As some of you may know, this morning President Obama released his FY 2011 budget. Last week, the State of the Union address warned of spending freezes and tough decisions on what programs to keep and what programs to discontinue in the coming year.

BIAA is pleased to announce that the HRSA state grant program, authorized by the TBI Act, has been level funded in the President’s budget.

Although the appropriations process for 2011 is far from over, we are off to a good start. BIAA would like to make a push for increased appropriations for this program at the 2010 Brain Injury Awareness Day on March 17th on Capitol Hill. Please contact Sarah D’Orsie, Director of Government Affairs, BIAA at sdorsie@biausa.org if you are planning to attend.

It is recognized that survivors of traumatic brain injury have to cope with numerous life challenges. The growing concern for the number of veterans returning with a brain injury has prompted a tremendous influx of research. These new studies contribute to the understanding of brain injury in both civilian and military populations.

The Institute of Medicine recently created a Committee on Gulf War and Health for Brain Injury in Veterans and Long-Term Health Outcomes. The results of their research reviews were published in the December 2009 issue of the Journal of Head Trauma Rehabilitation.

While many of the results should come as no surprise to people dealing with traumatic brain injury (for instance that TBI is associated with unemployment, depression, or cognitive deficits), the Committee also outlined health trends that are not as well known. Here we present a short summary of the Committee’s findings on the social, cognitive, neurological, and psychiatric long-term outcomes after traumatic brain injury.

Social functioning describes the ability to maintain social relationships, employment, independent living, and leisure activities. Moderate, severe, and penetrating brain injury is well associated with problems maintaining long-term employment and adverse social function outcomes.

Cognitive outcomes describe potential difficulties in thought processes such as attention, memory, initiation, planning, or problem solving. Severe brain injury and penetrating brain injury are well associated with cognitive impairments that correspond to the injured brain area. Moderate brain injury is somewhat associated with cognitive impairments.

Neurological outcome refers to disorders of the brain such as seizures, Alzheimer’s type dementia, parkinsonism (a combination of symptoms similar to Parkinson’s disease), endocrine disorders, or visual problems. Moderate and severe brain injuries are well associated with:

1. Dementia of the Alzheimer’s type
2. Parkinsonism
3. Unprovoked seizures
4. Endocrine dysfunction, especially hypopituitarism
5. Growth hormone insufficiency, and
6. Diabetes insipidus.

Mild brain injury is somewhat associated with dementia of the Alzheimer’s type and parkinsonism (when there is loss of consciousness). Severe brain injury is somewhat associated with the development of ocular/visual motor deterioration.

Psychiatric outcomes describe mood disorders such as depression or anxiety, as well as behaviors such as aggression or drug and alcohol use. Mild, moderate, and severe brain injuries are well associated with mood disorders and aggressive behaviors. Additionally, brain injury of any severity is somewhat associated with drug and alcohol use.

While several past studies have focused on immediate or short-term effects of brain injury, these reviews focus on studies of outcomes several months after injury. The most critical point made by the Committee is that traumatic brain injury can lead to chronic health conditions and needs long-term management in order to avoid potential consequences.

Severity of brain injury seemed to show differences in how well associated it was with a long-term outcome (particularly in mild TBI, where there were few strong associations). However, there were inconsistencies in how individual studies diagnosed mild and moderate brain injury, leading to difficulties when reviewing several studies as a whole.

It is likely that the more severe the brain injury, the more severe the long-term outcomes will be. But further research needs to be conducted in the field of mild brain injury in order to clarify some of the diagnostic inconsistencies and the controversial conflicts in past study results.

Bazarian JJ, Cernak I, Noble-Haesslein L, et al. Long-term neurologic outcomes after traumatic brain injury. Journal of Head Trauma Rehabilitation. (December 2009).

Dikmen SS, Corrigan JD, Levin HS, et al. Cognitive outcome following traumatic brain injury. Journal of Head Trauma Rehabilitation. (December 2009).

Hesdorffer DC, Rauch SL, & Tamminga CA. Long-term psychiatric outcomes following traumatic brain injury: A review of the literature. Journal of Head Trauma Rehabilitation. (December 2009).

Temkin NR, Corrigan JD, Dikmen SS, & Machamer J. Social functioning after traumatic brain injury. Journal of Head Trauma Rehabilitation. (December 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).

