Monthly Archives: May 2010
Federal Medicaid Assistance Percentage (FMAP)
Today, May 28, 2010, the House will consider amendments to the Senate amendment to the American Jobs and Closing Tax Loopholes Act (HR 4213). As part of the anticipated amendment package, it is expected that the House will vote on eliminating a provision in the measure that extends enhanced funding through the Federal Medical Assistance Percentage (FMAP – enhanced federal funding for state Medicaid programs) through June 30, 2011. The enhanced FMAP funding was originally authorized by the economic stimulus law and under current law the enhanced funding will end as of Dec. 31, 2010.
BIAA, its chartered state affiliates and the National Association of State Head Injury Administrators (NASHIA) have been advocating to preserve the provision that extends the enhanced funding through June, 2011 in the bill. BIAA will monitor the situation closely, and will consider next steps in the event that the amendment not to extend this benefit is adopted.
Federal Medicaid Assistance Percentage (FMAP)
Prospects for Senate passage remain unclear for the amended tax and benefits “extenders” bill, HR 4213, which would revive or extend various expired tax provisions and social safety-net programs including $24 billion in special federal Medicaid aid for states. The provision to extend this increased match through June, 2011 was dropped from the bill passed by the House on May 28, 2010.
With 59 senators in the Democratic Caucus, Majority Leader Reid needs at least one Republican senator to reach 60 votes for a possible cloture motion to limit debate on the measure, which could be filed as early as Monday. If you haven’t taken action on this important issue, you still have time!
TENS therapy for spasticity in spinal cord injury
Transcutaneous electrical nerve stimulation (TENS) is a therapy that delivers electrical stimulation to the peripheral nervous system. Traditionally used for pain, TENS has also proven to be a safe and affective treatment of spasticity in stroke patients.
Spinal cord injury can also cause spasticity (the involuntary increase of muscle tone or contractions). A randomized controlled trial recently showed that one 60-minute treatment of TENS provided a significant reduction of spasticity in spinal cord injury patients. This improvement was not seen in the control group that did not receive TENS treatment.
Depression is distinct from grief in family members of patients in a vegetative state
Patients in a vegetative state may never recover from their severe brain injuries and regain consciousness. The family members of these patients are under an extreme mental and psychological burden in that they know there is limited chance of recovery, even with signs of primitive responsiveness.
This paradox between signs of life and death can create complicated feelings of grief in family members. The decreased interest in social activity, loss of interest in friends and hobbies, and feelings of isolation that may be experienced by a family member can often be interpreted as depression. A recent study, however, proposed that Prolonged Grief Disorder (an intense feeling of longing and yearning for the lost person) is a better description of their feelings.
Return to driving after moderate to severe traumatic brain injury
One of the most defining elements of an American’s perception of independence is driving. And yet, when a person suffers from traumatic brain injury, the decision (by both patient and family) to return to driving is a difficult and complex one. Motor and cognitive challenges create a concern for family members, but the independence and freedom that it represents can be a boost to rehabilitation efforts.
House Education and Labor Committee Holds Sports and Concussion Hearing
On May 20, 2010, The House Education and Labor Committee held a hearing to investigate the impact of concussions on student athletes and their academic performance. BIAA was contacted by the Committee early in the planning stages for general guidance of the issue including expertise regarding appropriate witnesses.
In conjunction with the hearing, a Government Accountability Office (GAO) report was released finding that concussions in high school athletes are widely unreported and under-diagnosed suggesting a gross underestimate of the overall national occurrence of concussion in high school sports.
BIAA has and will continue to be a frontrunner on this issue and will sustain efforts with state affiliates to promote state laws regarding return to play guidelines for student athletes.
Recombinant human growth hormone replacement in mild TBI
Recent studies have shown that the pituitary gland is particularly susceptible to traumatic brain injury. Since the pituitary gland is responsible for hormone release, hormone deficiency is a common problem in brain injury survivors.
Growth hormone deficiency is the most common hormone deficiency found after TBI, regardless of severity. Growth hormone deficiency is related to muscle weakness, diminished lean muscle mass, increased fat mass, and reduced bone density. TBI survivors with this deficiency may also experience extreme fatigue, sleep disturbances, metabolic changes, as well as an increased risk of cardiovascular disease and mortality.
Severe pediatric brain injury means less efficient cardiac fitness
The low tolerance for exercise that is a common complaint after traumatic brain injury is typically justified by motor impairment or secondary physical injury. However, a recent study has shown that the low tolerance may also be related to cardiac fitness.
The study measured the heart rate—at rest and after exercise—of 12 boys who had survived a severe traumatic brain injury. They found that, as compared to healthy controls, the TBI survivors had significantly higher heart rates at rest and after exercise. Although the nature of brain injury varied between the boys, it was suggested that diffuse axonal injury could contribute to impairment of the autonomic nervous system.
Challenges of attending college with traumatic brain injury
Young people (15-19) are at particular risk for traumatic brain injury. Although these young TBI survivors often recover enough to attend college, they do so having to face challenges in cognition, social skills, and daily living.
A recent research study documented the challenges and triumphs of four college students who had suffered a severe traumatic brain injury from between 4 and 10 years earlier. Although each student managed their challenges in slightly different ways, there were themes common to all four.
How to treat apathy in traumatic brain injury
Apathy is a term that refers to a general state of not caring—lack of initiative or drive, limited activity or energy, and no motivation to work towards goals. In traumatic brain injury, apathy is common; it’s reported in as much as 71% of patients.
Traditionally, apathy has been detrimental to rehabilitation efforts because of the difficulties in getting the apathetic patient motivated enough to participate. And treatment of apathy itself has been extremely limited, with no guiding program for rehabilitation specialists to follow.
However, a recent experimental case study has shown that apathy can be treated effectively. The treatment used motivational interviewing techniques and external compensation in order to initiate and sustain goal-oriented behaviors. The motivational interviewing included one-on-one sessions where specific goals were created, progress was reviewed, and barriers were addressed. External compensation was provided in the form of reminder alerts in the patient’s PDA.
The treatment not only significantly reduced the patient’s apathy, it also improved his functional and cognitive scores as well. Although the treatment consumed a good deal of time and energy from the rehabilitation staff, the results showed that the investment of focused treatment could ultimately provide a more efficient rehabilitation program.
Lane-Brown A, & Tate R. Evaluation of an intervention for apathy after traumatic brain injury: A multiple-baseline, single-case experimental design. Journal of Head Trauma Rehabilitation. (April 2010).
