Aggressive behavior after traumatic brain injury, whether it comes in the form of physical or verbal expressions, can interfere with family life, rehabilitation, and recovery. Prevention of aggressive behavior after traumatic brain injury is important, and yet how exactly aggressive behavior was related to injury had not previously been explored.

A group of researchers from Johns Hopkins School of Medicine recently reported the prevalence and specific risk indicators of aggression after traumatic brain injury. The following summarizes their results:

1. Verbal aggression was quite prevalent after traumatic brain injury, but physical aggression was nearly absent.
2. Aggression was associated with:
   1. Impaired psychosocial functioning
   2. New-onset major depression
   3. Increased dependence in daily living activities
   4. Major depression that occurred before injury was not a predictor of aggression.
   5. Aggression was not associated with pre-injury behavior problems, substance abuse, legal charges, or neuropsychological tests.

These associations mean that aggression after traumatic brain injury could potentially be addressed by alternative methods, such as providing stronger social connections, increased independence in daily living, or direct treatments of depression. Additionally, their research dissociated the social or pre-injury factors commonly thought to magnify aggressive behavior.

Rao V, Rosenberg P, Bertrand M, et al. Aggression after traumatic brain injury: Prevalence and correlates. Journal of Psychiatry and Clinical Neuroscience. (Fall 2009).

Whether you promise to pick up milk after work, or you make doctor’s appointment for the next day, a little post-it note forms in your mind to remind you of the task. And hopefully, that post-it note will signal you to remember that task at the right time. This process of remembering to remember is called prospective memory. And it’s commonly impaired in people with traumatic brain injury.

Prospective memory impairment in mild traumatic brain injury has only recently been studied. The Journal of Neurotrauma published a study that suggests that people with mild traumatic brain injury show immediate problems with prospective memory, which persist even after 3 months.

Prospective memory is based on a complex system of cognitive process: intention, initiation, attention, appropriate sense of time, and proper recall of events. Given this complexity, prospective memory impairment (or forgetting to remember) can also be an indicator of general cognitive impairment in mild traumatic brain injury. The authors of the study suggest that prospective memory assessments, such as the Memory for Intentions Screening Test, could be used as a sensitive tool for diagnosing cognitive impairment in mild traumatic brain injury.

Tay SY, Ang BT, Lau, XY, et al. Chronic impairment of prospective memory after mild traumatic brain injury. Journal of Neurotrauma. (January 2010).

San Francisco based trial lawyer Randall H. Scarlett, principal of The Scarlett Law Group, testifies before the California Senate Health Committee with Recommendations Regarding State Facilitated Treatment of California Survivors of Traumatic Brain Injury

For the first time in California’s history, the Senate Health Committee undertook extensive preliminary hearings yesterday on the issue of  Traumatic Brain Injury and its impact, fiscally and otherwise, on the State of California. These historic hearings involved approximately two hours of testimony and presentation by physicians and by members of the California Brain Injury Association. The hearings, promised to be the first in a number of educational and exploratory hearings on Traumatic Brain Injury, were telling as to the staggering costs associated with the treatment of survivors of Traumatic Brain Injury.

For a view of the complete hearings please visit the following link:

The hearings involved the testimony of several board members of the California Brain Injury Association, including Dr. Mark Ashley, Dr. David Hovda, Sharon Grandinette, and Randall H. Scarlett. The California Brain Injury Association also invited Dave Woodruff, co-founder of the Bob Woodruff Foundation (and older brother of Bob Woodruff) in order to address Traumatic Brain Injury issues relative California’s returning veterans.

Several recommendations were made by CALBIA to the Senate Health Committee, including the formal formation of a Traumatic Brain Injury taskforce to advise the California Governor’s Office, Senate and Assembly on these important and fiscally demanding topics. The packed hearings promise to be the first in a number of such hearings likely to be held on this important topic.

Mr. Scarlett addressed the Senate Committee on the issue of mild Traumatic Brain Injury, concussion and insurance coverage issues such as exclusions under the term “medically necessary”. Mr. Scarlett also addressed the Senators on the staggering costs of care associated with Traumatic Brain Injury.

Randall H. Scarlett, principal, concentrates his practice in the areas of  catastrophic personal injury,  traumatic brain injury, spinal cord injury, wrongful death and other serious wrongs. The Scarlett Law Group also handles cases involving product liability, aviation disaster, medical malpractice, international human rights, domestic civil rights, environmental and complex consumer actions.

To view the California Brain Injury Association Handout for this hearing, please see: Senate Hearings

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

Recently, the National Institute on Disability and Rehabilitation Research (NIDRR) appears to be deemphasizing medical rehab research, including valuable research related to TBI. BIAA is working as part of a coalition of advocacy groups to send NIDRR a message that resources for medical rehabilitation research (referred to by NIDRR as “health and function” research) needs to be increased, not decreased. We need your help!

In the past six months, NIDRR has eliminated funding for four Rehabilitation Research and Training Centers (RTCs) focused on medical rehabilitation research, including centers focused on neuromuscular research, arthritis, TBI community reintegration, and spinal cord injury. Four additional medical rehab RTCs (stroke, MS, aging with a disability, and psychiatric aspects of disability) have been delayed and NIDRR intends to announce these grants with a greater focus on employment and vocational rehab.

