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!

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).

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.)

It has been considered unlikely that a person in a vegetative state will regain consciousness beyond 12 months after a traumatic brain injury or 3 months after an anoxic or hemorrhagic injury.

However, ongoing improvements in both research methodology and medical intervention may be changing this way of thinking. A recent study of long-term vegetative state patients showed that 20% recovered responsiveness after 12 months, and 12% of those further progressed to regain consciousness. This recovery was associated strongly with younger age and occurred more often in traumatic brain injury, rather than anoxic or hemorrhagic.

Unfortunately, although responsiveness and consciousness can be recovered in some cases of vegetative state, it is also associated with severe functional impairments. Still, that the recovery rates were unexpectedly high in this study is an issue with ethical implications that should be addressed by medical and legal professionals.

Estraneo A, Moretta P, Loreto V, et al. Late recovery after traumatic, anoxic, or hemorrhagic long-lasting vegetative state. Neurology. (July 2010).

Dear Advocates,

As many of you know, the House of Representatives passed a historic health care overhaul package late Sunday that marks one of the biggest victories in the history of the Brain Injury Association and for people affected by brain injury across the country.  BIAA advocated tirelessly for more than a year to ensure that people with brain injury gain access to the care that they need.

Specifically, the measure:

Coverage

• Prohibits private health insurance exclusions for pre-existing conditions.
• Eliminates annual and lifetime insurance limits or “caps” in private insurance policies.
• Restricts the consideration of health status in setting premiums.

Benefits

• Ensures that minimum covered benefits include products and services that enable people with brain injury to maintain and improve function, such as rehabilitation and habilitative services and devices. BIAA, along with our Business and Professional Council, and assisted by Powers, Pyles, Sutter & Verville, PC was the driving force in ensuring that rehabilitation was listed as a minimum benefit in this bill.  Originally, when the bill was made public, rehabilitation was not listed as a minimum benefit.

Long Term Services and Supports

• The Community Living Assistance Services and Supports (CLASS) Act creates a national long term services insurance program which assists eligible individuals and their families to meet long term needs with a cash benefit and without forcing them into poverty to receive Medicaid benefits.
• The Community First Choice Option helps to eliminate institutional bias by encouraging  states to cover personal attendant services under the state’s optional service plan instead of through the waiver system by offering a 6% increase in the federal share of Medicaid for these services.

It is also important to note that, as part of the debate, Congressman Bill Pascrell, Jr., co-chairman of the Congressional Brain Injury Task Force, submitted a statement for the record detailing his understanding of the intent of the bill with regards to coverage of the treatment continuum for people with brain injury.  BIAA thanks him for his hard work and dedication to this important issue.

Along with passing the Senate bill, House Democrats also approved a reconciliation bill that reflects negotiations reached by congressional Democrats and the White House to modify the version earlier passed by the Senate.  This would be a “fix” that would eliminate the special deals given to certain states in return for Senate votes as the bill was passed by the Senate in December.

The Senate is expected to take up the bill as early as Tuesday under special budget reconciliation rules that will shield it from filibusters.  BIAA will continue to monitor the situation closely as consideration concludes.

Finally, BIAA would like to recognize the grassroots advocates that have truly made a difference in advocating for this historic legislation.  Thank you to everyone who invested so much of their time to push this forward!

This year’s House version of the FY2011 Defense Authorization Act (HR 5136) will go to conference with two amendments addressing the problem of faulty brain injury screening in which the military has been under fire because of in recent reports.

Congresswoman Mary Fallin of Oklahoma offered an amendment to the bill that was adopted stating that no later than September 30, 2011, the Secretary of Defense, in coordination with the Secretary of Veterans Affairs, shall develop and implement a comprehensive policy on pre- and post-deployment neurocognitive assessment.

Also, assisted by BIAA and NASHIA, Congressman Bill Pascrell, Jr., co-chairman of the Congressional Brain Injury Task Force, offered a complimentary amendment that was later adopted detailing that until a comprehensive screening policy is implemented, the Defense Department must use the same cognitive screening tool for both pre-deployment and post-deployment screening in order to compare new data to previous baseline data for the purposes of detecting brain injury.

BIAA is hopeful that these provisions will remain in the bill as conference discussions continue.  We will monitor the situation closely and alert grassroots advocates if any action becomes necessary.

Last week, the Health and Human Services (HHS) department asked for public comments regarding their draft strategic framework on multiple chronic conditions (MCC).  The framework addresses approaches to improving the health of individuals with concurrent MCC by providing options for HHS to strengthen coordination of its efforts internally and collaboration with stakeholders externally.

BIAA submitted a document detailing the concern that the draft framework does not include TBI in the list of conditions that constitute concurrent multiple chronic conditions.  BIAA argued that because brain injury has been linked to epilepsy, Parkinson’s and Alzheimer’s disease and that  individuals with brain injury manifest neurologic, neuroendocrine and psychiatric disorders as well as cardiovascular, musculoskeletal, gastrointestinal, urologic and sexual dysfunction it absolutely should be addressed in the framework.

BIAA will continue to advocate for its inclusion and will update grassroots advocates on our progress.

Last week, Senate Democrats came four votes short of invoking cloture on the tax extenders bill that includes the extension of increased federal Medicaid monies through June, 2011. After passing a Medicare physicians’ payment bill on its own instead of as a part of the larger extender package, Senator Max Baucus is encouraged that the larger bill still has the support and momentum  needed for approval. The bill is expected to be considered in the Senate this week.

BIAA will continue to monitor the situation closely.  If you haven’t taken action on this alert, it’s not too late!

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‐week break is planned, and it is likely policymakers will be forced to accept a substantially scaled‐back 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’s 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’ve 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’t mean you’re 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’s address!

Brain Injury Association of America

1608 Spring Hill Road, Suite 110
Vienna, VA  22182