We are on our third full day of the AAJ 2010 Winter Convention in Maui. The sessions have been packed, the weather has been great
• CLE programs today include:
Specialized Track: Social Networking and Other New Online Tools – 8:00 am – 12:00 pm, Kula Ballroom at the Westin Maui.
The Brain Injury Association of America reports the following legislative update.
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!
Frankly, I am not one of those bleeding heart plaintiff lawyers. I absolutely believe in compensation for preventable injuries, too often mislabeled "accidents." But I also believe in accountability and reasonable expectation of risk assumption when engaging in many of life's activities. In essence I believe the pendulum swings both ways - too far one way is no good nor too far the other.
My biggest upset about the Massachusette's election of a Republican Senator to replace long time Democrat Senator Kennedy is not the "shift in power." Rather it is the amount of time, money and energy that went into crafting health care bills in the House and Senate which, by many accounts, will all be for naught. That is a shame. Health Care reform could have failed, but it was never given a chance. What has failed is the time, money and energy that was expended and wasted by one election.
Politics suck.
That said, here is the latest from the Wallstreet Journal:
JANUARY 25, 2010, 9:19 A.M. ET
Democrats Focus on Key Elements of Health Bill
By JANET ADAMY
WASHINGTON—The White House, with its health-care initiative in doubt, on Sunday zeroed in on several elements it hoped would survive, including measures to extend the life of Medicare, lower prescription drug costs for seniors and cap consumers' out-of-pocket medical expenses.
As Democrats regroup on plans to overhaul the health-care system after a Republican win in last week's Massachusetts Senate election, comments Sunday indicated that any revamped legislation would likely focus on the least-controversial elements of earlier proposals.
White House officials notably didn't emphasize that any revised legislation should include a major expansion of health insurance. Expanding coverage to the uninsured was the key plank of the separate health bills passed by the House and Senate last year, but such efforts largely accounted for the about $1 trillion cost of the bills, and Republicans decried them as too costly.
President Barack Obama spoke with congressional leaders over the weekend to determine how to move forward on the issue. Now that the Democrats no longer have a filibuster-proof 60-vote majority in the Senate, they are likely to need Republican support to pass any new legislation, something they weren't able to win last year. Officials stressed that discussions were still going on, and Democrats are also looking at ways to salvage the current legislation.
White House adviser David Axelrod, appearing on ABC News's "This Week," said the president didn't want to abandon several elements of the current bills. These include extending the life of the Medicare insurance program for the elderly, which the bills propose to do through payment cuts to health providers, and issuing tax breaks to help small employers provide insurance. Medicare will become insolvent by 2017 without more funding or payment cuts.
Mr. Axelrod also cited assistance to help seniors pay for prescription drugs. The bills would help close a gap in Medicare Part D insurance that forces some seniors to pay thousands of dollars a year for medicine. He also said the overhaul should help people with pre-existing health conditions buy insurance and cap out-of-pocket medical costs. He didn't discuss how these measures would be paid for.
A White House aide said Sunday those were just some of the provisions, among others, that the administration hoped to include in a final package.
Republicans agree that Medicare needs to become more sustainable, but argue that the Democrats' proposed payment cuts are the wrong way to do it. Some Democrats also fear they are too deep.
While Republicans have also emphasized helping small businesses and lowering consumers' out-of-pocket costs, their approaches have been different.
Senate Minority Leader Mitch McConnell (R., Ky.) said Sunday that Republicans wanted to start over and craft a plan that did more to lower the growth of health costs.
Mr. McConnell, speaking on NBC's "Meet the Press," said the plan should change the tax code to allow individuals who buy policies without the help of an employer to get the same tax break that companies get. He said the overhaul should also reduce the number of medical malpractice lawsuits and allow insurers to sell policies across state lines.
The Democrats' bills contain no substantive changes to the malpractice system and they don't make insurance tax-free for individuals, as is the case for companies.
Malpractice is one area where Democrats could show more flexibility in any revamped legislation. Reducing unnecessary lawsuits is an area that resonates with voters, regardless of party affiliation, and Democratic leaders have already added some malpractice provisions into the current bills, though they remain largely symbolic.
