUT,

4632
02:46:32,057 --> 02:46:35,828
YOU KNOW MAYBE THERE'S NO 1 TYPE

4633
02:46:35,828 --> 02:46:38,030
OF CLINICAL ASSESSMENT TOOL.

4634
02:46:38,030 --> 02:46:41,133
HAS ANYONE BEGUN TO KIND OF COME

4635
02:46:41,133 --> 02:46:42,401
UP WITH THE NEUROPSYCHOLOGICAL

4636
02:46:42,401 --> 02:46:44,970
BATTERY LIKE THEY DO FOR

4637
02:46:44,970 --> 02:46:51,210
COGNITIVE PRESENTATIONS FOR ARK

4638
02:46:51,210 --> 02:46:51,844
ASSESSING HIV, NEURODISORDERS,

4639
02:46:51,844 --> 02:46:53,545
JUST KIND OF LIKE A GROUP OF

4640
02:46:53,545 --> 02:46:59,985
BEST  PRACTICES, LOOK AT THESE

4641
02:46:59,985 --> 02:47:01,387
TESTS AND THESE TESTS AND THEN

4642
02:47:01,387 --> 02:47:03,589
THE GROUP TOGETHER MIGHT GIVE

4643
02:47:03,589 --> 02:47:07,192
YOU SOME INSIGHT?

4644
02:47:07,192 --> 02:47:08,594
>> YEAH, THATIA JUST A
REALLY

4645
02:47:08,594 --> 02:47:10,662
IMPORTANT QUESTION NOT ONLY IN

4646
02:47:10,662 --> 02:47:12,398
THE PSYCHOLOGICAL REALM BUT

4647
02:47:12,398 --> 02:47:13,198
ACROSS THE BOARD.

4648
02:47:13,198 --> 02:47:14,433
HOW DO WE REDUCE THE NUMBER OF

4649
02:47:14,433 --> 02:47:15,801
TESTS THAT ARE KEY TO PROBING

4650
02:47:15,801 --> 02:47:20,506
WHAT WE WANT TO PROBE IN EACH OF

4651
02:47:20,506 --> 02:47:21,206
THOSE BIOPHYSICAL, PSYCHOLOGICAL

4652
02:47:21,206 --> 02:47:23,509
AND SOCIAL, IN THE PSYCHOLOGICAL

4653
02:47:23,509 --> 02:47:24,476
REALM THIS IS INTERESTING WORK I

4654
02:47:24,476 --> 02:47:25,677
WANTED TO TALK ABOUT BECAUSE OF

4655
02:47:25,677 --> 02:47:32,050
TIME I DIDN'T, THERE IS A

4656
02:47:32,050 --> 02:47:33,685
MEASURE THAT'S LACKING AT

4657
02:47:33,685 --> 02:47:36,155
PSYCHOLOGICAL AND SOCIAL FACTORS

4658
02:47:36,155 --> 02:47:39,691
LOOKING AT BOTH KIND OF THESE

4659
02:47:39,691 --> 02:47:41,093
NEGATIVE RISK FACTORS FOR

4660
02:47:41,093 --> 02:47:42,861
PROCEEDING NOSEIS VERSUS ALSO

4661
02:47:42,861 --> 02:47:44,596
THESE POSITIVE FACTORS, THINGS

4662
02:47:44,596 --> 02:47:47,800
THAT ARE PROTECTIVE, IT'S CALLED

4663
02:47:47,800 --> 02:47:50,235
THE OSPRO, I DON'T REMEMBER WHAT

4664
02:47:50,235 --> 02:47:51,270
THAT ACRONYM STANDS FOR RIGHT

4665
02:47:51,270 --> 02:47:52,838
FOURTH APPEARANCE BTS IT'S WORK

4666
02:47:52,838 --> 02:47:53,739
BEING DONE AT DUKE UNIVERSITY

4667
02:47:53,739 --> 02:47:55,441
AND THEY HAVE COME UP WITH, IT'S

4668
02:47:55,441 --> 02:47:59,011
A DOWN TO AN 11 ITEM SCREENING

4669
02:47:59,011 --> 02:48:00,245
TOOL THAT ACTUALLY EVENT WHEN

4670
02:48:00,245 --> 02:48:03,649
YOU CONTROL FOR OTHER FACTORS

4671
02:48:03,649 --> 02:48:04,817
HELPS TO PREDICT HOW SOMEONE'S

4672
02:48:04,817 --> 02:48:07,052
GOING TO DO LONG-TERM, LIKE OUT

4673
02:48:07,052 --> 02:48:07,953
TO 12 MONTHS.

4674
02:48:07,953 --> 02:48:09,521
AND THAT'S THE EXTENT OF WHAT I

4675
02:48:09,521 --> 02:48:10,122
KNOW ABOUT IT.

4676
02:48:10,122 --> 02:48:15,561
WE'RE USING IT NOW  IN A CROSS

4677
02:48:15,561 --> 02:48:15,961
SECTIONAL STUDY.

4678
02:48:15,961 --> 02:48:18,564
SO THERE IS GOOD WORK BEING DONE

4679
02:48:18,564 --> 02:48:19,665
AND THEY HAVE BEEN WORKING ON

4680
02:48:19,665 --> 02:48:22,134
THIS FOR 6 OR 7 YEARS NOW.

4681
02:48:22,134 --> 02:48:23,635
>> THANK YOU.

4682
02:48:23,635 --> 02:48:24,770
THANK YOU DR. VAN DILLEN AND

4683
02:48:24,770 --> 02:48:27,473
THANK TO YOU EACH OF THE

4684
02:48:27,473 --> 02:48:31,477
SPEAKERS THIS MORNING FOR

4685
02:48:31,477 --> 02:48:34,413
KEEPING THINGS ACTIVE AND

4686
02:48:34,413 --> 02:48:34,646
ENGAGED.

