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!

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.

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).

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).

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).

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.

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).

Occupational therapists work one-on-one with people after a traumatic brain injury in order to recover as much of a pre-injury daily life as possible. Return to work, with its financial, social, and psychological advantages, is one important goal in occupational therapy. However, assessing a patient for the ability to return to work can be challenging—factors such as pre-injury job duties, personality changes, disability, limited self-awareness, or employer understanding can all complicate the issue.

A recent study rated the issues that were most relevant in the decision to return to work. The personal attributes most important to success in the return to work were not especially surprising:

• Motivation
• Functional and physical independence
• Cognitive abilities
• Use of compensatory strategies and feedback

What made this study different, however, was that they addressed the employer’s readiness to provide a safe, sensitive, and financially feasible workplace for the TBI survivor. They found the most relevant workplace environment factors to be the following:

• Workplace demands (safety, risk assessment)
• Employer resources and resulting burden (time, money)
• Risks with information sharing (communication, confidentiality)
• Financial impacts of Return To Work (litigation outcome, cost of therapy, disability benefits)

Stergiou-Kita M, Yantzi A, & Wan J. The personal and workplace factors relevant to work readiness evaluation following acquired brain injury: Occupational therapists’ perceptions. Brain Injury. (July 2010.)

On Thursday, July 1, 2010, the House adopted a one-year spending (H. Res. 1493) plan instead of a traditional five-year budget resolution, which has stalled because of intraparty differences over spending levels and concern over budget deficits.

The plan, which Democrats call a “budget enforcement resolution” for fiscal 2011, would set a limit of $1.121 trillion on discretionary spending. Democrats say it would allow about $7 billion less to be spent in fiscal 2011 than President Obama requested.

The Senate Budget Committee approved a full fiscal 2011 budget resolution (S. Con. Res. 60) on April 22, 2010 that called for $4 billion less in discretionary spending next year than President Obama requested. The full Senate has not taken up that measure and is not expected to since the House will not move a similar plan. (CQ)

BIAA will continue to advocate for increased funding for programs authorized through the TBI Act as well as for NIDRR’s Model Systems of Care program even in this tough appropriations climate.  We will alert grassroots advocates if action is needed.

With House Appropriations Committee consideration of the FY2011 Labor, Health and Human Services, Education, and Related Agencies around the corner, BIAA is working diligently to secure funding for programs authorized through the TBI Act, as well as for NIDRR’s TBI Model Systems of Care.

Specifically, BIAA and other TBI stakeholders recommend:

• $10 million (+ $4 million) for the Centers for Disease Control and Prevention TBI Registries and Surveillance, Brain Injury Acute Care Guidelines, Prevention and National Public Education/Awareness
• $8 million (+ $1 million) for the Health Resources and Services Administration (HRSA) Federal TBI State Grant Program
• $4 million (+ $1 million) for the HRSA Federal TBI Protection & Advocacy (P&A) Systems Grant Program
• $11 million (+1.5 million) for NIDRR’s TBI Model Systems of care for one new collaborative research project

Based on the requests of the stakeholders, The Congressional Brain Injury Task Force submitted a letter to the House Appropriations Committee on March 12, 2010 to encourage the funding increases necessary to sustain and bolster important research and improve state TBI services and supports.

Also, to supplement the meetings that BIAA and other stakeholders participated in with Appropriations Committee staff in both the House and the Senate, BIAA and NASHIA also facilitated an organizational letter to both appropriations committees with over 70 signers to show nationwide support for this essential funding.

Finally, BIAA submitted official testimony to both the House and the Senate Appropriations Committees to further cement our position.

As the appropriations process moves forward, BIAA will monitor the situation closely and alert grassroots advocates if action is necessary.