This week, The Senate released and began debate on their Health Care Reform leadership measure. As many of you may know, originally, rehabilitation was not included in the Senate Finance bill as a minimum benefit. Due to the lobbying efforts of BIAA, largely supported and funded by our Business and Professional Council, we have been able to ensure that rehabilitation is a part of the minimum benefits package of the final product now being debated in the Senate.
Specifically, the Patient Protection and Affordable Care Act being considered would:
(Democratic leadership summary)

- Include immediate changes to the way health insurance companies do business to protect consumers from discriminatory practices and provide Americans with better preventive coverage and the information they need to make informed decisions about their health insurance.

-Uninsured Americans with a pre-existing condition will have access to an immediate insurance program to help them avoid medical bankruptcy and retirees will have greater certainty due to reinsurance provisions to help maintain coverage.

-New health insurance Exchanges will make coverage affordable and accessible for individuals and small businesses.

-Insurance companies will be barred from discriminating based on pre-existing conditions, health status, and gender.

-Expand eligibility for Medicaid to include all non-elderly Americans with income below 133 percent of the Federal Poverty Level (FPL), with substantial assistance to States for the cost of covering these individuals.
- Make long-term supports and services more affordable for millions of Americans by providing a lifetime cash benefit that will help people with severe disabilities remain in their homes and communities.
- Eliminate lifetime insurance limits in all new individual and group plans for plan years beginning 6 months after enactment.
Today, as the Senate opened a two-day debate on the bill, Congressional Quarterly reported that Majority Leader, Harry Reid is closing in on the 60 votes needed to overcome an anticipated filibuster and bring the measure to the floor. Reid has filed cloture the bill and the vote on the motion to proceed to the bill is expected to occur on Saturday at 8:00 pm.

BIAA will continue to monitor the bill’s progress closely as debate continues. Also, documents relating to the Senate leadership bill can be found on BIAA’s website under the Health Care Reform Library section:
http://www.biausa.org/policyissues.htm#library

The Legislature finally went into Interim Recess for the 2009-2010 Legislative Session on September 11. To say this first half of the two-year legislative session was the most difficult, heart wrenching, and brutal Sessions of all time would be a huge understatement. The on-going State fiscal crisis remains the dominate issue that is driving all policy and fiscal decisions. Few bills reached the Governor’s desk this year, and fewer will be signed by the Governor. The Governor has until midnight on October 11 to act on the remaining bills that came his way in the last days leading up to the end of the Session. Among them is a bill that would transfer California’s brain injury program from the Department of Mental Health to the Department of Rehabilitation. AB 398 is now pending before the Governor.

Our efforts at the Capitol this year have resulted in a lessening of the impact in reductions to services to those with brain injury. We were successful in not being singled out for deeper reductions in the final Budget as approved by the Legislature and Governor. Starting in January we will be back on the front lines fighting the budget battles once again. The State has yet to turn the corner on this recession.

The joint Senate hearing by the Senate Health Committee and Senate Veterans Committee that was scheduled for this Fall has been postponed until January due to the pending nuptials of Senator Elaine Alquist (D-San Jose), chair of the Senate Health Committee. We are excited about this hearing, and look forward to reporting more details to you in the very near future.

Dianna Bolen
A life can change dramatically in a flash and sometimes for the best. On September 16, 2004, I, Dianna Bolen, was on my way to a bike fest in Las Vegas, NV on my 1993 Harley Davidson Sportster with 3 other bikers. For some unknown reason, and not even the highway patrol knows why, I went off the freeway, flew 100 feet, went over a barb wire fence, and landed in the desert ground with my bike on top of me. This accident happened in Arizona where wearing a helmet is optional. I was SMART and was wearing mine. I was airlifted to a Phoenix Hospital where I was taken immediately into surgery. While on the operating table the doctors called Code Blue three times. They had to put a titanium rod into my left leg and my ankle is held together by screws. As a result of my TBI, I was in a coma for 2 months. After awakening from my “sleep”, I realized that my memory disappeared, all the way till “who knows when”. After being released, I also realized that I lost my smell and taste. Overall, after going through a lot, I ended up in Fresno. I got hooked up to a TBI support group in Fresno. At the time I was not looking for anyone – just a support group. At a meeting, we were told about the first annual Walk For Thought that was going to be held in Bakersfield in March of 2008. The support group agreed to meet at the center in Fresno and carpool to Bakersfield. I ended up in the car of a funny man, named Michael Taylor, who would end up being my fiancé.

Michael Taylor
On Sunday, April 8, 1989, my day started off as normal as a day can start off for a Sheriff. I was advised of a burglar alarm that was going off at a market in Madera. I proceeded to the market when I was involved in my accident. A Bronco towing a boat, traveling 55 mph, smashed into my patrol car on the driver’s side. I was flown to a hospital in Fresno where I was in a coma for 10 days. After awakening from my coma, I was released to my mom’s care. I was then enrolled into Neurological Retraining Center (N.R.C.). I was with N.R.C. until December 1989. Then I started putting my life together again. I started attending CORC meeting in Fresno. I was very active with CORC. Then February, 2008 I attended the 1st Annual Walk For Thought in Bakersfield. Since I had a good car and was able to drive with no problems, I volunteered to drive down to the Walk with 4 others in my car. That was the day I met Dianna Bolen and her service dog, Sierra. Little did I know, she was the answer to a prayer I made to God shortly after my new life with TBI started.