Mr. Obama signaled shortly after the Massachusetts election that he might be willing to sign a scaled-down version of the House and Senate measures. In addition to the provisions Mr. Axelrod outlined, revamped legislation could include new restrictions on insurance companies, such as limits on the amount they can reap in profit and a revocation of their decades-old antitrust exemption.
Congressional Democrats are also weighing several options aimed at salvaging the current bills. One idea is to make a series of modifications to the Senate bill, aimed at addressing House Democrats' concerns. Changes likely would include minimizing a tax on high-value insurance plans and stripping out sweeteners aimed at winning Senate votes, such as a deal to fund Nebraska's Medicaid expansion, Democrats have indicated.
The Senate would need fewer votes to pass the changes—a simple majority compared with the 60 they would need to block a filibuster—and the House could pass the package of modifications with the Senate bill.
But many Democrats consider that a complicated scenario that would be difficult to pull off.
Democrats are also still considering some mechanisms to expand insurance coverage, such as by broadening the Medicaid federal-state insurance program for the poor, and by allowing young adults to stay on their parents' insurance policies until they reach their late 20s.
Write to Janet Adamy at janet.adamy@wsj.com
I just saw the Hurt Locker directed and produced by Kathryn Bigelow.
A movie about the solitude of explosive munitions neutralizer soldiers. The entire movie portrays disarming Improvised Explosive Devices (IED) sometimes successfully and sometimes not. The movie is nominated for an Oscar.
An IED is a device fabricated or placed in an improvised manner, incorporating lethal, noxious, pyrotechnic, or incendiary materials designed to destroy, incapacitate, harass, or distract. It may incorporate military parts, but is normally constructed from nonmilitary components.
What the movie does not provide is the reality these repeated trauma have on soldiers.
To study such biomechanics and injury, the North American Brain Injury Society (NABIS) formed one of the first committees. Blast Injury and TBI by Ronald C. Savage, EdD Executive Vice President, NABIS, states:
During the Vietnam War and the Persian Gulf War, 76 percent of American troops survived combat wounds. But in this century, the U.S. military's surgical teams "have saved the lives of an unprecedented 90 percent of the soldiers wounded in battle…" (New England Journal of Medicine, December, 2006). Furthermore, Walter Reed Army Medical Center reported that nearly 30% of all patients with combat-related injuries seen at Walter Reed from 2003 to 2005 sustained a TBI and that blast injuries are a significant cause of TBIs In addition, they reported that TBI is often associated with severe multiple trauma, post traumatic stress disorder (PTSD) or undiagnosed concussions. Thus, screening soldiers who are at risk for a TBI is important in order to ensure that TBIs are identified and appropriately treated.
Diagnosis can be difficult even when TBI is apparent or the patient is able to describe a concussive head injury to their doctors. The more common mild brain injury often has more than mild consequences and can cause depression, reduced cognitive functioning, nausea,
sleep disturbance, erratic behavior, and mood swings. These impairments are exacerbated by misdiagnosis, lack of treatment and the public’s misperceptions about brain injury and mental illness. For veterans with brain injuries, the lack of physical signs and the diffuse nature of symptoms may be met with skepticism, considered to be psychological, or worse, malingering.
As professionals in the field know, the “walking wounded” do not disappear. And many more will be seen and heard in this decade. Thanks to improvements in protective gear and swift medical treatment, more of America's wounded are surviving - and returning home with serious, permanent injuries. How will these veterans fare in the routines of daily life? Will they be able to maintain employment? How will their injuries impact their families, friends, co-workers, and communities?
The North American Brain Injury Society has begun to address these important issues. We recently published a special edition of Brain Injury Professional that focused solely on blast injury and TBI. NABIS would like to extend our sincere appreciation and thanks to Representative Bill Pascrell, co-chair of the Congressional Brain Injury Task Force, who wrote a thoughtful introduction, and also to Dr. Tina Trudel who served as Guest Editor.
In addition, the Planning Committee of our 2007 conference has organized a number of sessions devoted to the topic of blast injury. NABIS will continue to explore additional ways that we can create positive change in this area and we look forward to sharing those ideas with our membership in the future.
