Also this week, the House Energy and Commerce Subcommittee on Health passed a slightly revised version of H.R. 5613, legislation recently introduced which would place a moratorium until March 2009 on seven Medicaid regulations issued by the Department of Health and Human Services. BIAA has strongly endorsed this legislation and submitted an official letter of endorsement to the bill’s sponsors, Rep. Dingell (D-MI) and Rep. Murphy (R-PA), this week.

The legislation, which was originally introduced by Representatives John D. Dingell (D-MI) and Tim Murphy (R-PA) on March 13, 2008, would delay the implementation of seven harmful Medicaid regulations through March 2009, including several rules which would be especially deleterious to individuals with traumatic brain injury.

One of these rules would limit rehabilitation services for Medicaid beneficiaries, severely curtailing the ability of people with disabilities – including TBI – to receive rehabilitation services now covered under Medicaid. Access to these rehabilitative services is essential, as in many cases, these services play a vital role in allowing people with TBI to live independently in the community.

A copy of BIAA’s letter endorsing H.R. 5613 can be obtained by visiting BIAA’s website at the following address: http://www.biausa.org/policyissues.htm.

by Rick Rollens – Consultant for CALBIA

The Legislature will reconvene from its recess on January 7.

The $14 billion State Budget deficit will dominate Sacramento for months to come. The Governor will release his proposed 2008-2009 Budget on January 10.

It is expected to contain much pain, and little relief.

Our efforts continue in a positive direction with the Schwarzeneger Administration to bring CALBIA’s Brian Injury Initiatives to reality. There will be challenges, but we continue to receive positive comments and actions from those within the Administration and Legislature. Meetings will continue in January between CALBIA and the Administration on our proposals while at the same time exploring other opportunities in the Legislative process.

Doctors inducing hypothermia in trauma cases

By JACOB GOLDSTEIN
Knight Ridder Newspapers

MIAMI – Twenty years ago, W. Dalton Dietrich and his colleagues had a problem: the rats in their laboratory experienced the same kind of stroke but had dramatically different outcomes.

“We were perplexed,” Dietrich says.

To try to figure out what was going on, they started measuring the temperature of the rats’ brains. The results were shocking.

Rats whose brains were just a few degrees cooler than normal fared far better than others. Outcomes for those whose brains were a few degrees warmer than normal were, in Dietrich’s words, “really, really, really bad.”

That discovery inspired new interest in an old idea that had lost favor: using hypothermia to help patients who have suffered grave harm to the heart, brain or spinal cord. Now research is moving out of the laboratory and into the clinic. Some studies have shown no benefit from inducing hypothermia, but others have shown great promise.

Doctors are using a wide range of techniques for cooling — from simple ice packs to high-tech machines that run cold fluid through the veins. Specific treatments vary, but patients are typically cooled until their body temperature is in the low 90s (98.6 is normal), and kept that way for 12 to 48 hours. Treatment must be started early — usually within hours of the injury or cardiovascular event.

Last year, following the publication of two major studies, the American Heart Association recommended inducing hypothermia in some patients after cardiac arrest. Doctors at Jackson Memorial Hospital in Miami plan to adopt the recommendations in the coming months, said Dr. Kathy Schrank, who runs the hospital’s emergency department.

In other studies, doctors are cooling oxygen-deprived newborns as well as adults who have suffered strokes, heart attacks and traumatic brain injuries.

At the Miami Project to Cure Paralysis, where Dietrich is now scientific director, researchers are trying to understand exactly how temperature variations affect cell behavior. And Dr. Barth Green, the Miami Project’s co-founder, is inducing hypothermia in some of the most gravely injured spinal cord patients in the minutes or hours after they arrive at the trauma center.

“It’s a wonderful opportunity for us, for the first time ever, to protect the spinal cord after injury,” Green says.

Manny Gomez, a policeman who fell from his horse in January, was the first South Florida spinal cord trauma patient to be treated with hypothermia. Doctors lowered his body temperature by several degrees for two days following his injury. Now he’s slowly learning to walk again.