4687
02:48:34,646 --> 02:48:35,314
THANK YOU.

4688
02:48:35,314 --> 02:48:36,548
>> THANK YOU.

4689
02:48:36,548 --> 02:48:43,655
>> AND NOW WE WILL NOW
MOVE TO

4690
02:48:43,655 --> 02:48:47,826
THINKING ABOUT THE--SORRY.

4691
02:48:47,826 --> 02:48:48,026
OKAY.

4692
02:48:48,026 --> 02:48:49,928
SO WE'RE NOW AT THE POINT WE'RE

4693
02:48:49,928 --> 02:48:54,900
GOING TO BE LOOKING FORWARD TO

4694
02:48:54,900 --> 02:49:00,572
MAY AND TOPICS WE MIGHT WANT TO

4695
02:49:00,572 --> 02:49:05,911
INCLUDE AND STEVE IS FIRST IN

4696
02:49:05,911 --> 02:49:06,111
LINE.

4697
02:49:06,111 --> 02:49:07,379
NTHANKS, BARBARA, A LITTLE BIT

4698
02:49:07,379 --> 02:49:11,850
OF A DIFFERENT TANGENT.

4699
02:49:11,850 --> 02:49:12,484
THE LAST 3 SPEAKERS THIS OTHER

4700
02:49:12,484 --> 02:49:13,352
THAN MODEL CITIZENNING DID A

4701
02:49:13,352 --> 02:49:16,889
REALLY GOOD JOB OF PROVIDING AN

4702
02:49:16,889 --> 02:49:21,927
OVERVIEW, EXCUSE ME, OF THEIR

4703
02:49:21,927 --> 02:49:24,596
TOPIC AREA BUT I WAS REMINDED AS

4704
02:49:24,596 --> 02:49:25,964
I WAS LISTENING THROUGH THIS AND

4705
02:49:25,964 --> 02:49:28,267
IF WE ARE AN ADVISORY GROUP,IME

4706
02:49:28,267 --> 02:49:29,902
NOT SURE I CAME AWAY WITH OR

4707
02:49:29,902 --> 02:49:36,241
THERE WAS SOME THERE BUT CLEARLY

4708
02:49:36,241 --> 02:49:38,343
WHAT STEPS CAN WE DO AS AN

4709
02:49:38,343 --> 02:49:39,978
ADVISORY GROUP OR HOW DOES THE

4710
02:49:39,978 --> 02:49:43,916
BORD AS AN ADVISORY GROUP SEE

4711
02:49:43,916 --> 02:49:48,453
THE GAPS PRIORITIZE THE GAPS,

4712
02:49:48,453 --> 02:49:50,289
DECIDE TO EITHER ANNOUNCE FOR

4713
02:49:50,289 --> 02:49:53,892
INTERESTING GAPS OR FUN GAPS

4714
02:49:53,892 --> 02:49:55,861
THAT ARE THERE, AGAIN ALL THE

4715
02:49:55,861 --> 02:49:57,829
TOPICS GAVE ME A GREAT OVERVIEW

4716
02:49:57,829 --> 02:49:59,698
OF THE CHALLENGES THEY HAVE AND

4717
02:49:59,698 --> 02:50:01,066
THE WORK THEY'VE DONE BUT I'M

4718
02:50:01,066 --> 02:50:05,571
WANTING A LITTLE BIT TO BETTER

4719
02:50:05,571 --> 02:50:09,174
UNDERSTAND HOW CAN WE BEST HELP

4720
02:50:09,174 --> 02:50:11,109
THEM IN TERMS OF THIS IS WHERE

4721
02:50:11,109 --> 02:50:12,444
FUNDING IS OR NOT IS, AND THIS

4722
02:50:12,444 --> 02:50:14,980
IS WHERE WE NEED TO PRIORITIZE.

4723
02:50:14,980 --> 02:50:15,948
WHAT INFORMATION DO WE NEED TO

4724
02:50:15,948 --> 02:50:18,216
DO TO GET THERE AND WHAT

4725
02:50:18,216 --> 02:50:19,384
PROCESSES DID THE BOARD HAVE TO

4726
02:50:19,384 --> 02:50:29,828
HELP US FIGHT THROUGH IT?

4727
02:50:32,331 --> 02:50:33,665
>> THANKS STEVE, BECAUSE I

4728
02:50:33,665 --> 02:50:35,200
THOUGHT YOU MIGHT ASK A QUESTION

4729
02:50:35,200 --> 02:50:37,002
LIKE THIS, AND I WANTED TO DO

4730
02:50:37,002 --> 02:50:38,437
BACKGROUND AND SAY WELL, HERE'S

4731
02:50:38,437 --> 02:50:39,471
THE RESEARCH FUNDING FOR THE

4732
02:50:39,471 --> 02:50:42,341
TOPICS AND WE DON'T TRACK

4733
02:50:42,341 --> 02:50:45,377
INJURY. 

4734
02:50:45,377 --> 02:50:46,612
MCRUCIATE LIGAMENT SCULOSKELETAL

4735
02:50:46,612 --> 02:50:48,380
INJURY, SO I THOUGHT WOW, WE

4736
02:50:48,380 --> 02:50:50,816
DON'T BE ABLE TO DO THAT MUCH SO

4737
02:50:50,816 --> 02:50:52,117
NIH NEEDS TO DO A LITTLE BIT

4738
02:50:52,117 --> 02:50:55,520
MORE WORK TO GIVE YOU SOME OF

4739
02:50:55,520 --> 02:50:55,988
THAT INFORMATION.

