The release of stress hormones (such as cortisol or norepinephrine) after a traumatic injury can induce stress hyperglycemia. Past research has shown that this state of elevated glucose has been related to increased medical complications and mortality rates.

A recent study from New York verified that serum glucose levels were useful in distinguishing major from minor traumatic injury at admission. Stress hyperglycemia was a sensitive predictor for major injury (just as sensitive as base deficit or lactate), suggesting that appropriate treatment could be administered earlier. In the early stages of traumatic brain injury, when complications such as secondary brain injury can quickly lead to further damage or death, a reliable diagnosis is critical. Glucose level is a potentially sensitive indicator of major injury that should be considered at admission.

Paladino L, Subramanian RA, Nabors S, Bhadwaj S, & Sinert R. Triage hyperglycemia as a prognostic indicator of major trauma. The Journal of Trauma: Injury, Infection, and Critical Care. (April 2010).

On Thursday, April 22, 2010, the Senate cleared an omnibus veterans’ health care measure that provides important assistance to both veterans and caregivers. S. 1963, as modified by the House, includes nearly $1.6 billion in authorizations for programs designed to aid caregivers of eligible veterans.

The measure, which now goes to the White House for President Obama’s signature, is intended to strengthen the health care support system for veterans and to expand services in rural areas. The measure will also expand caregiver programs, making them eligible for training and education assistance.

The bill also authorizes VA hospitals to contract with non-VA providers, as stated in the bill:

“The Secretary may contract with appropriate entities to provide specialized residential care and rehabilitation services to a veteran of Operation Enduring Freedom or Operation Iraqi Freedom who the Secretary determines suffers from a traumatic brain injury…”

Both BIAA and the Wounded Warrior Project have long advocated for approval of this measure and yesterday’s final passage signified a great victory for service members who suffer from TBI and their families.

Health Care Reform Update

After several weeks of delving into the final text of the health care reform bill, our partners at Powers, Pyles, Sutter & Verville, PC, sponsored by BIAA’s Business and Professional Council, have prepared an analysis http://www.biausa.org/elements/policy/2010/hcr_anayliticalmemo.pdf of the major provisions that impact our community.

BIAA will continue to work to identify and advocate for favorable regulations to ensure access to brain injury care as the process moves forward.

On Thursday, April 22, 2010, the Senate cleared an omnibus veterans’ health care measure that provides important assistance to both veterans and caregivers.  S. 1963, as modified by the House, includes nearly $1.6 billion in authorizations for programs designed to aid caregivers of eligible veterans.

The measure, which now goes to the White House for President Obama’s signature, is intended to strengthen the health care support system for veterans and to expand services in rural areas. The measure will also expand caregiver programs, making them eligible for training and education assistance.

The bill also authorizes VA hospitals to contract with non-VA providers, as stated in the bill:

“The Secretary may contract with appropriate entities to provide specialized residential care and rehabilitation services to a veteran of Operation Enduring Freedom or Operation Iraqi Freedom who the Secretary determines suffers from a traumatic brain injury…”

Both BIAA and the Wounded Warrior Project have long advocated for approval of this measure and yesterday’s final passage signified a great victory for service members who suffer from TBI and their families.

Health Care Reform Update

After several weeks of delving into the final text of the health care reform bill, our partners at Powers,  Pyles, Sutter & Verville, PC, sponsored by BIAA’s Business and Professional Council, have prepared an analysis of the major provisions that impact our community.

BIAA will continue to work to identify and advocate for favorable regulations to ensure access to brain injury care as the process moves forward.

It is estimated that nearly one-quarter of deployed service members have sustained a traumatic brain injury, with mild brain injury being the most diagnosed severity. A short screening assessment that is given to service members after deployment has been used to identify the presence of mild traumatic brain injury, and has helped to identify many injured individuals. However, it has not been effective at singling out symptoms from brain injury when there is a potential for post-traumatic stress, pre-existing psychological conditions such as depression, or other co-morbid symptoms such as insomnia or pain. And this has become a challenge for military researchers and clinicians.