“I think the treatment really does work,” Gomez says.

His doctor, Dr. Steven Vanni, agrees — but adds that hypothermia is only one piece of a larger treatment puzzle. And the kind of solid research that would definitively prove whether hypothermia works for spinal cord trauma has not yet been done, Green says.

The research is further along in other fields. Two studies published in the New England Journal of Medicine in 2002 found that patients who were cooled after suffering cardiac arrest were more likely to survive and less likely to have severe brain damage than patients who were not cooled.

Both studies focused on a small sub-set of patients researchers thought most likely to benefit from hypothermia; patients had to meet several criteria, including having hearts that stopped before they were admitted to the hospital, suffering from a particular abnormal rhythm and remaining in a coma after their heartbeat had been restored by CPR.

The evidence compelled the American Heart Association to endorse the procedure last year for patients like those in the studies. Dr. Vinay Nadkarni, a University of Pennsylvania intensive care specialist who served on the committee that issued the endorsement, called hypothermia “the most promising intervention for CPR outcomes over the past 40 years.”

He cautioned, though, that more research is needed to figure out whether a broader pool of patients would benefit from hypothermia, and to determine the best methods for cooling and rewarming.

Doctors in one of the cardiac arrest studies used ice packs; in the other they used a device that blows cool air under a blanket. In both studies it took several hours, on average, to drop body temperatures by a few degrees. Some believe they can do better by using other devices that can lower temperatures in minutes rather than hours.

At the Baptist Cardiac and Vascular Institute in Miami, Dr. Ramon Quesada will soon begin enrolling heart attack patients in a multi-center study using a device that circulates cool fluid within a closed plastic tube threaded into the patient’s veins. A study published last year showed promising results using tiny caps to cool the heads of newborns at risk for brain damage because they didn’t get enough oxygen at birth.

The original idea behind hypothermic therapy is simple: Hypothermia slows metabolism, allowing cells to survive longer when deprived of oxygen — as in the rare cases when someone falls into a frozen lake and survives after spending 20 minutes or more underwater.

Inspired by cases like these, researchers experimented with hypothermia in the 1940s and 1950s. Cooling patients became popular as a protective measure during heart and brain surgeries. But using hypothermia as therapy fell out of favor in the 1960s and 1970s with the emergence of promising new drugs and growing concerns over the risks — including potentially deadly abnormal heart rhythms — of inducing profound hypothermia.

The work of Dietrich and others in the 1980s showing the benefits of mild or moderate hypothermia — lowering body temperature by a few degrees — revived interest.

Since then, scientists have gained new insight into the way cooling reduces the problems that follow injury, such as widespread inflammation and the release of harmful chemicals that can set off a cascade of damage to surviving tissue. Hypothermia may also reduce many of the harmful chemical reactions that occur when blood flow is restored after a stroke or heart attack.

One possible problem: Mild hypothermia may inhibit the immune system and make the patient more susceptible to infection, Dietrich says. Also, it can be necessary to prescribe drugs and, in some cases, temporarily paralyze the patient to prevent shivering, which carries a low risk. A small risk is also associated with inserting a catheter to cool a patient. But in general, the risks of mild cooling appear minimal, particularly when applied in cases where the outlook is grim, doctors say.

The devil remains in the details: Which patients will benefit most? What is the best way to cool patients? How soon after injury does cooling need to begin? Should the whole body be cooled, or just one region? How cool, and for how long? And how should a patient be re-warmed?

“The great hope would be that in the near future we could appropriately identify… the patients at risk who could benefit, and who could be cooled quickly and safely,” said Nadkarni, reflecting on the prospects for hypothermia in cardiac arrest patients. “If we can do that, we’ve got the intervention of the century on our hands.”

Source: http://www.mercurynews.com/mld/montereyherald/living/health/14552436.htm?source=rss

Name : BRAD KELLY
The Patriot Ledger
Helping victims of traumatic brain injuries often can be a frustrating process. But the owners of Community Rehab Care have been able to build a rewarding career guiding those with such disabilities to recovery.