4740
02:50:55,988 --> 02:51:01,960
BUT PART OF THE BOARD'S ROLE IS

4741
02:51:01,960 --> 02:51:04,396
TO PUT THINGS OUT THERE FOR

4742
02:51:04,396 --> 02:51:05,097
INVESTIGATOR INITTIAITED IDEAS

4743
02:51:05,097 --> 02:51:07,733
SO I HEARD A HUNDRED RO-1S THIS

4744
02:51:07,733 --> 02:51:08,900
MORNING THAT PEOPLE COULD PUT

4745
02:51:08,900 --> 02:51:10,669
TOGETHER AND SEND IN, YOU KNOW

4746
02:51:10,669 --> 02:51:12,738
WHEN I TALKED ABOUT THE

4747
02:51:12,738 --> 02:51:15,607
INCREDIBLE GROWTH IN THE REHAB

4748
02:51:15,607 --> 02:51:17,676
PORTFOLIO, THAT WASN'T BECAUSE

4749
02:51:17,676 --> 02:51:19,277
WE PUT OUT ANNOUNCEMENTS SAYING

4750
02:51:19,277 --> 02:51:20,912
WE NEED THIS RESEARCH, IT WAS

4751
02:51:20,912 --> 02:51:24,182
BECAUSE THE FIELD DID THAT.

4752
02:51:24,182 --> 02:51:26,718
SO I THINK WE'RE ALREADY IN A

4753
02:51:26,718 --> 02:51:28,186
LITTLE WAY, DOING WHAT YOU'RE

4754
02:51:28,186 --> 02:51:29,287
ASKING BY HAVING THESE MEETINGS

4755
02:51:29,287 --> 02:51:32,958
AND PUTTING IT OUT THERE AND

4756
02:51:32,958 --> 02:51:33,925
LETTING PEOPLE KNOW THAT THESE

4757
02:51:33,925 --> 02:51:36,461
ARE ISSUES IN THE FIELD.

4758
02:51:36,461 --> 02:51:39,064
SO I'M NOT ANSWERING YOUR

4759
02:51:39,064 --> 02:51:42,501
QUESTION EXACTLY,--YEAH, GO

4760
02:51:42,501 --> 02:51:42,701
AHEAD.

4761
02:51:42,701 --> 02:51:43,769
>> THAT HELPS, I GUESS.

4762
02:51:43,769 --> 02:51:48,040
SO WE REALLY IN TERPS OF A FEET

4763
02:51:48,040 --> 02:51:52,077
FORWARD MECHANISM, WEB CONNECTED

4764
02:51:52,077 --> 02:51:56,148
DON'T NECESSARILY PROVIDE A

4765
02:51:56,148 --> 02:51:57,015
DOCUMENT OR CIRCULATE MATERIAL

4766
02:51:57,015 --> 02:52:01,353
TO SAY THIS IS WHAT WE'VE HEARD

4767
02:52:01,353 --> 02:52:02,287
AND INDEPENDENT INVESTIGATORS

4768
02:52:02,287 --> 02:52:03,822
WHO LIVE IN THIS SPACE, THESE

4769
02:52:03,822 --> 02:52:06,458
ARE NEEDS, THESE ARE NOT NEEDS,

4770
02:52:06,458 --> 02:52:08,727
ET CETERA.

4771
02:52:08,727 --> 02:52:10,228
WE LET THE--IT HAPPENS

4772
02:52:10,228 --> 02:52:11,496
ORGANICALLY IS THE BEST WAY TO

4773
02:52:11,496 --> 02:52:12,330
PUT IT.

4774
02:52:12,330 --> 02:52:14,766
>> WELL, THERE'S 2 WAYS.

4775
02:52:14,766 --> 02:52:16,368
SO, YOU ALREADY VOLUNTEERED TO

4776
02:52:16,368 --> 02:52:17,803
HELP WITH THE RESEARCH PLAN, SO

4777
02:52:17,803 --> 02:52:20,906
THAT'S A GOOD WAY TO SAY, HEY

4778
02:52:20,906 --> 02:52:24,609
GUYS, THESE ARE AREAS THAT ARE

4779
02:52:24,609 --> 02:52:26,745
READY AND RIPE FOR RESEARCH

4780
02:52:26,745 --> 02:52:29,247
APPLICATIONS, SO THAT WOULD BE

4781
02:52:29,247 --> 02:52:32,284
THE DOCUMENT, AND THEN THE OTHER

4782
02:52:32,284 --> 02:52:33,585
IS THESE DISCUSSIONS AND RALPH

4783
02:52:33,585 --> 02:52:34,886
LIKES TO SAY, WE EXPECT YOU GUYS

4784
02:52:34,886 --> 02:52:36,188
TO GO BACK TO YOUR COMMUNITY

4785
02:52:36,188 --> 02:52:38,356
ANDS SAY, YOU KNOW I HEARD THIS

4786
02:52:38,356 --> 02:52:39,858
REALLY GREAT TALK AND MAYBE WE

4787
02:52:39,858 --> 02:52:42,227
SHOULD DIG INTO THIS.

4788
02:52:42,227 --> 02:52:50,869
SO IT'S A FEW WAYS THAT WE COULD

4789
02:52:50,869 --> 02:52:51,903
DO IT.

4790
02:52:51,903 --> 02:52:53,772
>> AND STEE FEN, I WANTED
TO ADD

4791
02:52:53,772 --> 02:52:55,874
THERE ARE ISSUES OUT THERE AND

4792
02:52:55,874 --> 02:52:56,708
SOMETIMES PEOPLE ARE AWARE OF

4793
02:52:56,708 --> 02:52:58,577
THESE ISSUES AND PUTTING IN THE

4794
02:52:58,577 --> 02:52:59,478
RIGHT APPLICATIONS AND STEVE

4795
02:52:59,478 --> 02:53:01,813
GAVE A GOOD EXAMPLE OF HOW THE

4796
02:53:01,813 --> 02:53:02,981
D.O.D. CULTURE AND VA ARE ALL

4797
02:53:02,981 --> 02:53:04,850
OVER AND THE GREAT PARTNERS AND

4798
02:53:04,850 --> 02:53:05,984
THEY HAVE SOME UNIQUE ANGLES AND

4799
02:53:05,984 --> 02:53:10,155
HOW YOU DEAL WITH IT THE ACUTE

4800
02:53:10,155 --> 02:53:11,456
AND IN THE BATTLEFIELD SENSE.