As an advocate for increased TBI services and research, you are encouraged to join NIDRR’s national meeting/conference call on NIDRR’s long range plan scheduled for Wednesday, March 19th, from 1:00 to 5:00 p.m. and express your views. The toll-free conference call number is (800) 762-6085. An operator will ask if you would like to submit input or just listen to the event. The operator will track the order of the people who want to provide input.

(Note: There are other ways to submit comments as well by the end of March if you cannot make the call. Please contact Laura Schiebelhut, BIAA’s Director of Government Affairs, at lschiebelhut@biausa.org, if you have questions.)

We suggest making some or all of the following points:

1. NIDRR has served as the nation’s lead federal agency on rehabilitation and disability research – including valuable research on TBI – and as such has maintained a broad portfolio of research as reflected in its current Long-Range Plan. This research portfolio includes three broad domains designed to enhance the quality of life of persons with disabilities in the areas of employment, community living, and health and function, including medical rehabilitation research.

2. This approach is to be commended as it recognizes the critical interplay between medical rehabilitation research, health and functioning, and the ability to return to school or work where appropriate.

3. A shift in focus at NIDRR away from health and function research is unwise and seriously erodes our nation’s ability to solve the important questions that confront people with disabilities in seeking to return to functional and fulfilling lives after the onset of a disabling condition.

4. NIDRR should continue and re-emphasize the importance in its funding priorities of health and function research, including medical rehab research.

Please see the press release below for further information. Thank you.

FOR IMMEDIATE RELEASE
March 4, 2008

NATIONAL VIDEOCONFERENCE AND WEBCAST TO SOLICIT INPUT ON THE NATIONAL INSTITUTE ON DISABILITY AND REHABILITATION RESEARCH 2010-2014 LONG-RANGE PLAN

The National Institute on Disability and Rehabilitation Research (NIDRR) today announced a national videoconference to solicit remarks regarding NIDRR’s long-range plan for fiscal years 2010-2014. The purpose of the videoconference is to obtain ideas from the public on the content and direction of the new NIDRR long-range plan.

NIDRR, a component of the Office of Special Education and Rehabilitative Services at the US Department of Education, is the major federal agency sponsoring disability research.

Videoconference: The videoconference will take place:
March 19, 2008
1 p.m. to 5 p.m. EST
There are several ways to participate:
· Attend in person at one of the eight sites across the country;
· Access the meeting via webcast; or
· Participate in a toll-free teleconference.
To learn more about locations and methods of participation and how to RSVP, please visit www.neweditions.net/nidrrlrp.
Other Input Opportunities: If you are unable to participate in the videoconference, webcast or teleconference, there are several alternate ways to submit comments through March 31, 2008.

Comments may be submitted via email, using the following address: NIDRR-Maibox@ed.gov
or through the Web, using the following address: www.neweditions.net/nidrrlrp
or by mail:

Donna Nangle
U.S. Department of Education
400 Maryland Avenue, SW
Room 6029
Washington, DC 20202-2700

Brain Injury Awareness Fair
10:00 a.m. – 2:00 p.m.
First Floor Foyer of the Rayburn House Office Building

Congressional Briefing on “Traumatic Brain Injury and Community Needs”
3:00 p.m. – 4:00 p.m.
1116 Longworth House Office Building

Congressional Reception Celebrating Brain Injury Awareness Day
5:00 p.m. – 6:30 p.m.
2105 Rayburn House Office Building

Please RSVP by Monday, March 3, 2008, to Hope Mandel in Congressman Bill Pascrell’s office if you wish to attend and/or exhibit materials during the Awareness Fair. You may also contact Hope at (202) 225-5751 or Becky Wolfkiel in Congressman Platts’ office at (202) 225-5836 with questions or for more information. In addition, as always, you may contact Laura Schiebelhut, BIAA’s Director of Government Affairs, at lschiebelhut@biausa.org, or 703-761-0750 ext. 637, for further clarification.

In the year 1990, The Americans with Disabilities Act (ADA) affirmed the rights of citizens with disabilities which makes American society more accessible. It paved the way for the Supreme Court’s Olmstead decision, which led to President Bush’s new Freedom Initiative. This initiative is about getting federal agencies to coordinate disability services. It includes systems-change grants to states, which has helped brain injury get to the “proverbial table” in many states.

Neuroscientists at the Uni-versity of California, Berkeley have, for the first time, measured the electrical activity of nerve cells and correlated it to changes in blood flow in response to transcranial magnetic stimulation (TMS), a noninvasive method to stimulate neurons in the brain.

Their findings, reported in the journal Science, could substantially improve the effectiveness of brain stimulation as a therapeutic and research tool.

With technological advances over the past decade, TMS has emerged as a promising new tool in neuroscience to treat various clinical disorders, including depression, and to help researchers better understand how the brain is organized and functions.