Ann Gillespie of Marshfield, Eileen Chernoff of Ashland and Virginia Mills of Wellesley started their first Community Rehab Care center in 1996 in Newton. The business, which opened a Medford location in 1997 and a Quincy center in 2001, specializes in treating people with neurological disorders, and traumatic brain injury victims in particular.

The three met while working for the Braintree Rehabilitation Hospital — and decided to start their own business to help meet a need in the region for outpatient rehab centers.
The three centers — treat more than 80 patients in their neurological rehab program.

‘‘Most of our patients have injuries resulting from accidents inflicted in motor vehicles and at job sites as well as assaults and gunshots,’’ said Gillespie, chief operating officer and a therapeutic rehab specialist.

Mills said the centers treat memory and concentration loss, disorientation, slowness of thought and speech, fatigability, visual and hearing impairment and other ailments.

The centers are in busy areas where patients can take the physical therapy into public spaces. Mills said it is important to get patients comfortable with everyday life activities like crossing the street.

‘‘Our purpose is to try and restore some semblance of their life prior to (the patient’s) accident,’’ said Mills, president of Community Rehab Care and a physical therapist at the center.

Chernoff said getting patients into a routine is the best way to get them back to daily life and a little more independent.

‘‘We teach them everyday activities that you and I take for granted,’’ said Chernoff, a vice president and nurse. ‘‘Grocery shopping, paying the bills and cooking are difficult tasks for people with a traumatic brain injury.’’

Most patients will never fully recover and always need some kind of supervision, Gillespie said. But many still can make noticeable progress as they recover from trauma.

‘‘The majority of the patients’ families were told their loved ones might not make it,’’ Gillespie said. ‘‘This rehabilitation is life-altering for everyone involved.’’

Source: http://ledger.southofboston.com/articles/2006/05/08/news/news12.txt

Farmington Hills site is planned
April 21, 2006
Name: JULIE EDGAR
FREE PRESS STAFF WRITER

A chain of centers that treats people with brain injuries is opening another inpatient location in Farmington Hills in the fall.

Ypsilanti-based Rainbow Rehabilitation Centers plans to move into the spot formerly occupied by Hospice of Michigan, on Middlebelt near 11 Mile Road. If it gets a license from the state, it plans to operate it as a foster care center that can accommodate 40 adults.

Rainbow, founded in 1983, treats children and adults who have suffered spinal cord and traumatic head injuries. It operates a physical therapy center for children on Grand River in Farmington and nine other residential and outpatient centers in the Farmington/Farmington Hills area.

Sean Youngren, Rainbow’s administrative director, said Hospice built the building on Middlebelt in 1995 and moved out a few years ago.

It’s in such good shape, he said, that Rainbow should be able to move in without doing too many renovations.

“It’s nearly a turnkey operation, from our perspective,” he said.

Youngren said the cost of the 23,000-square-foot building is about $4.7 million, but Rainbow hasn’t yet closed on the purchase.

That should happen in early July, he said, and the facility could be up and running by September.

The land, about 9 acres, was tied up in a zoning-related lawsuit going back 27 years, which resulted in a consent judgment that has been modified three times.

Last week, the City Council approved the latest version, which essentially says Rainbow must get the city’s written consent if it transfers ownership.

Hospice donated property at 11 Mile and Middlebelt to the city in 1995 for Memorial Park. That is to remain intact and, under the new consent judgment, is not part of the land’s legal description.

Youngren said under state law, adult foster care facilities may house only 20 people. Rainbow’s new center will technically be two facilities in one, he said, thus the facility will seek to house up to 40 clients. A little more than a year ago, Rainbow opened its Grand River center, a former Benchmark outdoor goods store, after adding a pool for aquatic therapy, a gym and clinical offices.

Rainbow runs about 30 centers in Oakland, Wayne and Washtenaw counties. Most are adult foster care facilities, Youngren said.