4801
02:53:11,456 --> 02:53:14,926
I THINK WE GO BACK TO THE FIRST

4802
02:53:14,926 --> 02:53:18,396
TALK TODAY BUT WE HAVE A SENSE

4803
02:53:18,396 --> 02:53:21,233
FROM FLORA HOW THE DIFFERENCE

4804
02:53:21,233 --> 02:53:21,867
BETWEEN SHORT-TERM ACUTE CARE

4805
02:53:21,867 --> 02:53:26,004
AND THE LACK OF LONG-TERM

4806
02:53:26,004 --> 02:53:30,509
COMMITMENT AND IN AS MUCH AS OUR

4807
02:53:30,509 --> 02:53:31,576
COLLEAGUES IS AWARE OF THESE

4808
02:53:31,576 --> 02:53:32,978
THINGS IS THERE A NEED TO

4809
02:53:32,978 --> 02:53:36,081
HIGHLIGHT THEM OR A NEED TO

4810
02:53:36,081 --> 02:53:36,815
INCENTIVIZE SOME BEHAVIOR, SOME

4811
02:53:36,815 --> 02:53:40,152
NEED FOR US TO SET UP A

4812
02:53:40,152 --> 02:53:41,019
CENTRALIZED INFRASTRUCTURE TO

4813
02:53:41,019 --> 02:53:42,287
FACILITATE THE RESEARCH, SO YOU

4814
02:53:42,287 --> 02:53:47,092
KNOW HELPING US UNDERSTAND WHERE

4815
02:53:47,092 --> 02:53:47,993
OUR BLIND SPOTS.

4816
02:53:47,993 --> 02:53:50,095
THE FIELD IS ALREADY VERY GOOD

4817
02:53:50,095 --> 02:53:50,896
AT SELF-IDENTIFYING AND IT'S

4818
02:53:50,896 --> 02:53:52,197
JUST A MATTER OF SOMETIMES THERE

4819
02:53:52,197 --> 02:53:53,064
ISN'T A BREAK THROUGH AND WE

4820
02:53:53,064 --> 02:53:54,800
KIND OF LEAVE IT FOR THAT BUT IN

4821
02:53:54,800 --> 02:53:56,101
AS MUCH AS WE'RE KIND OF

4822
02:53:56,101 --> 02:53:58,603
INRIGHTING YOU TO OUR SIDE SO

4823
02:53:58,603 --> 02:54:00,071
YOU GET TO SEE THESE THING ANDS

4824
02:54:00,071 --> 02:54:02,073
IN AS MUCH AS YOU CAN IDENTIFY

4825
02:54:02,073 --> 02:54:03,775
WHERE DOES SOMETHING WE REALLY

4826
02:54:03,775 --> 02:54:12,184
HAVE TO INTERVENE SPEAK UP,

4827
02:54:12,184 --> 02:54:12,784
THAT'S YOUR ROLE.

4828
02:54:12,784 --> 02:54:15,153
>> YEAH, I WAS THINKING

4829
02:54:15,153 --> 02:54:16,988
SOMETHING THAT I THINK AIAN LOT

4830
02:54:16,988 --> 02:54:18,890
IS HOW DO WE--IT WOULD BE NICE

4831
02:54:18,890 --> 02:54:20,559
TO MAYBE SOME SOME EXAMPLES OF

4832
02:54:20,559 --> 02:54:22,661
THIS, THAT'S WHY I'M BRINGING IT

4833
02:54:22,661 --> 02:54:25,897
UP, OF PEOPLE THAT HAVE

4834
02:54:25,897 --> 02:54:26,798
SUCCESSFULLY INTORPERATED

4835
02:54:26,798 --> 02:54:29,634
MECHANISTIC WORK AND

4836
02:54:29,634 --> 02:54:30,602
REHABILITATION TOGETHER, NOT

4837
02:54:30,602 --> 02:54:32,370
AS--MY WORRY IS THAT WE SAY THAT

4838
02:54:32,370 --> 02:54:35,106
AND WE GET PEOPLE WHO ARE BASIC

4839
02:54:35,106 --> 02:54:38,076
SCIENTISTS AND THEN ENCLUED THE

4840
02:54:38,076 --> 02:54:40,245
EDSS, AND SHAY THEY NOW SPANNED

4841
02:54:40,245 --> 02:54:42,113
THAT SPECTRUM AND THEY HAVEN'T,

4842
02:54:42,113 --> 02:54:42,814
RIGHT?

4843
02:54:42,814 --> 02:54:45,350
OR THE REHABILITATION WORK THAT

4844
02:54:45,350 --> 02:54:46,484
DOESN'T INCORPORATE MECHANISTIC

4845
02:54:46,484 --> 02:54:47,552
WORK, BUT SOMEHOW, I DON'T THINK

4846
02:54:47,552 --> 02:54:50,655
IT'S GOING TO BE AS SIMPLE AS

4847
02:54:50,655 --> 02:54:52,424
JUST BRIDGING THIS GAP BUT AT

4848
02:54:52,424 --> 02:54:53,525
LEAST STUDIES THAT HAVE BEEN

4849
02:54:53,525 --> 02:54:54,693
SUCCESSFUL IN TRYING TO DO THAT

4850
02:54:54,693 --> 02:54:58,697
MIGHT BE REALLY HELPFUL TO THE

4851
02:54:58,697 --> 02:54:58,897
FIELD.