TMS works by generating magnetic pulses via a wire coil placed on top of the scalp. The pulses pass harmlessly through the skull and induce short, weak electrical currents that alter neural activity. Yet the relative scarcity of data describing the basic effects of TMS, and the uncertainty in how the method achieves its effects, prompted the researchers to conduct their own study.

“There are potentially limitless applications in both the treatment of clinical disorders as well as in could be used to help determine what parts of the brain are used in object recognition or speech comprehension. However, to develop effective applications of TMS, it is first necessary to determine basic information about how the technique works.”

Other techniques for studying neural activity in humans, such as functional magnetic resonance imaging (fMRI) or electroencephalogram (EEG), only measure ongoing activity. TMS, on the other hand, offers the opportunity to non-invasively and reversibly manipulate neural activity in a specific brain area.

In a set of experiments, the researchers used TMS to generate weak, electrical currents in the brain with quick 2- to 4-second bursts of magnetic pulses to the visual cortex of cats. Direct measurements of the electrical discharge of nerve cells in the region in response to the pulses revealed that TMS predictably caused an initial flurry of neural activity, significantly increasing cell firing rates. This increased activity lasted 30 to 60 seconds, followed by a relatively lengthy 5 to 10 minutes of decreased activity.

What the researchers were able to determine for the first time was that the neural response to TMS correlated directly to changes in blood flow to the region. Using oxygen sensors and optical imaging, the researchers found that an initial increase in blood flow was followed by a longer period of decreased activity after the magnetic pulses were applied.

“This long-lasting suppression of activity was surprising,” said Brian Pasley, a graduate student at HWNI and co-lead author of the study. “We’re still trying to understand the physiological mechanisms underlying this effect, but it has implications for how TMS could be used in clinical applications.”

The critical confirmation of the connection between blood flow and neural activity means that researchers can use TMS to alter neural activity, and then use fMRI, which tracks blood flow changes, to assess how the nerve cells respond over time.

“One of the most exciting applications of TMS is the ability to non-invasively modify neural activity in specific ways,” said Pasley. “The brain is malleable, so brain stimulation may be used to alter and promote specific functions, like learning and memory, or suppress abnormal activity that underlies neurologi¬cal disorders. If we can figure out the right ways to stimulate the brain, TMS will likely be useful in attempts to improve neural function.”

The researchers noted that one of the difficulties in using TMS for specific applications is the fact that its effects vary in different brain regions and individuals. “Using TMS is inherently challenging because its neural effects can be so variable,” said Ralph Freeman, UC Berkeley professor of vision science and optometry and principal investigator of the fMRI may serve as a guide to determine adjustments in treatment parameters.”

The study was also co-authored by Thang Duong, a UC Berkeley graduate student in vision science. The National Eye Institute of the National Institutes of Health and the National Science Foundation helped support this research.

CALBIA is busy making plans for Brain Injury Awareness Month in March 2008. Please mark your calendar for the following events:

March 8, 2008
2nd Annual Greek Dinner & Dance for Thought, Long Beach, CA

March 14, 2008 –
Condors Hockey, Bakersfield, CA

March 16, 2008 -
A Night At The Opera, Los Gatos, CA

March 29, 2008 -
Statewide Walk For Thought. Confirmed locations are: Bakersfield Sacramento San Diego Victorville

Each event will provide awareness opportunities, as well as raise funds for CALBIA. More information on each of these events will be posted on the website in the near future.

WEDNESDAY, April 26 (HealthDay News) — Resuscitation with a special hemoglobin oxygen-carrying solution may cut risks for secondary brain injury in patients with traumatic brain injury and hemorrhage, new research shows.

The solution, called HBOC-201, is a type of balanced salt solution that contains chemically stabilized bovine (cow) or human hemoglobin meant to increase oxygen delivery to tissues. These solutions are compatible with all human blood types, the researchers said.

HBOC-201 carries as much oxygen on a gram-per-gram basis as hemoglobin in human red blood cells and is stable at room temperature for up to three years.

In this study, researchers inflicted brain impact injury and hemorrhage on 20 pigs that were then randomly selected to be resuscitated with either HBOC-201 (6 mL/kg) or lactated Ringer’s (LR) solution (12 mL/kg), one of the crystalloid solutions typically used to resuscitate patients with hemorrhage. Crystalloid solutions don’t contain hemoglobin, limiting their ability to carry oxygen to tissues.

Following resuscitation, the pigs were observed for a few hours. They were then killed and their brains removed for analysis.

While HBOC-201 did not improve primary brain damage following impact injury and hemorrhage, it did seem to reduce the amount of secondary brain damage on the side opposite the impact.

“If resuscitation with HBOC-201 can decrease secondary brain injury in TBI patients with hemorrhage, it holds promise for improving outcome,” researcher Dr. Guy Rosenthal said in a prepared statement. HBOC “may potentially be of greatest benefit in rural settings and combat situations where banked blood is not available and transport times are long,” he said.

The study was presented at this week’s annual meeting of the American Association of Neurological Surgeons in San Francisco.

Source: http://www.medicinenet.com/script/main/art.asp?articlekey=61223