In the weeks following a severe traumatic brain injury, family members of the patient will often develop symptoms of post-traumatic stress disorder. This stress tends to be higher in women, and when initial Glasgow Coma Scale scores are very low.

In cases of severe traumatic brain injury, family members are sometimes called upon to make treatment or end-of-life decisions. But when family members are showing signs of post-traumatic stress, the burden of these decisions may be too difficult to handle. Furthermore, high levels of stress at the onset of the injury may negatively impact a family member’s long-term ability to adjust to change, or adequately care for the patient.

A recent study of post-traumatic stress after severe traumatic brain injury found that an assessment tool for family members, The Impact of Event Scale, can help to determine family members who are in need of more intense support.

Pielmaier L, Walder B, Rebetez MML, & Maercker A. Post-traumatic stress symptoms in relatives in the first weeks after severe traumatic brain injury. Brain Injury. (March 2011).

Post-traumatic stress disorder (PTSD) can occur after experiencing a traumatic event and may lead to poor recovery and psychological difficulties. Studies over the past few years have shown that admission to an intensive care unit (ICU) is associated with the development of PTSD.

There are several established reasons why PTSD might be associated with admittance to ICU. For instance, life-threatening injuries and the psychological trauma associated with witnessing a traumatic event can increase the risk of developing PTSD. Additionally, people with a psychiatric history are more likely to be admitted to ICU for a traumatic injury than the general population.

An Australian team of researchers recently conducted a study to determine if admittance to ICU itself increased the risk of developing PTSD, and to uncover any other factors that might increase that risk even further. They found that, independent from any other risk factor, people admitted to ICU were three times as likely to develop PTSD. Other factors that increased this risk were:

1. The presence of a mild traumatic brain injury
2. Female gender
3. History of trauma or psychiatric disorder
4. Longer length of hospital admission

The research team cited 3 possible reasons that ICU admission could increase the risk of PTSD. Sleep disturbance, increased stress, and delirium from certain drugs could all play a role in how the brain processes traumatic events. Screening tools to identify high-risk patients and low doses of sleep agents may be effective interventions.

O’Donnell ML, Creamer M, Holmes ACN, et al. Posttraumatic stress disorder after injury: Does admission to intensive care unit increase risk? Journal of Trauma Injury, Infection, and Critical Care. (February 2010).

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).

On Thursday, November 19, 2009, The Senate voted to pass a package of veteran’s bills (S1963) that included both S. 801 and S. 252, both important Veteran’s health care measures supported by BIAA.

The bill would expand services in rural areas and ensure that veterans who are catastrophically disabled or who need emergency care in the community are not charged for those services. It would also authorize VA hospitals to contract with non-VA providers to ensure that our returning service members have access to the care that they so desperately need and deserve.

Thank you to all of our grassroots advocates that responded to the two action alerts that helped to move this measure successfully through the Senate!

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.

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!

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, President Barack Obama held a White House summit on health care reform. At the summit, President Obama made his intentions clear that an overhaul of the nation’s healthcare system should be completed by the end of this year. The President addressed a room full of lawmakers, healthcare providers, labor unions, and journalists calling healthcare reform a “fiscal imperative” vital to restoring the nation’s economic status.

In his opening address, the President detailed that the purpose of the summit was to determine how to improve quality of care and access to care in an inclusive and transparent manner. He specifically noted that American small businesses are struggling to insure their employees and large corporations are battling to compete with overseas entities. He also expressed the fact that Medicare costs are a substantial burden on the federal budget and Medicaid expenses are consuming much of the states’ budgets.

The President addressed the need for an investment in reform that will lower costs, create jobs, and help to erase our nation’s deficit in the long term.

Peter Thomas of Powers, Pyles, Sutter and Verville PC attended the White House summit as a representative of the Consortium for Citizens with Disability’s (CCD) Health Task Force, of which BIAA is a member.

On November 12, 2008, BIAA joined the Coalition to End the Two-Year Wait for Medicare – which represents over 75 health advocacy organizations – in launching its campaign to urge the next Congress to end the 24-month wait for Medicare coverage faced by people with disabilities.

At a press conference held on Capitol Hill, people currently caught up in the waiting period described their experiences and Representative Gene Green (D-TX) described legislative efforts to eliminate the waiting period.

In addition, at the press conference Coalition leaders released a letter signed by Coalition members – including BIAA – addressed to Democratic and Republican leaders of the Senate Finance Committee and the House Ways and Means Committee. The letter calls for health coverage for people with disabilities to be at the forefront of future legislative efforts to cover the uninsured.

The issue this Coalition is working to address is that people who become severely and permanently disabled qualify for Social Security Disability Insurance and Medicare coverage. However, according to federal statute, they must wait two years from their date of eligibility for SSDI before their Medicare coverage begins. About one quarter of people in this waiting period are without insurance for the entire time. Many cannot afford to pay COBRA premiums to maintain coverage from their former employer, and private coverage on the individual market is unavailable or too expensive for this high-cost population, including many individuals with brain injuries.

In a formal statement circulated at the press conference, BIAA noted that, “In causing delay of proper treatment, this unnecessary waiting period promotes increased lifelong disability for individuals with brain injury and significantly decreases cost efficiency in medical and rehabilitative treatment.”