Long-term studies of specific injuries, their interventions, and their outcomes help to help to identify trends, recognize potential therapeutic problems, and direct future guidelines of care. Such a study was recently conducted in Canada in order to determine the characteristics, trends, and potential predictors of spinal trauma and its associated injuries.

The most significant results of their studies were as follows:

1. Traumatic spinal injury admissions have tripled over the last 20 years. In addition to the possibility of an increased number of trauma patients, this finding could also be due to changes in admission criteria.
2. Patients with traumatic spinal injury have become almost a decade older over the last 20 years. This increase could be due to an increased risk of falling in older people, but it could also mean a decreased risk of injury in younger people due to better injury prevention.
3. Traumatic spinal cord injury has decreased over the last 20 years. This could be a result of better injury prevention.
4. Falling and violence have become increasingly frequent contributing factors of spinal and spinal cord injuries. The increasing age of patients may contribute to incidence of falling.
5. Motor vehicle accidents have consistently been the most frequent cause of injury.
6. Length of stay in the hospital has decreased by 40% in the last 20 years, from a median of 24 to 14 days.
7. Fatality rates from a spinal or spinal cord injury have not changed over the last 20 years.
8. The presence of a spinal cord injury is not associated with an increased rate of fatality.

Pirouzmand F. Epidemiological trends of spine and spinal cord injuries in the largest Canadian adult trauma center from 1986 to 2006. Journal of Neurosurgery: Spine. (February 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).

In 1997, Texas implemented a law that made motorcycle helmets optional for motorcycle operators and passengers (age 21 or older). Past research, however, has consistently shown that wearing a protective helmet during a motorcycle accident increases survival rates and decreases the chance of brain injury and fatality.

This year, a research report from the University of Arkansas outlined the trends of helmet use and fatal injuries after the 1997 Texas Motorcycle Helmet Law was passed. Three major findings were associated with this law:

1. Once motorcycle helmet use became optional, fewer people wore helmets.
2. Subsequently, there was a significant increase in motorcycle fatalities.
3. The law had a negative overall effect on road safety.

As of 2009, only 20 states require all motorcyclists to wear a helmet. Only 27 states require young riders to wear a helmet. Although research has shown that a universal motorcycle helmet law would most certainly increase helmet use and decrease injury or fatality, such a law has been met with resistance by many state legislatures.

Given that motorcycle accidents can cause very severe head injuries (such as the recent case study of an un-helmeted motorcyclist who collided so violently with another un-helmeted motorcyclist’s head that three of his teeth penetrated the other’s brain), the case for passing a universal helmet law is solid and timely.

Bavon A & Standerfer C. The effect of the 1997 Texas motorcycle helmet law on motorcycle crash fatalities. Southern Medical Journal. (January 2010).

Houston DJ. The case for universal motorcycle helmet laws. Southern Medical Journal. (January 2010).

Singh D, Gupta V, Kataria R, et al. An unusual presentation of head injury: Teeth in brain. Turkish Neurosurgery. (January 2010).

The Senate Finance Committee, whose members have been negotiating a bipartisan proposal behind the scenes this week left Thursday for the July Fourth recess without a deal, although Senate Finance Chairman Max Baucus said he has developed policy to pay for legislation that would cost less than $1 trillion over 10 years.

According to Congressional Quarterly, Baucus said the bill’s cost would be offset, in part, by taxing some employer-sponsored health benefits, something that makes the White House and many lawmakers in both parties uneasy. Nonetheless, limiting the bill’s spending to $1 trillion is a significant step for the Finance Committee, which has been seen as the main arena for those hoping to get a bipartisan health care bill.

This week, BIAA submitted comments to the National Institute on Disability and Rehabilitation Research (NIDRR) specifically regarding the fourth priority included in the proposed plan for the Rehabilitation Research and Training Centers (RRTCs) entitled, “Developing Strategies to Foster Community Integration and Participation for Individuals with Traumatic Brain Injury.”

BIAA expressed strong support for the inclusion of a brain injury related research priority. However, BIAA also detailed some concerns related to the strategies used in the priority to foster community integration and participation for affected individuals. As proposed, this priority would develop a classification system based on symptoms experienced by individuals with TBI who are living in the community.

BIAA explained that no two brains are alike and each and every individual presents with different symptoms, and each injury results in different challenges. Therefore, trying to categorize these injuries could be counterproductive to the priority’s goal.

BIAA also suggested several suggestions in lieu of a categorization strategy. For further reading, the full text will be posted on BIAA’s web site shortly.

