Monthly Archives: July 2010
Appropriations July 29 Update
On Thursday, July 29, 2010, the Senate Appropriations Committee approved a $732 billion fiscal 2011 spending bill for the departments of Labor, Health and Human Services, and Education. The draft bill would provide $169.6 billion in discretionary funding — a $5.9 billion, or 4 percent, increase from the level for the current fiscal year, but $986 million less than President Obama requested. The bill also includes $562.3 billion in mandatory spending.
BIAA’s appropriations advocacy efforts in the midst of Brain Injury Awareness Month campaigns and the final health care reform vote paid off with proposed increases in both Traumatic Brain Injury (TBI) Act programs and the Department of Education’s National Institute for Disability and Rehabilitation Research (NIDRR), which houses the TBI Model Systems of Care program.
The Senate Committee included $9,939,000 million, comparable to $9,918,000 million in FY2010, to continue programs authorized by the TBI Act including public awareness and education efforts, state grants, studies on incidence and prevalence, and protection and advocacy.
With regards to NIDRR, the committee recommended $111,919,000 million, comparable to $109,241,000 million in FY2010, for research, demonstration projects and related activities. The committee specified that resources should focus on “statutory research priorities to ensure the advancement of economic and social self-sufficiency and full community inclusion and participation. Future Rehabilitation Research Training Centers’ priorities should advance knowledge of effective strategies to reduce the impact of poverty, promote affordable housing and independent living with improved access to long-term supports, and facilitate greater individual choice and control of individualized plans under the Rehabilitation and Social Security Laws.”
The Committee also detailed the need to “facilitate the development and implementation of a comprehensive Government-wide long-term strategic plan for disability and rehabilitation research by the spring of 2011. The strategic plan should reflect the active involvement of disability senior policy advisors, program directors and other staff from NIDRR and the Department of Health and Human Services, in partnership with stakeholders conducting disability and rehabilitation research.” BIAA has advocated as a part of the Disability and Rehabilitation Research Coalition (DRRC) for these specifications and is encouraged by their inclusion.
It is important to note that with the increased federal deficit largely due to stimulus spending, this appropriations cycle has been extremely tight and sometimes uncertain. Lawmakers have been forced to cut programs and lower funding levels, making BIAA’s advocacy, including grassroots activity, vital to achieving these proposed increases found in the Senate committee report. The House has yet to unveil their Appropriations Committee report, but BIAA will continue to monitor the situation and will call on grassroots advocates if action becomes necessary.
Tell your Representatives to Support the Medicaid Funding Extention Through June 2011 (HR 1586)
This week, the Senate has taken action to approve HR 1586, which would extend the elevated Federal Medical Assistance Percentage (FMAP) for Medicaid. The House is expected to vote on the measure next week.
Without an extension, the increased Medicaid funding will expire December 31, 2010, and many states will be forced to make drastic cuts to the federal-state program. With states in fiscal peril due to unemployment, it is vital that the extra federal funding be sustained in order to keep health care accessible for many brain injury patients and caregivers!
Tell Your Senators To Increase Funding for Important Brain Injury Programs!
On Tuesday July 27, 2010, the Senate Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (Labor/HHS) will consider a draft version of a Fiscal Year 2011 appropriations bill. Contained in the bill will be provisions important to people with brain injury including programs authorized through the TBI Act as well as the TBI Model Systems of Care program.
It is essential that these underfunded programs gain the resources necessary to improve access to quality care for people with brain injury. Write your Senators now!
Appropriations Update
On Tuesday July 27, 2010, the Senate Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (Labor/HHS) will consider a draft version of the FY11 appropriations bill. Contained in the bill will be provisions important to people with brain injury including programs authorized through the TBI Act as well as the TBI Model Systems of Care program.
If you haven’t taken action on this matter and would like to write your Senators to advocate for increased funding, there’s still time! BIAA will monitor the situation closely and will alert grassroots advocates if further action is necessary.
Also, stay tuned next week for additional appropriations alerts concerning possible consideration of a draft bill by the House Appropriations Committee.
Active versus passive coping after traumatic brain injury
Coping with the negative effects of traumatic brain injury is an important aspect of a person’s ability to rehabilitate, as well as adapt to a changed lifestyle. There are different coping strategies that a patient can use. One is to actively confront a challenge by gathering information, cultivating skills, or changing a situation in order to adapt. Another, more passive, coping strategy is to regulate one’s emotional response to a challenge by suppressing negative thinking, distracting one’s thoughts, or learning to accept a negative situation.
A recent study found that people who used a passive coping strategy had a greater number of subjective complaints, and were less likely to seek social support to help with their challenges. People whose injury had occurred a long time before were more likely to use a passive coping strategy, suggesting that, over time, people may stop actively trying to change their situation and instead enter a more passive, emotion-based frame of mind.
Additionally, people with higher education more readily used active coping strategies in order to directly deal with their challenges, and people with lower levels of education tended to use passive coping strategies. Since passive coping strategies tend not to be as effective as active coping strategies, rehabilitation professionals might consider guiding their patients towards more active participation.
Wolters G, Stapert S, Brands I, & van Heugten C. Coping following acquired brain injury: Predictors and correlates. Journal of Head Trauma Rehabilitation. (July 2010).
