People who lead a sedentary lifestyle are prone to cardiovascular disease, osteoporosis, colon cancer, glucose intolerance, and depression—among other disorders. People with a traumatic brain injury often lead a sedentary lifestyle because of motor impairment and cognitive dysfunction, but have an additional detriment of a decreased aerobic capacity—running on as little as 64% of normal.

Research shows that sedentary people who participate in a formal exercise intervention (rather than a simple increase in activity) will decrease their risk of developing disease. Very few studies have been performed with traumatic brain injury survivors. However, a recent research review has shown that those few studies do support an intervention of endurance training.

The following guidelines were recommended for creating a safe and effective cardiorespiratory and endurance training program for people with traumatic brain injury:

1. The exercise should be low-resistance, rhythmic, and dynamic (varied such as walking, jogging, cycling, etc).
2. The intensity of training should somewhere between 60-90% of age-predicted maximal heart rate (normally 220 minus age).
3. The duration should be no more than 20-40 minutes per session (depending on individual).
4. The frequency should be no more than 3-4 times per week.

Mossberg KA, Amonette WE, & Masel BE. Endurance training and cardiorespiratory conditioning after traumatic brain injury. Journal of Head Trauma Rehabilitation. (May 2010).

Diffuse axonal injury (DAI) describes damage to the axon of a neuron. Axons are covered in white, fatty matter that helps to quickly relay messages back and forth, and the major region of the brain that is dense with this white matter is called the corpus callosum. As such, the corpus callosum is the most vulnerable to damage from DAI.

Recently, a team of UCLA researchers studied the long-term effects of injury to the corpus callosum in pediatric brain injury patients, as well as the correlation of injury to cognitive functioning. They found that there were structural and metabolic differences in the corpus callosum between the acute and chronic stages of injury. These metabolic changes could be related to the energy used during neural repair, or from changes due to permanent cell death. Furthermore, metabolic dysfunction and structural damage seen in the corpus callosum after DAI was associated with declines in cognitive functioning.

The preliminary results of this study contribute to the understanding of how metabolic and structural changes might develop long-term in cases of pediatric traumatic brain injury. Although future studies may pinpoint the exact time course of these changes, it is important to acknowledge that degeneration of the corpus callosum may continue long after the initial injury.

Babikian T, Marion SD, Copeland S, Alger JR, et al. Metabolic levels in the corpus callosum and their structural and behavioral correlates after moderate to severe pediatric TBI. Journal of Neurotrauma. (March 2010).

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

Hormonal problems caused by damage to the pituitary gland are considered common in traumatic brain injury. However, reports of rates of pituitary gland impairment after traumatic brain injury have varied from 15-90%. Researchers from the Netherlands recently suggested that this variation could be due to differences in diagnostic criteria, in the type of tests given, in the severity of the injury, or even in the time of day the test is given. They reviewed data from 931 patients to determine what exactly created such discrepancies.

Several factors were found that could lead to misdiagnosis of endocrine problems after traumatic brain injury. For instance, body mass index could affect rates of growth hormone insufficiency. The age of a woman could affect levels of LH and FSH levels. The amount of time after injury also made a difference in diagnosis. Several studies used different sets of cutoff rates and diagnostic guidelines.

Given that there may be a high incidence of pituitary-related hormonal problems after traumatic brain injury, and that these problems may contribute to poor recovery, it is important that clinicians carefully consider all the potential factors that could lead to a misdiagnosis. Additionally, tests and diagnostic guidelines should be reviewed to ensure they are sensitive and reliable.

Kokshoorn NE, Wassenaar MJE, Biermasz NR, et al. Hypopituitarism following traumatic brain injury: Prevalence is affected by the use of different dynamic tests and different normal values. European Journal of Endocrinology. (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).

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).

On Wednesday, October 7, 2009, the House and Senate Armed Services Committees announced that they had reached an agreement on a conference report to H.R. 2647, the Fiscal Year 2010 National Defense Authorization Act.

In a major victory for the brain injury community, the report included an amendment that authorizes the Secretary of Defense to carry out a pilot program for providing cognitive rehabilitation therapy services under TRICARE. BIAA worked with the Congressional Brain Injury Task Force to preserve its status as part of the final conference report. We are thrilled to have contributed to this important step towards providing better access to care for returning service members.

A link to the full text of the amendment can be found below:

http://www.biausa.org/elements/policy/cognitive_rehabilitation_ndaa_letter.pdf

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.

As reported by CQ, President Obama nominated Democratic Gov. Kathleen Sebelius of Kansas as secretary of Health and Human Services. No confirmation hearing has been scheduled yet, but Sebelius will eventually go before the Senate Finance Committee. BIAA will continue to monitor this nomination.

In response to the tragic death of Montclair High School’s Ryne Dougherty, U.S. Rep. Bill Pascrell, Jr. (D-NJ), the co-founder and co-chairman of the Congressional Brain Injury Task Force yesterday introduced legislation in the House of Representatives to help schools better protect student athletes from brain injuries.

The legislation, called the Concussion Treatment and Care Tools (ConTACT) Act, will authorize federal grants to states to be used to help schools invest in concussion screening technology and adopt better concussion management guidelines.

“Providing basic preventative technology and guidelines to mitigate the effects of head injuries can reduce the number of tragic deaths and countless injuries that occur in youth athletics,” stated Pascrell. “I will push hard with the weight of the entire Congressional Brain Injury Task Force to implement the ConTACT Act.”

Specifically, the ConTACT Act will create a state grant program through the Centers for Disease Control and Prevention (CDC) that will fund computerized pre-season baseline and post-concussion neurological testing for school sponsored sports. Schools that enroll students from grades 6 through 12 will be eligible for the funding.

The grant program would be authorized for 5 years and is estimated to cost $5 million in the first year. It would require a report to Congress within 2 years of enactment regarding the use and results of screening technology.

Pascrell has long been a strong advocate for expanding concussion management technology to youth athletics. In August of 2006, Pascrell visited a Nutley High School football practice to announce a new round of grants for New Jersey high schools to implement concussion management technology.

The legislation was developed by Rep. Pascrell, Rep. Todd Platts (R-PA) and the Brain Injury Task Force with consultation from the Brain Injury Association of America, the New Jersey Brain Injury Association, the National Association of State Head Injury Administrators, the Athletic Trainers Society of New Jersey, the International Brain Research Foundation and the New Jersey Office of Disability Services.