After I learned again to walk and talk, I broke windows, frustrated because words wouldn’t dislodge from my fractured brain. I put my fist through any type of glass, including a tough–to-break telephone booth. But my memory is weak on these points, even with my emotionally-challenged discovery of drawings and poetry, which I apparently had dictated to someone else long ago as evidenced by my words written in an unknown legible hand. I don’t recognize numerous scribbles of thin suggestions scrawled across aged paper.

Eventually I wrote my own poems, beginning in an immature block awkward print. I was lost inside my drawings, as the one above, being deathly focused on each intricate detail. A leaf, tree bark, a flower or a blade of grass was how I sailed away from my pain. Years later, medical evaluations measured my academic performance level around fourth grade. I was twenty-seven then. I found myself also dealing with a common result of Traumatic Brain Injury, that of anger, which is a cause of incarceration, broken families, domestic abuse or an increase in public violence. Like many others suffering with Traumatic Brain Injury, anger is both our savior and curse, one arrives with bells on to chase our heads with bolts of energy such as motivation, false courage, and determination, while the other offers an explosive additive to fuel a weakened neurologic system. With the bridge washed out and streetlights gone with a zap, anger delivered more salt in the wound, which pain led to dying.

One memory of how anger sped me along a path of death felt like an artery burst at one hundred miles per hour riding flat-lined on my Yamaha RD 400, which was akin to straddling a stick of dynamite; I was the match! This tenacious effort to drive “TBI” out of my life failed by my living, couldn’t kill it without killing me. Matter-a-fact, I kept living so there’s something to that. You keep living too! Once a Highway Patrol Officer pulled me over on my motorcycle near the University of California, Santa Barbara. Upon orders, I tried to remove my helmet but it was stuck like a cord in a tight socket. Pulling the helmet off finally released a long mane of blonde hair. In the dark stood an obedient-to-theauthority, lanky butch. He stared a minute, then broke into song, “Oh my God you’re a girl! Oh my God. What are you doing riding like that? I have a daughter your age!” He shrieked upon seeing his first butch, defined then as those women who ride motorcycles bravely tipping fate at higher speeds. Upon a milder voice, of course, he expected a guy.

“Guys are stupid and suicidal, not girls.” He obviously didn’t know any brain damaged ones! I stood silent taking my carving to the core like a tough “boy,” wondering what was next. Arrest? I thought to myself, I had something to kill inside, My loss of life; My pain; My rage; My disorientation; My future; My dreams, that another would live, not me! My mind turned back to what he was saying, still standing at attention, is that he cared! That two-stroke motorcycle was my instrument of expression and I did have a lot to say!

After the car accident my father and two older brothers left us like trash thrown out a car window, to be blown away quietly alongside a highway, or if lucky, we’d survive the repeated run-overs. My mother and I formed a bond surviving repeated run-overs, struggling through our lives minus a father’s child support or alimony. We lived in poverty. The car accident that brought hell on the wind happened July 7th on Highway 46, a desolate and dehydrated country road made famous in 1955 by James Dean’s tragic death in a car crash with his mechanic Rolf surviving. Like Dean’s fate, someone died in my crash. I was thrown out of a roadster onto the highway at high speeds, directly on my head. I was seventeen years old then and I will never know now who I would have been, but for the accident. Nor will Rodney’s parents know whether their son would’ve ever changed his life from where it was going with drugs at the time, because I took that. I was the driver who survived! That haunts me at my emotional center, it is hidden in everything I am. Where enormous guilt pushes my hand to scribbling poetry, to rid the angst punching against my insides, banging outward to express hell. It was the beauty of poetry written by others that drew me back to living. It was the area of my brain that stayed intact for the journey home. Where pain and sorrow could romp and spill freely from a split-gut. Where I could feel love and romance made-up, fantasized, unreal. Pen to paper over my senses of being alive. Quivering, beneath the surface buzzing through the silence of redwood trees on a sunny day. I was living. I created a world I could bear to acknowledge through poetry. A world, in which I would recover my self, not the dark hole thought to be me. A remanufactured self, but nonetheless a person, to eventually find great love and passion transformed through literature.

Poetry penetrated a brain that no longer sensed or connected with “real” pain. As a reminder, I’d put cigarettes out on the back of my hand. Done during recess in the yard, mingling with other locked-up psych ward crazies. Yes there are scars. But I never winced. I didn’t feel pain. I felt poetry. When I watched my skin smoke it was no more upsetting than the news of the day. Burning my flesh, I imagined a glowing dot pulling me in. A lava-colored transparent red windowpane opened to my soul, just smoldering. Then one day, I jumped back from the burning, the practice was over. I not only didn’t want pain, but I could feel it as the cigarette came within closer proximity. I was a miserable heap of someone who had no past, no present, and certainly no future. I was the question mark!

