Leisure activities—such as reading, sports, outdoor activities, or other hobbies—are an important part of our day-to-day lives. Leisure activities can also contribute greatly to a recovery after TBI. Not only do such activities add opportunities for social interaction and physical health, they can also enhance a sense of independence and personal accomplishment for returning to an activity that was enjoyed before the injury.

A recent study looked at three aspects of leisure activities after TBI. One, how does participation in leisure activities change from before injury to one year after injury? Two, how do age and gender affect participation in leisure activities? Three, are people with TBI bothered about how well they can participate in leisure activities?

Their results found that, one year after injury, 81% of people with TBI were not participating in leisure activities at the same level they did before injury. The most popular new leisure activity after injury was watching television. These changes contributed to a more sedentary, less social life—which dissatisfied most participants. Although decreasing some leisure activities, such as partying or drug and alcohol use, were considered to be positive changes, participants felt there were few new activities that could replace the lost ones.

Wise EK, Mathews-Dalton C, Dikmen S, et al. Impact of traumatic brain injury on participation in leisure activities. Archives of Physical and Medical Rehabilitation. (September 2010).

This year’s House version of the FY2011 Defense Authorization Act (HR 5136) will go to conference with two amendments addressing the problem of faulty brain injury screening in which the military has been under fire because of in recent reports.

Congresswoman Mary Fallin of Oklahoma offered an amendment to the bill that was adopted stating that no later than September 30, 2011, the Secretary of Defense, in coordination with the Secretary of Veterans Affairs, shall develop and implement a comprehensive policy on pre- and post-deployment neurocognitive assessment.

Also, assisted by BIAA and NASHIA, Congressman Bill Pascrell, Jr., co-chairman of the Congressional Brain Injury Task Force, offered a complimentary amendment that was later adopted detailing that until a comprehensive screening policy is implemented, the Defense Department must use the same cognitive screening tool for both pre-deployment and post-deployment screening in order to compare new data to previous baseline data for the purposes of detecting brain injury.

BIAA is hopeful that these provisions will remain in the bill as conference discussions continue.  We will monitor the situation closely and alert grassroots advocates if any action becomes necessary.

A recent retrospective study of cognitive assessment in traumatic brain injury patients found no clear pattern of cognitive ability associated with neurological impairment.

Cognitive assessment—in the form of tests such as the WAIS (in various versions) or the HRB (Halstead-Reitan Neurological Test Battery)—is often administered early to traumatic brain injury patients in order to determine cognitive functioning, diagnosis, and rehabilitation requirements. However, this study concluded that age and employment status was more strongly associated to cognitive assessment results than neurological findings, such as injury severity.

The researchers looked specifically for clear patterns of cognitive impairment —such as lowered cognitive results associated with lowered neurological results. And there were some sub-groups of cognitive testing did show such as association (such as processing speed). However, their overall finding was that demographics played a stronger role in cognitive assessment results than neurological factors.

Goldstein G, Allen DN, & Caponigro JM. A retrospective study of heterogeneity in neurocognitive profiles associated with traumatic brain injuries. Brain Injury. (April 2010).

Diffuse axonal injury (DAI) describes damage to the axon of a neuron. Axons are covered in white, fatty matter that helps to quickly relay messages back and forth, and the major region of the brain that is dense with this white matter is called the corpus callosum. As such, the corpus callosum is the most vulnerable to damage from DAI.

Recently, a team of UCLA researchers studied the long-term effects of injury to the corpus callosum in pediatric brain injury patients, as well as the correlation of injury to cognitive functioning. They found that there were structural and metabolic differences in the corpus callosum between the acute and chronic stages of injury. These metabolic changes could be related to the energy used during neural repair, or from changes due to permanent cell death. Furthermore, metabolic dysfunction and structural damage seen in the corpus callosum after DAI was associated with declines in cognitive functioning.

The preliminary results of this study contribute to the understanding of how metabolic and structural changes might develop long-term in cases of pediatric traumatic brain injury. Although future studies may pinpoint the exact time course of these changes, it is important to acknowledge that degeneration of the corpus callosum may continue long after the initial injury.

Babikian T, Marion SD, Copeland S, Alger JR, et al. Metabolic levels in the corpus callosum and their structural and behavioral correlates after moderate to severe pediatric TBI. Journal of Neurotrauma. (March 2010).

People who suffer from a spinal cord injury are at greater risk of developing bladder cancer than those without injury. Patients with indwelling catheters have also been shown to be at greater risk of developing bladder cancer. There has been a question of whether the increased risk of cancer was related to the spinal cord injury itself, or the subsequent use of an indwelling catheter.