The challenges of screening for mild traumatic brain injury in the military are similar to the challenges found in the civilian population. Dr. Grant Iverson, a member of the Defense Health Board, recently recommended some changes to the military screening assessment. Some of his recommendations are also applicable to the civilian population.

For example, loss of consciousness is impossible to verify or quantify unless there was a witness to the event. Another screening item that asks whether an individual was “dazed or confused,” is problematic because it fails to determine if the confusion came from a concussion, stress, or other physical injury.

With many millions of dollars currently being spent on military-related traumatic brain injury research, it would be wise for civilian researchers, clinicians, and other professionals to follow and adapt to any updates in military screening and diagnostic practices.

Iverson GL. Clinical and methodological challenges with assessing mild traumatic brain injury in the military. Journal of Head Trauma Rehabilitation. (April 2010).

The House of Representatives is set to vote on the Senate health care reform bill at the end of this week. If the measure fails, the hope of health care reform will likely vanish for this year and maybe even for years to come.

Even though the House and Senate have both passed their versions of health care reform, the only way forward for the bill is for the House to approve the Senate version.

Your voice matters now more than ever. Call TOLL FREE 1-888-876-6242, if you don’t know who your representative is, click here.

Tell your representative that you are a constituent that is concerned about health care reform. Specifically, people that have sustained brain injuries need health care reform because:

• Millions with health insurance are now at the mercy of insurance companies that charge premiums beyond affordability. The legislation would limit these increases.
• Many with insurance find that it won’t cover them when they get sick – even after they have paid premiums for years. The legislation will ban denials based on pre-existing conditions in children and adults.
• Patients who reach their lifetime insurance cap after a catastrophic injury or illness will be able to continue treatment in order to regain functionality and have a better chance of returning to work or school. The bill will eliminate lifetime insurance limits.

AND…

Investing money now will save the government millions of dollars later when the private insurance companies are required to take responsibility for the premiums they collect instead of turning individuals facing catastrophic injury or illness away to rely on public plans and ultimately, the American taxpayers.

Some representatives in the House are debating on whether to vote for or against the bill. Regardless of how they voted in the past, many are still waying their options. This measure is vital to the brain injury community, and we need your help to ensure that people with brain injury gain access to the care that they need and deserve! CALL NOW!

Health care reform at the federal level is officially on hold. Republican Scott Brown gained the Massachusetts seat vacated by the death of Edward Kennedy, thereby breaking the 60-vote majority in the Senate. Democrats met privately in the days following the Massachusetts special election but were unable to cultivate a strategy for moving forward at this time. A six (Bweek break is planned, and it is likely policymakers will be forced to accept a substantially scaled (Bback package or abandon health care reform altogether.

The Brain Injury Association of America is deeply disappointed. Through our partnership with the Brain Injury Business & Professional Council, we made important gains in the proposed legislation. We cannot forgo this progress; we cannot quit now. We will continue to fight for access to the full continuum of brain injury treatment.

On January 24, 2010, Dateline NBC aired the compelling story of Patrick Gannon, a man who battled a severe anoxic brain injury and was then forced to wage war against his insurance company. The Dateline story accurately portrays how the health care system victimizes patients and families when they are most vulnerable.

I urge brain injury advocates everywhere to watch Patrick (Bs story and then write to Ann Curry, Dateline correspondent, to thank her for bringing national attention to the extraordinary challenges individuals with brain injury and their families face. I urge advocates to share their own stories with Ms. Curry and ask that she continue to educate the public about the rehabilitation needs of people with brain injury after their lives have been saved. Please address your letters to:

Ms. Ann Curry
Dateline / NBC News
30 Rockefeller Center, Studio 3B
New York, NY 10012

E-mail: Dateline@NBCUNI.com

Once you (Bve written your letter (and sent copies to your legislators and BIAA), I ask that you share the Dateline story with friends and neighbors and that you encourage them to spread the story to others. With your help, we can tell the public that a brain injury can happen to anyone at anytime and that having insurance doesn (Bt mean you(Bre covered!

