Traumatic brain injury is often thought of, and treated as, a one-time event. And yet, it is well understood that TBI is the root of many ongoing complications. Some complications can be seen immediately and continue for many years after the event: cognitive dysfunction, sleep disorders, motor impairments, or psychiatric disease. Some might not manifest until long after the event: seizures, hypopituitarism, or early onset of degenerative diseases like Parkinson’s or Alzheimer’s.

In a recent commentary published in the Journal of Neurotrauma, Drs. Masel and DeWitt of the University of Texas wrote, “Historically, individuals living with a brain injury have been referred to as brain injury ‘survivors’.” As if staying alive was the endpoint of brain injury, the same way cure is the endpoint to cancer. “However,” they continued, “annually in the United States alone, over 90,000 TBI patients become disabled,” and many face a future of “an ongoing, perhaps life-long, process” of managing critical, permanent, and expensive complications.

Perhaps, as was suggested in this commentary, TBI should be referred to as “chronic traumatic brain injury disease” because this definition will help to researchers, clinicians, and legal professionals understand that TBI may require life-long support, assessment, treatment, and funding.

Masel BE, & DeWitt DS. Traumatic brain injury: A disease process, not an event. Journal of Neurotrauma. (June 2010).

The release of stress hormones (such as cortisol or norepinephrine) after a traumatic injury can induce stress hyperglycemia. Past research has shown that this state of elevated glucose has been related to increased medical complications and mortality rates.

A recent study from New York verified that serum glucose levels were useful in distinguishing major from minor traumatic injury at admission. Stress hyperglycemia was a sensitive predictor for major injury (just as sensitive as base deficit or lactate), suggesting that appropriate treatment could be administered earlier. In the early stages of traumatic brain injury, when complications such as secondary brain injury can quickly lead to further damage or death, a reliable diagnosis is critical. Glucose level is a potentially sensitive indicator of major injury that should be considered at admission.

Paladino L, Subramanian RA, Nabors S, Bhadwaj S, & Sinert R. Triage hyperglycemia as a prognostic indicator of major trauma. The Journal of Trauma: Injury, Infection, and Critical Care. (April 2010).

Although it is not completely understood why, cases of mild traumatic brain injury are more often associated with new-onset depression than those of moderate or severe traumatic brain injuries. Studies have shown that rates of depression prior to injury are associated with rates of depression after injury, but the risk factors for those who have never experienced depression prior to the injury have not previously been made clear.

In a preliminary study, researchers recently found that there were two significant indicators of new-onset depression in cases of mild traumatic brain injury. These indicators were increased age (in relation to the controls, not necessary a certain age) and the presence of a subdural lesion in the left frontal lobe. The prevalence of new-onset depression was 18% and was found up to a year after the trauma.

These two indicators could help identify high-risk individuals so that proper treatment could be administered earlier.

Rao V, Bertrand M, Rosenberg P, et al. Predictors of new-onset depression after mild traumatic brain injury. The Journal of Neuropsychiatry and Clinical Neurosciences. April 2010).

CALL THE CAPITOL SWITCHBOARD AT 800-828-0498

Over the past week, you may have seen news reports suggesting that health care reform is in serious jeopardy. WE MUST INSIST THAT CONGRESS COMPLETE HEALTH CARE REFORM NOW!

Too many Americans with disabilities and chronic conditions are not well served by the current system and will make tremendous gains through enactment of health care reform.

Take action NOW! Starting TODAY and continuing until the final votes on legislation, call your members of Congress and tell them NOT TO GIVE UP ON AMERICANS WITH DISABILITIES AND CHRONIC CONDITIONS! TELL THEM THAT YOU WANT THEM TO CONTINUE FIGHTING FOR HEALTH CARE REFORM!!!

