On Friday, January 13, 2012, BIAA’s government affairs director along with NASHIA’s lobbyist met with staff representing the National Disability Rights Network to discuss TBI Act reauthorization in 2012. BIAA will continue to work closely with other stakeholders as the reauthorization of the TBI Act moves forward.

AHRQ Reports Open for Public Comment

The Effective Health Care Program, Agency for Healthcare Research and Quality (AHRQ) made available to the public two draft reports that are available for comment. This review is part of a new series of reports on Closing the Quality Gap: Revisiting the State of the Science (hereafter, CQG series).

The report, Multidisciplinary Postacute Rehabilitation for Moderate to Severe Traumatic Brain Injury, is available for public comment until February 9, 2012.

The report, Closing the Quality Gap Series: QI Measurement of Outcomes for People with Disabilities, is available for public comment until February 6, 2012.

I look forward to seeing you all at the Brain Injury Awareness Day on March 21, 2012!

Schedule for March 21, 2012

10:00 AM – 1:00 PM – Brain Injury Awareness Fair, First Floor Foyer of the Rayburn House Office Building

2:30 PM – 4:00 PM – Congressional Briefing, Location to Be Announced

5:30 PM – 7:30 PM – Reception Celebrating Brain Injury Awareness Month, Location to be announced

Other Activities

BIAA

strongly encourages

everyone that plans to attend Brain Injury Awareness Day to make appointments with their Representatives and Senators to advocate for increased funding for the programs authorized through the TBI Act. Please see tips below:

Congressional Appointments

To find House of Representatives information:

www.house.gov, type in zip code to locate your

Representative

. Click on your member’s link for their Web site where you will find their address and phone number.

To find Senate information:

www.senate.gov, select state and view Senators’ individual Web sites for address and phone number.

When calling the main number of the Senator or Representative, ask to meet with the health legislative assistant (House) or the health policy staff (Senate).

• Make sure to let them know that you are a constituent
  • Ask them for a few minutes of their time on March 21, 2012 to discuss the need for increased resources for brain injury programs in their state.

Example:

Hello ______________ my name is ______________________. I am a constituent of yours and will be visiting Capitol Hill on Wednesday, March 21, 2012 as part of Brain Injury Awareness Day. Could I have a few minutes on that day to talk to you about (state’s) brain injury resources and how they affect the brain injury community in your district/state?

Navigating Capitol Hill

If you are coming in from out of town and require a hotel, below you will find a list of accommodations within a few miles of Capitol Hill:

Hyatt Regency, http://washingtonregency.hyatt.com/hyatt/hotels/index.jsp

Courtyard, Marriott, http://www.marriott.com/hotels/travel/wasny-courtyard-washington-capitol-hill-navy-yard

Capitol Hill Suites, http://www.capitolhillsuites.com

Hotel George, http://www.hotelgeorge.com

Marriott, Residence Inn, http://www.marriott.com/hotels/travel/wascp-residence-inn-washington-dc-capitol

A map of the key House and Senate buildings can be found below:

http://www.aoc.gov/cc/cc_map.cfm

BIAA encourages advocates to check with their state brain injury organizations to determine if others from their state will be attending and if so, to coordinate meetings.

BIAA will provide printed maps of the Senate and House buildings as well as easy to follow fact sheets outlining the issues that you will be advocating for in your meetings. Electronic versions will be distributed and posted to BIAA’s website in early March. BIAA will also provide color copies at the Brain Injury Awareness Fair. Please check back for updated information on Brain Injury Awareness Day! If you have any questions or concerns, please contact Amy Colberg at acolberg@biausa.org.

A traumatic brain injury can result in cognitive, emotional, and physical impairments that make the patient more vulnerable to future injury. For instance, cognitive impairments may result in slow decision-making or faulty judgment that can put a person at risk while driving. Emotional impairments may lead to an increased risk of assault-related injury or self-harm. And physical impairments can increase the risk of falls.

In a recent study of veterans, researchers reported that 32% of people with a traumatic brain injury subsequently suffered from another non-fatal injury. Most of these injuries were from falls and car accidents. Assault, burns, and poisoning were less common causes of subsequent injuries.

The specific impairments that contributed the most to subsequent injury were vision loss, hearing loss, speech problems, chronic pain, and depression. Other impairments that were identified as less significant risk factors were balance problems, anxiety, anger problems, and sleep problems.

Carlson KF, Meis LA, Jensen AC, et al. Caregiver reports of subsequent injuries among veterans with traumatic brain injury after discharge from inpatient polytrauma rehabilitation program. Journal of Head Trauma Rehabilitation. (February 2012).

