Hearing loss in head injury poses a difficult problem—patients are sometimes unaware of their hearing problems because of cognitive impairment, and others may mistake their hearing loss as a memory or communication problem. It has long been known that hearing loss is common in head injury, and yet it is not always properly diagnosed.

Direct damage can occur to the middle and inner ear, or by tearing the neuronal pathways to the auditory areas of the brain. Secondary damage can occur from bleeding and pressure, or from diffuse axonal injury. A recent study of 290 head injury patients was conducted in order to confirm the prevalence and type of hearing loss found after head injury. Patients received a broad range of audiological assessments and the results confirmed that about 30% of the patients suffered from hearing loss. In most patients, the hearing loss was mild.

Even mild hearing loss can be potentially frustrating, not only for the patient but also for family members and rehabilitation specialists. In addition, proper rehabilitation and recovery can be delayed if the hearing loss is mistaken for cognitive impairment. With the relatively high prevalence of hearing loss in head injury confirmed in this study, clinicians should consider adding hearing tests to their battery of assessments for head injury.

Munjal SK, Panda NK, & Pathak A. Audiological deficits after closed head injury. The Journal of Trauma: Injury, Infection, and Critical Care. (January 2010).

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).

Even when the head is not in direct contact with an electrical power source, head injuries can occur by means of an electrical surge to the peripheral nervous system (from contact to an extremity such as arm or leg). Electrical injury survivors often show mental deficits and slowed motor skills as a result of the secondary head injury.

Although the effect of electrical injury on cognitive dysfunction has been well established by research, studies that attempt to pinpoint the specific changes in the brain have been few. In a recent study by medical researchers in Chicago, electrical injury survivors (who did not experience direct electrical contact to the head) performed cognitive and sensorimotor tasks while being assessed for brain activation using functional MRI (fMRI).

When the electrical injury survivors performed these tasks, the fMRI images of their brain showed abnormal activation as compared to healthy participants. The study therefore provided the first evidence of functional and physical changes in the brain corresponding to cognitive and sensorimotor deficits after electrical injury.

Ramati A, Pliskin NH, Keedy S, et al. Alteration in functional brain systems after electrical injury. Journal of Neurotrauma. (October 2009).

Quality of life describes a person’s sense of satisfaction in life and the ability to enjoy normal activities. Spinal cord injury may have tremendous impact on a person’s quality of life in general, and the specific factors that contribute most to quality of life were not previously well known. Additionally, it was not known if a person’s perception of quality of life after the injury changed over time.

Canadian researchers recently conducted a long-term study of quality of life in spinal cord injury survivors. They found a number of factors that significantly predicted the ability to enjoy normal activities: 1) health competence, which describes the ability to find solutions for medical issues such as pain or stress; 2) participation factors, which describe a person’s habits such as nutrition, personal care, or education; and 3) environmental factors, such as physical accessibility, assistive technology, or social support from family and friends.

Although the general perception of quality of life did not change over the long-term, there were two specific factors that predicted short- and long-term quality of life. Mood state (feelings of depression, anxiety, tension, etc) was a significant factor in the few months after the injury, but not in the long term. Family support was not a significant factor of quality of life in the short term, but became significant many months after the injury.

The researchers suggested that, in order to support satisfactory quality of life, interventions should address providing better social support, addressing negative mood states, and improving access to solutions for medical issues.

Mortenson WB, Noreau L, & Miller WC. The relationship between and predictors of quality of life after spinal cord injury at 3 and 15 months after discharge. Spinal Cord. (January 2010).

Women are more likely to be depressed in the early stages of traumatic brain injury.

An article by Michigan researchers in The Journal of Neuroscience Nursing recently reported that women are more likely than men to suffer from depression after traumatic brain injury. Additionally, women are more likely than men to have post-traumatic difficulties with memory, communication, body pains, and control of body movements.

The difference between men and women, however, was only significant within the first 6 months after the injury. After 6 months, there was no difference in the rate of depression between men and women.

Symptoms of depression in the early stages of recovery seem to be related to the amount of stress and pain a brain injury survivor perceives—both of which are more common in women than in men. The exact reasons for this is still unknown, but the researchers suggest that differences in hormones or brain structure could be the cause.

Bay E, Sikorskii A, & Saint-Arnault D. Sex differences in depressive symptoms and their correlates after mild-to-moderate traumatic brain injury. The Journal of Neuroscience Nursing. (December 2009).

In a process that has taken more than 3 years to accomplish, California Brain Injury Association (CALBIA) has arranged for Senate Hearings before the following committees to educate our State Senators about brain injury. Our goal is to secure additional hearings which will lead to the introduction of legislation and address the many health care issues that impact persons with brain injury.