4852
02:54:58,897 --> 02:55:01,867
>> THANK YOU EMPLOY IT
MIGHT BE

4853
02:55:01,867 --> 02:55:10,008
CAREERS, NOT JUST STUDIES, BUT

4854
02:55:10,008 --> 02:55:10,475
YEAH.

4855
02:55:10,475 --> 02:55:11,943
NCHRIS, THANK YOU.

4856
02:55:11,943 --> 02:55:13,578
NTHANKS, SO IT WAS BEING THE

4857
02:55:13,578 --> 02:55:14,880
SESSION, WE HEARD A LITTLE BIT

4858
02:55:14,880 --> 02:55:16,381
FROM THE VA, WE HEARD A BIT

4859
02:55:16,381 --> 02:55:18,984
ABOUT D.O.D. PERSPECTIVE ON

4860
02:55:18,984 --> 02:55:19,818
REHABILITATION AND I'M WONDERING

4861
02:55:19,818 --> 02:55:22,454
IF THE GROUP IS INTERESTED IN

4862
02:55:22,454 --> 02:55:24,756
HEARING FROM THE ARP A-H GROUP

4863
02:55:24,756 --> 02:55:35,300
ABOUT THE ROLE OF REHABILITATION

4864
02:55:37,002 --> 02:55:38,203
IN THAT AGENCY

4865
02:55:38,203 --> 02:55:38,937
EN--STRATEGIESITUTE, WHATEVER

4866
02:55:38,937 --> 02:55:41,039
THAT WORD IS.

4867
02:55:41,039 --> 02:55:50,415
IT'S DIFFERENT.

4868
02:55:50,415 --> 02:55:52,417
>> DAWN IN N2 IDEAS 1 IN

4869
02:55:52,417 --> 02:55:54,486
RESPONSE TO CATHY'S I WAS JUST

4870
02:55:54,486 --> 02:55:55,754
THINK BEING A COLLEAGUE MARK

4871
02:55:55,754 --> 02:55:58,556
JENSEN SOME OF YOU MAY KNOW A

4872
02:55:58,556 --> 02:56:00,625
PINE PSYCHOLOGIST WITH LOTS OF

4873
02:56:00,625 --> 02:56:01,927
FUNDING FROM NIH, PAIN

4874
02:56:01,927 --> 02:56:03,561
REHABILITATION AND HE HAS DONE A

4875
02:56:03,561 --> 02:56:06,197
NICE JOB OF INTEGRATING

4876
02:56:06,197 --> 02:56:07,232
PSYCHOSOCIAL MECHANISMS THAT AT

4877
02:56:07,232 --> 02:56:08,733
LEAST IN SOME BRAIN MECHANISMS

4878
02:56:08,733 --> 02:56:09,868
INTO BANE, RESEARCH AND THE

4879
02:56:09,868 --> 02:56:14,906
CONTEXT OF CLINICAL TRIALS,

4880
02:56:14,906 --> 02:56:18,710
FUNDED BY NCI,--NCCIH, WHERE THE

4881
02:56:18,710 --> 02:56:20,245
PRIMARY CAN'T BE THE EFFICACY,

4882
02:56:20,245 --> 02:56:25,383
THAT HAS TO BE A SECONDARY HAIM

4883
02:56:25,383 --> 02:56:27,352
AND THE PRIMEY IS MECHANISMS

4884
02:56:27,352 --> 02:56:29,621
SOPHISTICATED I THINK HE'S HAD

4885
02:56:29,621 --> 02:56:31,156
YEARS OF EXPERIENCE WITH

4886
02:56:31,156 --> 02:56:32,424
MECHANISMS IN PSYCHOLOGY OF PAIN

4887
02:56:32,424 --> 02:56:33,858
AND MAYBE THERE WOULD BE

4888
02:56:33,858 --> 02:56:34,926
TRANSLATION TO OTHERS.

4889
02:56:34,926 --> 02:56:35,760
THAT'S 1 TOPIC.

4890
02:56:35,760 --> 02:56:37,362
JUST ANOTHER TOPIC, I THOUGHT

4891
02:56:37,362 --> 02:56:39,597
WAS WAS JUST MANY OF US IN THE

4892
02:56:39,597 --> 02:56:40,799
TRAINING GROUP TALKED ABOUT

4893
02:56:40,799 --> 02:56:41,099
MENTORS AND

4894
02:56:41,099 --> 02:56:41,666
M-TEBURKEULOSEISORRING AND I

4895
02:56:41,666 --> 02:56:43,101
DON'T KNOW WHAT I'M SUGGESTING

4896
02:56:43,101 --> 02:56:50,342
HERE BUT SOME THEME OF

4897
02:56:50,342 --> 02:56:51,042
 MENTORING

4898
02:56:51,042 --> 02:56:51,943
SCIENTISTSENTIOUS SPECIALLY

4899
02:56:51,943 --> 02:56:53,478
THOSE IN UNDERREPRESENT

4900
02:56:53,478 --> 02:56:55,180
COMMUNITIES HOWY CAN WE TALK

4901
02:56:55,180 --> 02:56:57,615
ABOUT THAT HERE, DO MORE TO

4902
02:56:57,615 --> 02:56:58,783
PROMOTE THEIR CAREERS BEYOND THE

4903
02:56:58,783 --> 02:57:05,123
TRAIPING AND MECHANISMS THAT

4904
02:57:05,123 --> 02:57:07,492
ALREADY EXIST?

4905
02:57:07,492 --> 02:57:07,959
>> LEWIS?