The Brain Injury Association of California (BIACAL) is pleased to sponsor Senate Bill 253, The Brain Injury Access To Treatment Act. SB 253 will enable access to treatment for acquired brain injury across an established continuum of licensed treatment settings specifically designed to provide the most clinically effective and cost efficient specialized treatment for acquired brain injury and to ensure that acquired brain injury as a catastrophic health condition is treated on par with other major medical conditions which have no time limitations. Current rehabilitation provisions are time limited and are intended for orthopedic conditions, rather than neurologic injury. Arbitrary time or cost limitations on neurological rehabilitation are inappropriate and passage of SB 253 will provide opportunities for recovery as observed in individuals like ABC reporter Bob Woodruff and Congresswoman Gabrielle Giffords, who have demonstrated what is possible with proper access to specialized treatment of appropriate timing, duration and intensity.

The Brain Injury Association of California would like to ask for your support by way of writing letters and attending the Senate Health Committee Hearing in Sacramento on Wednesday, January 11, 2012, in State Capitol Room 4203 at 1:30 pm.

Please address letters of support to Senator Michael Rubio at the following address:

Senator Michael Rubio

State Capitol, Room 2066

Sacramento, CA 95814

These support letters are needed by Friday, December 30, 2011. To expedite the receipt of these letters, we ask that you either email or fax the letters to the attention of Mr. Martin Radosevich at martin.radosevich@sen.ca.gov or fax to Mr. Radosevich’s attention at (916) 327-5989. We also request that you send copies of all support letters to Paula Daoutis, Administrative Director of BIACAL via email to pdaoutis@biacal.org or by fax to (661) 873-2508.

Sample support letters can be accessed from BIACAL’s website by clicking on the link to the left. Please edit as appropriate and all Hospitals, Rehab Facilities, Other Treating Facilities, and Organizations should submit letters of support on company letterhead. Individuals are encouraged to insert a paragraph that will highlight struggles to receive appropriate levels of rehabilitation due to the denials of the insurance carriers.

BIACAL wants to stress the importance and urgency of sending these letters of support and with the approaching Holidays, we ask that you send these support letters right away to avoid missing the opportunity to support this legislation.

Please direct any questions to Paula Daoutis at pdaoutis@biacal.org

Laser therapy has been long known to heal wounds, alleviate pain, and reduce inflammation. Low level light therapy (LLLT) is considered to be a “cold” type of laser therapy because it does not emit enough power to produce significant heat—making it safe for use in most people.

More recent research has begun to narrow the science of LLLT into certain wavelengths and sources that provide the greatest benefit to specific diseases.
However, because LLLT must be given at a dosage and source that is very disease-specific to be a benefit, it has been a challenge to produce consistent results. LLLT has therefore remained a somewhat controversial and “alternative” treatment.

A recent review of LLLT has suggested that it should be seriously considered for the treatment of traumatic brain and spinal cord injuries. Animal studies of brain and spinal injury, as well as trials with stroke patients have already shown some benefits from LLLT. Very few effective therapies currently exist for brain and spinal injury, and LLLT has the potential to provide a safe method of reducing inflammation and pain.

Chung H, Dai T, Sharma SK, et al. The nuts and bolts of low-level laser (light) therapy. Annals of Biomedical Engineering. (November 2011).

Student athletes do not usually have the benefit of formal on-site evaluation for concussion. However, student athletes still need to follow removal and return-to-sport guidelines in order to support recovery and prevent further damage.

Researchers recently developed an iPhone app called The Concussion Test, which is available for no charge ancussiot iTunes. The Con Test stores the athlete’s name, demographics, and pre-season baseline cognition scores into a secured database. During the season, if the athlete is concussed, The Concussion Test provides cognitive and balance testing, which is then used against baseline scores to determine if the athlete should return to play or not.

The Concussion test is easy to use, which is important on the field, and comprehensive, which is important when determining return-to-play. It also stores data so that previous concussions can be taken into consideration during the season.

Curaudeau GA, Sharma N, & Rovin RA. Development of an iPhone application for sidelines concussion testing. Neurosurgical Focus. (November 2011).

Essential Benefits Package

On October 7, 2011, the Institute of Medicine (IOM) issued Essential Health Benefits: Balancing Coverage and Costs , a consensus report commissioned by the U.S. Department of Health and Human Services (HHS) for establishing the criteria and methods to define and update the essential health benefits package that will be included in most private health plans offered to individuals and small groups beginning in 2014 as required by the Patient Protection and Affordable Care Act (ACA).

The Brain Injury Association of America (BIAA) will undertake an in-depth analysis of the 300-page report, but our initial review, which is generally positive, indicates the report:

• Includes the Congressional floor statement of Rep. Bill Pascrell, Jr., calling for a broadly based interpretation for the category of rehabilitative and habilitative services and devices, including “items and services used to restore functional capacity, minimize limitations on physical and cognitive functions, and maintain or prevent deterioration of functioning,” one of the few examples of policymaker intent in enacting the ACA.

