Short- and Long-Term Effectiveness of a Subject's Specific Novel Brain and Vestibular Rehabilitation Treatment Modality in Combat Veterans Suffering from PTSD.

INTRODUCTION: Treatment for post-traumatic stress disorder (PTSD) in combat veterans that have a long-term positive clinical effect has the potential to modify the treatment of PTSD. This outcome may result in changed and saved lives of our service personnel and their families. In a previous before-after-intervention study, we demonstrated high statistical and substantively significant short-term changes in the Clinician Administered DSM-IV PTSD Scale (CAPS) scores after a 2-week trial of a subject's particular novel brain and vestibular rehabilitation (VR) program. The long-term maintenance of PTSD severity reduction was the subject of this study. MATERIAL AND METHODS: We studied the short- and long-term effectiveness of a subject's particular novel brain and VR treatment of PTSD in subjects who had suffered combat-related traumatic brain injuries in terms of PTSD symptom reduction. The trial was registered as ClinicalTrials.gov Identifier: NCT02003352. We analyzed the difference in the CAPS scores pre- and post-treatment (1 week and 3 months) using our subjects as their matched controls. RESULTS: The generalized least squares (GLS) technique demonstrated that with our 26 subjects in the 3 timed groups the R (2) within groups was 0.000, R (2) between groups was 0.000, and overall the R (2) was 0.000. The GLS regression was strongly statistically significant z = 21.29, p < 0.001, 95% CI [58.7, 70.63]. The linear predictive margins over time demonstrated strong statistical and substantive significance of decreasing PTSD severity scores for all timed CAPS tests. DISCUSSION: Our investigation has the promise of the development of superior outcomes of treatments in this area that will benefit a global society. The length of the treatment intervention involved (2 weeks) is less that other currently available treatments and has profound implications for cost, duration of disability, and outcomes in the treatment of PTSD in combat veterans.

Evaluation of the Effectiveness of a Novel Brain and Vestibular Rehabilitation Treatment Modality in PTSD Patients Who have Suffered Combat-Related Traumatic Brain Injuries.

INTRODUCTION: Blast-related head injuries are among the most prevalent injuries suffered by military personnel deployed in combat and mild traumatic brain injury (mTBI) or concussion on the battlefield in Iraq/Afghanistan has resulted in its designation as a "signature injury." Vestibular complaints are the most frequent sequelae of mTBI, and vestibular rehabilitation (VR) has been established as the most important treatment modality for this group of patients. MATERIALS AND METHODS: We studied the effectiveness of a novel brain and VR treatment post-traumatic stress disorder (PTSD) in subjects who had suffered combat-related traumatic brain injuries in terms of PTSD symptom reduction. The trial was registered as ClinicalTrials.gov Identifier: NCT02003352. (http://clinicaltrials.gov/ct2/show/NCT02003352?term=carrick&rank=6). We analyzed the difference in the Clinician Administered DSM-IV PTSD Scale (CAPS) scores pre- and post-treatment using our subjects as their own matched controls. The study population consisted of 98 combat veterans maintaining an alpha of <0.05 and power of 80%. RESULTS: Prior to treatment, 75 subjects representing 76.53 % of the sample were classified in the 2 most severe categories of PTSD. Forty-one subjects, representing 41.80 % of the total sample, were classified in the extreme category of PTSD and 34 subjects, representing 34.70 % of the total sample, were classified in the severe category of PTSD. After treatment, we observed a large reduction in CAPS severity scores with both statistical and substantive significance. DISCUSSION: Treatment of PTSD as a physical injury rather than a psychiatric disorder is associated with strong statistical and substantive significant outcomes associated with a decrease of PTSD classification. The stigma associated with neuropsychiatric disorders may be lessened when PTSD is treated with brain and VR with a potential decrease in suffering of patients, family, and society.

The influence of ageing on the ability of the skin to dissipate heat.

BACKGROUND: Ageing reduces the resting blood flow to the skin as well as the blood flow response to thermal stimuli. However, the interrelationships between skin thickness, subcutaneous fat, and skin blood flow in determining the heat dissipation characteristics of the skin have not been investigated. MATERIAL/METHODS: In the present investigation, 60 male and female subjects were examined with either a continuous 0.15 watt heat source or a 40 degrees C instantaneous heat source applied to the skin. Data was correlated to skin and subcutaneous fat thickness measured by ultrasound and to skin blood flow measured by a laser Doppler flow meter. RESULTS: The results of the experiments showed a significant negative correlation between age and skin thickness (p<0.0001) and between age and subcutaneous fat thickness (p<0.001). Blood flows in the skin, with the subject in a 24 degrees C, room were 61.8% less in the older subjects compared to the younger subjects. This was due to both a reduction in red cell concentration and red cell velocity. The lower concentration of red cells matches the reduction in skin thickness, implying a loss in the dermal layer of the skin associated with ageing. The skin blood flow response to continuous heat and to a single heat exposure were both reduced in the older subjects (p<0.01). Ageing also caused a slower response of the skin to heat stress. CONCLUSIONS: The results support a reduction in both the resting and post local heat skin blood flows associated with ageing. Some of this may be due to a reduction in dermal layer thickness due to ageing.