4906
02:57:07,959 --> 02:57:08,560
>> YEAH, ACTUALLY 1 OF THE

4907
02:57:08,560 --> 02:57:10,095
THOUGHTS I HAD WAS SIMILAR TO

4908
02:57:10,095 --> 02:57:11,963
THAT PREVIOUS COMMENT SO THAT'S

4909
02:57:11,963 --> 02:57:13,298
REALLY REALLY GREAT EMPLOY I HAD

4910
02:57:13,298 --> 02:57:14,499
A COUPLE THINGS WRITTEN BOW I

4911
02:57:14,499 --> 02:57:16,534
WON'T GO THROUGH ALL OF THEM BUT

4912
02:57:16,534 --> 02:57:19,204
1 THAT REALLY RANG OUT TO ME A

4913
02:57:19,204 --> 02:57:20,572
LITTLE BIT PARTICULARLY FROM

4914
02:57:20,572 --> 02:57:24,976
JAIM'S TALK AND FROM SOME OF THE

4915
02:57:24,976 --> 02:57:27,345
OTHERS AS WELL IS IN THE CASE OF

4916
02:57:27,345 --> 02:57:29,280
LIMB LOSS WITH PROSTHESIS THERE,

4917
02:57:29,280 --> 02:57:30,815
'S A BIG DISTRICT ATTORNEY WHERE

4918
02:57:30,815 --> 02:57:33,151
THERE'S A SEA OF THING, SO MANY

4919
02:57:33,151 --> 02:57:35,987
TOOLS, TECHNIQUES,A PROACHS, YOU

4920
02:57:35,987 --> 02:57:39,891
KNOW FROM A RESEARCH, PURELY

4921
02:57:39,891 --> 02:57:40,525
RESEARCH PERSPECTIVE, SOMETIMES

4922
02:57:40,525 --> 02:57:42,227
IT CAN BE DIFFICULT TO REALLY

4923
02:57:42,227 --> 02:57:44,829
UNDERSTAND, YOU KNOW HOW TO

4924
02:57:44,829 --> 02:57:46,865
MERGE THINGS TOGETHER, HOW TO

4925
02:57:46,865 --> 02:57:50,068
YOU KNOW MOVE THINGS FORWARD,

4926
02:57:50,068 --> 02:57:52,303
HOW TO PRUNE AWAY THINGS WE

4927
02:57:52,303 --> 02:57:54,039
SHOULDN'T BE DOING AND SEEING

4928
02:57:54,039 --> 02:57:56,574
GOOD MODELS OF WHAT THAT LOOKS

4929
02:57:56,574 --> 02:57:57,876
LIKE, SEEING REALLY GOOD MODELS

4930
02:57:57,876 --> 02:58:00,645
MAY BE OF HOW TECHNOLOGIES HAVE

4931
02:58:00,645 --> 02:58:03,581
COME ON BOARD AND HAVE BEEN SUN

4932
02:58:03,581 --> 02:58:06,785
SETTED BECAUSE OF BASIC SCIENCE

4933
02:58:06,785 --> 02:58:07,318
INVESTIGATION, MECHANISTIC

4934
02:58:07,318 --> 02:58:07,986
INVESTIGATION INTO THOSE THINGS,

4935
02:58:07,986 --> 02:58:10,388
AND HOW WE CAN COULD BE DOING

4936
02:58:10,388 --> 02:58:11,890
THAT MORE.

4937
02:58:11,890 --> 02:58:13,391
ANOTHER IDEA, THIS IS HAS COME

4938
02:58:13,391 --> 02:58:15,527
UP BECAUSE I'VE HEARD THE PHRASE

4939
02:58:15,527 --> 02:58:17,929
WHICH I'M ALWAYS EXCITED TO

4940
02:58:17,929 --> 02:58:18,897
HEAR, SOCIAL DETERMINANTS OF

4941
02:58:18,897 --> 02:58:20,265
HEALTH IN THINKING A LOT MORE

4942
02:58:20,265 --> 02:58:25,437
ABOUT MAYBE HOW THAT CAN HELP US

4943
02:58:25,437 --> 02:58:27,405
UNDERSTAND THE PRECISION

4944
02:58:27,405 --> 02:58:28,540
MEDICINE AND REHABILITATION,

4945
02:58:28,540 --> 02:58:28,773
RIGHT?

4946
02:58:28,773 --> 02:58:31,443
I MEAN, ARE THEY REALLY STRONG

4947
02:58:31,443 --> 02:58:36,081
MODELS THAT WE CAN BE THINKING

4948
02:58:36,081 --> 02:58:37,148
ABOUT EXPANDING INTO VARIOUS

4949
02:58:37,148 --> 02:58:39,884
SPACES WHERE WE'RE UNDERSTANDING

4950
02:58:39,884 --> 02:58:41,886
DEEPER QUESTIONS PARTICULARLY AS

4951
02:58:41,886 --> 02:58:43,888
PEOPLE CHANGE RIGHT, FROM THE

4952
02:58:43,888 --> 02:58:48,893
MOMENT OF INJURY OR IMPACT AS

4953
02:58:48,893 --> 02:58:50,595
TIME GOES ON, THOSE FORCES ON

4954
02:58:50,595 --> 02:58:52,564
THEIR HEALTH AND THEIR REHAB

4955
02:58:52,564 --> 02:58:54,799
POTENTIAL MAY BE SIGNIFICANTLY

4956
02:58:54,799 --> 02:58:55,900
EXEXPANDED UPON GOING BACK IT

4957
02:58:55,900 --> 02:59:00,271
WHAT RALPH WAS TALKING ABOUT A

4958
02:59:00,271 --> 02:59:03,007
LOT ARE ACUTE BUT WHAT DID

4959
02:59:03,007 --> 02:59:07,979
CRONISITY MEAN AND HOW CAN WE BE

4960
02:59:07,979 --> 02:59:10,482
ADAPTIVE BUT PRECISE AS PEOPLE

4961
02:59:10,482 --> 02:59:14,385
GO ON THROUGH THEIR COURSE OF

4962
02:59:14,385 --> 02:59:15,286
THEIR INJURY.

4963
02:59:15,286 --> 02:59:15,887
>> GREAT BRACHYTHERAPY.