Susan Lance, a speech pathologist specializing in •developmental problems •strokes
•brain injuries and •other neurological disorders, states,
According to the Defense and Veterans Brain Injury Center (DVBIC), over 50% of injuries sustained in combat are the result of explosive munitions including bombs, grenades, land mines, missiles, and mortar/artillery shells (Coupland & Meddings). The polytrauma conditions sustained by these explosions affect various systems of the body. TBI has been associated with between 59% and 61% of blast-associated injuries seen at Walter Reed Army Medical Center (WRAMC). Since November 4, 2006, blasts have been the most common cause of injury among American soldiers treated at WRAMC (Ippolitito).
Blast injuries result from the complex pressure wave generated by an explosion, causing an instantaneous rise in pressure over atmospheric pressure. This is called a blast over-pressurization wave (CDC, Mass Casualties).
Primary blast injury occurs from an interaction of the over-pressurization wave and the body. The resulting injuries affect various organs. Air-filled organs such as the ear, lung, and gastrointestinal tract are especially vulnerable to blast injury. Equally susceptible are organs surrounded by fluid-filled cavities, such as the brain and spinal cord (Elsayed; Mayorga). The over-pressurization wave dissipates quickly, causing the greatest risk of injury to those closest to the explosion.
There are two categories of explosives:
High-order explosives (HE) such as TNT, C-4 and dynamite produce a definitive supersonic over-pressurization shock wave.
Low-order explosives (LE) such as pipe bombs, gunpowder and Molotov cocktails create a subsonic explosion and lack HE’s over-pressurization wave.
There are four basic mechanisms of blast injury, all of which may result in Central Nervous System (CNS) injuries (CDC, Mass Casualties).
Read more at Suite101: What Are Blast Injuries?: Explosive Munitions Cause Multiple Injuries In Combat http://disabilities.suite101.com/article.cfm/what_are_blast_injuries#ixzz0df3sNthr
Sherry Stock of the Oregon Brain Injury Association asked me to post news of the upcoming conference. For registration brochure click here.
Living with Brain Injury: Hope
March 5-6, 2010
7 am - 5 pm
Pre-Conference March 4 8am -5:30 pm
Understanding Brain Injury and Managing Behavioral Challenges Following Brain Injury
ACBIS National Certification Training
The Academy for the Certification of Brain Injury Specialists (ACBIS) offers a national certification program for both entry-level staff and experienced professionals working in brain injury services. ACBIS provides the opportunity to learn important information about brain injury, to demonstrate learning in a written examination, and to earn a nationally recognized credential.
The Brain Injury Association of Oregon is offering a training program geared toward preparing for the CBIS examination. This training will be delivered in a one day workshop March 4, 2010, from 8:00-4:00pm. Students must attend the entire session. The workshop will include study materials and interactive workshop with Sherry Stock, Certified Brain Injury Specialist Trainer. The National Written Examination will be given at the end of the day, from 4:00-5:30.
Registration fee: $375 (early registration is $350), includes The Essential Brain Injury Guide, materials, instructor time, and the ACBIS certification fee.
Join us for this comprehensive training, and gain your national certification in Brain Injury, with support through BIAOR.
Attending class only-does not include test or book: $75 (early registration $50)
It is estimated that approximately two million individuals in the United Sates suffer from some form of a traumatic brain injury every year. Of those who survive a TBI about 90,000 of them will have some long-term effect of the injury, whether it be physical, mental or cognitive. Often times the impaired and their family need aid in order to regain a level or normalcy for the injured individual and they often times turn to rehabilitation and assisted living center for help.
Therapy often depends on the injuries of the patient, but there are a number of common problems
that are often dealt with in rehabilitation and assisted living centers. While hospitals initially treat TBI patients, often times the injuries may require medical specialists who can be found at facilities like CareMeridian.
Often times early treatment centers focus around increasing alertness and orientation. Unfortunately some sufferers of TBI fall into a coma and special measures and rehabilitative treatments must be undergone in order to sustain life and make an effort towards regaining consciousness. These patients are continually monitored with equipment that keeps track of their breathing, blood pressure, heart rhythm, etc. Constant care and attention must be given to those patients who suffer a coma.