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.

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.

House Considers FY10 TBI Act Appropriations, take action now!

Take Action!

Friday, July 24, 2009, the House of Representatives will be considering a bill which will provide the funding allocation for programs authorized through the TBI Act and for NIDRR’s TBI-related research programs, including TBI Model Systems of Care.

Federal funding for these important TBI programs has remained stagnant over the last several years, as Congress has not provided increases sufficient to keep up with the increasing cost of doing business. The urgent need for increased federal support for a national TBI public health infrastructure and TBI research is further heightened by the recognition of TBI as the signature wound of the wars in Iraq and Afghanistan.

The time is now to urge Members of Congress to adequately fund TBI programs!

Today, July 10, 2009, the House Appropriations Subcommittee on Labor, Health and Human Services and Education will begin considering the Fiscal Year 2010 spending bill that will provide the funding allocation for programs authorized through the TBI Act and for NIDRR’s TBI-related research programs, including TBI Model Systems of Care.

BIAA and other stakeholders authored a letter that was circulated today on Capitol Hill urging increased funding for TBI programs. Specifically:

• $11 million for the Centers for Disease Control and Prevention TBI Registries and Surveillance, Prevention and National Public Education/Awareness
• $20 million for the Health Resources and Services Administration (HRSA) Federal TBI State Grant Program
• $6 million for the HRSA Federal TBI Protection & Advocacy (P&A) Systems Grant Program
• $13.3 million for NIDRR’s TBI Model Systems of Care Program

For further reading, a copy of the letter can be found on our web site by clicking on the following link:

http://www.biausa.org/elements/policy/2009/tbi_act_appropriations_2010_support_letter.pdf

If you would like to take action and encourage your Congressman to support increased funding for TBI programs, click on the link below to be directed to our legislative action center!

http://capwiz.com/bia/home/

BIAA will continue to monitor the Appropriations proceedings and alert grassroots advocates to take action when needed.

This week, as part of the Disability and Rehabilitaion Research Coalition (DRRC), BIAA signed on to comments regarding the proposed long range plan (Fiscal Years 2010-2014) for the National Institute on Disability and Rehabilitation Research (NIDRR).

The NIDRR proposal focuses mainly on employment, making only passing references to health and function research.

In the comments, BIAA and other members of the DRRC urge NIDRR to restore the broad focus of research and development activities by recognizing the critical importance of all major life domains affecting persons with disabilities, i.e., participation and community living, health and function, as well as employment.

On Tuesday, March 3, 2009, the House Appropriations Subcommittee on Defense held a hearing to address the need to improve the quality of care for servicemembers suffering from traumatic brain injury.

The witness list included, Ellen Embry, the Deputy Assistant Secretary of Defense for Force Health Protection and Gen. Loree Sutton, the Special Assistant to the Assistant Secretary of Defense for Psychological Health and Traumatic Brain Injury.

General Sutton shared with the Committee that the Defense Centers of Excellence is committed to research that is aimed at understanding the differences between blast injuries that would occur on the battlefield and concussions that may be experienced on a football field or during civilian activities. The spectrum of ingredients that include life-threatening situations, psychological stressors, and moral conflicts are all factors that contribute to the unique nature of brain injury incurred through battle.

On Thursday, Congressmen Pascrell and Platts hosted a briefing featuring Col. Michael Jaffee of the Department of Defense, DOD Defense Center of Excellence (DCoE), Defense and Veterans Brain Injury Center.

The briefing highlighted several growth factors and accomplishments that had taken place over the course of 2008. Notably, the symposia and collaboration between DOD and the National Football League TBI and concussion experts as well as the International Conference on Behavioral Health and Traumatic Brain Injury that was held on October 12, 2008 in conjunction with the Congressional Brain Injury Task Force. With more than 100 international experts, the areas of focus included research, education, assessment, family, and treatment.

Looking forward, Col. Jaffe announced several new partnerships fostered to help those with TBI including with the American College of Radiology, National Academy of Neuropsychology, The Kennedy Center, the Professional Golf Association, and the National Football League. These partnerships will continue to foster activities that will help educate both servicemen and civilians about the symptoms and dangers of traumatic brain injury.