The majority of Rainbow’s money comes from private insurance, automotive included, and workers compensation. The company’s outpatient facilities are accredited by the Commission on Accreditation of Rehabilitation Facilities, based in Tucson, Ariz.

Source: http://www.freep.com/apps/pbcs.dll/article?AID=/20060421/NEWS03/604210485/1005

Name : Daniella Miletic
May 9, 2006
A DRUG-AFFECTED driver who was speeding when he smashed into a car, leaving a 71-year-old woman wheelchair-bound, has been jailed for two years.

Michael Joseph Taranto, 27, was travelling at more than 116 km/h in a 70 km/h zone and had taken cannabis before smashing his Commodore into a car at the intersection of the Hume Highway and Major Road, Fawkner, in June 2004.

The County Court heard that Arsinoe Nikolakopoulos, now 73, was left with brain damage and amnesia as a result of the crash. She is wheelchair-bound and incapable of dressing or feeding herself. The court was told that before the crash she had an active life, including visiting and receiving visits from her children and grandchildren.

In a victim impact statement tendered to the court, Mrs Nikolakopoulos said she was in constant pain.

“I don’t remember anything of my life,” she said. “I have forgotten my mother, my father, my brothers and sisters.

“I feel like I am a burden to myself and my family. He destroyed my life. He has made me into a piece of rubbish. He has taken my life away from me.”

Taranto, formerly of Fawkner, had pleaded guilty to negligently causing serious injury, using an unroadworthy vehicle and unlicensed driving.

Judge Tom Wodak sentenced him to two years’ jail with a minimum of one year and disqualified him from driving for two years.

Judge Wodak said he took into account Taranto’s pattern of undisciplined driving, with convictions for speeding and a “road rage” incident.

“It was a matter of time before your propensity for driving too fast would have heartbreaking consequences,” he said. “For Mrs Nikolakopoulos, her car was in the wrong place at the wrong time.

“Had you driven even up to the speed limit applying at the scene of the collision, it is most probable that you would have been able to stop well before any collision occurred,” he said.

He accepted Taranto was remorseful and had suffered post-traumatic stress disorder since the accident.

Source: http://www.theage.com.au/news/national/driver-destroyed-my-life-pensioner/2006/05/08/1146940475926.html

PORTLAND, Oregon – Oregon Health & Science University is part of the National Institutes of Health- funded Resuscitation Outcomes Consortium (ROC). This group of 11 regional medical centers across the United States and Canada seeks to find promising scientific and clinical advances to improve survival from cardiac arrest and severe trauma.

Source: http://www.centralpointnews.com/articles/index.cfm?artOID=330366&cp=4310

The ARC of Northwestern Vermont is holding its 29th Annual Pancake Breakfast as part of the Maple Festival on April 29th and 30th. The breakfast will be held at the St Albans City School Cafeteria on Bellows Street from 7:00 a.m. to Noon; Adults $6.00 and Children 3 to 10 will cost $3.00, toddlers two and younger are free.

The ARC is celebrating fifty years of supporting individuals with developmental disabilities such as downs syndrome, autism, traumatic brain injury, etc. in Franklin and Grand Isle Counties.

They help people with developmental disabilities and their families by:

- Assisting them with accessing formal and informal resources
- Providing support at important meetings and helping to advocate for themselves and family members
- Educating the community, legislators and others about the needs of the developmentally disabled.
For more information call (802) 524-7592.

Source: http://champlainislander.com/index.php?option=com_content&task=view&id=1532&Itemid=58

Name : Richard Kenney
Special for The Republic
Apr. 15, 2006 12:00 AM
Kelly Ramella helps people focus on their abilities, not their disabilities.

When they enroll in her Foundations of Therapeutic Recreation course at Arizona State University in Tempe, they quickly learn her message.

“Unfortunately, we live in a society where it’s harder to see the strengths of a person with a disability because we’re so stuck on the disability we can see,” Ramella said. “So I teach the students to focus on ability, not disability.”
To illustrate the concept, the two-year ASU lecturer likes to show her class the film Murder Ball, a movie about rugby-playing individuals who are quadriplegic. The students cannot fathom how anyone can play rugby with limitations in four limbs.