Very truly yours,

Susan H. Connors
President/CEO

Please send copies of your letters to your state and federal legislators and to me at BIAA Bs address!

Brain Injury Association of America

1608 Spring Hill Road, Suite 110
Vienna, VA 22182

Complete spinal cord injuries do not often occur in professional sports, but they can produce devastating results when they do. Although the primary injury is serious, a substantial amount of damage occurs during the secondary response to the injury. Much research has focused on reducing this secondary response, by slowing inflammation, cell death, or bleeding.

One treatment that has been proven useful in reducing secondary damage in traumatic brain injury and stroke is hypothermia, or the cooling of body temperature. A well-timed treatment of hypothermia can lower metabolic demands, which helps to decrease inflammation and cell death—hopefully to stop further damage and aid in recovery.

A medical team recently reported a case study of an NFL football player who sustained a spinal injury during a helmet-to-helmet hit. The player had complete paralysis and sensory loss below the clavicles at his initial evaluation. His medical team applied a moderate hypothermia treatment during his ambulance ride, which was continued throughout his standard treatment.

Within 3 days, the player was showing considerable motor and sensory improvement, and continued to improve even after his subsequent discharge. Although the researchers noted that it was difficult to evaluate the amount of recovery directly related to the systemic hypothermia, they believe the treatment was a valuable one.

Cappuccino A, Bisson LJ, Carpenter B, et al. The use of systemic hypothermia for the treatment of an acute cervical spinal cord injury in a professional football player. Spine. (January 2010).

Power outages can continue for several days after a disastrous storm. Many people who live in hurricane-prone areas prepare their household by keeping a portable generator on hand to maintain refrigeration and air temperature, or for powering electronic or entertainment devices. However, improper use of these generators can lead to an increased risk of carbon monoxide poisoning.

A recent study analyzed the number of people exposed to carbon monoxide after Hurricane Ike hit Texas in 2008. By compiling data from poison center calls, emergency room visits, hyperbaric oxygen treatments, and deaths that occurred as a result of carbon monoxide exposure after the hurricane, the researchers estimated that as much as 82-87% of storm-related carbon monoxide exposures were the result of improper generator use.

Carbon monoxide exposure can cause symptoms such as headaches, dizziness, and nausea. Increased exposure can lead to death. But carbon monoxide poisoning can also lead to long-term negative effects such as memory impairment and attention problems as a result of the significant reduction of oxygen to the brain. The memory centers of the brain, such as the hippocampus, are particularly vulnerable to carbon monoxide, and can be permanently damaged during exposure.

The CDC recommends that, to reduce the number of carbon monoxide poisonings and deaths, prevention tips for proper generator use need to be widely broadcast before and during storms.

Centers for Disease Control and Prevention (CDC). Carbon monoxide exposures after Hurricane Ike—Texas, September 2008. As reprinted in the Journal of the American Medical Association. (January 2010).

After being favorably reported out of the Senate Veterans Affairs committee last week, the full Senate plans to consider S. 252, the Veterans Health Care Authorization Act of 2009 in the coming days.

Among other things, the legislation authorizes the Department of Veterans Affairs (VA) to provide care to veterans with traumatic brain injury through contracts with non-VA providers when necessary.

BIAA strongly supports this legislation as it is vital to ensuring our returning service members suffering from traumatic brain injury get access to the care that they so desperately need and deserve.

If you have not taken action on this issue and would like to get involved, click on the link below for action alert instructions.

http://capwiz.com/bia/home/

This week, the House began debating their draft Health Care Reform bill that was developed by the chairmen of the three committees of jurisdiction.

Both the Energy and Commerce and Education and Labor committees held public hearings on the measure Tuesday. The hearings covered the gamut of health policy issues under debate in Congress at the moment, including the merits of creating a government-run insurance plan to compete with private insurers, how to finance an overhaul and how to protect doctor-patient relationships.

Importantly, the draft bill includes Rehabilitative services as part of the minimum benefits package and does not impose annual or lifetime limits on coverage.