4964
02:59:15,887 --> 02:59:17,388
DO WE HAVE ENOUGH?

4965
02:59:17,388 --> 02:59:20,625
>> I THINK WE HAVE A GREAT

4966
02:59:20,625 --> 02:59:20,959
START.

4967
02:59:20,959 --> 02:59:28,500
AND I I'M SURE THAT WE CAN

4968
02:59:28,500 --> 02:59:30,869
TERESA AND RALPH ARK DITIONAL

4969
02:59:30,869 --> 02:59:32,871
THOUGHTS AS WE MOVE TOWARD

4970
02:59:32,871 --> 02:59:33,505
FORWARD, 1 OF THE OTHER

4971
02:59:33,505 --> 02:59:34,706
QUESTIONS WE WANT TO TALK ABOUT

4972
02:59:34,706 --> 02:59:36,508
IS YOUR THOUGHTS ABOUT THE

4973
02:59:36,508 --> 02:59:38,543
HYBRID FORMAT, IS IT WORKS, HOW

4974
02:59:38,543 --> 02:59:41,846
IS IT WORKING, ARE THERE THINGS

4975
02:59:41,846 --> 02:59:45,683
WE CAN CHANGE OR IMPROVE?

4976
02:59:45,683 --> 02:59:47,919
AND DO WE NEED 2 DAYS, DO WE

4977
02:59:47,919 --> 02:59:54,526
WANT TO CHANGE IT TO A DAY?

4978
02:59:54,526 --> 03:00:02,100
OR 2 HALF DAYS?

4979
03:00:02,100 --> 03:00:03,334
>> HI, I'M SORRY.

4980
03:00:03,334 --> 03:00:04,536
>> NO, YOU WERE FIRST.

4981
03:00:04,536 --> 03:00:06,738
>> JUST QUICKLY I WOULD
SAY THAT

4982
03:00:06,738 --> 03:00:08,473
REGARDLESS OF LANDING ON A DAY

4983
03:00:08,473 --> 03:00:10,542
AND HALF OR 2 HALF OR STARTING

4984
03:00:10,542 --> 03:00:12,277
LATE OR ANYWAY, BUT I WOULD

4985
03:00:12,277 --> 03:00:17,615
ADVOCATE FOR THE HYBRID FORMAT

4986
03:00:17,615 --> 03:00:20,919
SIMPLY BECAUSE IT ALLOWS PEOPLE

4987
03:00:20,919 --> 03:00:23,555
TO PARTICIPATE AND INCLUDES

4988
03:00:23,555 --> 03:00:24,789
EVERYBODY, SO THE IDEA THAT

4989
03:00:24,789 --> 03:00:26,090
MAYBE I WOULD BE PLANNING TO

4990
03:00:26,090 --> 03:00:28,226
COME HERE BUT SOMETHING HAPPENS

4991
03:00:28,226 --> 03:00:29,827
AND I YOU KNOW I CAN'T LEAVE THE

4992
03:00:29,827 --> 03:00:32,697
HOUSE FOR A WHILE, BUT I CAN

4993
03:00:32,697 --> 03:00:36,734
STILL BE HERE IN OTHER PEOPLE

4994
03:00:36,734 --> 03:00:37,702
THAT SIMPLY HAVE--NEED TO WORK

4995
03:00:37,702 --> 03:00:40,939
FROM A HOME LOCATION, SO I'M A

4996
03:00:40,939 --> 03:00:42,340
BIG ADVOCATE AND HYBRID AND

4997
03:00:42,340 --> 03:00:44,342
THAT'S HOW I SEE THE WORLD NOW

4998
03:00:44,342 --> 03:00:46,477
IS WE NEED TO BE HYBRID BECAUSE

4999
03:00:46,477 --> 03:00:48,479
THAT INCLUDES EVERYBODY.

5000
03:00:48,479 --> 03:00:51,216
>> I WOULD JUST FOLLOW UP
WITH

5001
03:00:51,216 --> 03:00:52,650
SAYING THAT WE ARE PRIVILEGED TO

5002
03:00:52,650 --> 03:00:56,921
BE IN A HYBRID ENVIRONMENT WITH

5003
03:00:56,921 --> 03:00:57,889
THE LEVEL OF SUPPORT THAT WE

5004
03:00:57,889 --> 03:01:00,391
HAVE SO THAT IT ACTUALLY WORKS.

5005
03:01:00,391 --> 03:01:03,394
THIS IS NOT THE NORM IN A LOT OF

5006
03:01:03,394 --> 03:01:07,932
HYBRID SITUATIONS THAT I'VE BEEN

5007
03:01:07,932 --> 03:01:09,200
IN.

5008
03:01:09,200 --> 03:01:09,434
BOB?

5009
03:01:09,434 --> 03:01:10,635
>> YEAH, I AGREE WITH THAT
IN

5010
03:01:10,635 --> 03:01:12,837
TERMS OF THE FORMAT, I LIKE

5011
03:01:12,837 --> 03:01:14,906
HAVING THE IN-PERSON OPTION, 1

5012
03:01:14,906 --> 03:01:17,008
DAY VERSUS 1 HALF, 2 DAYS MY

5013
03:01:17,008 --> 03:01:18,343
CONCERN IS ACTUALLY THAT IF WE

5014
03:01:18,343 --> 03:01:20,845
MAKE IT 1 DAY IT'S GOING TO

5015
03:01:20,845 --> 03:01:23,014
BECOME COMPLETELY REMOTE BECAUSE

5016
03:01:23,014 --> 03:01:24,182
IT'S NOT--PEOPLE AREN'T GOING TO

5017
03:01:24,182 --> 03:01:27,619
FLY IN FOR 1 DAY, PROBABLY NOT

5018
03:01:27,619 --> 03:01:28,920
DRIVE EITHER, SO, I THINK IT'S

5019
03:01:28,920 --> 03:01:36,594
PRETTY GOOD THE WAY IT IS.