A medical research team from California recently conducted a retrospective study of spinal cord injury patients, both with and without an indwelling Foley catheter. They found that 32 out of the 1319 spinal cord injury patients they studied had developed bladder cancer, but that fewer than half of those had an indwelling catheter.

The team therefore suggested that spinal cord injury itself was an independent risk factor for bladder cancer. They suggested that more stringent cancer screens that include all patients with spinal cord injury, rather than only those with an indwelling catheter, should be considered.

Kalisvaart JF, Katsumi HK, Ronnington LD, & Hovey RM. Bladder cancer in spinal cord injury patients. Spinal Cord. (March 2010).

Health care reform at the federal level is officially on hold. Republican Scott Brown gained the Massachusetts seat vacated by the death of Edward Kennedy, thereby breaking the 60-vote majority in the Senate. Democrats met privately in the days following the Massachusetts special election but were unable to cultivate a strategy for moving forward at this time. A six‐week break is planned, and it is likely policymakers will be forced to accept a substantially scaled‐back package or abandon health care reform altogether.

The Brain Injury Association of America is deeply disappointed. Through our partnership with the Brain Injury Business & Professional Council, we made important gains in the proposed legislation. We cannot forgo this progress; we cannot quit now. We will continue to fight for access to the full continuum of brain injury treatment.

On January 24, 2010, Dateline NBC aired the compelling story of Patrick Gannon, a man who battled a severe anoxic brain injury and was then forced to wage war against his insurance company. The Dateline story accurately portrays how the health care system victimizes patients and families when they are most vulnerable.

I urge brain injury advocates everywhere to watch Patrick’s story and then write to Ann Curry, Dateline correspondent, to thank her for bringing national attention to the extraordinary challenges individuals with brain injury and their families face. I urge advocates to share their own stories with Ms. Curry and ask that she continue to educate the public about the rehabilitation needs of people with brain injury after their lives have been saved. Please address your letters to:

Ms. Ann Curry
Dateline / NBC News
30 Rockefeller Center, Studio 3B
New York, NY 10012

E-mail: Dateline@NBCUNI.com

Once you’ve written your letter (and sent copies to your legislators and BIAA), I ask that you share the Dateline story with friends and neighbors and that you encourage them to spread the story to others. With your help, we can tell the public that a brain injury can happen to anyone at anytime and that having insurance doesn’t mean you’re covered!

Very truly yours,

Susan H. Connors
President/CEO

Please send copies of your letters to your state and federal legislators and to me at BIAA’s address!

Brain Injury Association of America

1608 Spring Hill Road, Suite 110
Vienna, VA 22182

After the devastating Massachusetts special election, House and Senate leaders are expected to resume negotiations this week to attempt to finish the health care overhaul. Although a clear path is still unknown, BIAA will continue to monitor the situation closely. A big thank you to all of our grassroots advocates who answered the call last week to urge members of Congress to push forward on Health Care Reform!

State Concussion Legislation

Following the extraordinary success of BIA of Washington and BIA of Oregon in the adoption of state level sports concussion legislation, BIAA, in partnership with the Sports Legacy Institute, has become committed to encouraging, and assisting wherever possible, the enactment of sports concussion legislation in all states.

BIAA has developed a sample piece of legislation based on current laws and pending bills that exist throughout the country. This model legislation along with a sample testimony for use in state concussion hearings, distributed on January 25, 2010 to BIAA’s state affiliates, is a step foward in facilitating action in each state.

Due to the increased visibility of sports concussions within the National Football League in recent weeks, BIAA is encouraged that all states will be able to tip the scales in favor of protecting our youth athletes.

Brain Injury Awareness Day 2010

This year’s Brain Injury Awareness Day on Capitol Hill is set to take place on March, 17, 2010. BIAA will be unveiling our 2010 legislative agenda and encouraging the grassroots community along with state affiliates to participate in advocating for increased TBI Act appropriations, increased access to care, federal and state level concussion legislation, increased TBI research, military coverage of cognitive rehabilitation and caregiver assistance.

All issues mentioned will be outlined in fact sheets that advocates will receive that day and can use as reference during congressional visits and may leave behind for review by congressional staff.