Yet, poetry reached me, keeping me from falling through the red-stained window. Love and romance fed my desire to feel anything good about living. As if “future” were an item one could win or buy from surviving battle like a powerful winged, flying dragon swooping over the forest, or the mightiest sword pulled from the stone, waiting years for its master’s strength. I would discover through monumental pain and suffering, a steady private romancing of my soul. The heart center of my brain romantically revived my body, shuttering it to the living. “Something” feeling painfully good, that could hold my feet to the ground while propelling me upward, to climb hope’s highest mountain as the writer and poet emerged. The broken comes to the page with desperate dreams in hand.

After my accident my brain was completely disconnected like a severed ventricle, the ends sanded clean of any association of the other before seventeen. In the last photo of me, I am standing in front of a wire fence in a public park. I look at the photo now to see a young girl, one who died suddenly in a crash. That one I don’t know? My childhood recollections are spotty where memories are held in conflict. It is the remake of any great movie. The script begins at the computer screen, blank of course. If you are reading this book you are part of my dream so welcome to my succeeding against trauma that devoured years of my life. This work is for those who faithfully survive life’s crippling effects of disability. It is for those of us who dare to scale hope’s mountain while broken, to kneel before her majestic heights unafraid. One step at a time keeps your eye on the peak!

This week, BIAA submitted testimony to the House and Senate Appropriations Committees, Subcommittees on Labor, Health and Human Services, Education and Related Agencies.

http://www.biausa.org/

The testimony detailed the importance of appropriating $37 million to preserve and advance TBI Act Programs, as well as the need to designate $13.3 to sustain and bolster health and function research — including the TBI Model Systems of Care, Rehabilitation, Research & Training Centers; and field-initiated investigations—within the National Institute on Disability and Rehabilitation Research (NIDRR).

This week, the House and Senate have agreed on a tentative deal on major elements of the fiscal year 2010 budget resolution which includes fast-track procedures for healthcare reform, but would cut $10 billion from the President’s discretionary spending request.

The negotiators plan to hold a formal conference committee meeting next week. In the mean time, behind-the-scenes negotiations will continue today and through the weekend. According to CQ, democratic leaders would like to have the final budget adopted next week as President Obama marks his first 100 days in office.

BIAA will continue to monitor the situation as the Appropriations process moves forward.

On Tuesday, February 24, 2009, President Obama addressed Congress and the Nation to announce an overall plan to spend $634 billion on healthcare reform.

The President’s address simply provided a general overview of his budget that will be released in its entirety later this spring. Given that this was just an overview, no specific traumatic brain injury funding levels were released, however, BIAA will continue to monitor the situation this spring when the full detailed budget is presented.

On February 25, the House passed the FY 2009 omnibus spending bill covering the Department of Health and Human Services, the Department of Labor, and the Department of Education. These agencies are currently being funded at 2008 levels under a continuing resolution that is set to expire on March 6, 2009. The Senate is expected to consider the bill this week.

Department of Education

The FY09 omnibus bill allocates nearly $108 million for the National Institute on Disability and Rehabilitation Research (NIDRR) which supports disability research, demonstration projects, and related activities for individuals with disabilities.

The bill includes language directing the increase in funding to be used to restore the number of rehabilitation research and training centers (RRTCs) focusing on issues of traumatic brain injury, arthritis, neuromuscular disease and spinal cord injury.

Centers for Disease Control (CDC)

As a component of the TBI Act, the line item specification in the omnibus legislation allocates $6.137 Million for CDC, an increase of $428,000 from Fiscal Year 2008.

National Institute of Health (NIH)

The omnibus bill provides just over $30 billion for the National Institutes of Health (NIH), over $1 billion more than the budget request, and the first time the agency’s one year budget has exceeded $30 billion. After accounting for this increase and the additional temporary funding in the recent stimulus legislation, NIH will have $11 billion over their existing budget to spend over the next two years.

The NIH has reported that this influx of funds will allow the agency to capitalize on unprecedented scientific opportunities with almost 10,600 new research grants. Before this infusion, funding for NIH projects had been at critically low levels.

Most importantly, the bill provides nearly $1.6 billion for the National Institute of Neurological Disorders and Stroke, $52 million more than the 2008 level.

(Pyles, Powers, Sutter, & Verville appropriations memo, February 26, 2009)

Health Resources and Services Administration (HRSA)

Another component of the TBI Act funding, HRSA State Grants for TBI and Traumatic Brain Injury Protection and Advocacy Services, together received nearly $9.9 million, an increase of about $1.1 million dollars from last year. It is unclear at this point the allocation for each component.

Social Security Administration

To address the mounting backlog of disability claims at the Social Security Administration, improve claims processing times, and support field offices, the bill provides $10.5 billion to combat these pitfalls.

(Pyles, Powers, Sutter, & Verville appropriations memo, February 26, 2009)