5020
03:01:36,594 --> 03:01:37,895
>> I REALLY WANTED TO BE
HERE IN

5021
03:01:37,895 --> 03:01:39,631
PERSON AS A NEW MEMBER TO GET TO

5022
03:01:39,631 --> 03:01:40,598
MEET PEOPLE AND GET TO KNOW

5023
03:01:40,598 --> 03:01:42,433
PEOPLE AND I THINK ALTHOUGH LAST

5024
03:01:42,433 --> 03:01:44,736
NIGHT WAS A SOCIAL EVENT, IT WAS

5025
03:01:44,736 --> 03:01:45,837
VERY HELPFUL TO HAVE A CHANCE TO

5026
03:01:45,837 --> 03:01:46,904
MEET AND TALK WITH PEOPLE AND I

5027
03:01:46,904 --> 03:01:48,940
THINK THAT WOULD BE HARD TO DO

5028
03:01:48,940 --> 03:01:50,642
ON A 1 DAY, BECAUSE EVERYBODY

5029
03:01:50,642 --> 03:01:55,980
WOULD LEAVE, RIGHT, AFTER THE

5030
03:01:55,980 --> 03:01:56,314
5:00.

5031
03:01:56,314 --> 03:02:00,118
>> THAT WAS VERY HELPFUL. 

5032
03:02:00,118 --> 03:02:01,019
THANK YOU.

5033
03:02:01,019 --> 03:02:04,622
>> THERE, THANK YOU AGAIN
TO

5034
03:02:04,622 --> 03:02:08,826
EVERYONE FOR YOUR THOUGHTFUL AND

5035
03:02:08,826 --> 03:02:10,561
ACTIVE PARTICIPATION OVER THESE

5036
03:02:10,561 --> 03:02:12,030
LAST 2 DAYS.

5037
03:02:12,030 --> 03:02:14,265
AND WISHING EVERYONE SAFE

5038
03:02:14,265 --> 03:02:14,499
TRAVELS.

5039
03:02:14,499 --> 03:02:16,534
>> AND I HAVE A LIST OF
THANK

5040
03:02:16,534 --> 03:02:19,203
YOUS I HAVE TO GO GO THROUGH SO

5041
03:02:19,203 --> 03:02:20,571
FIRST THIS WAS BARBARA'S FESTER

5042
03:02:20,571 --> 03:02:22,006
MEETING AS CHAIR SO I THINK SHE

5043
03:02:22,006 --> 03:02:25,443
DID A GREAT JOB.

5044
03:02:25,443 --> 03:02:27,545
WE NEED TO THANK ELIZA, BECAUSE

5045
03:02:27,545 --> 03:02:29,514
NONE OF YOU WOULD BE HERE IF IT

5046
03:02:29,514 --> 03:02:31,783
WASN'T FOR ALL THE LOGISTICS

5047
03:02:31,783 --> 03:02:34,752
THAT ELIZA HAS DONE AND WHEN SHE

5048
03:02:34,752 --> 03:02:35,820
ASKED FOR RECEIPTS, I EXPECT ALL

5049
03:02:35,820 --> 03:02:38,156
OF YOU TO GET BACK TO HER RIGHT

5050
03:02:38,156 --> 03:02:38,389
AWAY.

5051
03:02:38,389 --> 03:02:43,494
I WANT TO THANK THE IN-ROOM

5052
03:02:43,494 --> 03:02:44,662
INFINITY TEAM, DEBBIE AND CHEN

5053
03:02:44,662 --> 03:02:47,098
ARD, THERE ARE OTHER IT PEOPLE,

5054
03:02:47,098 --> 03:02:49,734
THERE ARE I.T. PEOPLE ONLINE,

5055
03:02:49,734 --> 03:02:51,869
THEY ARE AT THE NIH VIDEOCAST SO

5056
03:02:51,869 --> 03:02:54,405
WOE HAVE LOTS OF SUPPORT AND AS

5057
03:02:54,405 --> 03:02:57,775
BARBARA SAID THEY'VE DONE A

5058
03:02:57,775 --> 03:02:58,609
FABULOUS JOB MAKING THIS.

5059
03:02:58,609 --> 03:03:00,945
I WANT TO THANK OUR SPEAKERS OUR

5060
03:03:00,945 --> 03:03:02,146
GUEST SPEAKERS YESTERDAY, OUR

5061
03:03:02,146 --> 03:03:08,152
SPEAKERS TODAY, THANK YOU SO

5062
03:03:08,152 --> 03:03:08,386
MUCH.

5063
03:03:08,386 --> 03:03:09,687
AND THEN ALL THE BOARD MEMBERS

5064
03:03:09,687 --> 03:03:11,823
FOR FILLING OUT YOUR PAPERWORK,

5065
03:03:11,823 --> 03:03:15,193
AND FOR REAL LYE FOR YOUR ACTIVE

5066
03:03:15,193 --> 03:03:16,027
PARTICIPATION, YOUR ENGAGE AM,

5067
03:03:16,027 --> 03:03:17,895
ISSUE THE GREAT QUESTIONS, WE DO

5068
03:03:17,895 --> 03:03:22,500
APPRECIATE IT AND THEN OF

5069
03:03:22,500 --> 03:03:24,936
COURSE, RALPH, HE HAS--HE MAKES

5070
03:03:24,936 --> 03:03:26,571
THIS HAPPEN, SO A BIG HAND TO

5071
03:03:26,571 --> 03:03:26,804
HIM.

5072
03:03:26,804 --> 03:03:37,315
THANK YOU ALL AND TRAVEL SAFE.

5073
03:03:38,946 --> 03:03:40,380
THANK YOU EVERYONE, HOPE TO YOU

5074
03:03:40,380 --> 03:03:50,758
SEE IN PERSON IN MAY.