To view the full PDF click here.

On Wednesday, October 28, 2009, House Democrats introduced their consensus health bill, HR 3962, at a rally on the Capitol’s West Front. According to House Majority Leader, Steny Hoyer, the bill could be considered on the House floor as early as November 5,2009The consensus bill prohibits insurance rating based on health status or pre-existing conditions and prohibits annual or lifetime limits on medical spending. It also establishes important consumer protections, including internal and external appeal requirements, provider network adequacy requirements, and greater transparency by insurance companies.

BIAA will continue to monitor the situation closely and alert grassroots advocates if any action is necessary.

This week, the Senate HELP committee continued to mark up a draft health care overhaul bill drafted by its chairman, Sen. Edward Kennedy.

On Wednesday, the HELP committee adopted 20 amendments to the bill that were considered noncontroversial. The amendments were adopted by voice vote.

Sen. Christopher Dodd, who is leading the markup while Kennedy is being treated for brain cancer at home in Massachusetts, said the committee has adopted 240 amendments to the bill thus far.

Pennsylvania motorcyclists suffered large increases in head injury deaths and hospitalizations in the two years following the repeal of its motorcycle helmet law, according to a University of Pittsburgh study. Even after accounting for increases in motorcycle registrations that occurred during this period, study authors noted a 32 percent increase in head injury deaths and a 42 percent increase in head injury-related hospitalizations, raising concerns about motorcyclists’ safety and the impact of this trend on health care costs.

Pennsylvania repealed its universal motorcycle helmet law in 2003. Under the current law, only motorcyclists under 21 and riders with less than two years experience who have not taken a safety course are required to wear helmets.

Study authors analyzed data from Pennsylvania’s departments of Health and Transportation during the years 2001-2002 and 2004-2005. They found helmet use by motorcyclists involved in reported crashes decreased from 82 percent to 58 percent in the two years after repeal.

The authors also looked at data from head injury and non-head injury deaths to determine specifically how many deaths were caused by not wearing helmets. They found the registration-adjusted head injury death rate increased by 32 percent, whereas the non-head injury death rate did not change.

“Our study shows that since the repeal of Pennsylvania’s motorcycle helmet law, helmet use has gone down, while head injuries from motorcycle crashes have gone up, even after increased motorcycle registration,” said Kristen Mertz, M.D., M.P.H., study lead author and assistant professor, Department of Epidemiology, University of Pittsburgh Graduate School of Public Health. “We looked at both head injuries and non-head injuries to get a clearer picture of the impact of the helmet law repeal. The relatively large increase in head injury deaths and hospitalizations after the repeal suggests that the law was protecting riders.”

The study authors looked at hospitalizations per 10,000 registrations from motorcycle crashes by examining discharge data compiled from all acute care hospitals in the state. They found an increase of 42 percent in the head injury hospitalization rate and a 2 percent increase in the non-head injury hospitalization rate. The number of headinjured, hospitalized motorcyclists requiring further care at facilities specializing in rehabilitation and long-term care increased 87 percent after the repeal, and increased 16 percent for non-head injured motorcyclists.

Total acute care hospital charges stemming from motorcycle-related head injuries increased 132 percent in the two years following repeal compared to 69 percent for non-head injuries.

“Our findings strengthen the argument for more comprehensive helmet laws that help protect riders and lower the cost of health care,” said Hank Weiss, Ph.D., M.P.H., study co-author and associate professor, Department of Neurological Surgery, Center for Injury Research and Control, University of Pittsburgh. “Serious head injuries, causing anything from shortterm memory loss, inability to concentrate to coma and death, can severely impact quality of life and affect not just those injured, but their families as well. Until a universal helmet law is reinstated, Pennsylvania needs effective voluntary strategies to increase helmet use.”

Motorcycle helmet laws have weakened nationwide since 1975, when the federal government stopped withholding highway money from states without such regulations. Only 20 states now have laws that require all riders to wear helmets.

BIAA Signs On In Support of National Shaken Baby Syndrome Awareness Week Resolution

BIAA was proud to sign on as a supporter of the National Shaken Baby Syndrome Awareness Week Resolution (S. Res. 518), which passed the Senate on Monday. The Resolution, introduced by Senator Dodd (D-CT), dedicates this week (the week of April 21st through 25th) to raise awareness of Shaken Baby Syndrome and to ultimately eliminate its occurrence.

BIAA was included as a supporter of the resolution in Senator Dodd’s floor statement that was submitted to the Congressional Record when it was introduced on Thursday, April 16, 2008.