Metamemory is the awareness and control of your ability to remember. This could include judging how well you remember something, detecting memory mistakes, or developing learning strategies. An impairment in metamemory can therefore hinder cognitive rehabilitation after a traumatic brain injury.

In a recent study that compared memory performance (recall of information) to metamemory performance (judgment of well one recalled information), researchers found that pediatric brain injury patients showed poor metamemory in general. Interestingly, even as patients’ performance for memory improved, patients did not necessarily improve in metamemory. Patients with more severe injuries were the least likely to have accurate judgment of their memory performance.

This suggests that patients with severe traumatic brain injuries not only need rehabilitation for the recovery of memory, but also rehabilitation of awareness and judgment of their memory impairments.

Crowther JE, Hanten G, Li X, et al. Impairments in learning, memory, and metamemory following childhood head injury. Journal of Head Trauma Rehabilitation. (June 2011).

Insomnia is one of the most common complaints after traumatic brain injury, and is not only distressing to the patient, but can also negatively impact recovery and rehabilitation efforts. Commonly prescribed and over-the-counter drugs for insomnia may help increase sleep, but can also negatively impact the patient with daytime sleepiness and slower cognitive functioning.

Acupuncture is a well-known practice of Chinese medicine, and past research has shown it to be effective for the treatment of insomnia in non-brain-injured people. A recent study looked at the effect of acupuncture on insomnia in brain injury patients—first, to see if it could be as effective as drug therapies, and second, to see if daytime cognition could be improved.

The results were that acupuncture did not increase actual sleep time, but it did increase the perception of sleep time—a perception that was sustained even one month after treatment ceased. This is important because the perception alone of less sleep is known to be associated with depression. Additionally, cognitive function improved in patients who received acupuncture, but not in those who received a placebo.

Zollman FS, Larson EB, Wasek-Throm LK, Cyborskie CM, & Bode RK. Acupuncture for treatment of insomnia in patients with traumatic brain injury: A pilot intervention study. Journal of Head Trauma Rehabilitation. (April 2011).

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).

House

After more contentious private and public negotiations on a health overhaul between House leaders and moderate Democrats, prospects are uncertain for a vote on the bill before lawmakers leave for a long August recess.

The Energy and Commerce Committee Chairman, Henry Waxman, is aiming to come to an agreement by Monday or Tuesday of this week in order to report the bill to the full house.

House Democratic leaders will attempt to convince their caucus of the merits of the legislation Monday evening, in the hope of holding a vote at the end of this week or early next week.

Majority Leader Steny Hoyer, had earlier dismissed the idea that Energy and Commerce might have to discharge the bill without voting on it — something Waxman said, in the heat of his dispute with moderate democrats, that he was considering himself. “I’m not interested in that, and I don’t think the Speaker is either,” Hoyer said. (CQ)

He said chances are “very small” they will take the bill to the floor before the House’s scheduled July 31 break for the August recess. However, he said it was possible the leadership would hold the chamber in session beyond that date.

Senate

Senate leaders last week abandoned plans to pass their own bill before August, but work continues among a bipartisan group of six Finance Committee members – backed by their leadership – to reach agreement on an overhaul.

This week the Senate, Health, Education, Labor and Pensions (HELP) Committee approved its draft Health Care Reform measure, and the Finance Committee is expected to begin consideration next week.

In the House, the Education and Labor Committee approved its section of the bill (HR 3200) after a very long session lasting through the night on Thursday. The Ways and Means Committee also finished action on its portion of the legislation early Friday, while the Energy and Commerce Committee is expected to continue its proceedings on Monday.

BIAA will continue to monitor the situation closely as the House is hoping to send their bill to the floor before the August recess.

Last week the National Institute on Disability and Rehabilitation Research (NIDRR) released a Notice of its Proposed Long-Range Plan for Fiscal Years 2010 through 2014.

BIAA agrees with analysis conducted by Bobby Silverstein, a principal at Powers Pyles Sutter & Verville PC, that the proposed long-range plan is flawed in that it materially departs from previous plans by focusing on one category of research (employment) rather than on all three congressionally directed areas of research (health and function, employment and community participation).

BIAA is committed to working to restore the longstanding balance in the type of disability and rehabilitation research that NIDRR supports, and has accepted a position on the NIDDR working group within the Disability and Rehabilitation Research Coalition or DRRC.

Save the Date

In support of Brain Injury Awareness Month in March of 2009, plans are underway for the following annual events:

3rd Annual Greek Dinner & Dance For Thought on March 7th in Long Beach. Tickets are $100 per person and will be available on the website soon or by contacting Paula Daoutis at the CALBIA office at (661) 872-4903.

2nd Annual Statewide Walk For Thought. This year, walks will be held in 4 locations across the state on two different dates. Beginning in early January, individuals wanting to register, sponsor, or help CAL­BIA to solicit donations will be able to do so from the CALBIA website. See below for dates and locations:

March 14, 2009
Bakersfield – Yokuts Park
Sacramento – William Land Park

2008 Bakersfield “Walk For Thought”
March 28, 2009
San Diego – Mission Bay Park at De Anza Cove
Oakland – Lakeside Park (Lake Merritt)
Also on March 28th, the Brainstorming 4 Us Sup­port Group will be hosting their 3rd Annual Walk 4 Thought at Spring Valley Lake in Victorville.

CALBIA continues to participate in the CA TBI Advisory Council, whose purpose is to advise State leaders and legislators about the needs of people with TBI. The Council is hosting a conference titled, “Moving the TBI Agenda: Change, Challenges & Collaboration” to be held on February 9-10, 2009 in Sacramento.
The conference topics include:

Promising Research
Emerging Issues
Returning Troops/Veterans with TBI
Elderly & TBI
Best Practices
Community and Long-Term Supports
Public Policy and Advocacy
California Services and Resources

Registration fees are $195 per person and a reduced fee of $100 per person for persons with brain injury, care­givers and students. Limited financial assistance is available. For more information, call Yvonne Shifflette at the CA Department of Mental Health at (916) 654­2147 or e-mail her at Yvonne.shifflette@dmh.ca.gov Registration is available online at:
www.regonline.com/TBIConference

Legislation to Delay Harmful Medicaid Regulations Added to War Spending Bill

Also this week, Democrats included legislation which would place a moratorium until March 2009 on several harmful Medicaid regulations (H.R. 5613), in the FY 2008 war supplemental appropriations bill. BIAA continues to strongly endorse H.R. 5613 and supports efforts to keep the bill in the war supplemental legislation as it moves towards final passage, likely within the next two weeks.

According to CQ Today, by attaching H.R. 5613 to the war spending bill, Democrats hope to avoid an extra set of cloture votes in the Senate, where the Medicaid moratorium bill on its own had been facing a GOP filibuster (Alex Wayne, CQ Today, 5/6/2008).

The House of Representatives passed H.R. 5613 by a veto-proof margin, 349-62, on April 23. Without a moratorium, all seven of the regulations would go into effect by June 30 of this year, including regulations which would limit access to essential services for individuals with brain injury.

Stay tuned to BIAA for further potential Legislative Action Alerts on this issue in coming weeks.

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This recent article focuses on the “Hidden Causes of Social Disorders”, tying social symptoms to traumatic brain and head injuries.

Researchers studying brain injury believe they’ve found a common thread running through many cases of seemingly unrelated social problems: a long-forgotten blow to the head.

Read more here…