• Health care reform will end discrimination based on health status in the private market – discrimination that currently leaves millions of vulnerable Americans uninsured
• Health care reform will include new, affordable voluntary long term care insurance coverage—the CLASS Act—and expand Medicaid coverage for home and community based services
• Health care reform will expand Medicaid eligibility and provide subsidies in the private market, creating more affordable coverage for people with disabilities
• Health care reform will prohibit annual and lifetime limits on coverage so that individuals with serious conditions will not be forced into medical bankruptcy

CALL THE CAPITOL SWITCHBOARD AT 800-828-0498. (If you can’t get through on the 800 number, call the Capitol switchboard (202-224-3121) or your member’s district office.)

Tell your Senators and Representatives that NOW is the time for Congress to complete meaningful health care reform that prevents discrimination against people with pre-existing conditions, includes the CLASS Act and expands coverage of Medicaid home and community based services.

People with disabilities and their families cannot wait any longer for relief!

With the Christmas holiday looming, the Senate is working around the clock to finish passage of their health care reform package. BIAA continues to play a large role in securing important provisions necessary to provide access to care for the brain injury community.

Currently, the Senate is working to muster the 60 votes needed to overcome filibusters and conclude a series of votes by Christmas Eve. BIAA is actively engaged in this process and will issue a special edition of Policy Corner when a resolution has been reached.

On another note, thank you to all of our grassroots advocates who have helped to make many positive changes possible in 2009. I look forward to working with all of you to further our initiatives to provide access to treatment, increased research, services, awareness and funding for people with brain injury in the New Year!

CALBIA’s website is the #1 website on Google for search terms “California Brain Injury.” The annual number of visitors is over 10,000, with over 1,151 page views. About 70% of the visitors were new to the site and 39% came from search engines, 33% came from refer­ring sites, and 28% were direct traffic. Visitors originated from 15 countries and 37 states.

2009 will bring changes to the website as we, and other state affiliates, begin the process of branding with the Brain Injury Association (BIAA).

Last week, the House passed an omnibus veterans health care package (S. 2612), including key provisions of The Epilepsy Centers of Excellence Act (H.R. 2818/S. 2004), which BIAA has strongly endorsed.

Over the weekend, the Senate also passed this legislation and it is expected to be signed into law by the President imminently.

The legislation, championed by the American Academy of Neurology and endorsed by BIAA, anticipates an expected increase in the number of TBI-related epilepsy cases among veterans returning from service in Iraq and Afghanistan. The bill will create up to six Epilepsy Centers of Excellence (ECoE) at the Department of Veterans’ Affairs (VA), and is aimed at restoring the VA as a national leader in epilepsy care and research.

The bill was sponsored by Rep. Ed Perlmutter (D-CO) in the House of Representatives and Sen. Patty Murray (D-WA) in the Senate.

Town Hall Would Facilitate Discussion of Issues Facing America’s Military and Veteran Community, Including Traumatic Brain Injury

The Brain Injury Association of America (BIAA) recently joined a consortium of non-profit organizations dedicated to serving active military, veterans, their families and their survivors, in inviting the Republican and Democratic presidential candidates to Fort Hood, Texas, for an in-depth discussion of the increasingly complex issues facing America’s military and veteran community. The CBS television network has agreed to produce and broadcast the very important Town Hall meeting in prime time on Monday, August 11, 2008.

As of July 17, 2008, the Republican presidential candidate, Senator John McCain (R-AZ) has agreed to participate in the Town Hall, but the Democratic presidential candidate, Senator Barack Obama (D-IL) has not agreed to attend the event.

BIAA is a non-partisan organization dedicated to improving the lives of all individuals with brain injuries and their families. During this presidential campaign, BIAA strongly advocates for an open, transparent discussion of public policy issues related to traumatic brain injury (TBI) among both returning service members and civilians. BIAA believes the 2008 Fort Hood Presidential Town Hall represents a tremendous opportunity to facilitate this discussion in regards to returning service members.

Fort Hood is the largest U.S. military installation in the world. As a result, it has deployed, and continues to deploy, the most soldiers to Iraq and Afghanistan as part of our continuing global war on terror. Consequently, BIAA cannot imagine a more appropriate audience—or a more compelling location—for such a discussion concerning the health care needs of returning service members, including TBI.