Hyperbaric oxygen therapy for brain injury is beneficial, but only within small time frame
One of the more disturbing results of traumatic brain injury is that secondary damage can often occur after the initial trauma. Such secondary damage can lower oxygen levels in the brain—making tissue oxygenation through hyperbaric oxygen therapy a potentially promising therapy for traumatic brain injury.
A recent animal study confirmed that a single treatment of hyperbaric oxygen therapy does indeed reduce secondary brain damage after injury. However, the benefit occurred only if the single treatment was administered within 6 hours of the initial injury. The benefit was considerably lessened if therapy was administered 12 hours after injury, and no benefit was seen if therapy was delayed even longer.
Although the best time for a single treatment of hyperbaric oxygen treatment was within 6 hours after injury, multiple treatments applied later (up to 2 days after injury) could also reduce injury and recover function. The most significant benefit, however, was a single treatment within 6 hours of injury.
Hyperbaric oxygen therapy is therefore a potentially useful treatment for traumatic brain injury, but only within limited time frames.
Wang G-H, Zhang X-G, Jiang Z-L, et al. Neuroprotective effects of hyperbaric oxygen treatment of traumatic brain injury of rat. Journal of Neurotrauma. (June 2010).
Growth hormone replacement therapy improves cognition
We are now beginning to understand that traumatic brain injury may often include damage to the pituitary gland—a small, pea-sized area of the brain that can easily be sheared or obstructed by the bony cradle it sits in. The result of pituitary gland damage can be hypopituitarism (a condition in which the pituitary gland doesn’t produce sufficient amount of hormones), more specifically, a growth hormone deficiency.
Clinical studies are now underway to determine the various effects of growth hormone replacement therapy on traumatic brain injury. One such study has found that growth hormone replacement therapy for a year can reverse some of the cognitive deficits common to TBI. As compared to the placebo group, patients who received growth hormone replacement therapy showed improvements in memory, information processing speed, motor speed, and executive functioning tests.
Patients did not report negative side effects of growth hormone replacement therapy, even after a year of continued therapy. It may therefore be a viable addition to rehabilitation efforts in the future.
High WM, Briones-Galang M, Clark JA, et al. Effect of growth hormone replacement therapy on cognition after traumatic brain injury. Journal of Neurotrauma. (June 2010).
Appropriations Update
On Thursday, July 15, 2010, the House Subcommittee on Labor, Health and Human Services, Education and Related Agencies voted to approve a FY2011 draft spending bill. The bill would provide a total of $738.7 billion, $12.7 billion more than FY2010 levels but $1.5 billion less than the President’s request. The draft bill contains the funding levels for programs authorized through the TBI Act as well as the TBI Model Systems of Care program. BIAA sent out a targeted action alert on Wednesday in order to improve the visibility of these programs among subcommittee members.
BIAA is analyzing the information released by the Subcommittee and will report to grassroots advocates once a committee report is release detailing specific program allotments. Stay tuned for further action when consideration is scheduled for the bill in the full Appropriations Committee.
BIAA Participates in ITEM Coalition Annual Meeting
On Wednesday, July 14, 2010, BIAA participated in the annual meeting of the Independence Through Enhancement of Medicare and Medicaid Coalition (ITEM). The group discussed defining rehabilitation for the implementation of the health care reform law as well as the impact on Medicaid after the failure of congress to extend the enhanced Federal Medical Assistance Percentage.
BIAA will continue important work with the coalition and report any action taken.
Glasgow Coma Scale not affected by alcohol intoxication
It is common perception that alcohol intoxication lowers the Glasgow Coma Scale (GCS) rating in cases of traumatic brain injury, and is therefore not a reliable rating for intoxicated patients.
In a large study of nearly 500 TBI patients, however, no association was found between alcohol intoxication and GCS score. Only when controlling for injury severity did very high intoxication levels and positive intracranial CT scans correlate with lower GCS scores.
The implication of this research is that GCS scores should be taken at face value when evaluating a patient’s injury severity. The perception that GCS scores are lowered by alcohol intoxication is very likely a false one, and may hinder critical and acute care management decisions for TBI patients.
Lange RT, Iverson GL, Brunacher JR, & Franzen MD. Effect of blood alcohol level on Glasgow Coma Scale scores following traumatic brain injury. Brain Injury. (July 2010).
Social outcomes of preschoolers with TBI
It is commonly thought that children show rapid improvement after a traumatic brain injury because of either increased neuroplasticity or the ability for young brains to re-organize after injury. However, research that supports this notion has often been limited to cognitive and motor skills.
A recent study took a broader view of recovery after pediatric TBI. They found that when TBI occurs in younger (under age 4) preschoolers, they have social impairments that persist until at least age 8. These impairments are greater than if the TBI occurred between ages 4-6, implying that a critical time for social development is being disrupted in the younger preschoolers.
The long-term implications of this research have yet to be fully investigated, but parents and clinicians should be aware that children who suffer from TBI as a younger preschooler may have poorer social outcomes in later years.
Sonnenberg LK, Dupuis A, & Rumney PG. Pre-school traumatic brain injury and its impact on social development at 8 years of age. Brain Injury. (July 2010).