Now Dianna and Sierra are a big part of my life. All the way down and all the way back home, I kept looking in my rear view mirror at her, (and she has said to me that she never knew I was looking at her). After seeing each other for a few weeks, I volunteered my service (along with another TBI friend) and we built a redwood deck in the back of her condo. From that day on, we have never been separated. After a few months, I got down on my knees and proposed to her. She has told me several times that if Sierra didn’t approve of me, she would have to decline. Needless to say, Sierra is just as much a part of my life than she is to Dianna.

Michael & Dianna
We feel that if it wasn’t for the Walk For Thought in Bakersfield, we would have never gotten to know each other. We help each other to overcome the many obstacles we have to deal with since our accidents. We thank the California Brain Injury Association for organizing that awesome Walk that put us together and we will always have a special place in our “head” for that great Walk!

Concussions, whether from an accident, sporting event, or combat, can lead to permanent loss of higher level mental processes. Scientists have debated for centuries whether concussions involve structural damage to brain tissue or whether physiological changes that merely impair the way brain cells function, explain this loss. Now, for the first time, researchers at Albert Einstein College of Medicine of Yeshiva University have linked areas of brain injury to specific altered mental processes caused by concussions.

The research, described in the August 26 edition of Radiology, provides compelling evidence that concussions involve brain damage. The findings suggest that diffusion tensor imaging (DTI), the brain scanning method used by the Einstein scientists, could help in diagnosing concussions and in assessing the effectiveness of treatments.

“DTI has been used to look at other brain disorders, but this is the first study to focus on concussions,” said Michael Lipton, M.D., Ph.D., associate director of the Gruss Magnetic Resonance Research Center (MRRC) and associate professor of radiology, of psychiatry and behavioral sciences, and of neuroscience at Einstein and lead author of the study. “It proved to be a powerful tool for detecting the subtle brain damage that we found to be associated with concussions.”

Each year, more than one million Americans sustain a concussion (technically referred to as mild traumatic brain injury). Concussions in adults result mainly from motor vehicle accidents or falls. While most people recover from concussions with no lasting ill effects, as many as 30 percent suffer permanent impairment — undergoing a personality change or being unable to plan an event. A 2003 federal study called concussions “a serious public health problem” that costs the U.S. an estimated $80 billion a year.

At present, diagnosis of concussions is based primarily on the patient’s accident history and on clinical examinations that check for common concussion symptoms including headache, dizziness and behavioral abnormalities. There is no way of knowing from these exams who will suffer the most severe consequences and who will recover quickly. The results of the Einstein study indicate DTI scanning could provide a more objective way to diagnose concussions, determine whether brain injury has actually occurred following trauma, and possibly predict the lasting loss of executive function. Executive function refers to the ability to make decisions, organize, set priorities and manage time.

The Einstein research involved 20 people known to have suffered concussions (18 from motor vehicle accidents and two from falls) and 20 healthy control subjects. The patients were recruited from one hospital emergency room; two of them had lost consciousness, but only for a few minutes. Both the patients and control subjects underwent conventional brain imaging with magnetic resonance (MR) and computed tomography (CT) scanning, plus a battery of neuropsychological tests to assess executive function, which is often impaired after a concussion. All concussion patients underwent brain imaging and testing within two weeks of their accidents.

Experienced reviewers who evaluated the conventional MR and CT images of patients and controls found no abnormalities in either group. However, the neuropsychological results showed that the patients performed significantly worse than the controls on tests of executive function.

Patients and controls also underwent diffusion tensor imaging (DTI), a recently developed MRI-based imaging technique that can detect subtle changes in the brain by measuring the diffusion of water in the brain’s white matter. DTI revealed abnormal brain regions in 15 of the concussion patients, while no abnormal regions were found in controls. Most importantly, the presence of major areas of structural damage in concussion patients (as shown by large alterations in normal water diffusion using DTI) predicted low scores on their executive-function tests. These damaged areas were located mainly in the brain’s prefrontal cortex, which is essential for normal executive function and is susceptible to injury in concussion.

Dr. Lipton notes that use of DTI could prompt doctors to begin treatment early, when it’s likely to be most useful. “The problems in functioning caused by concussions often don’t become evident until weeks or months after the injury, suggesting that the brain pathology may actually expand over time,” he notes. “By detecting brain injury early with DTI and then initiating cognitive rehabilitation therapies for those patients, we may be able to limit the effects of concussions.”

“We are really excited by these findings,” indicates Craig Branch, Ph.D., a co-author of the study and director of the Gruss MRRC. “For the first time we appear to be able to identify the subtle pathology sometimes caused by concussion, providing researchers a ‘pathology target’ for the development of therapies to reduce or eliminate the damage identified by this novel imaging method.” Dr. Lipton adds that DTI could help in evaluating the effectiveness of existing therapies for concussion.

In August, BIAA launched a pilot program dedicated to encouraging area brain injury survivors to become more effective self-advocates. The program included identifying likely targets, making appointments, participating in a day of meetings in Capitol Hill, and following up and maintaining relationships with Congressional staffters.

Due to the success of the program, BIAA will continue to offer the opportunity on a quarterly basis to survivors who would like to learn more about advocacy. Space is limited, so if you would like to participate and you live in the Washington, DC area, please send me an email so that I can begin assembling the next advocacy group.