“They just don’t get it,” she said. “But after they watch the film they agree anything is possible.”

The Phoenix resident has been a certified therapeutic recreation specialist since 1992. According to the National Therapeutic Recreation Society, therapeutic recreation uses treatment, education and recreation to help people with illnesses, disabilities and other conditions to develop and use their leisure in ways that enhance their health, independence and well-being.

“In the first grade, my best friend had cerebral palsy,” she recalled. “The teacher used students in the classroom to help other students, and I happened to be partnered with Tracey. I knew Tracey; I didn’t know cerebral palsy.”

Ramella is grateful for her experience with her childhood friend. It helped her to see the person first. She also learned to be comfortable with a person with “activity limitations,” a term she prefers to use to the more common “disability.”

“Many students have fears,” she said. “We all do. If a person who is visually impaired comes up and asks you for directions, your heart rate goes up, your palms sweat. You’re not sure what to say. We’re trying to teach students to be more responsive, to overcome those fears.”

After her studies in recreation management at the University of Connecticut, Ramella continued her education at Webster University in St. Louis, where she earned a master’s degree in health services management. She worked in several East Coast hospitals where she provided recreational therapy services to individuals in traumatic brain injury units and adolescents in need of psychiatric care.

“That’s the big selling point about this field,” she said. “It’s very diverse in its applications. You can work with such a variety of populations. You can help a senior with dementia relearn to play the piano or help a teen with Down syndrome train for the Special Olympics.”

Just as there are many populations with which to work, there are as many activities to help individuals grow well.

“When we think about recreation, we tend to think about traditional things like sports or card games,” Ramella said. “But with therapeutic recreation we also look at non-traditional leisure activities like gardening, photography and even scrap-booking. We want to help people find their niche and foster that strength.”

One person who seems to have found her niche is Alexis Newly of Tempe. The 22-year-old ASU senior will soon graduate with her bachelor’s degree in recreation management with an emphasis in therapeutic recreation. Diagnosed with borderline personality disorder one year ago, Newly looks forward to her career possibilities.

“I want to help people with psychiatric disorders,” she said. “I know what it’s like to go through that and feel that I have something to offer them.”

She credits her teacher with helping her to find ways to deal with some of her difficulties.

“Kelly is so amazing,” she said. “She got me into blogging. It’s a way to write my feelings, like a diary. And I’m into art big-time. I volunteer at Art Awakenings, where I help people with mental illness. I help them with art projects like candle-making.”

Newly is enthusiastic about attending an upcoming conference sponsored by the Arizona State Therapeutic Recreation Association, of which Ramella is president.

The organization’s spring convention will be from 8 a.m. to 4 p.m. Friday at ASU at the West campus in Phoenix. Participants will learn more about life-story development, youth activities and storytelling to help facilitate self-exploration.

“What’s great about this conference is that people leave with tools,” Ramella said. “They’re going to leave saying, ‘I can use these ideas in my facility.’ ”

There is a limit of 75 participants at the conference. Individuals may register at the door if space is available. For more information, call (623) 584-0040 or (480) 965-6428.

Source: http://www.azcentral.com/community/phoenix/articles/0415phx-recreation0415Z3.html

New Mexico Business Weekly – April 26, 2006
Maas BioIAB LLC has received a $50,000 grant to continue development of its cyclosporin neuroprotection products.

Maas is a pharmaceutical firm based in Albuquerque. The funds came from the Fort Detrick Technology Transfer Initiative, managed by the Maryland Technology Development Corp. Maas is developing proprietary cyclosporin formulations for the treatment of battlefield traumatic brain injury and nerve agent exposure, which are being tested at the Walter Reed Army Institute of Research in Silver Spring, Md.

Source: http://charlotte.bizjournals.com/albuquerque/stories/2006/04/24/daily12.html