Below is the schedule of events for the day:

10:00 AM – 1:00 PM – Brain Injury Awareness Fair, First Floor Foyer of the Rayburn House Office Building
2:30 PM – 4:00 PM – Briefing: “From the Playground to the Pros: A Heads-Up on Concussion”, Capitol Visitors Center – Congressional Meeting Room South
5:30 PM – 7:30 PM – Reception Celebrating Brain Injury Awareness Month, First Floor Foyer of the Rayburn House Office Building

The Policy Corner is made possible by the Centre for Neuro Skills, James F. Humphreys and Associates, and Lakeview. Brain Injury Association of America gratefully acknowledges their support for legislative action.b

On March 21, 2010 the House of Representatives passed a historic health care overhaul package that marks one of the biggest victories in the history of the Brain Injury Association and for people affected by brain injury across the country.  BIAA advocated tirelessly for more than a year to ensure that people with brain injury gain access to the care that they need.  Specifically, the measure:

Coverage

• Prohibits private health insurance exclusions for pre-existing conditions.
• Eliminates annual and lifetime caps in private insurance policies.
• Restricts the consideration of health status in setting premiums.

Benefits

• Ensures that minimum covered benefits include products and services that enable people with disabilities to maintain and improve function, such as rehabilitation and habilitation services and devices. BIAA, supported by our Business and Professional Council and assisted by Powers, Pyles, Sutter & Verville, PC was the driving force in ensuring that rehabilitation was listed as a minimum benefit in this bill.  Originally, when the bill was made public, rehabilitation was not listed as a minimum benefit.

Long Term Services and Supports

• The Community Living Assistance Services and Supports (CLASS) Act creates a national long term services insurance program which assists eligible individuals and their families to meet long term needs with a cash benefit and without forcing them into poverty to receive Medicaid benefits.
• The Community First Choice Option helps to eliminate the institutional bias by encouraging states to cover personal attendant services under the state’s optional service plan instead of through the waiver system by offering a 6% increase in the federal share of Medicaid for these services.

It is also important to note that, as part of the debate, Congressman Bill Pascrell, Jr., co-chairman of the Congressional Brain Injury Task Force submitted a statement for the record detailing his understanding of the intent of the bill with regards to coverage of the treatment continuum for people with brain injury.  BIAA thanks him for his hard work and dedication to this important issue.

Along with passing the Senate bill, House Democrats also approved a reconciliation bill that reflects negotiations reached by congressional Democrats and the White House to modify the version earlier passed by the Senate.  This would be a “fix” that would eliminate the special deals given to certain states in return for their votes as the bill was passed by the Senate in December.  On Thursday, March 25, 2010, both the Senate and the House had voted in favor of passing the corrections bill completing the package.

BIAA would like to recognize the grassroots advocates that have truly made a difference in advocating for this historic legislation.  Thank you to everyone that invested so much of their time to push this forward!

Hormonal problems caused by damage to the pituitary gland are considered common in traumatic brain injury. However, reports of rates of pituitary gland impairment after traumatic brain injury have varied from 15-90%. Researchers from the Netherlands recently suggested that this variation could be due to differences in diagnostic criteria, in the type of tests given, in the severity of the injury, or even in the time of day the test is given. They reviewed data from 931 patients to determine what exactly created such discrepancies.

Several factors were found that could lead to misdiagnosis of endocrine problems after traumatic brain injury. For instance, body mass index could affect rates of growth hormone insufficiency. The age of a woman could affect levels of LH and FSH levels. The amount of time after injury also made a difference in diagnosis. Several studies used different sets of cutoff rates and diagnostic guidelines.

Given that there may be a high incidence of pituitary-related hormonal problems after traumatic brain injury, and that these problems may contribute to poor recovery, it is important that clinicians carefully consider all the potential factors that could lead to a misdiagnosis. Additionally, tests and diagnostic guidelines should be reviewed to ensure they are sensitive and reliable.

Kokshoorn NE, Wassenaar MJE, Biermasz NR, et al. Hypopituitarism following traumatic brain injury: Prevalence is affected by the use of different dynamic tests and different normal values. European Journal of Endocrinology. (January 2010).

Older age has been known to be a negative factor in recovery after traumatic brain injury. While there are several factors that may be involved in this association, such as pre-existing conditions or multiple medications that negatively impact the injury, a cellular explanation has also been proposed.

Mitochondria are critical to cell functioning because they are involved in producing energy and promoting growth. Mitochondrial dysfunction has long been associated with aging, and past research has shown that mitochondrial dysfunction in aging is much more evident when the brain has been injured than when it has not.

A recent study from the University of Kentucky has verified that mitochondrial dysfunction plays a role in negative recovery after traumatic brain injury in older patients. They found that mitochondria in the cells of the synapse of a neuron are particularly vulnerable after traumatic brain injury. The interaction between aging and injury creates a stress on mitochondria that can impair recovery, as well as increase mortality rates.

Gilmer LK, Ansari MA, Roberts KN, & Scheff SW. Age-related mitochondrial changes following traumatic brain injury. Journal of Neurotrauma. (February 2010).