Rehabilitative care and assisted living primarily revolve around a particular patients needs and are catered to the short term and long-term goals set for that patient. All in all the purpose of TBI rehabilitation is to enable the patient and family to function and return to some level of normalcy in their home and society.
Daniel responds to my post on Understanding Depression at http://brainandspine.titololawoffice.com/2009/11/articles/psychiartric-psychological-iss/understanding-depression/
I appreciate the support because depression almost always results in traumatic brain injury cases I handle. Not to mention the clinical nature of the disorder in non-traumatic brain injury cases.
Thanks for this interesting article. I think it is very important to talk about this topic, because it becomes more and more up to date. Lots of people are adversely affected by depression without knowing it. And this is very dangerous because of the consequences of not treating this suffering.
The BIAA has posted this Health Care Update:
On December 24, 2009, the Senate advanced its version of health care reform, opening the doors for negotiation with the House to reconcile differences between the two bills.
This week, negotiators worked to arrive at an agreement in principle to meld the bills, in the hope that a product be brought to the House floor this month. (CQ)
BIAA continues to fight to preserve several provisions from the House bill that are important for people with brain injury. Specifically, BIAA is working to ensure that insurance rating based on health status or pre-existing conditions and annual or lifetime limits on medical spending are prohibited. Also, BIAA is advocating to keep important consumer protections, including internal and external appeal requirements, provider network adequacy requirements, and greater transparency by insurance companies, in the final product.
Findings published in Nature Neuroscience help explain why light makes Migraine Headaches worse.
Ask anyone who suffers from migraine headaches what they do when they're having an attack, and you're likely to hear "go into a dark room." And although it's long been known that light makes migraines worse, the reason why has been unclear.
Migraine is a recurring, episodic neurological disorder characterized as throbbing headache that is commonly associated with a variety of other symptoms (for example, nausea, vomiting, irritability and fatigue). Migraines are chronic headaches that can cause significant pain for hours or even days. Symptoms can be so severe that all you can think about is finding a dark, quiet place to lie down.
For light to make pain worse, the pathways have to converge somewhere, thought the researchers at Beth Israel Deaconess Medical Center. Exacerbation of migraine headache by light is prevalent among blind individuals. Light can increase the electrical activity in neurons.
One expert said these findings should put to rest any suggestion that patients exaggerate their sensitivity to light; they are not whining or imagining their symptoms.
"A neural mechanism for exacerbation of headache by light."
Rodrigo Noseda, Vanessa Kainz, Moshe Jakubowski, Joshua J Gooley, Clifford B Saper, Kathleen Digre & Rami Burstein.
Nature Neuroscience, Advance online publication 10 January 2010.
DOI:10.1038/nn.2475
Now the million of cell phone users have good reason to keep on talking. It baffles my mind to learn of something typically regarded as negative being cast into a positive light. Reminds me of Woody Allen's Sleeper where future scientists discover cigarette smoking and eating fat is healthy.
An international team of researchers studying the long term effects of electromagnetic waves like those emitted by cell phones on mice were surprised to find they protected their brains against Alzheimer's and even reversed the memory damage caused by the disease.
The neuroscientists, electrical engineers, and neurologists published the study and findings in the Journal of Alzheimer's Disease.
The research results are exciting. But since they occur in mice, the ultimate human affects are still not known. Dr. Susan Sorenson, Alzheimer's Society Head of Research, comments, 'This study could open new doors in Alzheimer's research but it also poses some interesting questions that need answers. However, dementia research is dramatically underfunded. The government currently spends eight times less on dementia research than cancer research. In order to make further scientific advances dementia needs to be given higher priority.'
"Electromagnetic Field Treatment Protects Against and Reverses Cognitive Impairment in Alzheimer's Disease Mice."
Gary W. Arendash, Juan Sanchez-Ramos, Takashi Mori, Malgorzata Mamcarz, Xiaoyang Lin, Melissa Runfeldt, Li Want, Guixin Zhang, Vasyl Sava, Juan Tan and Chuanhai Cao.
Journal of Alzheimer's Disease, Volume 19:1 (January 2010).
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