• Distinguishes between habilitative services, which are designed to help a person first attain a particular function, from rehabilitation services, which are designed to restore function after illness or injury.

• Discusses the definition of medical necessity and recommends that rather than a universal definition, the HHS Secretary provide guidance to states and health plans in which it is emphasized that the treatment be (1) clinically appropriate for the individual patient, (2) based on the best scientific evidence, taking into account the available hierarchy of medical evidence and (3) likely to produce incremental health benefits relative to the next best alternative that justify any added cost, which in some cases may be no treatment at all, but also adding that “Inflexibility in the application of medical necessity, clinical policies, medical management, and limits without consideration of the circumstances of an individual case is undesirable and potentially discriminatory.”

• Gives a recommendation to establish a National Benefits Advisory Council to advise the HHS Secretary on updating the essential benefits through evaluation of the nature of appeals to understand if more specific guidance is required on a particular benefit or service.

Heath care reform has been a centerpiece of BIAA’s public policy efforts for more than two years, with staff and volunteers advocating on a daily basis for inclusion of rehabilitation in the authorizing legislation, conducting meetings and submitting testimony and written comments on numerous regulation proposed under the law, and representing the interests of individuals with brain injury in important forums, including to the National Association of Insurance Commissioners. These efforts have been guided, in part, by technical expertise of veteran lobbyists, Peter Thomas and Bobby Silverstein of Pyles, Powers, Sutter and Verville PC, whose engagement was financially supported by BIAA’s Business & Professional Council.

Please visit the Legislative Prioritiessection of BIAA’s website to links to key documents related to these efforts.

State Insurance Exchanges

On September 26, 2011, BIAA staff acting in the capacity as a consumer representative to the National Association of Insurance Commissioners (NAIC), submitted extensive comments to Health and Human Services Secretary Kathleen Sebelius concerning proposed rules relating to the establishment of state insurance exchanges under the Patient Protection and Affordable Care Act.

In summary, the comments address the operation of a federal exchange in states that opt out; requirements for state exchange governing boards; initial, open and special enrollment periods for exchanges; transparency in coverage; consumer assistance tools and programs; the roles of agents, brokers and navigators within the exchange; and marketing practices of qualified health plans.

A recent case study has been published about a young man who was treated with therapeutic barbiturate coma after a traumatic brain injury. Coma was induced after the patient showed signs of intracranial pressure that did not subside. He remained in the barbiturate coma for three days, with no abnormal lab findings.

When he was brought out of the coma, however, his labs showed a steep rise in potassium and sodium, then a subsequent drop in sodium that is indicative of cerebral salt wasting syndrome. Saline was administered, and he improved within a week.

Cerebral salt wasting syndrome can sometimes occur after traumatic brain injury. But in this case study, the reaction was related to the increased excretion of sodium after termination of barbiturate therapy. Clinicians should therefore be aware of this possibility, especially in traumatic brain injury patients for whom the syndrome is especially critical.

Kontogiorgi M, Opsimoulis P, Diamanti-Kandarakis E, & Karabinis A. Cerebral salt wasting syndrome in traumatic brain injury following therapeutic barbiturate coma. Acta Neurochirurgica. (August 2011).

Dispositional optimism is a personality trait that defines people who tend to expect the best possible outcome of a situation. A recent study looked at the relationship between dispositional optimism and long-term outcomes after a traumatic brain injury.

The results of the study were that those with an optimistic personality, as defined by the Life Orientation Test-Revised, were less likely to experience psychological distress. However, dispositional optimism was not directly associated with cognitive ability or functional outcome. This was surprising, as psychological distress has been associated with cognitive and functional outcomes in past research.

The researchers suggest that dispositional optimism may be a mediating variable for outcome after brain injury—those who experience less psychological distress may eventually have better outcome after their injury. The outcome of study also highlights the fact that patient optimism alone is not enough to predict a positive outcome.

Ramanathan DM, Wardecker BM, Slocomb JE, & Hillary FG. Dispositional optimism and outcome following traumatic brain injury. Brain Injury. (April 2011).

Today, March 2, 2011, USA Today issued a story about access to a continuum of care following brain injury. BIAA contributed to its contents and is pleased by how  accurately USA Today reported the need for individuals who sustain brain injuries to access medically-necessary rehabilitation of sufficient scope, intensity and duration from licensed professionals in accredited settings to regain the physical abilities and cognitive skills needed to live healthy, independent and satisfying lives.

To follow up on the information presented by USA Today, BIAA recommends everyone check their health insurance plan to make sure they’re adequately covered in case of a serious injury. BIAA will continue to urge the U.S. Department of Health and Human Services to consider catastrophic injury in formulating regulations for the essential health benefits package under the Patient Protection and Affordable Care Act.